Witnessed arrest, but not delayed bystander cardiopulmonary resuscitation improves prehospital cardiac arrest survival.

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Vukmir, R B

2004-05-01

This study correlated the effect of witnessing a cardiac arrest and instituting bystander CPR (ByCPR), as a secondary end point in a study evaluating the effect of bicarbonate on survival. This prospective, randomised, double blinded clinical intervention trial enrolled 874 prehospital cardiopulmonary arrest patients encountered in a prehospital urban, suburban, and rural regional emergency medical service (EMS) area. This group underwent conventional advanced cardiac life support intervention followed by empiric early administration of sodium bicarbonate (1 mEq/l), monitoring conventional resuscitation parameters. Survival was measured as presence of vital signs on emergency department (ED) arrival. Data were analysed using chi(2) with Pearson correlation and odds ratio where appropriate. The overall survival rate was 13.9% (110 of 792) of prehospital cardiac arrest patients. The mean (SD) time until provision of bystander cardiopulmonary resuscitation (ByCPR) by laymen was 2.08 (2.77) minutes, and basic life support (BLS) by emergency medical technicians was 6.62 (5.73) minutes. There was improved survival noted with witnessed cardiac arrest-a 2.2-fold increase in survival, 18.9% (76 of 402) versus 8.6% (27 of 315) compared with unwitnessed arrests (ptwo minutes (p = 0.3752). Survival after prehospital cardiac arrest is more likely when witnessed, but not necessarily when ByCPR was performed by laymen.

Prolonged cardiopulmonary resuscitation and outcomes after out-of-hospital cardiac arrest

DEFF Research Database (Denmark)

Rajan, Shahzleen; Folke, Fredrik; Kragholm, Kristian

2016-01-01

AIM: It is unclear whether prolonged resuscitation can result in successful outcome following out-of-hospital cardiac arrests (OHCA). We assessed associations between duration of pre-hospital resuscitation on survival and functional outcome following OHCA in patients achieving pre-hospital return...

[Basic and advanced resuscitation of children

DEFF Research Database (Denmark)

Lauritsen, T.L.; Jensen, Tim; Greisen, G.

2008-01-01

The ERC Guidelines 2005 regarding the resuscitation of children and neonates recommend changes in treatment algorithms. Cardiac arrest in children is most often caused or worsened by hypoxic conditions. On confirmation of cardiac arrest in a child, treatment is initiated with 5 ventilations and c...... of basic life support, i.e. before a new attempt of defibrillation Udgivelsesdato: 2008/11/17...

A Turbine-Driven Ventilator Improves Adherence to Advanced Cardiac Life Support Guidelines During a Cardiopulmonary Resuscitation Simulation.

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Allen, Scott G; Brewer, Lara; Gillis, Erik S; Pace, Nathan L; Sakata, Derek J; Orr, Joseph A

2017-09-01

Research has shown that increased breathing frequency during cardiopulmonary resuscitation is inversely correlated with systolic blood pressure. Rescuers often hyperventilate during cardiopulmonary resuscitation (CPR). Current American Heart Association advanced cardiac life support recommends a ventilation rate of 8-10 breaths/min. We hypothesized that a small, turbine-driven ventilator would allow rescuers to adhere more closely to advanced cardiac life support (ACLS) guidelines. Twenty-four ACLS-certified health-care professionals were paired into groups of 2. Each team performed 4 randomized rounds of 2-min cycles of CPR on an intubated mannikin, with individuals altering between compressions and breaths. Two rounds of CPR were performed with a self-inflating bag, and 2 rounds were with the ventilator. The ventilator was set to deliver 8 breaths/min, pressure limit 22 cm H 2 O. Frequency, tidal volume (V T ), peak inspiratory pressure, and compression interruptions (hands-off time) were recorded. Data were analyzed with a linear mixed model and Welch 2-sample t test. The median (interquartile range [IQR]) frequency with the ventilator was 7.98 (7.98-7.99) breaths/min. Median (IQR) frequency with the self-inflating bag was 9.5 (8.2-10.7) breaths/min. Median (IQR) ventilator V T was 0.5 (0.5-0.5) L. Median (IQR) self-inflating bag V T was 0.6 (0.5-0.7) L. Median (IQR) ventilator peak inspiratory pressure was 22 (22-22) cm H 2 O. Median (IQR) self-inflating bag peak inspiratory pressure was 30 (27-35) cm H 2 O. Mean ± SD hands-off times for ventilator and self-inflating bag were 5.25 ± 2.11 and 6.41 ± 1.45 s, respectively. When compared with a ventilator, volunteers ventilated with a self-inflating bag within ACLS guidelines. However, volunteers ventilated with increased variation, at higher V T levels, and at higher peak pressures with the self-inflating bag. Hands-off time was also significantly lower with the ventilator. (ClinicalTrials.gov registration NCT

Evaluating an undergraduate interprofessional simulation-based educational module: communication, teamwork, and confidence performing cardiac resuscitation skills

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Marian Luctkar-Flude

2010-11-01

Full Text Available Marian Luctkar-Flude1, Cynthia Baker1, Cheryl Pulling1, Robert McGraw2, Damon Dagnone2, Jennifer Medves1, Carly Turner-Kelly11School of Nursing, Queen’s University, Kingston, Ontario, Canada; 2School of Medicine, Queen’s University, Kingston, Ontario, CanadaPurpose: Interprofessional (IP collaboration during cardiac resuscitation is essential and contributes to patient wellbeing. The purpose of this study is to evaluate an innovative simulation-based IP educational module for undergraduate nursing and medical students on cardiac resuscitation skills.Methods: Nursing and medical trainees participated in a new cardiac resuscitation curriculum involving a 2-hour IP foundational cardiac resuscitation skills lab, followed by three 2-hour IP simulation sessions. Control group participants attended the existing two 2-hour IP simulation sessions. Study respondents (N = 71 completed a survey regarding their confidence performing cardiac resuscitation skills and their perceptions of IP collaboration.Results: Despite a consistent positive trend, only one out of 17 quantitative survey items were significantly improved for learners in the new curriculum. They were more likely to report feeling confident managing the airway during cardiac resuscitation (P = 0.001. Overall, quantitative results suggest that senior nursing and medical students were comfortable with IP communication and teamwork and confident with cardiac resuscitation skills. There were no significant differences between nursing students’ and medical students’ results. Through qualitative feedback, participants reported feeling comfortable learning with students from other professions and found value in the IP simulation sessions.Conclusion: Results from this study will inform ongoing restructuring of the IP cardiac resuscitation skills simulation module as defined by the action research process. Specific improvements that are suggested by these findings include strengthening the team

Time matters--realism in resuscitation training.

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Krogh, Kristian B; Høyer, Christian B; Ostergaard, Doris; Eika, Berit

2014-08-01

The advanced life support guidelines recommend 2min of cardiopulmonary resuscitation (CPR) and minimal hands-off time to ensure sufficient cardiac and cerebral perfusion. We have observed doctors who shorten the CPR intervals during resuscitation attempts. During simulation-based resuscitation training, the recommended 2-min CPR cycles are often deliberately decreased in order to increase the number of scenarios. The aim of this study was to test if keeping 2-min CPR cycles during resuscitation training ensures better adherence to time during resuscitation in a simulated setting. This study was designed as a randomised control trial. Fifty-four 4th-year medical students with no prior advanced resuscitation training participated in an extra-curricular one-day advanced life support course. Participants were either randomised to simulation-based training using real-time (120s) or shortened CPR cycles (30-45s instead of 120s) in the scenarios. Adherence to time was measured using the European Resuscitation Council's Cardiac Arrest Simulation Test (CASTest) in retention tests conducted one and 12 weeks after the course. The real-time group adhered significantly better to the recommended 2-min CPR cycles (time-120s) (mean 13; standard derivation (SD) 8) than the shortened CPR cycle group (mean 45; SD 19) when tested (ptraining to optimise outcome. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Current Pharmacological Advances in the Treatment of Cardiac Arrest

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Andry Papastylianou

2012-01-01

Full Text Available Cardiac arrest is defined as the sudden cessation of spontaneous ventilation and circulation. Within 15 seconds of cardiac arrest, the patient loses consciousness, electroencephalogram becomes flat after 30 seconds, pupils dilate fully after 60 seconds, and cerebral damage takes place within 90–300 seconds. It is essential to act immediately as irreversible damage can occur in a short time. Cardiopulmonary resuscitation (CPR is an attempt to restore spontaneous circulation through a broad range of interventions which are early defibrillation, high-quality and uninterrupted chest compressions, advanced airway interventions, and pharmacological interventions. Drugs should be considered only after initial shocks have been delivered (when indicated and chest compressions and ventilation have been started. During cardiopulmonary resuscitation, no specific drug therapy has been shown to improve survival to hospital discharge after cardiac arrest, and only few drugs have a proven benefit for short-term survival. This paper reviews current pharmacological treatment of cardiac arrest. There are three groups of drugs relevant to the management of cardiac arrest: vasopressors, antiarrhythmics, and other drugs such as sodium bicarbonate, calcium, magnesium, atropine, fibrinolytic drugs, and corticosteroids.

European Resuscitation Council (ERC) - the Network to fight against cardiac arrest in Europe.

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Raffay, Violetta

2013-09-01

The ideas of collaboration and formation of scientific societies and registries for cardiac arrest were developed in the 18th century. The European Resuscitation Council (ERC) was formed in 1990. Nowadays, the ERC network consists of 30 National Resuscitation Councils (NRCs), which have an obligation to ensure that effective resuscitation services are provided and to promote education, training, and research in all aspects of resuscitation science. The central role of NRCs in decreasing the incidence of cardiac arrest may be highlighted and enhanced by the incorporation and implementation of the following suggestions. NRCs should emphasize and actively participate in acute care training of healthcare professionals and of lay rescuers. Implementation of current resuscitation guidelines should be a priority of each NRC and identification of the weakest link in the chain of survival should be a priority. Copyright © 2013 Elsevier Ltd. All rights reserved.

Time matters – Realism in resuscitation training

DEFF Research Database (Denmark)

Krogh, Kristian; Høyer, Christian Bjerre; Østergaard, Doris

2014-01-01

-based resuscitation training, the recommended 2-min CPR cycles are often deliberately decreased in order to increase the number of scenarios. The aim of this study was to test if keeping 2-min CPR cycles during resuscitation training ensures better adherence to time during resuscitation in a simulated setting......Background: The advanced life support guidelines recommend 2 min of cardiopulmonary resuscitation (CPR) and minimal hands-off time to ensure sufficient cardiac and cerebral perfusion. We have observed doctors who shorten the CPR intervals during resuscitation attempts. During simulation....... Methods: This study was designed as a randomised control trial. Fifty-four 4th-year medical students with no prior advanced resuscitation training participated in an extra-curricular one-day advanced life support course. Participants were either randomised to simulation-based training using real-time (120...

Pharmacotherapy In Cardiopulmonary Resuscitation (CPR)

OpenAIRE

GÜNAYDIN, Berrin

2014-01-01

Cardiac arrest is defined as cessation of cardiac mechanical activity. Cardiopulmonary resuscitation (CPR) is an attempt to restore spontaneous circulation through several maneuvers and techniques. Although the two interventions, which are competent basic life support and prompt defibrillation, improve the survival rate, several adjuvant cardiac medication drugs are advocated to treat cardiac arrest during advanced cardiac life support. Since the introduction of modern CPR there have been man...

The effectiveness of and satisfaction with high-fidelity simulation to teach cardiac surgical resuscitation skills to nurses.

Science.gov (United States)

McRae, Marion E; Chan, Alice; Hulett, Renee; Lee, Ai Jin; Coleman, Bernice

2017-06-01

There are few reports of the effectiveness or satisfaction with simulation to learn cardiac surgical resuscitation skills. To test the effect of simulation on the self-confidence of nurses to perform cardiac surgical resuscitation simulation and nurses' satisfaction with the simulation experience. A convenience sample of sixty nurses rated their self-confidence to perform cardiac surgical resuscitation skills before and after two simulations. Simulation performance was assessed. Subjects completed the Satisfaction with Simulation Experience scale and demographics. Self-confidence scores to perform all cardiac surgical skills as measured by paired t-tests were significantly increased after the simulation (d=-0.50 to 1.78). Self-confidence and cardiac surgical work experience were not correlated with time to performance. Total satisfaction scores were high (mean 80.2, SD 1.06) indicating satisfaction with the simulation. There was no correlation of the satisfaction scores with cardiac surgical work experience (τ=-0.05, ns). Self-confidence scores to perform cardiac surgical resuscitation procedures were higher after the simulation. Nurses were highly satisfied with the simulation experience. Copyright © 2016 Elsevier Ltd. All rights reserved.

Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: A Statement for Healthcare Professionals From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.

Science.gov (United States)

Perkins, Gavin D; Jacobs, Ian G; Nadkarni, Vinay M; Berg, Robert A; Bhanji, Farhan; Biarent, Dominique; Bossaert, Leo L; Brett, Stephen J; Chamberlain, Douglas; de Caen, Allan R; Deakin, Charles D; Finn, Judith C; Gräsner, Jan-Thorsten; Hazinski, Mary Fran; Iwami, Taku; Koster, Rudolph W; Lim, Swee Han; Ma, Matthew Huei-Ming; McNally, Bryan F; Morley, Peter T; Morrison, Laurie J; Monsieurs, Koenraad G; Montgomery, William; Nichol, Graham; Okada, Kazuo; Ong, Marcus Eng Hock; Travers, Andrew H; Nolan, Jerry P

2015-11-01

Utstein-style guidelines contribute to improved public health internationally by providing a structured framework with which to compare emergency medical services systems. Advances in resuscitation science, new insights into important predictors of outcome from out-of-hospital cardiac arrest, and lessons learned from methodological research prompted this review and update of the 2004 Utstein guidelines. Representatives of the International Liaison Committee on Resuscitation developed an updated Utstein reporting framework iteratively by meeting face to face, by teleconference, and by Web survey during 2012 through 2014. Herein are recommendations for reporting out-of-hospital cardiac arrest. Data elements were grouped by system factors, dispatch/recognition, patient variables, resuscitation/postresuscitation processes, and outcomes. Elements were classified as core or supplemental using a modified Delphi process primarily based on respondents' assessment of the evidence-based importance of capturing those elements, tempered by the challenges to collect them. New or modified elements reflected consensus on the need to account for emergency medical services system factors, increasing availability of automated external defibrillators, data collection processes, epidemiology trends, increasing use of dispatcher-assisted cardiopulmonary resuscitation, emerging field treatments, postresuscitation care, prognostication tools, and trends in organ recovery. A standard reporting template is recommended to promote standardized reporting. This template facilitates reporting of the bystander-witnessed, shockable rhythm as a measure of emergency medical services system efficacy and all emergency medical services system-treated arrests as a measure of system effectiveness. Several additional important subgroups are identified that enable an estimate of the specific contribution of rhythm and bystander actions that are key determinants of outcome. Copyright © 2014 European

Neonatal resuscitation: advances in training and practice

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Sawyer T

2016-12-01

Full Text Available Taylor Sawyer, Rachel A Umoren, Megan M Gray Department of Pediatrics, Division of Neonatology, Neonatal Education and Simulation-based Training (NEST Program, University of Washington School of Medicine, Seattle, WA, USA Abstract: Each year in the US, some four hundred thousand newborns need help breathing when they are born. Due to the frequent need for resuscitation at birth, it is vital to have evidence-based care guidelines and to provide effective neonatal resuscitation training. Every five years, the International Liaison Committee on Resuscitation (ILCOR reviews the science of neonatal resuscitation. In the US, the American Heart Association (AHA develops treatment guidelines based on the ILCOR science review, and the Neonatal Resuscitation Program (NRP translates the AHA guidelines into an educational curriculum. In this report, we review recent advances in neonatal resuscitation training and practice. We begin with a review of the new 7th edition NRP training curriculum. Then, we examine key changes to the 2015 AHA neonatal resuscitation guidelines. The four components of the NRP curriculum reviewed here include eSim®, Performance Skills Stations, Integrated Skills Station, and Simulation and Debriefing. The key changes to the AHA neonatal resuscitation guidelines reviewed include initial steps of newborn care, positive-pressure ventilation, endotracheal intubation and use of laryngeal mask, chest compressions, medications, resuscitation of preterm newborns, and ethics and end-of-life care. We hope this report provides a succinct review of recent advances in neonatal resuscitation. Keywords: neonatal resuscitation, Neonatal Resuscitation Program, NRP, simulation, deliberate practice, debriefing, eSIM

Factors affecting team leadership skills and their relationship with quality of cardiopulmonary resuscitation.

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Yeung, Joyce H Y; Ong, G J; Davies, Robin P; Gao, Fang; Perkins, Gavin D

2012-09-01

This study aims to explore the relationship between team-leadership skills and quality of cardiopulmonary resuscitation in an adult cardiac-arrest simulation. Factors affecting team-leadership skills were also assessed. Forty advanced life-support providers leading a cardiac arrest team in a standardized cardiac-arrest simulation were videotaped. Background data were collected, including age (in yrs), sex, whether they had received any leadership training in the past, whether they were part of a professional group, the most recent advanced life-support course (in months) they had undergone, advanced life-support instructor/provider status, and whether they had led in any cardiac arrest situation in the preceding 6 months. Participants were scored using the Cardiac Arrest Simulation test score and Leadership Behavior Description Questionnaire for leadership skills. Process-focused quality of cardiopulmonary resuscitation data were collected directly from manikin and video recordings. Primary outcomes were complex technical skills (measured as Cardiac Arrest Simulation test score, preshock pause, and hands-off ratio). Secondary outcomes were simple technical skills (chest-compression rate, depth, and ventilation rate). Univariate linear regressions were performed to examine how leadership skills affect quality of cardiopulmonary resuscitation and bivariate correlations elicited factors affecting team-leadership skills.Teams led by leaders with the best leadership skills performed higher quality cardiopulmonary resuscitation with better technical performance (R = 0.75, p resuscitation training.

The 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiac care: an overview of the changes to pediatric basic and advanced life support.

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Spencer, Becky; Chacko, Jisha; Sallee, Donna

2011-06-01

The American Heart Association (AHA) has a strong commitment to implementing scientific research-based interventions for cardiopulmonary resuscitation and emergency cardiovascular care. This article presents the 2010 AHA major guideline changes to pediatric basic life support (BLS) and pediatric advanced life support (PALS) and the rationale for the changes. The following topics are covered in this article: (1) current understanding of cardiac arrest in the pediatric population, (2) major changes in pediatric BLS, and (3) major changes in PALS. Copyright © 2011. Published by Elsevier Inc.

Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma (EPR-CAT)

Science.gov (United States)

2015-10-01

Award Number: W81XWH-07-1-0682 TITLE: Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma ( EPR -CAT) PRINCIPAL INVESTIGATOR...thoracotomy and open chest CPR, results in unacceptably low survival rates. Emergency Preservation and Resuscitation ( EPR ) was developed to rapidly preserve...further recommended that the trauma surgeons involved in the study obtain hospital privileges for cannulation for the EPR flush. This has been

Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma (EPR CAT)

Science.gov (United States)

2016-12-01

Award Number: W81XWH-07-1-0682 TITLE: Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma ( EPR -CAT) PRINCIPAL INVESTIGATOR...Preservation and Resuscitation ( EPR ) was developed to rapidly preserve the organism during ischemia, using hypothermia, drugs, and fluids, to “buy time...privileges for cannulation for the EPR flush. This has been accomplished. Given the complexity of our planned intervention for trauma patients in

Hypothermia and postconditioning after cardiopulmonary resuscitation reduce cardiac dysfunction by modulating inflammation, apoptosis and remodeling.

Directory of Open Access Journals (Sweden)

Patrick Meybohm

Full Text Available BACKGROUND: Mild therapeutic hypothermia following cardiac arrest is neuroprotective, but its effect on myocardial dysfunction that is a critical issue following resuscitation is not clear. This study sought to examine whether hypothermia and the combination of hypothermia and pharmacological postconditioning are cardioprotective in a model of cardiopulmonary resuscitation following acute myocardial ischemia. METHODOLOGY/PRINCIPAL FINDINGS: Thirty pigs (28-34 kg were subjected to cardiac arrest following left anterior descending coronary artery ischemia. After 7 minutes of ventricular fibrillation and 2 minutes of basic life support, advanced cardiac life support was started according to the current AHA guidelines. After successful return of spontaneous circulation (n = 21, coronary perfusion was reestablished after 60 minutes of occlusion, and animals were randomized to either normothermia at 38 degrees C, hypothermia at 33 degrees C or hypothermia at 33 degrees C combined with sevoflurane (each group n = 7 for 24 hours. The effects on cardiac damage especially on inflammation, apoptosis, and remodeling were studied using cellular and molecular approaches. Five animals were sham operated. Animals treated with hypothermia had lower troponin T levels (p<0.01, reduced infarct size (34+/-7 versus 57+/-12%; p<0.05 and improved left ventricular function compared to normothermia (p<0.05. Hypothermia was associated with a reduction in: (i immune cell infiltration, (ii apoptosis, (iii IL-1beta and IL-6 mRNA up-regulation, and (iv IL-1beta protein expression (p<0.05. Moreover, decreased matrix metalloproteinase-9 activity was detected in the ischemic myocardium after treatment with mild hypothermia. Sevoflurane conferred additional protective effects although statistic significance was not reached. CONCLUSIONS/SIGNIFICANCE: Hypothermia reduced myocardial damage and dysfunction after cardiopulmonary resuscitation possible via a reduced rate of apoptosis

Patient-centric blood pressure-targeted cardiopulmonary resuscitation improves survival from cardiac arrest.

Science.gov (United States)

Sutton, Robert M; Friess, Stuart H; Naim, Maryam Y; Lampe, Joshua W; Bratinov, George; Weiland, Theodore R; Garuccio, Mia; Nadkarni, Vinay M; Becker, Lance B; Berg, Robert A

2014-12-01

Although current resuscitation guidelines are rescuer focused, the opportunity exists to develop patient-centered resuscitation strategies that optimize the hemodynamic response of the individual in the hopes to improve survival. To determine if titrating cardiopulmonary resuscitation (CPR) to blood pressure would improve 24-hour survival compared with traditional CPR in a porcine model of asphyxia-associated ventricular fibrillation (VF). After 7 minutes of asphyxia, followed by VF, 20 female 3-month-old swine randomly received either blood pressure-targeted care consisting of titration of compression depth to a systolic blood pressure of 100 mm Hg and vasopressors to a coronary perfusion pressure greater than 20 mm Hg (BP care); or optimal American Heart Association Guideline care consisting of depth of 51 mm with standard advanced cardiac life support epinephrine dosing (Guideline care). All animals received manual CPR for 10 minutes before first shock. Primary outcome was 24-hour survival. The 24-hour survival was higher in the BP care group (8 of 10) compared with Guideline care (0 of 10); P = 0.001. Coronary perfusion pressure was higher in the BP care group (point estimate +8.5 mm Hg; 95% confidence interval, 3.9-13.0 mm Hg; P < 0.01); however, depth was higher in Guideline care (point estimate +9.3 mm; 95% confidence interval, 6.0-12.5 mm; P < 0.01). Number of vasopressor doses before first shock was higher in the BP care group versus Guideline care (median, 3 [range, 0-3] vs. 2 [range, 2-2]; P = 0.003). Blood pressure-targeted CPR improves 24-hour survival compared with optimal American Heart Association care in a porcine model of asphyxia-associated VF cardiac arrest.

Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions-A nationwide prospective feasibility study

DEFF Research Database (Denmark)

Krarup, Niels Henrik; Terkelsen, Christian Juhl; Johnsen, Søren Paaske

2010-01-01

Quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome following out-of-hospital cardiac arrest. The aim of our study was to evaluate the quality of CPR provided by emergency medical service providers (Basic Life Support (BLS) capability) and emergency medical service...... providers assisted by paramedics, nurse anesthetists or physician-manned ambulances (Advanced Life Support (ALS) capability) in a nationwide, unselected cohort of out-of-hospital cardiac arrest cases....

Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions--a nationwide prospective feasibility study

DEFF Research Database (Denmark)

Krarup, Niels Henrik; Terkelsen, Christian Juhl; Johnsen, Søren Paaske

2011-01-01

Quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome following out-of-hospital cardiac arrest. The aim of our study was to evaluate the quality of CPR provided by emergency medical service providers (Basic Life Support (BLS) capability) and emergency medical service...... providers assisted by paramedics, nurse anesthetists or physician-manned ambulances (Advanced Life Support (ALS) capability) in a nationwide, unselected cohort of out-of-hospital cardiac arrest cases....

Chronic resuscitation after trauma-hemorrhage and acute fluid replacement improves hepatocellular function and cardiac output.

Science.gov (United States)

Remmers, D E; Wang, P; Cioffi, W G; Bland, K I; Chaudry, I H

1998-01-01

To determine whether prolonged (chronic) resuscitation has any beneficial effects on cardiac output and hepatocellular function after trauma-hemorrhage and acute fluid replacement. Acute fluid resuscitation after trauma-hemorrhage restores but does not maintain the depressed hepatocellular function and cardiac output. Male Sprague-Dawley rats underwent a 5-cm laparotomy (i.e., trauma was induced) and were bled to and maintained at a mean arterial pressure of 40 mmHg until 40% of maximal bleed-out volume was returned in the form of Ringer's lactate (RL). The animals were acutely resuscitated with RL using 4 times the volume of maximum bleed-out over 60 minutes, followed by chronic resuscitation of 0, 5, or 10 mL/kg/hr RL for 20 hours. Hepatocellular function was determined by an in vivo indocyanine green clearance technique. Hepatic microvascular blood flow was assessed by laser Doppler flowmetry. Plasma levels of interleukin-6 (IL-6) were determined by bioassay. Chronic resuscitation with 5 mL/kg/hr RL, but not with 0 or 10 mL/kg/hr RL, restored cardiac output, hepatocellular function, and hepatic microvascular blood flow at 20 hours after hemorrhage. The regimen above also reduced plasma IL-6 levels. Because chronic resuscitation with 5 mL/kg/hr RL after trauma-hemorrhage and acute fluid replacement restored hepatocellular function and hepatic microvascular blood flow and decreased plasma levels of IL-6, we propose that chronic fluid resuscitation in addition to acute fluid replacement should be routinely used in experimental studies of trauma-hemorrhage.

Successful resuscitation of hypermagnesaemic asystolic cardiac arrest with the use of early transvenous cardiac pacemaker: a case report.

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Miller, M A; Crystal, C S; Helphenstine, J; Young, S E

2006-03-01

A 63 year old woman presented to the emergency department (ED) with 1 week of progressive dyspnoea, constipation, and generalized weakness. She had undergone spinal fustion surgery 10 days previously, and had a history of chronic renal insufficiency. The patient had been using milk of magnesia and magnesium citrate in unknown amounts to alleviate her constipation over this time frame. During her ED stay she became progressively hypotensive and bradycardic, and despite aggressive resuscitative measures she suffered an asystolic arrest 1 hour into her ED course. She was resuscitated with conventional therapy, but her haemodynamic profile did not improve significantly until transvenous cardiac pacing was employed. Her magnesium level was 10.4 mmol/l. Treatment of magnesium overload has focused upon haemodialysis, forced diuresis, and the use of intravenous calcium salts. Case reports have previously documented survival of moderately to severely ill patients when these modalities have been used. Likewise, failure of resuscitation despite use of these methods has been previously noted. To our knowledge, this is the first reported case clearly demonstrating the efficacy of transvenous cardiac pacing to successfully resuscitate a patient upon whom multiple vasopressors, fluids, and calcium previously had no clear effect.

Milrinone and esmolol decrease cardiac damage after resuscitation from prolonged cardiac arrest.

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Zoerner, F; Lennmyr, F; Wiklund, L; Martijn, C; Semenas, E

2015-04-01

Long-term survival after cardiac arrest (CA) due to shock-refractory ventricular fibrillation (VF) is low. Clearly, there is a need for new pharmacological interventions in the setting of cardiopulmonary resuscitation (CPR) to improve outcome. Here, hemodynamic parameters and cardiac damage are compared between the treatment group (milrinone, esmolol and vasopressin) and controls (vasopressin only) during resuscitation from prolonged CA in piglets. A total of 26 immature male piglets were subjected to 12-min VF followed by 8-min CPR. The treatment group (n=13) received i.v. (intravenous) boluses vasopressin 0.4 U/kg, esmolol 250 μg/kg and milrinone 25 μg/kg after 13 min, followed by i.v. boluses esmolol 375 μg/kg and milrinone 25 μg/kg after 18 min and continuous esmolol 15 μg/kg/h infusion during 180 min reperfusion, whereas controls (n=13) received equal amounts of vasopressin and saline. A 200 J monophasic counter-shock was delivered to achieve resumption of spontaneous circulation (ROSC) after 8 min CPR. If ROSC was not achieved, another 200 J defibrillation and bolus vasopressin 0.4 U/kg would be administered in both groups. Direct current shocks at 360 J were applied as one shot per minute over maximally 5 min. Hemodynamic variables and troponin I as a marker of cardiac injury were recorded. Troponin I levels after 180 min reperfusion were lower in the treatment group than in controls (Pmilrinone, esmolol and vasopressin decreased cardiac injury compared with vasopressin alone. © 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Impact of a novel, resource appropriate resuscitation curriculum on Nicaraguan resident physician's management of cardiac arrest.

Science.gov (United States)

Taira, Breena R; Orue, Aristides; Stapleton, Edward; Lovato, Luis; Vangala, Sitaram; Tinoco, Lucia Solorzano; Morales, Orlando

2016-01-01

Project Strengthening Emergency Medicine, Investing in Learners in Latin America (SEMILLA) created a novel, language and resource appropriate course for the resuscitation of cardiac arrest for Nicaraguan resident physicians. We hypothesized that participation in the Project SEMILLA resuscitation program would significantly improve the physician's management of simulated code scenarios. Thirteen Nicaraguan resident physicians were evaluated while managing simulated cardiac arrest scenarios before, immediately, and at 6 months after participating in the Project SEMILLA resuscitation program. This project was completed in 2014 in Leon, Nicaragua. The Cardiac Arrest Simulation Test (CASTest), a validated scoring system, was used to evaluate performance on a standardized simulated cardiac arrest scenario. Mixed effect logistic regression models were constructed to assess outcomes. On the pre-course simulation exam, only 7.7% of subjects passed the test. Immediately post-course, the subjects achieved a 30.8% pass rate and at 6 months after the course, the pass rate was 46.2%. Compared with pre-test scores, the odds of passing the CASTest at 6 months after the course were 21.7 times higher (95% CI 4.2 to 112.8, PSEMILLA resuscitation course and retain these skills.

The Responses of Tissues from the Brain, Heart, Kidney, and Liver to Resuscitation following Prolonged Cardiac Arrest by Examining Mitochondrial Respiration in Rats.

Science.gov (United States)

Kim, Junhwan; Villarroel, José Paul Perales; Zhang, Wei; Yin, Tai; Shinozaki, Koichiro; Hong, Angela; Lampe, Joshua W; Becker, Lance B

2016-01-01

Cardiac arrest induces whole-body ischemia, which causes damage to multiple organs. Understanding how each organ responds to ischemia/reperfusion is important to develop better resuscitation strategies. Because direct measurement of organ function is not practicable in most animal models, we attempt to use mitochondrial respiration to test efficacy of resuscitation on the brain, heart, kidney, and liver following prolonged cardiac arrest. Male Sprague-Dawley rats are subjected to asphyxia-induced cardiac arrest for 30 min or 45 min, or 30 min cardiac arrest followed by 60 min cardiopulmonary bypass resuscitation. Mitochondria are isolated from brain, heart, kidney, and liver tissues and examined for respiration activity. Following cardiac arrest, a time-dependent decrease in state-3 respiration is observed in mitochondria from all four tissues. Following 60 min resuscitation, the respiration activity of brain mitochondria varies greatly in different animals. The activity after resuscitation remains the same in heart mitochondria and significantly increases in kidney and liver mitochondria. The result shows that inhibition of state-3 respiration is a good marker to evaluate the efficacy of resuscitation for each organ. The resulting state-3 respiration of brain and heart mitochondria following resuscitation reenforces the need for developing better strategies to resuscitate these critical organs following prolonged cardiac arrest.

Patient-centric Blood Pressure–targeted Cardiopulmonary Resuscitation Improves Survival from Cardiac Arrest

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Friess, Stuart H.; Naim, Maryam Y.; Lampe, Joshua W.; Bratinov, George; Weiland, Theodore R.; Garuccio, Mia; Nadkarni, Vinay M.; Becker, Lance B.; Berg, Robert A.

2014-01-01

Rationale: Although current resuscitation guidelines are rescuer focused, the opportunity exists to develop patient-centered resuscitation strategies that optimize the hemodynamic response of the individual in the hopes to improve survival. Objectives: To determine if titrating cardiopulmonary resuscitation (CPR) to blood pressure would improve 24-hour survival compared with traditional CPR in a porcine model of asphyxia-associated ventricular fibrillation (VF). Methods: After 7 minutes of asphyxia, followed by VF, 20 female 3-month-old swine randomly received either blood pressure–targeted care consisting of titration of compression depth to a systolic blood pressure of 100 mm Hg and vasopressors to a coronary perfusion pressure greater than 20 mm Hg (BP care); or optimal American Heart Association Guideline care consisting of depth of 51 mm with standard advanced cardiac life support epinephrine dosing (Guideline care). All animals received manual CPR for 10 minutes before first shock. Primary outcome was 24-hour survival. Measurements and Main Results: The 24-hour survival was higher in the BP care group (8 of 10) compared with Guideline care (0 of 10); P = 0.001. Coronary perfusion pressure was higher in the BP care group (point estimate +8.5 mm Hg; 95% confidence interval, 3.9–13.0 mm Hg; P < 0.01); however, depth was higher in Guideline care (point estimate +9.3 mm; 95% confidence interval, 6.0–12.5 mm; P < 0.01). Number of vasopressor doses before first shock was higher in the BP care group versus Guideline care (median, 3 [range, 0–3] vs. 2 [range, 2–2]; P = 0.003). Conclusions: Blood pressure–targeted CPR improves 24-hour survival compared with optimal American Heart Association care in a porcine model of asphyxia-associated VF cardiac arrest. PMID:25321490

Temperature Management After Cardiac Arrest: An Advisory Statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.

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Donnino, Michael W; Andersen, Lars W; Berg, Katherine M; Reynolds, Joshua C; Nolan, Jerry P; Morley, Peter T; Lang, Eddy; Cocchi, Michael N; Xanthos, Theodoros; Callaway, Clifton W; Soar, Jasmeet

2016-01-01

For more than a decade, mild induced hypothermia (32 °C-34 °C) has been standard of care for patients remaining comatose after resuscitation from out-of-hospital cardiac arrest with an initial shockable rhythm, and this has been extrapolated to survivors of cardiac arrest with initially nonshockable rhythms and to patients with in-hospital cardiac arrest. Two randomized trials published in 2002 reported a survival and neurological benefit with mild induced hypothermia. One recent randomized trial reported similar outcomes in patients treated with targeted temperature management at either 33 °C or 36 °C. In response to these new data, the International Liaison Committee on Resuscitation Advanced Life Support Task Force performed a systematic review to evaluate 3 key questions: (1) Should mild induced hypothermia (or some form of targeted temperature management) be used in comatose post-cardiac arrest patients? (2) If used, what is the ideal timing of the intervention? (3) If used, what is the ideal duration of the intervention? The task force used Grading of Recommendations Assessment, Development and Evaluation methodology to assess and summarize the evidence and to provide a consensus on science statement and treatment recommendations. The task force recommends targeted temperature management for adults with out-of-hospital cardiac arrest with an initial shockable rhythm at a constant temperature between 32 °C and 36 °C for at least 24 hours. Similar suggestions are made for out-of-hospital cardiac arrest with a nonshockable rhythm and in-hospital cardiac arrest. The task force recommends against prehospital cooling with rapid infusion of large volumes of cold intravenous fluid. Additional and specific recommendations are provided in the document. Copyright © 2015. Published by Elsevier Ireland Ltd.

Resuscitation and post resuscitation care of the very old after out-of-hospital cardiac arrest is worthwhile.

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Winther-Jensen, Matilde; Kjaergaard, Jesper; Hassager, Christian; Bro-Jeppesen, John; Nielsen, Niklas; Lippert, Freddy K; Køber, Lars; Wanscher, Michael; Søholm, Helle

2015-12-15

Out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis. As comorbidity and frailty increase with age; ethical dilemmas may arise when OHCA occur in the very old. We aimed to investigate mortality, neurological outcome and post resuscitation care in octogenarians (≥80) to assess whether resuscitation and post resuscitation care should be avoided. During 2007-2011 consecutive OHCA-patients were attended by the physician-based Emergency Medical Services-system in Copenhagen. Pre-hospital data based on Utstein-criteria, and data on post resuscitation care were collected. Primary outcome was successful resuscitation; secondary endpoints were 30-day mortality and neurological outcome (Cerebral Performance Category (CPC)). 2509 OHCA-patients with attempted resuscitation were recorded, 22% (n=558) were octogenarians/nonagenarians. 166 (30% of all octogenarians with resuscitation attempted) octogenarians were successfully resuscitated compared to 830 (43% with resuscitation attempted) patients <80 years. 30-day mortality in octogenarians was significantly higher after adjustment for prognostic factors (HR=1.61 CI: 1.22-2.13, p<0.001). Octogenarians received fewer coronary angiographies (CAG) (14 vs. 37%, p<0.001), and had lower odds of receiving CAG by multivariate logistic regression (OR: 0.19, CI: 0.08-0.44, p<0.001). A favorable neurological outcome (CPC 1/2) in survivors to discharge was found in 70% (n=26) of octogenarians compared to 86% (n=317, p=0.03) in the younger patients. OHCA in octogenarians was associated with a significantly higher mortality rate after adjustment for prognostic factors. However, the majority of octogenarian survivors were discharged with a favorable neurological outcome. Withholding resuscitation and post resuscitation care in octogenarians does not seem justified. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

The Responses of Tissues from the Brain, Heart, Kidney, and Liver to Resuscitation following Prolonged Cardiac Arrest by Examining Mitochondrial Respiration in Rats

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Junhwan Kim

2016-01-01

Full Text Available Cardiac arrest induces whole-body ischemia, which causes damage to multiple organs. Understanding how each organ responds to ischemia/reperfusion is important to develop better resuscitation strategies. Because direct measurement of organ function is not practicable in most animal models, we attempt to use mitochondrial respiration to test efficacy of resuscitation on the brain, heart, kidney, and liver following prolonged cardiac arrest. Male Sprague-Dawley rats are subjected to asphyxia-induced cardiac arrest for 30 min or 45 min, or 30 min cardiac arrest followed by 60 min cardiopulmonary bypass resuscitation. Mitochondria are isolated from brain, heart, kidney, and liver tissues and examined for respiration activity. Following cardiac arrest, a time-dependent decrease in state-3 respiration is observed in mitochondria from all four tissues. Following 60 min resuscitation, the respiration activity of brain mitochondria varies greatly in different animals. The activity after resuscitation remains the same in heart mitochondria and significantly increases in kidney and liver mitochondria. The result shows that inhibition of state-3 respiration is a good marker to evaluate the efficacy of resuscitation for each organ. The resulting state-3 respiration of brain and heart mitochondria following resuscitation reenforces the need for developing better strategies to resuscitate these critical organs following prolonged cardiac arrest.

2,3-Butanedione monoxime facilitates successful resuscitation in a dose-dependent fashion in a pig model of cardiac arrest.

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Lee, Byung Kook; Kim, Mu Jin; Jeung, Kyung Woon; Choi, Sung Soo; Park, Sang Wook; Yun, Seong Woo; Lee, Sung Min; Lee, Dong Hun; Min, Yong Il

2016-06-01

Ischemic contracture compromises the hemodynamic effectiveness of cardiopulmonary resuscitation (CPR) and resuscitability from cardiac arrest. In a pig model of cardiac arrest, 2,3-butanedione monoxime (BDM) attenuated ischemic contracture. We investigated the effects of different doses of BDM to determine whether increasing the dose of BDM could improve the hemodynamic effectiveness of CPR further, thus ultimately improving resuscitability. After 16minutes of untreated ventricular fibrillation and 8minutes of basic life support, 36 pigs were divided randomly into 3 groups that received 50mg/kg (low-dose group) of BDM, 100mg/kg (high-dose group) of BDM, or an equivalent volume of saline (control group) during advanced cardiovascular life support. During advanced cardiovascular life support, the control group showed an increase in left ventricular (LV) wall thickness and a decrease in LV chamber area. In contrast, the BDM-treated groups showed a decrease in the LV wall thickness and an increase in the LV chamber area in a dose-dependent fashion. Mixed-model analyses of the LV wall thickness and LV chamber area revealed significant group effects and group-time interactions. Central venous oxygen saturation at 3minutes after the drug administration was 21.6% (18.4-31.9), 39.2% (28.8-53.7), and 54.0% (47.5-69.4) in the control, low-dose, and high-dose groups, respectively (Pfashion. Copyright © 2016 Elsevier Inc. All rights reserved.

Future directions for resuscitation research. V. Ultra-advanced life support.

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Tisherman, S A; Vandevelde, K; Safar, P; Morioka, T; Obrist, W; Corne, L; Buckman, R F; Rubertsson, S; Stephenson, H E; Grenvik, A; White, R J

1997-06-01

Standard external cardiopulmonary resuscitation (SECPR) frequently produces very low perfusion pressures, which are inadequate to achieve restoration of spontaneous circulation (ROSC) and intact survival, particularly when the heart is diseased. Ultra-advanced life support (UALS) techniques may allow support of vital organ systems until either the heart recovers or cardiac repair or replacement is performed. Closed-chest emergency cardiopulmonary bypass (CPB) provides control of blood flow, pressure, composition and temperature, but has so far been applied relatively late. This additional low-flow time may preclude conscious survival. An easy, quick method for vessel access and a small preprimed system that could be taken into the field are needed. Open-chest CPR (OCCPR) is physiologically superior to SECPR, but has also been initiated too late in prior studies. Its application in the field has recently proven feasible. Variations of OCCPR, which deserve clinical trials inside and outside hospitals, include 'minimally invasive direct cardiac massage' (MIDCM), using a pocket-size plunger-like device inserted via a small incision and 'direct mechanical ventricular actuation' (DMVA), using a machine that pneumatically drives a cup placed around the heart. Other novel UALS approaches for further research include the use of an aortic balloon catheter to improve coronary and cerebral blood flow during SECPR, aortic flush techniques and a double-balloon aortic catheter that could allow separate perfusion (and cooling) of the heart, brain and viscera for optimal resuscitation of each. Decision-making, initiation of UALS methods and diagnostic evaluations must be rapid to maximize the potential for ROSC and facilitate decision-making regarding long-term circulatory support versus withdrawal of life support for hopeless cases. Research and development of UALS techniques needs to be coordinated with cerebral resuscitation research.

Impact of a novel, resource appropriate resuscitation curriculum on Nicaraguan resident physician’s management of cardiac arrest

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2016-01-01

Purpose: Project Strengthening Emergency Medicine, Investing in Learners in Latin America (SEMILLA) created a novel, language and resource appropriate course for the resuscitation of cardiac arrest for Nicaraguan resident physicians. We hypothesized that participation in the Project SEMILLA resuscitation program would significantly improve the physician’s management of simulated code scenarios. Methods: Thirteen Nicaraguan resident physicians were evaluated while managing simulated cardiac arrest scenarios before, immediately, and at 6 months after participating in the Project SEMILLA resuscitation program. This project was completed in 2014 in Leon, Nicaragua. The Cardiac Arrest Simulation Test (CASTest), a validated scoring system, was used to evaluate performance on a standardized simulated cardiac arrest scenario. Mixed effect logistic regression models were constructed to assess outcomes. Results: On the pre-course simulation exam, only 7.7% of subjects passed the test. Immediately post-course, the subjects achieved a 30.8% pass rate and at 6 months after the course, the pass rate was 46.2%. Compared with pre-test scores, the odds of passing the CASTest at 6 months after the course were 21.7 times higher (95% CI 4.2 to 112.8, PSEMILLA resuscitation course and retain these skills. PMID:27378010

Current and Future Status of Extracorporeal Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest.

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Singal, Rohit K; Singal, Deepa; Bednarczyk, Joseph; Lamarche, Yoan; Singh, Gurmeet; Rao, Vivek; Kanji, Hussein D; Arora, Rakesh C; Manji, Rizwan A; Fan, Eddy; Nagpal, A Dave

2017-01-01

Numerous series, propensity-matched trials, and meta-analyses suggest that appropriate use of extracorporeal cardiopulmonary resuscitation (E-CPR) for in-hospital cardiac arrest (IHCA) can be lifesaving. Even with an antecedent cardiopulmonary resuscitation (CPR) duration in excess of 45 minutes, 30-day survival with favourable neurologic outcome using E-CPR is approximately 35%-45%. Survival may be related to age, duration of CPR, or etiology. Associated complications include sepsis, renal failure, limb and neurologic complications, hemorrhage, and thrombosis. However, methodological biases-including small sample size, selection bias, publication bias, and inability to control for confounders-in these series prevent definitive conclusions. As such, the 2015 American Heart Association Advanced Cardiac Life Support guidelines update recommended E-CPR as a Level of Evidence IIb recommendation in appropriate cases. The absence of high-quality evidence presents an opportunity for clinician/scientists to generate practice-defining data through collaborative investigation and prospective trials. A multidisciplinary dialogue is required to standardize the field and promote multicentre investigation of E-CPR with data sharing and the development of a foundation for high-quality trials. The objectives of this review are to (1) provide an overview of the strengths and limitations of currently available studies investigating the use of E-CPR in patients with IHCA and highlight knowledge gaps; (2) create a framework for the standardization of terminology, clinical practice, data collection, and investigation of E-CPR for patients with IHCA that will help ensure congruence in future work in this area; and (3) propose suggestions to guide future research by the cardiovascular community to advance this important field. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Evaluation of an impedance threshold device in patients receiving active compression-decompression cardiopulmonary resuscitation for out of hospital cardiac arrest.

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Plaisance, Patrick; Lurie, Keith G; Vicaut, Eric; Martin, Dominique; Gueugniaud, Pierre-Yves; Petit, Jean-Luc; Payen, Didier

2004-06-01

The purpose of this multicentre clinical randomized controlled blinded prospective trial was to determine whether an inspiratory impedance threshold device (ITD), when used in combination with active compression-decompression (ACD) cardiopulmonary resuscitation (CPR), would improve survival rates in patients with out-of-hospital cardiac arrest. Patients were randomized to receive either a sham (n = 200) or an active impedance threshold device (n = 200) during advanced cardiac life support performed with active compression-decompression cardiopulmonary resuscitation. The primary endpoint of this study was 24 h survival. The 24 h survival rates were 44/200 (22%) with the sham valve and 64/200 (32%) with the active valve (P = 0.02). The number of patients who had a return of spontaneous circulation (ROSC), intensive care unit (ICU) admission, and hospital discharge rates was 77 (39%), 57 (29%), and 8 (4%) in the sham valve group versus 96 (48%) (P = 0.05), 79 (40%) (P = 0.02), and 10 (5%) (P = 0.6) in the active valve group. Six out of ten survivors in the active valve group and 1/8 survivors in the sham group had normal neurological function at hospital discharge (P = 0.1). The use of an impedance valve in patients receiving active compression-decompression cardiopulmonary resuscitation for out-of-hospital cardiac arrest significantly improved 24 h survival rates.

Effects of the administration of 2,3-butanedione monoxime during conventional cardiopulmonary resuscitation on ischaemic contracture and resuscitability in a pig model of out-of-hospital cardiac arrest.

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Lee, Byung Kook; Jeung, Kyung Woon; Choi, Sung Soo; Park, Sang Wook; Yun, Seong Woo; Lee, Sung Min; Kim, Nan Yeol; Heo, Tag; Min, Yong Il

2015-02-01

Ischaemic contracture compromises the haemodynamic effectiveness of cardiopulmonary resuscitation and resuscitability. 2,3-Butanedione monoxime (BDM) reduced ischaemic contracture by inhibiting actin-myosin crossbridge formation in an isolated heart model. We investigated the effects of BDM on ischaemic contracture and resuscitation outcomes in a pig model of out-of-hospital cardiac arrest (OHCA). After 15min of untreated ventricular fibrillation, followed by 8min of basic life support, 16 pigs were randomised to receive either 2mlkg(-1) of BDM solution (25gl(-1)) or 2mlkg(-1) of saline during advanced cardiac life support (ACLS). During the ACLS, the control group showed an increase in left ventricular (LV) wall thickness from 10.0mm (10.0-10.8) to 13.0mm (13.0-13.0) and a decrease in LV chamber area from 8.13cm(2) (7.59-9.29) to 7.47cm(2) (5.84-8.43). In contrast, the BDM group showed a decrease in the LV wall thickness from 10mm (9.0-10.8) to 8.5mm (7.0-9.8) and an increase in the LV chamber area from 9.86cm(2) (7.22-12.39) to 12.15 cm(2) (8.02-14.40). Mixed model analyses of the LV wall thickness and LV chamber area revealed significant group effects and group-time interactions. Spontaneous circulation was restored in four (50%) animals in the control group and in eight (100%) animals in the BDM group (p=0.077). All the resuscitated animals survived during an intensive care period of 4h. BDM administered during cardiopulmonary resuscitation reversed ischaemic contracture in a pig model of OHCA. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Cardiopulmonary resuscitation duration and survival in out-of-hospital cardiac arrest patients.

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Adnet, Frederic; Triba, Mohamed N; Borron, Stephen W; Lapostolle, Frederic; Hubert, Hervé; Gueugniaud, Pierre-Yves; Escutnaire, Josephine; Guenin, Aurelien; Hoogvorst, Astrid; Marbeuf-Gueye, Carol; Reuter, Paul-Georges; Javaud, Nicolas; Vicaut, Eric; Chevret, Sylvie

2017-02-01

Relationship between cardiopulmonary arrest and resuscitation (CPR) durations and survival after out-of-hospital cardiac arrest (OHCA) remain unclear. Our primary aim was to determine the association between survival without neurologic sequelae and cardiac arrest intervals in the setting of witnessed OHCA. We analyzed 27,301 non-traumatic, witnessed OHCA patients in France included in the national registry from June 1, 2011 through December 1, 2015. We analyzed cardiac arrest intervals, designated as no-flow (NF; from collapse to start of CPR) and low-flow (LF; from start of CPR to cessation of resuscitation) in relation to 30-day survival without sequelae. We determined the influence of recognized prognostic factors (age, gender, initial rhythm, location of cardiac arrest) on this relation. For the entire cohort, the area delimited by a value of NF greater than 12min (95% confidence interval: 11-13min) and LF greater than 33min (95% confidence interval: 29-45min), yielded a probability of 30-day survival of less than 1%. These sets of values were greatly influenced by initial cardiac arrest rhythm, age, sex and location of cardiac arrest. Extended CPR duration (greater than 40min) in the setting of initial shockable cardiac rhythm is associated with greater than 1% survival with NF less than 18min. The NF interval was highly influential on the LF interval regardless of outcome, whether return of spontaneous circulation (padvanced techniques. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Cardiopulmonary resuscitation: Advances

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William Andrés Vargas-Garzón

2011-06-01

Full Text Available Reanimation’s guidelines dictated by the AHA (American Heart Association are the strategies to follow in the envi­ronment of any situation related to cardiac arrest. They are acquired after the analysis of the evidence available in reani­mation from higher to less quality, with the best neurological results. After years of observation, was achieved to establish that survival behind cardiac arrest is, in general, low (6%, except that any witness starts immediately cardiopulmonary resuscitation (CPR maneuvers; therefore, medical personal must know and practice these maneuvers. With these con­siderations, it’s necessary to emphasize in the theoretical training of CPR of all health professional and laity, which guarantee everybody be prepared to emergency system ac­tivation, brain’s preservation and defibrillate to recuperate heart and life. The actual approach that combines compres­sions and defibrillation to closed chest, rescue ventilation and cardio tonic drugs. The guidelines AHA 2010, focus on increase frequency and quality of CPR. The objective of this article is to recognize various changes in these guidelines in cardiopulmonary reanimation and promote the continued education’s importance in reanimation.

Assessment of cardiopulmonary resuscitation practices in emergency departments for out-of-hospital cardiac arrest victims in Lebanon

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Samar Noureddine

2016-01-01

Full Text Available Background: The survival rate of out-of-hospital cardiac arrest (OHCA victims in Lebanon is low. A national policy on resuscitation practice is lacking. This survey explored the practices of emergency physicians related to the resuscitation of OHCA victims in Lebanon. Methods: A sample of 705 physicians working in emergency departments (EDs was recruited and surveyed using the LimeSurvey software (Carsten Schmitz, Germany. Seventy-five participants responded, yielding 10.64% response rate. Results: The most important factors in the participants' decision to initiate or continue resuscitation were presence of pulse on arrival (93.2%, underlying cardiac rhythm (93.1%, the physician's ethical duty to resuscitate (93.2%, transport time to the ED (89%, and down time (84.9%. The participants were optimistic regarding the survival of OHCA victims (58.1% reporting > 10% survival and reported frequent resuscitation attempts in medically futile situations. The most frequently reported challenges during resuscitation decisions were related to pressure or presence of victim's family (38.8% and lack of policy (30%. Conclusion: In our setting, physicians often rely on well-established criteria for initiating/continuing resuscitation; however, their decisions are also influenced by cultural factors such as victim's family wishes. The findings support the need for a national policy on resuscitation of OHCA victims.

Do Cardiac Rehabilitation Programs Offer Cardiopulmonary Resuscitation Training in Australia and New Zealand?

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Cartledge, Susie H; Bray, Janet E; Stub, Dion; Krum, Henry; Finn, Judith

2016-06-01

Cardiac rehabilitation may provide an ideal environment to train high-risk cardiac patients and their families in cardiopulmonary resuscitation (CPR). However, whether this training is currently offered is unknown. The aims of this study were to: 1) describe the prevalence of CPR training in cardiac rehabilitation programs in Australia and New Zealand (NZ); and 2) examine perceived barriers and attitudes of cardiac rehabilitation coordinators towards providing CPR training. We conducted a cross-sectional online survey of Australian and NZ cardiac rehabilitation coordinators. We received 253 completed surveys (46.7% response rate) (Australia n=208, NZ n=45). Cardiopulmonary resuscitation training was included in 23.9% of Australian programs and 56.6% in NZ. Common barriers to CPR training included lack of resources (49.7%) and a lack of awareness to provide CPR training for this high-risk group (33.7%). The majority of coordinators believed that lay people should be trained in CPR (96.3%) and were comfortable with recommending CPR training to this high-risk group (89.4%). While cardiac rehabilitation coordinators have positive attitudes towards CPR training, it is not currently part of most programs - particularly in Australia. Organisations formulating cardiac rehabilitation recommendations and guidelines should give consideration to include the provision of CPR training. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Cardiopulmonary resuscitation: knowledge and opinions among the U.S. general public. State of the science-fiction.

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Marco, Catherine A; Larkin, Gregory L

2008-12-01

Cardiopulmonary resuscitation is undertaken more than 250,000 times annually in the United States. This study was undertaken to determine knowledge and opinions of the general public regarding cardiopulmonary resuscitation. Validated multisite community-based cross-sectional survey. Knowledge and opinions about resuscitative practices and outcomes, using hypothetical clinical scenarios and other social, spiritual, and environmental considerations. Among 1831 participants representing 38 states, markedly inaccurate perceptions of cardiac arrest were reported. Participants' mean estimate of predicted survival rate after cardiac arrest was 54% (median 50%, IQR 35-75%), and mean estimated duration of resuscitative efforts in the ED was 28min (median 15min; IQR 10-30). Projected age and health status were independent predictors of resuscitation preferences in a series of 4 hypothetical scenarios. Participants indicated that physicians should consider patient and family wishes as the most important factors when making resuscitation decisions. Participants considered advanced technology and physician communication to be the most important actions during attempted resuscitation. Inaccurate perceptions regarding resuscitation and survival rates exist among the lay public. Participants indicated strong preferences regarding resuscitation and advance directives.

Successful resuscitation from two cardiac arrests in a female patient with critical aortic stenosis, severe mitral regurgitation and coronary artery disease

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Mijušković Dragan

2012-01-01

Full Text Available Introduction. The incidence of sudden cardiac death in patients with severe symptomatic aortic stenosis is up to 34% and resuscitation is described as highly unsuccessful. Case report. A 72-year-old female patient with severe aortic stenosis combined with severe mitral regurgitation and three-vessel coronary artery disease was successfully resuscitated following two in-hospital cardiac arrests. The first cardiac arrest occurred immediately after intraarterial injection of low osmolar iodinated agent during coronary angiography. Angiography revealed 90% occlusion of the proximal left main coronary artery and circumflex branch. The second arrest followed induction of anesthesia. Following successful open-chest resuscitation, aortic valve replacement, mitral valvuloplasty and three-vessel aortocoronary bypass were performed. Postoperative pericardial tamponade required surgical revision. The patient recovered completely. Conclusion. Decision to start resuscitation may be justified in selected patients with critical aortic stenosis, even though cardiopulmonary resuscitation in such cases is generally considered futile.

Are We Successful in Cardiopulmonary Resuscitation?

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Nalan Kozaci

2013-08-01

Full Text Available Purpose: In this study, we aimed to determine the success rate of cardiopulmonary resuscitation performed in the patients with diagnosis of cardiac arrest, and demographic characteristics of these patients. Material and Methods: The patients admitted to Adana Numune Education and Research Hospital, Department of Emergency Medicine between 01.01.2011 and 31.12.2012, and who underwent cardiopulmonary resuscitation were included to this study planned as retrospectively. The age, gender, status of judicial cases, causes and time of cardiac arrest, first observed arrest rhythm, the diseases prior to the arrest, means of arrival to emergency department, duration of cardiopulmonary resuscitation, results of cardiopulmonary resuscitation, the name of the hospitalised clinic, the existence of the operation, and outcome of the patients who underwent cardiopulmonary resuscitation in accordance with current advanced life support protocols were recorded in standard data entry form. Results: A total of 290 patients with completely accessible data were included to the study. Most of these patients were men (65.2%. The mean ages were 61 ± 19 years for men, 67 ± 14 years for women (p = 0.018. The most common diagnosis were ischemic heart disease and heart failure according to the analysis of the patient's medical history. 92 patients (31.7% were brought to the emergency department after death, and all of these patients were unsuccessful following to cardiopulmonary resuscitation. 198 patients (68.3% had cardiac arrest in the emergency department, and we determined that cardiopulmonary resuscitation application of 102 patients were successful. The most common causes of cardiac arrest were myocardial infarction and heart failure. Mostly first observed rhythm in the monitor was asystole. The response rate of cardiopulmonary resuscitation in patients with ventricular fibrillation and ventricular tachycardia was higher. Most patients were hospitalised to the

Post resuscitation management of cardiac arrest patients in the critical care environment: A retrospective audit of compliance with evidence based guidelines.

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Milonas, Annabel; Hutchinson, Ana; Charlesworth, David; Doric, Andrea; Green, John; Considine, Julie

2017-11-01

There is a clear relationship between evidence-based post resuscitation care and survival and functional status at hospital discharge. The Australian Resuscitation Council (ARC) recommends protocol driven care to enhance chance of survival following cardiac arrest. Healthcare providers have an obligation to ensure protocol driven post resuscitation care is timely and evidence based. The aim of this study was to examine adherence to best practice guidelines for post resuscitation care in the first 24h from Return of Spontaneous Circulation for patients admitted to the intensive care unit from the emergency department having suffered out of hospital or emergency department cardiac arrest and survived initial resuscitation. A retrospective audit of medical records of patients who met the criteria for survivors of cardiac arrest was conducted at two health services in Melbourne, Australia. Criteria audited were: primary cardiac arrest characteristics, oxygenation and ventilation management, cardiovascular care, neurological care and patient outcomes. The four major findings were: (i) use of fraction of inspired oxygen (FiO 2 ) of 1.0 and hyperoxia was common during the first 24h of post resuscitation management, (ii) there was variability in cardiac care, with timely 12 lead Electrocardiograph and majority of patients achieving systolic blood pressure (SBP) greater than 100mmHg, but delays in transfer to cardiac catheterisation laboratory, (iii) neurological care was suboptimal with a high incidence of hyperglycaemia and failure to provide therapeutic hypothermia in almost 50% of patients and (iv) there was an association between in-hospital mortality and specific elements of post resuscitation care during the first 24h of hospital admission. Evidence-based context-specific guidelines for post resuscitation care that span the whole patient journey are needed. Reliance on national guidelines does not necessarily translate to evidence based care at a local level, so

Respiratory and Cardiac Resuscitation Skills of the High School Athletic Coach.

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Furney, Steven

Athletic coaches (n=149) responded to a survey questionnaire on two cardiac and respiratory emergency procedures: cardiopulmonary resuscitation (CPR) and the Heimlich maneuver. The coaches were asked to indicate how proficient they were at these skills, how important these skills were to their job, the availability and the need for in-service…

2017 American Heart Association Focused Update on Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

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Kleinman, Monica E; Goldberger, Zachary D; Rea, Thomas; Swor, Robert A; Bobrow, Bentley J; Brennan, Erin E; Terry, Mark; Hemphill, Robin; Gazmuri, Raúl J; Hazinski, Mary Fran; Travers, Andrew H

2018-01-02

Cardiopulmonary resuscitation is a lifesaving technique for victims of sudden cardiac arrest. Despite advances in resuscitation science, basic life support remains a critical factor in determining outcomes. The American Heart Association recommendations for adult basic life support incorporate the most recently published evidence and serve as the basis for education and training for laypeople and healthcare providers who perform cardiopulmonary resuscitation. © 2017 American Heart Association, Inc.

Cardiopulmonary resuscitation: update, controversies and new advances

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Alexandre C. Zago

1999-03-01

Full Text Available Cardiopulmonary arrest is a medical emergency in which the lapse of time between event onset and the initiation of measures of basic and advanced support, as well as the correct care based on specific protocols for each clinical situation, constitute decisive factors for a successful therapy. Cardiopulmonary arrest care cannot be restricted to the hospital setting because of its fulminant nature. This necessitates the creation of new concepts, strategies and structures, such as the concept of life chain, cardio-pulmonary resuscitation courses for professionals who work in emergency medical services, the automated external defibrillator, the implantable cardioverter-defibrillator, and mobile intensive care units, among others. New concepts, strategies and structures motivated by new advances have also modified the treatment and improved the results of cardiopulmonary resuscitation in the hospital setting. Among them, we can cite the concept of cerebral resuscitation, the application of the life chain, the creation of the universal life support algorithm, the adjustment of drug doses, new techniques - measure of the end-tidal carbon dioxide levels and of the coronary perfusion pressure - and new drugs under research.

Impact of a novel, resource appropriate resuscitation curriculum on Nicaraguan resident physician’s management of cardiac arrest

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Breena R. Taira

2016-06-01

Full Text Available Purpose: Project Strengthening Emergency Medicine, Investing in Learners in Latin America (SEMILLA created a novel, language and resource appropriate course for the resuscitation of cardiac arrest for Nicaraguan resident physicians. We hypothesized that participation in the Project SEMILLA resuscitation program would significantly improve the physician’s management of simulated code scenarios. Methods: Thirteen Nicaraguan resident physicians were evaluated while managing simulated cardiac arrest scenarios before, immediately, and at 6 months after participating in the Project SEMILLA resuscitation program. This project was completed in 2014 in Leon, Nicaragua. The Cardiac Arrest Simulation Test (CASTest, a validated scoring system, was used to evaluate performance on a standardized simulated cardiac arrest scenario. Mixed effect logistic regression models were constructed to assess outcomes. Results: On the pre-course simulation exam, only 7.7% of subjects passed the test. Immediately post-course, the subjects achieved a 30.8% pass rate and at 6 months after the course, the pass rate was 46.2%. Compared with pre-test scores, the odds of passing the CASTest at 6 months after the course were 21.7 times higher (95% CI 4.2 to 112.8, P<0.001. Statistically significant improvement was also seen on the number of critical items completed (OR=3.75, 95% CI 2.71-5.19, total items completed (OR=4.55, 95% CI 3.4-6.11, and number of “excellent” scores on a Likert scale (OR=2.66, 95% CI 1.85-3.81. Conclusions: Nicaraguan resident physicians demonstrate improved ability to manage simulated cardiac arrest scenarios after participation in the Project SEMILLA resuscitation course and retain these skills.

Out-of-Hospital Cardiac Arrest in Denmark

DEFF Research Database (Denmark)

Wissenberg Jørgensen, Mads

challenges, due to the victim’s physical location, which brings an inherent risk of delay (or altogether absence) of recognition and treatment of cardiac arrest. A low frequency of bystander cardiopulmonary resuscitation and low 30-day survival after out-of-hospital cardiac arrest were identified nearly ten...... years ago in Denmark. These findings led to several national initiatives to strengthen bystander resuscitation attempts and advance care. Despite these nationwide efforts, it was unknown prior to this project whether these efforts resulted in changes in resuscitation attempts by bystanders and changes...

Relationship between arterial partial oxygen pressure after resuscitation from cardiac arrest and mortality in children.

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Ferguson, Lee P; Durward, Andrew; Tibby, Shane M

2012-07-17

Observational studies in adults have shown a worse outcome associated with hyperoxia after resuscitation from cardiac arrest. Extrapolating from adult data, current pediatric resuscitation guidelines recommend avoiding hyperoxia. We investigated the relationship between arterial partial oxygen pressure and survival in patients admitted to the pediatric intensive care unit (PICU) after cardiac arrest. We conducted a retrospective cohort study using the Pediatric Intensive Care Audit Network (PICANet) database between 2003 and 2010 (n=122,521). Patients aged oxygen status and outcome was modeled with logistic regression, with nonlinearities explored via multivariable fractional polynomials. Covariates included age, sex, ethnicity, congenital heart disease, out-of-hospital arrest, year, Pediatric Index of Mortality-2 (PIM2) mortality risk, and organ supportive therapies. Of 1875 patients, 735 (39%) died in PICU. Based on the first arterial gas, 207 patients (11%) had hyperoxia (Pa(O)(2) ≥300 mm Hg) and 448 (24%) had hypoxia (Pa(O)(2) <60 mm Hg). We found a significant nonlinear relationship between Pa(O)(2) and PICU mortality. After covariate adjustment, risk of death increased sharply with increasing hypoxia (odds ratio, 1.92; 95% confidence interval, 1.80-2.21 at Pa(O)(2) of 23 mm Hg). There was also an association with increasing hyperoxia, although not as dramatic as that for hypoxia (odds ratio, 1.25; 95% confidence interval, 1.17-1.37 at 600 mm Hg). We observed an increasing mortality risk with advancing age, which was more pronounced in the presence of congenital heart disease. Both severe hypoxia and, to a lesser extent, hyperoxia are associated with an increased risk of death after PICU admission after cardiac arrest.

Quality of bystander cardiopulmonary resuscitation during real-life out-of-hospital cardiac arrest

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Gyllenborg, Tore; Granfeldt, Asger; Lippert, Freddy

2017-01-01

BACKGROUND: Cardiopulmonary resuscitation (CPR) can increase survival in out-of-hospital cardiac arrest (OHCA). However, little is known about bystander CPR quality in real-life OHCA. AIM: To describe bystander CPR quality based on automated external defibrillator (AED) CPR process data during OH...

Pravastatin But Not Simvastatin Improves Survival and Neurofunctional Outcome After Cardiac Arrest and Cardiopulmonary Resuscitation

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Stefan Bergt, MD

2017-04-01

Full Text Available Summary: Cardiac arrest (CA followed by cardiopulmonary resuscitation (CPR is associated with high mortality and poor neurological outcome. We compared the effects of pravastatin and simvastatin on survival and neurofunction in a murine model of CA/CPR. Pravastatin, a hydrophilic statin, increased survival and neurofunction during a 28-day follow-up period. This therapy was associated with improved pulmonary function, reduced pulmonary edema, and increased endothelial cell function in vitro. In contrast, lipophilic simvastatin did not modulate survival but increased pulmonary edema and impaired endothelial cell function. Although pravastatin may display a therapeutic option for post-CA syndrome, the application of simvastatin may require re-evaluation. Key Words: cardiac arrest, endothelial cell function, ischemia and reperfusion injury, pravastatin, resuscitation, simvastatin

Extracorporeal cardiopulmonary resuscitation after out-of-hospital cardiac arrest in a Danish health region.

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Fjølner, J; Greisen, J; Jørgensen, M R S; Terkelsen, C J; Ilkjaer, L B; Hansen, T M; Eiskjaer, H; Christensen, S; Gjedsted, J

2017-02-01

Extracorporeal Cardiopulmonary Resuscitation (ECPR) has emerged as a feasible rescue therapy for refractory, normothermic out-of-hospital cardiac arrest (OHCA). Reported survival rates vary and comparison between studies is hampered by heterogeneous study populations, differences in bystander intervention and in pre-hospital emergency service organisation. We aimed to describe the first experiences, treatment details, complications and outcome with ECPR for OHCA in a Danish health region. Retrospective study of adult patients admitted at Aarhus University Hospital, Denmark between 1 January 2011 and 1 July 2015 with witnessed, refractory, normothermic OHCA treated with ECPR. OHCA was managed with pre-hospital advanced airway management and mechanical chest compression during transport. Relevant pre-hospital and in-hospital data were collected with special focus on low-flow time and ECPR duration. Survival to hospital discharge with Cerebral Performance Category (CPC) of 1 and 2 at hospital discharge was the primary endpoint. Twenty-one patients were included. Median pre-hospital low-flow time was 54 min [range 5-100] and median total low-flow time was 121 min [range 55-192]. Seven patients survived (33%). Survivors had a CPC score of 1 or 2 at hospital discharge. Five survivors had a shockable initial rhythm. In all survivors coronary occlusion was the presumed cause of cardiac arrest. Extracorporeal cardiopulmonary resuscitation is feasible as a rescue therapy in normothermic refractory OHCA in highly selected patients. Low-flow time was longer than previously reported. Survival with favourable neurological outcome is possible despite prolonged low-flow duration. © 2016 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Clinical experience and skills of physicians in hospital cardiac arrest teams in Denmark: a nationwide study

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Lauridsen KG

2017-03-01

Full Text Available Kasper G Lauridsen,1–3 Anders S Schmidt,1–3 Philip Caap,3,4 Rasmus Aagaard,2,3,5 Bo Løfgren1,3,4 1Department of Internal Medicine, 2Clinical Research Unit, Regional Hospital of Randers, Randers, 3Research Center for Emergency Medicine, Aarhus University Hospital, 4Institute of Clinical Medicine, Aarhus University, Aarhus, 5Department of Anesthesiology, Randers Regional Hospital, Denmark Background: The quality of in-hospital resuscitation is poor and may be affected by the clinical experience and cardiopulmonary resuscitation (CPR training. This study aimed to investigate the clinical experience, self-perceived skills, CPR training and knowledge of the guidelines on when to abandon resuscitation among physicians of cardiac arrest teams. Methods: We performed a nationwide cross-sectional study in Denmark. Telephone interviews were conducted with physicians in the cardiac arrest teams in public somatic hospitals using a structured questionnaire. Results: In total, 93 physicians (53% male from 45 hospitals participated in the study. Median age was 34 (interquartile range: 30–39 years. Respondents were medical students working as locum physicians (5%, physicians in training (79% and consultants (16%, and the median postgraduate clinical experience was 48 (19–87 months. Most respondents (92% felt confident in treating a cardiac arrest, while fewer respondents felt confident in performing intubation (41% and focused cardiac ultrasound (39% during cardiac arrest. Median time since last CPR training was 4 (2–10 months, and 48% had attended a European Resuscitation Council (ERC Advanced Life Support course. The majority (84% felt confident in terminating resuscitation; however, only 9% were able to state the ERC guidelines on when to abandon resuscitation. Conclusion: Physicians of Danish cardiac arrest teams are often inexperienced and do not feel competent performing important clinical skills during resuscitation. Less than half have

Termination of Resuscitation Rules to Predict Neurological Outcomes in Out-of-Hospital Cardiac Arrest for an Intermediate Life Support Prehospital System.

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Cheong, Randy Wang Long; Li, Huihua; Doctor, Nausheen Edwin; Ng, Yih Yng; Goh, E Shaun; Leong, Benjamin Sieu-Hon; Gan, Han Nee; Foo, David; Tham, Lai Peng; Charles, Rabind; Ong, Marcus Eng Hock

2016-01-01

Futile resuscitation can lead to unnecessary transports for out-of-hospital cardiac arrest (OHCA). The Basic Life Support (BLS) and Advanced Life Support (ALS) termination of resuscitation (TOR) guidelines have been validated with good results in North America. This study aims to evaluate the performance of these two rules in predicting neurological outcomes of OHCA patients in Singapore, which has an intermediate life support Emergency Medical Services (EMS) system. A retrospective cohort study was carried out on Singapore OHCA data collected from April 2010 to May 2012 for the Pan-Asian Resuscitation Outcomes Study (PAROS). The outcomes of each rule were compared to the actual neurological outcomes of the patients. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and predicted transport rates of each test were evaluated. A total of 2,193 patients had cardiac arrest of presumed cardiac etiology. TOR was recommended for 1,411 patients with the BLS-TOR rule, with a specificity of 100% (91.9, 100.0) for predicting poor neurological outcomes, PPV 100% (99.7, 100.0), sensitivity 65.7% (63.6, 67.7), NPV 5.6% (4.1, 7.5), and transportation rate 35.6%. Using the ALS-TOR rule, TOR was recommended for 587 patients, specificity 100% (91.9, 100.0) for predicting poor neurological outcomes, PPV 100% (99.4, 100.0), sensitivity 27.3% (25.4, 29.3), NPV 2.7% (2.0, 3.7), and transportation rate 73.2%. BLS-TOR predicted survival (any neurological outcome) with specificity 93.4% (95% CI 85.3, 97.8) versus ALS-TOR 98.7% (95% CI 92.9, 99.8). Both the BLS and ALS-TOR rules had high specificities and PPV values in predicting neurological outcomes, the BLS-TOR rule had a lower predicted transport rate while the ALS-TOR rule was more accurate in predicting futility of resuscitation. Further research into unique local cultural issues would be useful to evaluate the feasibility of any system-wide implementation of TOR.

Simulation-based training delivered directly to the pediatric cardiac intensive care unit engenders preparedness, comfort, and decreased anxiety among multidisciplinary resuscitation teams.

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Allan, Catherine K; Thiagarajan, Ravi R; Beke, Dorothy; Imprescia, Annette; Kappus, Liana J; Garden, Alexander; Hayes, Gavin; Laussen, Peter C; Bacha, Emile; Weinstock, Peter H

2010-09-01

Resuscitation of pediatric cardiac patients involves unique and complex physiology, requiring multidisciplinary collaboration and teamwork. To optimize team performance, we created a multidisciplinary Crisis Resource Management training course that addressed both teamwork and technical skill needs for the pediatric cardiac intensive care unit. We sought to determine whether participation improved caregiver comfort and confidence levels regarding future resuscitation events. We developed a simulation-based, in situ Crisis Resource Management curriculum using pediatric cardiac intensive care unit scenarios and unit-specific resuscitation equipment, including an extracorporeal membrane oxygenation circuit. Participants replicated the composition of a clinical team. Extensive video-based debriefing followed each scenario, focusing on teamwork principles and technical resuscitation skills. Pre- and postparticipation questionnaires were used to determine the effects on participants' comfort and confidence regarding participation in future resuscitations. A total of 182 providers (127 nurses, 50 physicians, 2 respiratory therapists, 3 nurse practitioners) participated in the course. All participants scored the usefulness of the program and scenarios as 4 of 5 or higher (5 = most useful). There was significant improvement in participants' perceived ability to function as a code team member and confidence in a code (P < .001). Participants reported they were significantly more likely to raise concerns about inappropriate management to the code leader (P < .001). We developed a Crisis Resource Management training program in a pediatric cardiac intensive care unit to teach technical resuscitation skills and improve team function. Participants found the experience useful and reported improved ability to function in a code. Further work is needed to determine whether participation in the Crisis Resource Management program objectively improves team function during real

The cognitive basis of effective team performance: features of failure and success in simulated cardiac resuscitation.

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Shetty, Pallavi; Cohen, Trevor; Patel, Bhavesh; Patel, Vimla L

2009-11-14

Despite a body of research on teams in other fields relatively little is known about measuring teamwork in healthcare. The aim of this study is to characterize the qualitative dimensions of team performance during cardiac resuscitation that results in good and bad outcomes. We studied each team's adherence to Advanced Cardiac Life Support (ACLS) protocol for ventricular fibrillation/tachycardia and identified team behaviors during simulated critical events that affected their performance. The process was captured by a developed task checklist and a validated team work coding system. Results suggest that deviation from the sequence suggested by the ACLS protocol had no impact on the outcome as the successful team deviated more from this sequence than the unsuccessful team. It isn't the deviation from the protocol per se that appears to be important, but how the leadership flexibly adapts to the situational changes with deviations is the crucial factor in team competency.

Automated cardiopulmonary resuscitation using a load-distributing band external cardiac support device for in-hospital cardiac arrest: a single centre experience of AutoPulse-CPR.

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Spiro, J R; White, S; Quinn, N; Gubran, C J; Ludman, P F; Townend, J N; Doshi, S N

2015-02-01

Poor quality cardiopulmonary resuscitation (CPR) predicts adverse outcome. During invasive cardiac procedures automated-CPR (A-CPR) may help maintain effective resuscitation. The use of A-CPR following in-hospital cardiac arrest (IHCA) remains poorly described. Firstly, we aimed to assess the efficiency of healthcare staff using A-CPR in a cardiac arrest scenario at baseline, following re-training and over time (Scenario-based training). Secondly, we studied our clinical experience of A-CPR at our institution over a 2-year period, with particular emphasis on the details of invasive cardiac procedures performed, problems encountered, resuscitation rates and in-hospital outcome (AutoPulse-CPR Registry). Scenario-based training: Forty healthcare professionals were assessed. At baseline, time-to-position device was slow (mean 59 (±24) s (range 15-96s)), with the majority (57%) unable to mode-switch. Following re-training time-to-position reduced (28 (±9) s, pCPR Registry: 285 patients suffered IHCA, 25 received A-CPR. Survival to hospital discharge following conventional CPR was 28/260 (11%) and 7/25 (28%) following A-CPR. A-CPR supported invasive procedures in 9 patients, 2 of whom had A-CPR dependant circulation during transfer to the catheter lab. A-CPR may provide excellent haemodynamic support and facilitate simultaneous invasive cardiac procedures. A significant learning curve exists when integrating A-CPR into clinical practice. Further studies are required to better define the role and effectiveness of A-CPR following IHCA. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Resuscitation of sudden cardiac death caused by acute epileptic seizures: A case report

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Dana-Oliviana Geavlete

2016-03-01

Full Text Available Symptomatic long QT syndrome in pediatric patients is a life-threatening condition. Sometimes, this pathology can be misdiagnosed and erroneously managed as generalized epilepsy due to similar clinical manifestations. The presented case discusses a 13-year-old female patient with generalized epilepsy since the age of 4, admitted for two episodes of resuscitated cardiac arrest due to torsades de pointes and ventricular fibrillation. The final diagnosis of congenital long QT was established and due to the patient's high-risk profile for future cardiac events, implantable cardiac defibrillator was subsequently indicated. Early recognition of congenital long QT and timing of cardiac therapy were crucial and potentially lower the incidence of fatal dysrhythmias commonly associated this condition. In high-risk patients, both medical and interventional therapy can be life-saving.

Assessment Of Nurses Performance During Cardiopulmonary Resuscitation In Intensive Care Unit And Cardiac Care Unit At The Alexandria Main University Hospital.

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Dr. Nagla Hamdi Kamal Khalil El- Meanawi

2015-08-01

Full Text Available Abstract Background Cardiopulmonary resuscitation one of the most emergency management the nurse has a pivotal role and should be highly qualified in performing these procedures. The aim of the study is to assess performance of nurses during Cardio pulmonary resuscitation for patient with cardiac arrest In Intensive Care Unit and Cardiac Care Unit at the Alexandria main university hospital. To answer the question what are the most common area of satisfactory and area of neglection in nurses performance during Cardio Pulmonary Resuscitation. The sample consists of 53 staff nurses working in Intensive care unit amp cardiac care unit at Alexandria main university hospital. The tools of data collection were structured of questionnaire sheet and observational cheek list. The results showed that unsatisfactory performance between nurses in both units. The study concluded that all nurses need to improve their performance during cardiopulmonary resuscitation for patient with cardiac arrest it is crucial for nursing staff to participate in CPR courses in order to refresh and update their theoretical knowledge and performance skills and consequently to improve the safety and effectiveness of care. The study recommended that continuous evaluation of nurses knowledge and performance is essential the optimal frequency with which CPR training should be implemented at least every 6 months in order to avoid deterioration in nurses CPR knowledge and skills.

[European Resuscitation Council guidelines for resuscitation 2010].

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Hunyadi-Anticević, Silvija; Colak, Zeljko; Funtak, Ines Lojna; Lukić, Anita; Filipović-Grcić, Boris; Tomljanović, Branka; Kniewald, Hrvoje; Protić, Alen; Pandak, Tatjana; Poljaković, Zdravka; Canadija, Marino

2011-01-01

All rescuers trained or not, should provide chest compressions to victims of cardiac arrest. The aim should be to push to a depth of at least 5 cm at a rate of at least 100 compressions per minute, to allow full chest recoil, and to minimise interruptions in chest compressions. Trained rescuers should also provide ventilations with a compression-ventilation ratio of 30:2. ELECTRICAL THERAPIES: Much greater emphasis on minimising the duration of the pre-shock and post-shock pauses; the continuation of compressions during charging of the defibrillator is recommended. Further development of AED programmes is encouraged. ADULT ADVANCED LIFE SUPPORT: Increased emphasis on high-quality chest compressions throughout any ALS intervention paused briefly only to enable specific interventions. Removal of the recommendation for a pre-specified period of cardiopulmonary resuscitation before out-of-hospital defibrillation following cardiac arrest unwitnessed by the EMS. The role of precordial thump is de-emphasized. Delivery of drugs via a tracheal tube is no longer recommended, drugs should be given by the intraosseous (IO) route. Atropine is no longer recommended for routine use in asystole or pulseless electrical activity. Reduced emphasis on early tracheal intubation unless achieved by highly skilled individuals with minimal interruptions in chest compressions. Increased emphasis on the use of capnography. Recognition of potential harm caused by hyperoxaemia. Revision of the recommendation of glucose control. Use of therapeutic hypothermia to include comatose survivors of cardiac arrest associated initially with shockable rhythms, as well as non-shockable rhythms, with a lower level of evidence acknowledged for the latter. INITIAL MANAGEMENT OF ACUTE CORONARY SYNDROMES: The term non-ST-elevation myocardial infarction-acute coronary syndrome (non-STEMI-ACS) has been introduced for both NSTEMI and unstable angina pectoris. Primary PCI (PPCI) is the preferred reperfusion

MRI evaluation of maternal cardiac displacement in pregnancy: implications for cardiopulmonary resuscitation.

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Holmes, Signy; Kirkpatrick, Iain D C; Zelop, Carolyn M; Jassal, Davinder S

2015-09-01

The purpose of this study was to determine, with the use of cardiac magnetic resonance imaging, whether there is vertical displacement of the heart during pregnancy. Cardiopulmonary resuscitation guidelines during pregnancy recommend placing the hands 2-3 cm higher on the sternum than in nonpregnant individuals. This recommendation is based on the presumption that the heart is displaced superiorly by the diaphragm during the third trimester. Whether there is true cardiac displacement because of the expanding uterus in pregnancy remains unknown. A total of 34 healthy female volunteers 18-35 years old were enrolled prospectively from 2010-2012 at 2 tertiary care centers. The conditions of all participants were evaluated with cardiac magnetic resonance imaging in the one-half left lateral decubitus position during the third trimester of pregnancy and again at a minimum of 3 months after delivery (surrogate for the nonpregnant state). Superior displacement of the heart was determined by measurement of the distance between the inferior aspect of the clavicular heads and the coronary sinus at both time points. The study population included 34 women (mean age, 29 ± 3 years; body mass index, 24 ± 4 kg/m(2)). The mean gestational age at third-trimester imaging was 237 ± 16 days (34 weeks ± 16 days); the mean number of days for postpartum imaging (baseline) was 107 ± 25 days (16 weeks ± 25 days). There was no statistical difference between the cardiac position at baseline (10.1 ± 1.2 cm) and during the third trimester (10.3 ± 1.1 cm; P = .22). Contrary to popular assumption, there is no significant vertical displacement of the heart in the third trimester of pregnancy relative to the nonpregnant state. Accordingly, there is no need to alter hand placement for chest compressions during cardiopulmonary resuscitation in pregnancy. Copyright © 2015 Elsevier Inc. All rights reserved.

Comparison of Quantitative Characteristics of Early Post-resuscitation EEG Between Asphyxial and Ventricular Fibrillation Cardiac Arrest in Rats.

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Chen, Bihua; Chen, Gang; Dai, Chenxi; Wang, Pei; Zhang, Lei; Huang, Yuanyuan; Li, Yongqin

2018-04-01

Quantitative electroencephalogram (EEG) analysis has shown promising results in studying brain injury and functional recovery after cardiac arrest (CA). However, whether the quantitative characteristics of EEG, as potential indicators of neurological prognosis, are influenced by CA causes is unknown. The purpose of this study was designed to compare the quantitative characteristics of early post-resuscitation EEG between asphyxial CA (ACA) and ventricular fibrillation CA (VFCA) in rats. Thirty-two Sprague-Dawley rats of both sexes were randomized into either ACA or VFCA group. Cardiopulmonary resuscitation was initiated after 5-min untreated CA. Characteristics of early post-resuscitation EEG were compared, and the relationships between quantitative EEG features and neurological outcomes were investigated. Compared with VFCA, serum level of S100B, neurological deficit score and brain histopathologic damage score were dramatically higher in the ACA group. Quantitative measures of EEG, including onset time of EEG burst, time to normal trace, burst suppression ratio, and information quantity, were significantly lower for CA caused by asphyxia and correlated with the 96-h neurological outcome and survival. Characteristics of earlier post-resuscitation EEG differed between cardiac and respiratory causes. Quantitative measures of EEG not only predicted neurological outcome and survival, but also have the potential to stratify CA with different causes.

Abordagem do paciente reanimado, pós-parada cardiorrespiratória Care of patient resuscitated from cardiac arrest

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João Carlos Ramos Gonçalves Pereira

2008-06-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: A parada cardiorrespiratória (PCR ocorrida em ambulatório tem elevada mortalidade, sendo a sobrevida entre 5% e 35%. Dos pacientes que são reanimados uma percentagem elevada permanece com déficits neurológicos, resultantes das lesões ocorridas, tanto no período de ausência de circulação ou durante a reperfusão. No entanto a compreensão dos mecanismos da lesão cerebral não tem traduzido na melhoria do prognóstico. A hipotermia terapêutica após a reanimação parece ser uma opção válida associada à diminuição destas seqüelas neurológicas. O objetivo deste estudo foi rever a evidência científica relativa à abordagem do paciente reanimado após PCR. CONTEÚDO: Descrição e abordagem dos principais fatores de risco associados à lesão neurológica após PCR, bem como dos seus critérios de prognóstico.Feita pesquisa não sistemática na base de dados PubMed dos artigos referentes à abordagem terapêutica dos pacientes reanimados de parada cardíaca. As referências bibliográficas dos artigos de revisão foram igualmente analisadas. Elaboradas normas práticas para essa abordagem. CONCLUSÕES: Os pacientes que sobrevivem à PCR têm elevado risco de permanecer com lesões neurológicas graves. A hipotermia terapêutica e o controle das variáveis fisiológicas, com otimização da perfusão cerebral, podem melhorar o seu prognóstico.BACKGROUND AND OBJECTIVES: Out-of-hospital cardiac arrest is a major cause of death with survival rates as low as 5% to 35%. A large number of patients who survive resuscitation will face significant neurological damage, as a result of the ischemia that occurs both during cardiac arrest and reperfusion. However understanding of the mechanisms responsible for brain damage has not resulted in prognostic improvement. Therapeutic hypothermia after resuscitation may be a valid option associated to reduction of neurological damage. The purpose of this study was to

Postoperative Cardiac Arrest after Heart Surgery: Does Extracorporeal Perfusion Support a Paradigm Change in Management?

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Edward Gologorsky

2010-01-01

Full Text Available Early institution of extracorporeal perfusion support (ECPS may improve survival after cardiac arrest. Two patients sustained unexpected cardiac arrest in the Intensive Care Unit (ICU following cardiac interventions. ECPS was initiated due to failure to restore hemodynamics after prolonged (over 60 minutes advanced cardiac life support (ACLS protocol-guided cardiopulmonary resuscitation. Despite relatively late institution of ECPS, both patients survived with preserved neurological function. This communication focuses on the utility of ECPS in the ICU as a part of resuscitative efforts.

Resuscitation outcomes of reproductive-age females who experienced out-of-hospital cardiac arrest.

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Hagihara, Akihito; Onozuka, Daisuke; Hasegawa, Manabu; Nagata, Takashi; Abe, Takeru; Nabeshima, Yoshihiro

2017-03-01

Although some studies have shown that women in their reproductive years have better resuscitation outcomes of out-of-hospital cardiac arrest (OHCA), conflicting results and methodological problems have also been noted. Thus, we evaluated the resuscitation outcomes of OHCA of females by age. This was a prospective observational study using registry data from all OHCA cases between 2005 and 2012 in Japan. The subjects were females aged 18-110 years who suffered an out-of-hospital cardiac arrest. Logistic regression analyses were performed using total and propensity-matched patients. There were 381,123 OHCA cases that met the inclusion criteria. Among propensity-matched patients, females aged 18-49 and 50-60 years of age had similar rates of return of spontaneous circulation before hospital arrival and 1-month survival (all p>0.60). In contrast, females aged 18-49 years of age had significantly lower rates of 1-month survival with minimal neurological impairment than did females aged 50-60 years of age (after adjusting for selected variables: Cerebral Performance Category scale 1 or 2 (CPC (1, 2)), OR=0.45, p=0.020; Overall Performance Category scale 1 or 2 (OPC (1, 2)): OR=0.42, p= 0.014; after adjustment for all variables: CPC (1, 2), OR=0.27, p= 0.008; OPC (1, 2), OR=0.29, p=0.009). Women of reproductive age did not show improved resuscitation outcomes in OHCA. Additionally, women in their reproductive years showed worse neurological outcomes one month after the event, which may be explained by the negative effects of estrogen. These findings need to be verified in further studies.

Survival without sequelae after prolonged cardiopulmonary resuscitation after electric shock.

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Motawea, Mohamad; Al-Kenany, Al-Sayed; Hosny, Mostafa; Aglan, Omar; Samy, Mohamad; Al-Abd, Mohamed

2016-03-01

"Electrical shock is the physiological reaction or injury caused by electric current passing through the human body. It occurs upon contact of a human body part with any source of electricity that causes a sufficient current through the skin, muscles, or hair causing undesirable effects ranging from simple burns to death." Ventricular fibrillation is believed to be the most common cause of death after electrical shock. "The ideal duration of cardiac resuscitation is unknown. Typically prolonged cardiopulmonary resuscitation is associated with poor neurologic outcomes and reduced long term survival. No consensus statement has been made and traditionally efforts are usually terminated after 15-30 minutes." The case under discussion seems worthy of the somewhat detailed description given. It is for a young man who survived after 65 minutes after electrical shock (ES) after prolonged high-quality cardiopulmonary resuscitation (CPR), multiple defibrillations, and artificial ventilation without any sequelae. Early start of adequate chest compressions and close adherence to advanced cardiac life support protocols played a vital role in successful CPR.

Attitude of elderly patients towards cardiopulmonary resuscitation in Greece.

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Chliara, Daphne; Chalkias, Athanasios; Horopanitis, Evaggelos E; Papadimitriou, Lila; Xanthos, Theodoros

2014-10-01

Although researchers in several countries have investigated patients' points of view regarding cardiopulmonary resuscitation, there has been no research investigating this issue in Greece. The present study aimed at identifying the attitude of older Greek patients regarding cardiopulmonary resuscitation. One basic questionnaire consisting of 34 questions was used in order to identify patients' opinions regarding cardiopulmonary resuscitation in five different hospitals from June to November 2011. In total, 300 questionnaires were collected. Although patients' knowledge regarding cardiopulmonary resuscitation was poor, most of them would like to be resuscitated in case they suffered an in-hospital cardiac arrest. Also, they believe that they should have the right to accept or refuse treatment. However, the legal and sociocultural norms in Greece do not support patients' choice for the decision to refuse resuscitation. The influence of several factors, such as their general health status or the underlying pathology, could lead patients to give a "do not attempt resuscitation" order. The attitudes of older Greek patients regarding resuscitation are not different from others', whereas the legal and sociocultural norms in Greece do not support patient choice in end-of-life decisions, namely the decision to refuse resuscitation. We advocate the introduction of advanced directives, as well as the establishment and implementation of specific legislation regarding the ethics of resuscitation in Greece. © 2013 Japan Geriatrics Society.

Incorporating cardiopulmonary resuscitation training into a cardiac rehabilitation programme: A feasibility study.

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Cartledge, Susie; Finn, Judith; Bray, Janet E; Case, Rosalind; Barker, Lauren; Missen, Diane; Shaw, James; Stub, Dion

2018-02-01

Patients with a cardiac history are at future risk of cardiac events, including out-of-hospital cardiac arrest. Targeting cardiopulmonary resuscitation (CPR) training to family members of cardiac patients has long been advocated, but is an area in need of contemporary research evidence. An environment yet to be investigated for targeted training is cardiac rehabilitation. To evaluate the feasibility of providing CPR training in a cardiac rehabilitation programme among patients, their family members and staff. A prospective before and after study design was used. CPR training was delivered using video self-instruction CPR training kits, facilitated by a cardiac nurse. Data was collected pre-training, post-training and at one month. Cardiac patient participation rates in CPR classes were high ( n = 56, 72.7% of eligible patients) with a further 27 family members attending training. Patients were predominantly male (60.2%), family members were predominantly female (81.5%), both with a mean age of 65 years. Confidence to perform CPR and willingness to use skills significantly increased post-training (both ptraining participants demonstrated a mean compression rate of 112 beats/min and a mean depth of 48 mm. Training reach was doubled as participants shared the video self-instruction kit with a further 87 people. Patients, family members and cardiac rehabilitation staff had positive feedback about the training. We demonstrated that cardiac rehabilitation is an effective and feasible environment to provide CPR training. Using video self-instruction CPR training kits enabled further training reach to the target population.

Blood levels of macrophage migration inhibitory factor after successful resuscitation from cardiac arrest.

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Christian Stoppe

Full Text Available Ischemia-reperfusion injury following cardiopulmonary resuscitation (CPR is associated with a systemic inflammatory response, resulting in post-resuscitation disease. In the present study we investigated the response of the pleiotropic inflammatory cytokine macrophage migration inhibitory factor (MIF to CPR in patients admitted to the hospital after out-of-hospital cardiac arrest (OHCA. To describe the magnitude of MIF release, we compared the blood levels from CPR patients with those obtained in healthy volunteers and with an aged- and gender-matched group of patients undergoing cardiac surgery with the use of extracorporeal circulation.Blood samples of 17 patients with return of spontaneous circulation (ROSC after OHCA were obtained upon admission to the intensive care unit, and 6, 12, 24, 72 and 96 h later. Arrest and treatment related data were documented according to the Utstein style.In patients after ROSC, MIF levels at admission (475.2±157.8 ng/ml were significantly higher than in healthy volunteers (12.5±16.9 ng/ml, p<0.007 and in patients after cardiac surgery (78.2±41.6 ng/ml, p<0.007. Six hours after admission, MIF levels were decreased by more than 50% (150.5±127.2 ng/ml, p<0.007, but were not further reduced in the subsequent time course and remained significantly higher than the values observed during the ICU stay of cardiac surgical patients. In this small group of patients, MIF levels could not discriminate between survivors and non-survivors and were not affected by treatment with mild therapeutic hypothermia.MIF shows a rapid and pronounced increase following CPR, hence allowing a very early assessment of the inflammatory response. Further studies are warranted in larger patient groups to determine the prognostic significance of MIF.ClinicalTrials.gov NCT01412619.

Cardiocerebral resuscitation: facts and prospects

OpenAIRE

Dejan Kupnik; Miljenko Križmarić

2009-01-01

Cardiopulmonary resuscitation in the prehospital setting still has to cope with poor lay-rescuer knowledge of resuscitation techniques, low public availability of automated external defi brillators, many detrimental interruptions of chest compressions during lay and professional resuscitation eff orts and suboptimal postresuscitation care. Th erefore the survival of patients aft er cardiac arrest remains poor. To address those fl aws, cardiopulmonary resuscitatio...

Neurologic outcome in comatose patients resuscitated from out-of-hospital cardiac arrest with prolonged downtime and treated with therapeutic hypothermia

Science.gov (United States)

Kim, Won Young; Giberson, Tyler A.; Uber, Amy; Berg, Katherine; Cocchi, Michael N.; Donnino, Michael W.

2014-01-01

Background Previous reports have shown that prolonged duration of resuscitation efforts in out-of-hospital cardiac arrest (OHCA) is associated with poor neurologic outcome. This concept has recently been questioned with advancements in post-cardiac arrest care including the use of therapeutic hypothermia (TH). The aim of this study was to determine the rate of good neurologic outcome based on the duration of resuscitation efforts in OHCA patients treated with TH. Methods This prospective, observational, study was conducted between January 2008 and September 2012. Inclusion criteria consisted of adult non-traumatic OHCA patients who were comatose after return of spontaneous circulation (ROSC) and received TH. The primary endpoint was good neurologic outcome defined as a cerebral performance category score of 1 or 2. Downtime was calculated as the length of time between the patient being recognized as pulseless and ROSC. Results 105 patients were treated with TH and 19 were excluded due to unknown downtime, leaving 86 patients for analysis. The median downtime was 18.5 (10.0–32.3) minutes and 33 patients (38.0%) had a good neurologic outcome. When downtime was divided into four groups (≤10 min, 11-20 min, 21-30 min, > 30 min), good neurologic outcomes were 62.5%, 37%, 25%, and 21.7%, respectively (p=0.02). However, even with downtime >20 minutes, 22.9% had a good neurologic outcome, and this percentage increased to 37.5% in patients with an initial shockable rhythm. Conclusions Although longer downtime is associated with worse outcome in OHCA patients, we found that comatose patients who have been successfully resuscitated and treated with TH have neurologically intact survival rates of 23% even with downtime > 20 minutes. PMID:24746783

Neurologic outcome in comatose patients resuscitated from out-of-hospital cardiac arrest with prolonged downtime and treated with therapeutic hypothermia.

Science.gov (United States)

Kim, Won Young; Giberson, Tyler A; Uber, Amy; Berg, Katherine; Cocchi, Michael N; Donnino, Michael W

2014-08-01

Previous reports have shown that prolonged duration of resuscitation efforts in out-of-hospital cardiac arrest (OHCA) is associated with poor neurologic outcome. This concept has recently been questioned with advancements in post-cardiac arrest care including the use of therapeutic hypothermia (TH). The aim of this study was to determine the rate of good neurologic outcome based on the duration of resuscitation efforts in OHCA patients treated with TH. This prospective, observational, study was conducted between January 2008 and September 2012. Inclusion criteria consisted of adult non-traumatic OHCA patients who were comatose after return of spontaneous circulation (ROSC) and received TH. The primary endpoint was good neurologic outcome defined as a cerebral performance category score of 1 or 2. Downtime was calculated as the length of time between the patient being recognized as pulseless and ROSC. 105 patients were treated with TH and 19 were excluded due to unknown downtime, leaving 86 patients for analysis. The median downtime was 18.5 (10.0-32.3)min and 33 patients (38.0%) had a good neurologic outcome. When downtime was divided into four groups (≤10min, 11-20min, 21-30min, >30min), good neurologic outcomes were 62.5%, 37%, 25%, and 21.7%, respectively (p=0.02). However, even with downtime >20min, 22.9% had a good neurologic outcome, and this percentage increased to 37.5% in patients with an initial shockable rhythm. Although longer downtime is associated with worse outcome in OHCA patients, we found that comatose patients who have been successfully resuscitated and treated with TH have neurologically intact survival rates of 23% even with downtime >20min. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Amitriptyline Intoxication Responded to Cardiopulmonary Resuscitation

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Güldem Turan

2012-04-01

Full Text Available The most severe effects in amitriptiline intoxications are related with central nervous system and cardiovascular system. Amitriptiline intoxication especially with high doses has severe cardiac effects and can result in cardiac arrest. Most favorable responses can be achieved with efficient and prolonged cardiopulmonary resuscitation. We wanted to present a case ingested high dose of amitriptiline for attempt to suicide and responded to prolonged cardiopulmonary resuscitation.

ERC 2010 guidelines for adult and pediatric resuscitation: summary of major changes.

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Sandroni, C; Nolan, J

2011-02-01

The new European Resuscitation Council (ERC) guidelines for cardiopulmonary resuscitation (CPR) published on October 18th, 2010, replace those published in 2005 and are based on the latest International Consensus on CPR Science with Treatment Recommendations (CoSTR). For both adult and pediatric resuscitation, the most important general changes include: the introduction of chest compression-only CPR in primary cardiac arrest as an option for rescuers who are unable or unwilling to perform expired-air ventilation; increased emphasis on uninterrupted, good-quality CPR and minimisation of both pre- and post-shock pauses during defibrillation. For adult resuscitation, the recommended chest compression depth and rate are 5-6 cm and 100-120 compressions per minute, respectively. Both a specific period of CPR before defibrillation during out-of-hospital resuscitation and use of endotracheal route for drug delivery during advanced life support are no longer recommended. During postresuscitation care, inspired oxygen should be titrated to obtain an arterial oxygen saturation of 94-98%, to avoid possible damage from hyperoxemia. In pediatric resuscitation, the role of pulse palpation for the diagnosis of cardiac arrest has been de-emphasised. The compression-to-ventilation ratio depends on the number of rescuers available, and a 30:2 ratio is acceptable even for rescuers with a duty to respond if they are alone. Chest compression depth should be at least 1/3 of the anterior-posterior chest diameter. The use of automated external defibrillators for children under one year of age should be considered.

Post-resuscitation care for survivors of cardiac arrest

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Ashvarya Mangla

2014-01-01

Full Text Available Cardiac arrest can occur following a myriad of clinical conditions. With advancement of medical science and improvements in Emergency Medical Services systems, the rate of return of spontaneous circulation for patients who suffer an out-of-hospital cardiac arrest (OHCA continues to increase. Managing these patients is challenging and requires a structured approach including stabilization of cardiopulmonary status, early consideration of neuroprotective strategies, identifying and managing the etiology of arrest and initiating treatment to prevent recurrence. This requires a closely coordinated multidisciplinary team effort. In this article, we will review the initial management of survivors of OHCA, highlighting advances and ongoing controversies.

Transient cardiac arrest in patient with left ventricular noncompaction (spongiform cardiomyopathy).

Science.gov (United States)

Yamazaki, Shinya; Ito, Hiroshi; Kawaai, Hiroyoshi

2011-01-01

Left ventricular noncompaction (LVNC), also known as spongiform cardiomyopathy, is a severe disease that has not previously been discussed with respect to general anesthesia. We treated a child with LVNC who experienced cardiac arrest. Dental treatment under general anesthesia was scheduled because the patient had a risk of endocarditis due to dental caries along with a history of being uncooperative for dental care. During sevoflurane induction, severe hypotension and laryngospasm resulted in cardiac arrest. Basic life support (cardiopulmonary resuscitation) was initiated to resuscitate the child, and his cardiorespiratory condition improved. Thereafter, an opioid-based anesthetic was performed, and recovery was smooth. In LVNC, opioid-based anesthesia is suggested to avoid the significant cardiac suppression seen with a volatile anesthetic, once intravenous access is established. Additionally, all operating room staff should master Advanced Cardiac Life Support/Pediatric Advanced Life Support (including intraosseous access), and more than 1 anesthesiologist should be present to induce general anesthesia, if possible, for this high-risk patient.

Outcome after resuscitation beyond 30 minutes in drowned children with cardiac arrest and hypothermia : Dutch nationwide retrospective cohort study

NARCIS (Netherlands)

Kieboom, J. K.; Verkade, H. J.; Burgerhof, J. G.; Bierens, J. J.; van Rheenen, P. F.; Kneyber, M. C.; Albers, M. J.

2015-01-01

OBJECTIVES To evaluate the outcome of drowned children with cardiac arrest and hypothermia, and to determine distinct criteria for termination of cardiopulmonary resuscitation in drowned children with hypothermia and absence of spontaneous circulation. DESIGN Nationwide retrospective cohort study.

Implementation of near-infrared spectroscopy in a rat model of cardiac arrest and resuscitation

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Rodriguez, Juan G.; Xiao, Feng; Ferrara, Davon; Ewing, Jennifer; Zhang, Shu; Alexander, Steven; Battarbee, Harold

2002-07-01

Transient global cerebral ischemia accompanying cardiac arrest (CA) often leads to permanent brain damage with poor neurological outcome. The precise chain of events underlying the cerebral damage after CA is still not fully understood. Progress in this area may profit from the development of new non-invasive tools that provide real-time information on the vascular and cellular processes preceding the damage. One way to assess these processes is through near-IR spectroscopy, which has demonstrated the ability to quantify changes in blood volume, hemoglobin oxygenation, cytochrome oxidase redox state, and tissue water content. Here we report on the successful implementation of this form of spectroscopy in a rat model of asphyxial CA and resuscitation, under hypothermic and normothermic conditions. Preliminary results are shown that provide a new temporal insight into the cerebral circulation during CA and post-resuscitation.

Willingness to Perform Chest Compression Only in Witnessed Cardiac Arrest Victims versus Cardiopulmonary Resuscitation in Iran

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Nesreen Yaghmour

2015-03-01

Full Text Available Background: Performing immediate bystander Cardio Pulmonary Resuscitation (CPR is the most important factor that determines survival from cardiac arrest. Recommended mouth to mouth ventilation maneuver during CPR has led to lower rate of CPR performance in the population. Objectives: The present survey aimed to evaluate the willingness of nurses at Shiraz University of Medical Sciences for performing CPR versus chest-compression-only CPR. Patients and Methods: During a CPR course, we performed a survey on 25 nurses from Shiraz University of Medical Sciences, Iran. This survey included age and gender of the participants. In the first question, they were asked about their willingness to perform CPR with mouth to mouth breathing for witnessed cardiac arrest victims. In the second question, they were asked about their willingness to perform chest compression only for cardiac arrest victims. Results: Among the participating nurses, 96% were female with a mean age of 31 years. Only 40% were willing to perform CPR that requires mouth to mouth ventilation. On the other hand, 92% were willing to perform chest compression only without mouth to mouth ventilation. The mean age of the nurses who would do CPR was lower compared to those who would not. Conclusions: In this survey, we demonstrated that eliminating mouth to mouth ventilation maneuver could lead to markedly higher willingness to perform CPR for witnessed cardiac arrest victims in CPR trained nursing personnel. Our study is in agreement with other studies advocating that chest-compression-only CPR could lead to higher bystander resuscitation efforts.

Inspiratory impedance during active compression-decompression cardiopulmonary resuscitation: a randomized evaluation in patients in cardiac arrest.

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Plaisance, P; Lurie, K G; Payen, D

2000-03-07

Blood pressure is severely reduced in patients in cardiac arrest receiving standard cardiopulmonary resuscitation (CPR). Although active compression-decompression (ACD) CPR improves acute hemodynamic parameters, arterial pressures remain suboptimal with this technique. We performed ACD CPR in patients with a new inspiratory threshold valve (ITV) to determine whether lowering intrathoracic pressures during the "relaxation" phase of ACD CPR would enhance venous blood return and overall CPR efficiency. This prospective, randomized, blinded trial was performed in prehospital mobile intensive care units in Paris, France. Patients in nontraumatic cardiac arrest received ACD CPR plus the ITV or ACD CPR alone for 30 minutes during advanced cardiac life support. End tidal CO(2) (ETCO(2)), diastolic blood pressure (DAP) and coronary perfusion pressure, and time to return of spontaneous circulation (ROSC) were measured. Groups were similar with respect to age, gender, and initial rhythm. Mean maximal ETCO(2), coronary perfusion pressure, and DAP values, respectively (in mm Hg), were 13.1+/-0.9, 25.0+/-1.4, and 36.5+/-1.5 with ACD CPR alone versus 19.1+/-1.0, 43.3+/-1.6, and 56.4+/-1.7 with ACD plus valve (PCPR alone after 26.5+/-0.7 minutes versus 4 of 11 patients with ACD CPR plus ITV after 19.8+/-2.8 minutes (PCPR increases the efficiency of CPR, leading to diastolic arterial pressures of >50 mm Hg. The long-term benefits of this new CPR technology are under investigation.

Persisting effect of community approaches to resuscitation

DEFF Research Database (Denmark)

Nielsen, Anne Møller; Isbye, Dan Lou; Lippert, Freddy Knudsen

2014-01-01

BACKGROUND: On the Danish island of Bornholm an intervention was carried out during 2008-2010 aiming at increasing out-of-hospital cardiac arrest (OHCA) survival. The intervention included mass media focus on resuscitation and widespread educational activities. The aim of this study was to compare....... There was no significant change in all-rhythm 30-day survival for non-EMS witnessed OHCAs with presumed cardiac aetiology (6.7% [95% CI 3-13] in the follow-up period; vs. 4.6% [95% CI 1-12], p=0.76). CONCLUSION: In a 3-year follow-up period after an intervention engaging laypersons in resuscitation through mass education...... in BLS combined with a media focus on resuscitation, we observed a persistent significant increase in the bystander BLS rate for all OHCAs with presumed cardiac aetiology. There was no significant difference in 30-day survival....

Strategy analysis of cardiopulmonary resuscitation training in the community

OpenAIRE

Wang, Jin; Ma, Li; Lu, Yuan-Qiang

2015-01-01

Bystander cardiopulmonary resuscitation (CPR) is a crucial therapy for sudden cardiac arrest. This appreciation produced immense efforts by professional organizations to train laypeople for CPR skills. However, the rate of CPR training is low and varies widely across communities. Several strategies are used in order to improve the rate of CPR training and are performed in some advanced countries. The Chinese CPR training in communities could gain enlightenment from them.

delta-Opioid-induced pharmacologic myocardial hibernation during cardiopulmonary resuscitation.

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Fang, Xiangshao; Tang, Wanchun; Sun, Shijie; Weil, Max Harry

2006-12-01

Cardiac arrest and cardiopulmonary resuscitation is an event of global myocardial ischemia and reperfusion, which is associated with severe postresuscitation myocardial dysfunction and fatal outcome. Evidence has demonstrated that mammalian hibernation is triggered by cyclic variation of a delta-opiate-like compound in endogenous serum, during which the myocardial metabolism is dramatically reduced and the myocardium tolerates the stress of ischemia and reperfusion without overt ischemic and reperfusion injury. Previous investigations also proved that the delta-opioid agonist elicited the cardioprotection in a model of regional ischemic intact heart or myocyte. Accordingly, we were prompted to search for an alternative intervention of pharmacologically induced myocardial hibernation that would result in rapid reductions of myocardial metabolism and therefore minimize the myocardial ischemic and reperfusion injury during cardiac arrest and cardiopulmonary resuscitation. Prospective, controlled laboratory study. University-affiliated research laboratory. In the series of studies performed in the established rat and pig model of cardiac arrest and cardiopulmonary resuscitation, the delta-opioid receptor agonist, pentazocine, was administered during ventricular fibrillation. : The myocardial metabolism reflected by the concentration of lactate, or myocardial tissue PCO2 and PO2, is dramatically reduced during cardiac arrest and cardiopulmonary resuscitation. These are associated with less severe postresuscitation myocardial dysfunction and longer duration of postresuscitation survival. delta-Opioid-induced pharmacologic myocardial hibernation is an option to minimize the myocardial ischemia and reperfusion injury during cardiac arrest and cardiopulmonary resuscitation.

Cardiopulmonary Resuscitation in Microgravity: Efficacy in the Swine During Parabolic Flight

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Johnston, Smith L.; Campbell, Mark R.; Billica, Roger D.; Gilmore, Stevan M.

2004-01-01

INTRODUCTION: The International Space Station will need to be as capable as possible in providing Advanced Cardiac Life Support (ACLS) and cardiopulmonary resuscitation (CPR). Previous studies with manikins in parabolic microgravity (0 G) have shown that delivering CPR in microgravity is difficult. End tidal carbon dioxide (PetCO2) has been previously shown to be an effective non-invasive tool for estimating cardiac output during cardiopulmonary resuscitation. Animal models have shown that this diagnostic adjunct can be used as a predictor of survival when PetCO2 values are maintained above 25% of pre-arrest values. METHODS: Eleven anesthetized Yorkshire swine were flown in microgravity during parabolic flight. Physiologic parameters, including PetCO2, were monitored. Standard ACLS protocols were used to resuscitate these models after chemical induction of cardiac arrest. Chest compressions were administered using conventional body positioning with waist restraint and unconventional vertical-inverted body positioning. RESULTS: PetCO2 values were maintained above 25% of both 1-G and O-G pre-arrest values in the microgravity environment (33% +/- 3 and 41 +/- 3). No significant difference between 1-G CPR and O-G CPR was found in these animal models. Effective CPR was delivered in both body positions although conventional body positioning was found to be quickly fatiguing as compared with the vertical-inverted. CONCLUSIONS: Cardiopulmonary resuscitation can be effectively administered in microgravity (0 G). Validation of this model has demonstrated that PetCO2 levels were maintained above a level previously reported to be predictive of survival. The unconventional vertical-inverted position provided effective CPR and was less fatiguing as compared with the conventional body position with waist restraints.

Myocardial infarction is a frequent cause of exercise-related resuscitated out-of-hospital cardiac arrest in a general non-athletic population.

Science.gov (United States)

Søholm, Helle; Kjaergaard, Jesper; Thomsen, Jakob Hartvig; Bro-Jeppesen, John; Lippert, Freddy K; Køber, Lars; Wanscher, Michael; Hassager, Christian

2014-11-01

Performing exercise is shown to prevent cardiovascular disease, but the risk of an out-of-hospital cardiac arrest (OHCA) is temporarily increased during strenuous activity. We examined the etiology and outcome after successfully resuscitated OHCA during exercise in a general non-athletic population. Consecutive patients with OHCA were admitted with return of spontaneous circulation (ROSC) or on-going resuscitation at hospital arrival (2002-2011). Patient charts were reviewed for post-resuscitation data. Exercise was defined as moderate/vigorous physical activity. A total of 1393 OHCA-patients were included with 91(7%) arrests occurring during exercise. Exercise-related OHCA-patients were younger (60 ± 13 vs. 65 ± 15, p<0.001) and predominantly male (96% vs. 69%, p<0.001). The arrest was more frequently witnessed (94% vs. 86%, p=0.02), bystander CPR was more often performed (88% vs. 54%, p<0.001), time to ROSC was shorter (12 min (IQR: 5-19) vs. 15 (9-22), p=0.007) and the primary rhythm was more frequently shock-able (91% vs. 49%, p<0.001) compared to non-exercise patients. Cardiac etiology was the predominant cause of OHCA in both exercise and non-exercise patients (97% vs. 80%, p<0.001) and acute coronary syndrome was more frequent among exercise patients (59% vs. 38%, p<0.001). One-year mortality was 25% vs. 65% (p<0.001), and exercise was even after adjustment associated with a significantly lower mortality (HR=0.40 (95%CI: 0.23-0.72), p=0.002). OHCA occurring during exercise was associated with a significantly lower mortality in successfully resuscitated patients even after adjusting for confounding factors. Acute coronary syndrome was more common among exercise-related cardiac arrest patients. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

[Prehospital thrombolysis during cardiopulmonary resuscitation].

Science.gov (United States)

Spöhr, F; Böttiger, B W

2005-02-01

Although prehospital cardiac arrest has an incidence of 40-90/100,000 inhabitants per year, there has been a lack of therapeutic options to improve the outcome of these patients. Of all cardiac arrests, 50-70% are caused by acute myocardial infarction (AMI) or massive pulmonary embolism (PE). Thrombolysis has been shown to be a causal and effective therapy in patients with AMI or PE who do not suffer cardiac arrest. In contrast, experience with the use of thrombolysis during cardiac arrest has been limited. Thrombolysis during cardiopulmonary resuscitation (CPR) acts directly on thrombi or emboli causing AMI or PE. In addition, experimental studies suggest that thrombolysis causes an improvement in microcirculatory reperfusion after cardiac arrest. In-hospital and prehospital case series and clinical studies suggest that thrombolysis during CPR may cause a restoration of spontaneous circulation and survival even in patients that have been resuscitated conventionally without success. In addition, there is evidence for an improved neurological outcome in patients receiving a thrombolytic therapy during during CPR. A large randomized, double-blind multicenter trial that has started recently is expected to show if this new therapeutic option can generally improve the prognosis of patients with cardiac arrest.

[Current recommendations for basic/advanced life support : Addressing unanswered questions and future prospects].

Science.gov (United States)

Fink, K; Schmid, B; Busch, H-J

2016-11-01

The revised guidelines for cardiopulmonary resuscitation were implemented by the European Resuscitation Council (ERC) in October 2015. There were few changes concerning basic and advanced life support; however, some issues were clarified compared to the ERC recommendations from 2010. The present paper summarizes the procedures of basic and advanced life support according to the current guidelines and highlights the updates of 2015. Furthermore, the article depicts future prospects of cardiopulmonary resuscitation that may improve outcome of patients after cardiac arrest in the future.

“Putting It All Together” to Improve Resuscitation Quality

Science.gov (United States)

Sutton, Robert M.; Nadkarni, Vinay; Abella, Benjamin S.

2013-01-01

Cardiac arrest is a major public health problem affecting thousands of individuals each year in both the before hospital and in-hospital settings. However, although the scope of the problem is large, the quality of care provided during resuscitation attempts frequently does not meet quality of care standards, despite evidence-based cardiopulmonary resuscitation (CPR) guidelines, extensive provider training, and provider credentialing in resuscitation medicine. Although this fact may be disappointing, it should not be surprising. Resuscitation of the cardiac arrest victim is a highly complex task requiring coordination between various levels and disciplines of care providers during a stressful and relatively infrequent clinical situation. Moreover, it requires a targeted, high-quality response to improve clinical outcomes of patients. Therefore, solutions to improve care provided during resuscitation attempts must be multifaceted and targeted to the diverse number of care providers to be successful. PMID:22107978

Interhospital Transport of Children Undergoing Cardiopulmonary Resuscitation: A Practical and Ethical Dilemma.

Science.gov (United States)

Noje, Corina; Fishe, Jennifer N; Costabile, Philomena M; Klein, Bruce L; Hunt, Elizabeth A; Pronovost, Peter J

2017-10-01

To discuss risks and benefits of interhospital transport of children in cardiac arrest undergoing cardiopulmonary resuscitation. Narrative review. Not applicable. Transporting children in cardiac arrest with ongoing cardiopulmonary resuscitation between hospitals is potentially lifesaving if it enables access to resources such as extracorporeal support, but may risk transport personnel safety. Research is needed to optimize outcomes of patients transported with ongoing cardiopulmonary resuscitation and reduce risks to the staff caring for them.

Nurses' knowledge and skill retention following cardiopulmonary resuscitation training: a review of the literature.

Science.gov (United States)

Hamilton, Rosemary

2005-08-01

This paper reports a literature review examining factors that enhance retention of knowledge and skills during and after resuscitation training, in order to identify educational strategies that will optimize survival for victims of cardiopulmonary arrest. Poor knowledge and skill retention following cardiopulmonary resuscitation training for nursing and medical staff has been documented over the past 20 years. Cardiopulmonary resuscitation training is mandatory for nursing staff and is important as nurses often discover the victims of in-hospital cardiac arrest. Many different methods of improving this retention have been devised and evaluated. However, the content and style of this training lack standardization. A literature review was undertaken using the Cumulative Index to Nursing and Allied Health Literature, MEDLINE and British Nursing Index databases and the keywords 'cardiopulmonary resuscitation', 'basic life support', 'advanced life support' and 'training'. Papers published between 1992 and 2002 were obtained and their reference lists scrutinized to identify secondary references, of these the ones published within the same 10-year period were also included. Those published in the English language that identified strategies to enhance the acquisition or retention of Cardiopulmonary resuscitation skills and knowledge were included in the review. One hundred and five primary and 157 secondary references were identified. Of these, 24 met the criteria and were included in the final literature sample. Four studies were found pertaining to cardiac arrest simulation, three to peer tuition, four to video self-instruction, three to the use of different resuscitation guidelines, three to computer-based learning programmes, two to voice-activated manikins, two to automated external defibrillators, one to self-instruction, one to gaming and the one to the use of action cards. Resuscitation training should be based on in-hospital scenarios and current evidence

Cardiopulmonary resuscitation standards for clinical practice and training in the UK.

Science.gov (United States)

Gabbott, David; Smith, Gary; Mitchell, Sarah; Colquhoun, Michael; Nolan, Jerry; Soar, Jasmeet; Pitcher, David; Perkins, Gavin; Phillips, Barbara; King, Ben; Spearpoint, Ken

2005-07-01

The Royal College of Anaesthetists, the Royal College of Physicians, the Intensive Care Society and the Resuscitation Council (UK) have published new resuscitation standards. The document provides advice to UK healthcare organisations, resuscitation committees and resuscitation officers on all aspects of the resuscitation service. It includes sections on resuscitation training, resuscitation equipment, the cardiac arrest team, cardiac arrest prevention, patient transfer, post-resuscitation care, audit and research. The document makes several recommendations. Healthcare institutions should have, or be represented on, a resuscitation committee that is responsible for all resuscitation issues. Every institution should have at least one resuscitation officer responsible for teaching and conducting training in resuscitation techniques. Staff with patient contact should be given regular resuscitation training appropriate to their expected abilities and roles. Clinical staff should receive regular training in the recognition of patients at risk of cardiopulmonary arrest and the measures required for the prevention of cardiopulmonary arrest. Healthcare institutions admitting acutely ill patients should have a resuscitation team, or its equivalent, available at all times. Clear guidelines should be available indicating how and when to call for the resuscitation team. Cardiopulmonary arrest should be managed according to current national guidelines. Resuscitation equipment should be available throughout the institution for clinical use and for training. The practice of resuscitation should be audited to maintain and improve standards of care. A do not attempt resuscitation (DNAR) policy should be compiled, communicated to relevant members of staff, used and audited regularly. Funding must be provided to support an effective resuscitation service.

Comparison of cardiopulmonary resuscitation techniques using video camera recordings.

OpenAIRE

Mann, C J; Heyworth, J

1996-01-01

OBJECTIVE--To use video recordings to compare the performance of resuscitation teams in relation to their previous training in cardiac resuscitation. METHODS--Over a 10 month period all cardiopulmonary resuscitations carried out in an accident and emergency (A&E) resuscitation room were videotaped. The following variables were monitored: (1) time to perform three defibrillatory shocks; (2) time to give intravenous adrenaline (centrally or peripherally); (3) the numbers and grade of medical an...

Collaborative effects of bystander-initiated cardiopulmonary resuscitation and prehospital advanced cardiac life support by physicians on survival of out-of-hospital cardiac arrest: a nationwide population-based observational study.

Science.gov (United States)

Yasunaga, Hideo; Horiguchi, Hiromasa; Tanabe, Seizan; Akahane, Manabu; Ogawa, Toshio; Koike, Soichi; Imamura, Tomoaki

2010-01-01

There are inconsistent data about the effectiveness of prehospital physician-staffed advanced cardiac life support (ACLS) on the outcomes of out-of-hospital cardiac arrest (OHCA). Furthermore, the relative importance of bystander-initiated cardiopulmonary resuscitation (BCPR) and ACLS and the effectiveness of their combination have not been clearly demonstrated. Using a prospective, nationwide, population-based registry of all OHCA patients in Japan, we enrolled 95,072 patients whose arrests were witnessed by bystanders and 23,127 patients witnessed by emergency medical service providers between 2005 and 2007. We divided the bystander-witnessed arrest patients into Group A (ACLS by emergency life-saving technicians without BCPR), Group B (ACLS by emergency life-saving technicians with BCPR), Group C (ACLS by physicians without BCPR) and Group D (ACLS by physicians with BCPR). The outcome data included 1-month survival and neurological outcomes determined by the cerebral performance category. Among the 95,072 bystander-witnessed arrest patients, 7,722 (8.1%) were alive at 1 month, including 2,754 (2.9%) with good performance and 3,171 (3.3%) with vegetative status or worse. BCPR occurred in 42% of bystander-witnessed arrests. In comparison with Group A, the rates of good-performance survival were significantly higher in Group B (odds ratio (OR), 2.23; 95% confidence interval, 2.05 to 2.42; P < 0.01) and Group D (OR, 2.80; 95% confidence interval, 2.28 to 3.43; P < 0.01), while no significant difference was seen for Group C (OR, 1.18; 95% confidence interval, 0.86 to 1.61; P = 0.32). The occurrence of vegetative status or worse at 1 month was highest in Group C (OR, 1.92; 95% confidence interval, 1.55 to 2.37; P < 0.01). In this registry-based study, BCPR significantly improved the survival of OHCA with good cerebral outcome. The groups with BCPR and ACLS by physicians had the best outcomes. However, receiving ACLS by physicians without preceding BCPR significantly

Medical students’ experiences of resuscitation and discussions surrounding resuscitation status

Directory of Open Access Journals (Sweden)

Aggarwal AR

2018-01-01

Full Text Available Asha R Aggarwal, Iqbal Khan Department of Medical Education, Northampton General Hospital, Northampton, UK Objectives: In the UK, cardiopulmonary resuscitation (CPR should be undertaken in the event of cardiac arrest unless a patient has a “Do Not Attempt CPR” document. Doctors have a legal duty to discuss CPR with patients or inform them that CPR would be futile. In this study, final-year medical students were interviewed about their experiences of resuscitation on the wards and of observing conversations about resuscitation status to explore whether they would be equipped to have an informed discussion about resuscitation in the future. Methods: Twenty final-year medical students from two medical schools were interviewed about their experiences on the wards. Interviews were transcribed verbatim, and thematic analysis was undertaken.Results: Students who had witnessed CPR on the wards found that aspects of it were distressing. A significant minority had never seen resuscitation status being discussed with a patient. No students reported seeing a difficult conversation. Half of the students interviewed reported being turned away from difficult conversations by clinicians. Only two of the twenty students would feel comfortable raising the issue of resuscitation with a patient. Conclusion: It is vital that doctors are comfortable talking to patients about resuscitation. Given the increasing importance of this aspect of communication, it should be considered for inclusion in the formal communication skills teaching during medical school. Keywords: undergraduate, communication, DNACPR, palliative care, end of life care

Results of rapid-response extracorporeal cardiopulmonary resuscitation in children with refractory cardiac arrest following cardiac surgery.

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Alsoufi, Bahaaldin; Awan, Abid; Manlhiot, Cedric; Guechef, Alexander; Al-Halees, Zohair; Al-Ahmadi, Mamdouh; McCrindle, Brian W; Kalloghlian, Avedis

2014-02-01

Survival of children having cardiac arrest refractory to conventional cardiopulmonary resuscitation (CPR) is very poor. We sought to examine current era outcomes of extracorporeal CPR (ECPR) support for refractory arrest following surgical correction of congenital heart disease. Demographic, anatomical, clinical, surgical and support details of children requiring postoperative ECPR (2007-12) were included in multivariable logistic regression models to determine the factors associated with survival. Thirty-nine children, median age 44 days (4 days-10 years), required postoperative ECPR at a median interval of 1 day (up to 15 days) after surgery. Thirteen (33%) children had single-ventricle pathology; Risk Adjustment in Congenital Heart Surgery (RACHS)-1 categories were 2, 3, 4 and 6 in 6, 15, 13 and 5 patients, respectively. Median CPR duration was 34 (8-125) min, while median support duration was 4 (1-17) days. Seven (18%) patients underwent cardiac re-operation, 28 (72%) survived >24 h after support discontinuation and 16 (41%) survived. Survival rates in neonates, infants and older children were 53, 39 and 17% (P=0.13). Survival rates for single- vs two-ventricle pathology patients were 54 and 35%, (P=0.25) and 50, 47, 23 and 60% in RACHS-1 2, 3, 4 and 6 patients, respectively (P=0.37). Survivors had shorter CPR duration (25 vs 34 min, P=0.05), lower pre-arrest lactate (2.6 vs 4.6 mmol/l, P=0.05) and postextracorporeal membrane oxygenation (ECMO) peak lactate (15.4 vs 20.0 mmol/l, P<0.001). On multivariable analysis, factors associated with death were higher immediate post-ECMO lactate (odds ratio, OR 1.34 per mmol/l, P=0.008) and renal failure requiring haemodialysis (OR 14.1, P=0.01). ECPR plays a valuable role in children having refractory postoperative cardiac arrest. Survival is unrelated to cardiac physiology or surgical complexity. Timely support prior to the emergence of end-organ injury and surgical correction of residual cardiac lesions might enhance

The Force-Displacement Relationship in Commonly Used Resuscitation Manikins: Not Very Human

DEFF Research Database (Denmark)

Thomsen, Jakob E; Stærk, Mathilde; Løfgren, Bo

2017-01-01

Introduction: Manikins are widely used for CPR training and designed to simulate a human in cardiac arrest. Previous studies show a non-linear force-displacement relationship in the human chest. This may not be the case for resuscitation manikins. The aim of this study was to investigate the force......-displacement relationship in commonly used resuscitation manikins.Methods: Commonly used infant and adult manikins for resuscitation training were included in the study. Manikins were tested by placing them in a material testing machine (ProLine Z050, Zwick/Roell, Ulm, Germany). A piston was placed on lower half...... (Laerdal) and CPR Anytime® Infant (inflatable; American Heart Association) and five adult manikins: Mini Anne (inflatable), Little Anne®, Resusci Anne, Resusci Anne Advanced(Laerdal) and Ambu® Man (Ambu). Infant manikins required a force of 57 N and 34 N to compress the chest 3 cm. The force required...

Extracorporeal Cardiopulmonary Resuscitation for Refractory Out-of-Hospital Cardiac Arrest: The State of the Evidence and Framework for Application.

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Grunau, Brian; Hornby, Laura; Singal, Rohit K; Christenson, Jim; Ortega-Deballon, Ivan; Shemie, Sam D; Bashir, Jamil; Brooks, Steve C; Callaway, Clifton W; Guadagno, Elena; Nagpal, Dave

2018-02-01

Out-of-hospital cardiac arrest (OHCA) affects 134 per 100,000 citizens annually. Extracorporeal cardiopulmonary resuscitation (ECPR), providing mechanical circulatory support, may improve the likelihood of survival among those with refractory OHCA. Compared with in-hospital ECPR candidates, those in the out-of-hospital setting tend to be sudden unexpected arrests in younger and healthier patients. The aims of this review were to summarize, and identify the limitations of, the evidence evaluating ECPR for OHCA, and to provide an approach for ECPR program application. Although there are many descriptions of ECPR-treated cohorts, we identified a paucity of robust data showing ECPR effectiveness compared with conventional resuscitation. However, it is highly likely that ECPR, provided after a prolonged attempt with conventional resuscitation, does benefit select patient populations compared with conventional resuscitation alone. Although reliable data showing the optimal patient selection criteria for ECPR are lacking, most implementations sought young previously healthy patients with rapid high-quality cardiopulmonary resuscitation. Carefully planned development of ECPR programs, in high-performing emergency medical systems at experienced extracorporeal membrane oxygenation centres, may be reasonable as part of systematic efforts to determine ECPR effectiveness and globally improve care. Protocol evaluation requires regional-level assessment, examining the incremental benefit of survival compared with standard care, while accounting for resource utilization. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

The Use of Extracorporeal Membrane Oxygenation-Cardiopulmonary Resuscitation in Prolonged Cardiac Arrest in Pediatric Patients: Is it Time to Expand It?

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Absi, Mohammed; Kumar, Susheel Tk; Sandhu, Hitesh

2017-09-01

Extracorporeal membrane oxygenation was instituted as an aid to in-hospital cardiopulmonary resuscitation (E-CPR) nearly 23 years ago, this led to remarkable improvement in survival considering the mortality rate associated with conventional cardiopulmonary resuscitation (CPR). Given this success, one begins to wonder whether the time has come for expanding the use of E-CPR to outside hospital cardiac arrests especially in the light of development of newer extracorporeal life support devices that are small, mobile, and easy to assemble. This editorial will review recent studies on this subject and address some key guidelines and limitations of this evolving and promising technology.

Cardiopulmonary resuscitation; use, training and self-confidence in skills. A self-report study among hospital personnel

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Hopstock Laila A

2008-12-01

Full Text Available Abstract Background Immediate start of basic cardiopulmonary resuscitation (CPR and early defibrillation have been highlighted as crucial for survival from cardiac arrest, but despite new knowledge, new technology and massive personnel training the survival rates from in-hospital cardiac arrest are still low. National guidelines recommend regular intervals of CPR training to make all hospital personnel able to perform basic CPR till advanced care is available. This study investigates CPR training, resuscitation experience and self-confidence in skills among hospital personnel outside critical care areas. Methods A cross-sectional study was performed at three Norwegian hospitals. Data on CPR training and CPR use were collected by self-reports from 361 hospital personnel. Results A total of 89% reported training in CPR, but only 11% had updated their skills in accordance with the time interval recommended by national guidelines. Real resuscitation experience was reported by one third of the respondents. Both training intervals and use of skills in resuscitation situations differed among the professions. Self-reported confidence decreased only after more than two years since last CPR training. Conclusion There is a gap between recommendations and reality in CPR training among hospital personnel working outside critical care areas.

Lay Bystanders' Perspectives on What Facilitates Cardiopulmonary Resuscitation and Use of Automated External Defibrillators in Real Cardiac Arrests

DEFF Research Database (Denmark)

Malta Hansen, Carolina; Rosenkranz, Simone Mørk; Folke, Fredrik

2017-01-01

BACKGROUND: Many patients who suffer an out-of-hospital cardiac arrest will fail to receive bystander intervention (cardiopulmonary resuscitation [CPR] or defibrillation) despite widespread CPR training and the dissemination of automated external defibrillators (AEDs). We sought to investigate what...... factors encourage lay bystanders to initiate CPR and AED use in a cohort of bystanders previously trained in CPR techniques who were present at an out-of-hospital cardiac arrest. METHODS AND RESULTS: One-hundred and twenty-eight semistructured qualitative interviews with CPR-trained lay bystanders...... to consecutive out-of-hospital cardiac arrest, where an AED was present were conducted (from January 2012 to April 2015, in Denmark). Purposive maximum variation sampling was used to establish the breadth of the bystander perspective. Twenty-six of the 128 interviews were chosen for further in-depth analyses...

Human factors in resuscitation: Lessons learned from simulator studies

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Hunziker S

2010-01-01

Full Text Available Medical algorithms, technical skills, and repeated training are the classical cornerstones for successful cardiopulmonary resuscitation (CPR. Increasing evidence suggests that human factors, including team interaction, communication, and leadership, also influence the performance of CPR. Guidelines, however, do not yet include these human factors, partly because of the difficulties of their measurement in real-life cardiac arrest. Recently, clinical studies of cardiac arrest scenarios with high-fidelity video-assisted simulations have provided opportunities to better delineate the influence of human factors on resuscitation team performance. This review focuses on evidence from simulator studies that focus on human factors and their influence on the performance of resuscitation teams. Similar to studies in real patients, simulated cardiac arrest scenarios revealed many unnecessary interruptions of CPR as well as significant delays in defibrillation. These studies also showed that human factors play a major role in these shortcomings and that the medical performance depends on the quality of leadership and team-structuring. Moreover, simulated video-taped medical emergencies revealed that a substantial part of information transfer during communication is erroneous. Understanding the impact of human factors on the performance of a complex medical intervention like resuscitation requires detailed, second-by-second, analysis of factors involving the patient, resuscitative equipment such as the defibrillator, and all team members. Thus, high-fidelity simulator studies provide an important research method in this challenging field.

Knowledge of cardiopulmonary resuscitation of clinicians at a South ...

African Journals Online (AJOL)

2011-11-28

Nov 28, 2011 ... patients and recognising cardiac arrest, to assess clinicians' ... programmes that are accessible, innovative and inexpensive. .... well as, and sometimes better than, traditional CPR.16 In ... resuscitation training programme resulted in a noticeable ... 31 physicians in Canada whose resuscitation skills were.

Extracorporeal Life Support and New Therapeutic Strategies for Cardiac Arrest Caused by Acute Myocardial Infarction - a Critical Approach for a Critical Condition

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Benedek Theodora

2016-10-01

Full Text Available This review summarizes the most recent developments in providing advanced supportive measures for cardiopulmonary resuscitation, and the results obtained using these new therapies in patients with cardiac arrest caused by acute myocardial infarction (AMI. Also detailed are new approaches such as extracorporeal cardiopulmonary resuscitation (ECPR, intra-arrest percutaneous coronary intervention, or the regional models for systems of care aiming to reduce the critical times from cardiac arrest to initiation of ECPR and coronary revascularization.

Variable effects of high-dose adrenaline relative to standard-dose adrenaline on resuscitation outcomes according to cardiac arrest duration.

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Jeung, Kyung Woon; Ryu, Hyun Ho; Song, Kyung Hwan; Lee, Byung Kook; Lee, Hyoung Youn; Heo, Tag; Min, Yong Il

2011-07-01

Adjustment of adrenaline (epinephrine) dosage according to cardiac arrest (CA) duration, rather than administering the same dose, may theoretically improve resuscitation outcomes. We evaluated variable effects of high-dose adrenaline (HDA) relative to standard-dose adrenaline (SDA) on resuscitation outcomes according to CA duration. Twenty-eight male domestic pigs were randomised to the following 4 groups according to the dosage of adrenaline (SDA 0.02 mg/kg vs. HDA 0.2mg/kg) and duration of CA before beginning cardiopulmonary resuscitation (CPR): 6 min SDA, 6 min HDA, 13 min SDA, or 13 min HDA. After the predetermined duration of untreated ventricular fibrillation, CPR was provided. All animals in the 6 min SDA, 6 min HDA, and 13 min HDA groups were successfully resuscitated, while only 4 of 7 pigs in the 13 min SDA group were successfully resuscitated (p=0.043). HDA groups showed higher right atrial pressure, more frequent ventricular ectopic beats, higher blood glucose, higher troponin-I, and more severe metabolic acidosis than SDA groups. Animals of 13 min groups showed more severe metabolic acidosis and higher troponin-I than animals of 6 min groups. All successfully resuscitated animals, except two animals in the 13 min HDA group, survived for 7 days (p=0.121). Neurologic deficit score was not affected by the dose of adrenaline. HDA showed benefit in achieving restoration of spontaneous circulation in 13 min CA, when compared with 6 min CA. However, this benefit did not translate into improved long-term survival or neurologic outcome. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Pharmacology of pediatric resuscitation.

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Ushay, H M; Notterman, D A

1997-02-01

The resuscitation of children from cardiac arrest and shock remains a challenging goal. The pharmacologic principles underlying current recommendations for intervention in pediatric cardiac arrest have been reviewed. Current research efforts, points of controversy, and accepted practices that may not be most efficacious have been described. Epinephrine remains the most effective resuscitation adjunct. High-dose epinephrine is tolerated better in children than in adults, but its efficacy has not received full analysis. The preponderance of data continues to point toward the ineffectiveness and possible deleterious effects of overzealous sodium bicarbonate use. Calcium chloride is useful in the treatment of ionized hypocalcemia but may harm cells that have experienced asphyxial damage. Atropine is an effective agent for alleviating bradycardia induced by increased vagal tone, but because most bradycardia in children is caused by hypoxia, improved oxygenation is the intervention of choice. Adenosine is an effective and generally well-tolerated agent for the treatment of supraventricular tachycardia. Lidocaine is the drug of choice for ventricular dysrhythmias, and bretylium, still relatively unexplored, is in reserve. Many pediatricians use dopamine for shock in the postresuscitative period, but epinephrine is superior. Most animal research on cardiac arrest is based on models with ventricular fibrillation that probably are not reflective of cardiac arrest situations most often seen in pediatrics.

Early cardiopulmonary resuscitation and use of Automated External Defibrillators by laypersons in out-of-hospital cardiac arrest using an SMS alert service

NARCIS (Netherlands)

Scholten, Annemieke C.; van Manen, Jeanette Gabrielle; van der Worp, Wim E.; IJzerman, Maarten Joost; Doggen, Catharina Jacoba Maria

2011-01-01

Aim: To evaluate an SMS service (SMS = short message service = text message) with which laypersons are alerted to go to patients with suspected out-of-hospital cardiac arrest and perform early cardiopulmonary resuscitation (CPR) and use an Automated External Defibrillator (AED). This study is the

Emergency Medical Technicians Are Often Consulted on Termination of Resuscitation, and Will Terminate Resuscitation Based on Controversial Single Factors

DEFF Research Database (Denmark)

Mygind-Klausen, Troels; Glerup Lauridsen, Kasper; Bødtker, Henrik

2016-01-01

Introduction: Many out-of-hospital cardiopulmonary resuscitation (CPR) attempts have to be terminated. Previous studies have investigated knowledge on abandoning resuscitation among physicians. In the prehospital setting emergency medical technicians (EMTs) may be involved in the decision......: 100%) participated. Median clinical experience was 12 (IQR: 6-22) years. All EMTs had performed resuscitation (median time since last resuscitation attempt: 1 (IQR: 0.5-2.8) month). Overall, 68% of EMTs had been consulted on termination of CPR, 74% felt it was important to be consulted, and 74% felt...... arrest (12%), witnessed cardiac arrest without bystander CPR within 10 minutes (30%), age above 80 years (20%), age above 90 years (62%), living at a nursing home (62%), known cancer (24%) and absence of pupillary light reflex (54%) during resuscitation. Conclusion: The majority of EMTs have been...

Prognostic EEG patterns in patients resuscitated from cardiac arrest with particular focus on Generalized Periodic Epileptiform Discharges (GPEDs).

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Milani, P; Malissin, I; Tran-Dinh, Y R; Deye, N; Baud, F; Lévy, B I; Kubis, N

2014-04-01

We assessed clinical and early electrophysiological characteristics, in particular Generalized Periodic Epileptiform Discharges (GPEDs) patterns, of consecutive patients during a 1-year period, hospitalized in the Intensive Care Unit (ICU) after resuscitation following cardiac arrest (CA). Consecutive patients resuscitated from cardiac arrest (CA) with first EEG recordings within 48hours were included. Clinical data were collected from hospital records, in particular therapeutic hypothermia. Electroencephalograms (EEGs) were re-analyzed retrospectively. Sixty-two patients were included. Forty-two patients (68%) were treated with therapeutic hypothermia according to international guidelines. Global mortality was 74% but not significantly different between patients who benefited from therapeutic hypothermia compared to those who did not. All the patients who did not have an initial background activity (36/62; 58%) died. By contrast, initial background activity was present in 26/62 (42%) and among these patients, 16/26 (61%) survived. Electroencephalography demonstrated GPEDs patterns in 5 patients, all treated by therapeutic hypothermia and antiepileptic drugs. One of these survived and showed persistent background activity with responsiveness to benzodiazepine intravenous injection. Patients presenting suppressed background activity, even when treated by hypothermia, have a high probability of poor outcome. Thorough analysis of EEG patterns might help to identify patients with a better chance of survival. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

[Assessment of the prognosis in patients who remain comatose after resuscitation from cardiac arrest].

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Ramberg, Emilie; Fedder, Anette Marianne; Dyrskog, Stig Eric; Degn, Niels Sanderhoff; Hassager, Christian; Jensen, Reinhold; Kirkegaard, Hans; Weber, Sven; Hoffmann-Petersen, Joachim Torp; Larsen, Niels Heden; Strange, Ditte Gry; Sonne, Morten; Lippert, Freddy K

2014-06-30

In Denmark there are around 3,500 unexpected cardiac arrests (CA) out of hospital each year. There is an unknown number of CA in hospitals. The survival rate after CA outside a hospital in Denmark is 10% after 30 days. There are varying data for the neurological outcome in this group of patients. The purpose of this work is to disseminate new knowledge and to help standardizing the treatment in the group of patients who remain comatose after being resuscitated from CA. Assessment of the prognosis for a patient in this group can be made after 72 hours and a multi-modal approach to the patient is required.

The Role of Post-Resuscitation Electrocardiogram in Patients With ST-Segment Changes in the Immediate Post-Cardiac Arrest Period.

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Kim, Youn-Jung; Min, Sun-Yang; Lee, Dong Hun; Lee, Byung Kook; Jeung, Kyung Woon; Lee, Hui Jai; Shin, Jonghwan; Ko, Byuk Sung; Ahn, Shin; Nam, Gi-Byoung; Lim, Kyoung Soo; Kim, Won Young

2017-03-13

The authors aimed to evaluate the role of post-resuscitation electrocardiogram (ECG) in patients showing significant ST-segment changes on the initial ECG and to provide useful diagnostic indicators for physicians to determine in which out-of-hospital cardiac arrest (OHCA) patients brain computed tomography (CT) should be performed before emergency coronary angiography. The usefulness of immediate brain CT and ECG for all resuscitated patients with nontraumatic OHCA remains controversial. Between January 2010 and December 2014, 1,088 consecutive adult nontraumatic patients with return of spontaneous circulation who visited the emergency department of 3 tertiary care hospitals were enrolled. After excluding 245 patients with obvious extracardiac causes, 200 patients were finally included. The patients were categorized into 2 groups: those with ST-segment changes with spontaneous subarachnoid hemorrhage (SAH) (n = 50) and those with OHCA of suspected cardiac origin group (n = 150). The combination of 4 ECG characteristics including narrow QRS (<120 ms), atrial fibrillation, prolonged QTc interval (≥460 ms), and ≥4 ST-segment depressions had a 66.0% sensitivity, 80.0% specificity, 52.4% positive predictive value, and 87.6% negative predictive value for predicting SAH. The area under the receiver-operating characteristic curves in the post-resuscitation ECG findings was 0.816 for SAH. SAH was observed in a substantial number of OHCA survivors (25.0%) with significant ST-segment changes on post-resuscitation ECG. Resuscitated patients with narrow QRS complex and any 2 ECG findings of atrial fibrillation, QTc interval prolongation, or ≥4 ST-segment depressions may help identify patients who need brain CT as the next diagnostic work-up. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Using adrenaline during neonatal resuscitation may have an impact on serum cardiac troponin-T levels.

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Helmer, Caroline; Skranes, Janne H; Liestøl, Knut; Fugelseth, Drude

2015-09-01

It has been suggested that serum cardiac troponin-T (cTnT) can predict the severity of neonatal hypoxic-ischaemic encephalopathy. We evaluated whether cTnT was better correlated with adrenaline during cardiopulmonary resuscitation (CPR) than with the severity of the insult itself, based on the Apgar scores. Serum cTnT was analysed in 47 asphyxiated newborn infants treated with hypothermia. Blood samples and resuscitation data were collected from medical records, and multiple linear regressions were used to evaluate the effect of the treatment and the Apgar scores on cTnT levels. The infants were divided into three groups: the no CPR group (n = 29) just received stimulation and ventilation, the CPR minus adrenaline group (n = 9) received cardiac compression and ventilation and the CPR plus adrenaline group (n = 9) received complete CPR, including adrenaline. In the univariate analysis, the five and ten-minute Apgar scores were significantly lower in the CPR plus adrenaline group and the cTnT was significantly higher. Multiple regression analysis showed significantly higher cTnT values in the CPR plus adrenaline group, but no significant relationship between cTnT and the Apgar scores. Although cTnT correlated with the severity of the insult in neonatal hypoxic-ischaemic encephalopathy, the levels may have been affected by adrenaline administered during CPR. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Knowledge and attitudes towards cardiopulmonary resuscitation and defibrillation amongst Asian primary health care physicians

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Marcus Eh Ong

2009-11-01

Full Text Available Marcus Eh Ong1, Susan Yap1, Kim P Chan1, Papia Sultana2, Venkataraman Anantharaman11Department of Emergency Medicine, 2Department of Clinical Research, Singapore General Hospital, SingaporeObjective: To assess the knowledge and attitudes of local primary health care physicians in relation to cardiopulmonary resuscitation (CPR and defibrillation.Methods: We conducted a survey on general practitioners in Singapore by using a self-administered questionnaire that comprised 29 questions.Results: The response rate was 80%, with 60 of 75 physicians completing the questionnaire. The average age of the respondents was 52 years. Sixty percent of them reported that they knew how to operate an automated external defibrillator (AED, and 38% had attended AED training. Only 36% were willing to perform mouth-to-mouth ventilation during CPR, and 53% preferred chest compression-only resuscitation (CCR to standard CPR. We found those aged <50 years were more likely to be trained in basic cardiac life support (BCLS (P < 0.001 and advanced cardiac life support (P = 0.005 or to have ever attended to a patient with cardiac arrest (P = 0.007. Female physicians tended to agree that all clinics should have AEDs (P = 0.005 and support legislation to make AEDs compulsory in clinics (P < 0.001. We also found that a large proportion of physicians who were trained in BCLS (P = 0.006 were willing to perform mouth-to-mouth ventilation.Conclusion: Most local primary care physicians realize the importance of defibrillation, and the majority prefer CCR to standard CPR.Keywords: general practitioners, cardiac arrest, resuscitation, defibrillation, attitude, knowledge

Protective head-cooling during cardiac arrest and cardiopulmonary resuscitation: the original animal studies

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Eric W. Brader

2010-02-01

Full Text Available Prolonged standard cardiopulmonary resuscitation (CPR does not reliably sustain brain viability during cardiac arrest. Pre-hospital adjuncts to standard CPR are needed in order to improve outcomes. A preliminary dog study demonstrated that surface cooling of the head during arrest and CPR can achieve protective levels of brain hypothermia (30°C within 10 minutes. We hypothesized that protective head-cooling during cardiac arrest and CPR improves neurological outcomes. Twelve dogs under light ketamine-halothane-nitrous oxide anesthesia were arrested by transthoracic fibrillation. The treated group consisted of six dogs whose shaven heads were moistened with saline and packed in ice immediately after confirmation of ventricular fibrillation. Six control dogs remained at room temperature. All 12 dogs were subjected to four minutes of ventricular fibrillation and 20 minutes of standard CPR. Spontaneous circulation was restored with drugs and countershocks. Intensive care was provided for five hours post-arrest and the animals were observed for 24 hours. In both groups, five of the six dogs had spontaneous circulation restored. After three hours, mean neurological deficit was significantly lower in the treated group (P=0.016, with head-cooled dogs averaging 37% and the normothermic dogs 62%. Two of the six head-cooled dogs survived 24 hours with neurological deficits of 9% and 0%, respectively. None of the control group dogs survived 24 hours. We concluded that head-cooling attenuates brain injury during cardiac arrest with prolonged CPR. We review the literature related to the use of hypothermia following cardiac arrest and discuss some promising approaches for the pre-hospital setting.

Teaching Cardiopulmonary Resuscitation in the Schools.

Science.gov (United States)

Carveth, Stephen W.

1979-01-01

Cardiopulmonary resuscitation is a key part of emergency cardiac care. It is a basic life support procedure that can be taught in the schools with the assistance of the American Heart Association. (JMF)

The combined use of mechanical CPR and a carry sheet to maintain quality resuscitation in out-of-hospital cardiac arrest patients during extrication and transport.

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Lyon, Richard M; Crawford, Anna; Crookston, Colin; Short, Steven; Clegg, Gareth R

2015-08-01

Quality of manual cardiopulmonary resuscitation (CPR) during extrication and transport of out-of-hospital cardiac arrest victims is known to be poor. Performing manual CPR during ambulance transport poses significant risk to the attending emergency medical services crew. We sought to use pre-hospital video recording to objectively analyse the impact of introducing mechanical CPR with an extrication sheet (Autopulse, Zoll) to an advanced, second-tier cardiac arrest response team. The study was conducted prospectively using defibrillator downloads and analysis of pre-hospital video recording to measure the quality of CPR during extrication from scene and ambulance transport of the OHCA patient. Adult patients with non-traumatic OHCA were included. The interruption to manual CPR to during extrication and to deploy the mechanical CPR device was analysed. In the manual CPR group, 53 OHCA cases were analysed for quality of CPR during extrication. The median time that chest compression was interrupted to allow the patient to be carried from scene to the ambulance was 270 s (IQR 201-387 s). 119 mechanical CPR cases were analysed. The median time interruption from last manual compression to first Autopulse compression was 39 s (IQR 29-47 s). The range from last manual compression to first Autopulse compression was 14-118 s. Mechanical CPR used in combination with an extrication sheet can be effectively used to improve the quality of resuscitation during extrication and ambulance transport of the refractory OHCA patient. The time interval to deploy the mechanical CPR device can be shortened with regular simulation training. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A comparative study of defibrillation and cardiopulmonary resuscitation performance during simulated cardiac arrest in nursing student teams

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Eikeland Husebø Sissel I

2012-04-01

Full Text Available Abstract Background Although nurses must be able to respond quickly and effectively to cardiac arrest, numerous studies have demonstrated poor performance. Simulation is a promising learning tool for resuscitation team training but there are few studies that examine simulation for training defibrillation and cardiopulmonary resuscitation (D-CPR in teams from the nursing education perspective. The aim of this study was to investigate the extent to which nursing student teams follow the D-CPR-algorithm in a simulated cardiac arrest, and if observing a simulated cardiac arrest scenario and participating in the post simulation debriefing would improve team performance. Methods We studied video-recorded simulations of D-CPR performance in 28 nursing student teams. Besides describing the overall performance of D-CPR, we compared D-CPR performance in two groups. Group A (n = 14 performed D-CPR in a simulated cardiac arrest scenario, while Group B (n = 14 performed D-CPR after first observing performance of Group A and participating in the debriefing. We developed a D-CPR checklist to assess team performance. Results Overall there were large variations in how accurately the nursing student teams performed the specific parts of the D-CPR algorithm. While few teams performed opening the airways and examination of breathing correctly, all teams used a 30:2 compression: ventilation ratio. We found no difference between Group A and Group B in D-CPR performance, either in regard to total points on the check list or to time variables. Conclusion We found that none of the nursing student teams achieved top scores on the D-CPR-checklist. Observing the training of other teams did not increase subsequent performance. We think all this indicates that more time must be assigned for repetitive practice and reflection. Moreover, the most important aspects of D-CPR, such as early defibrillation and hands-off time in relation to shock, must be highlighted in team

Clinical skills: cardiac rhythm recognition and monitoring.

Science.gov (United States)

Sharman, Joanna

With technological advances, changes in provision of healthcare services and increasing pressure on critical care services, ward patients' severity of illness is ever increasing. As such, nurses need to develop their skills and knowledge to care for their client group. Competency in cardiac rhythm monitoring is beneficial to identify changes in cardiac status, assess response to treatment, diagnosis and post-surgical monitoring. This paper describes the basic anatomy and physiology of the heart and its conduction system, and explains a simple and easy to remember process of analysing cardiac rhythms (Resuscitation Council UK, 2000) that can be used in first-line assessment to assist healthcare practitioners in providing care to their patients.

Cardiorespiratory interactions and blood flow generation during cardiac arrest and other states of low blood flow.

Science.gov (United States)

Sigurdsson, Gardar; Yannopoulos, Demetris; McKnite, Scott H; Lurie, Keith G

2003-06-01

Recent advances in cardiopulmonary resuscitation have shed light on the importance of cardiorespiratory interactions during shock and cardiac arrest. This review focuses on recently published studies that evaluate factors that determine preload during chest compression, methods that can augment preload, and the detrimental effects of hyperventilation and interrupting chest compressions. Refilling of the ventricles, so-called ventricular preload, is diminished during cardiovascular collapse and resuscitation from cardiac arrest. In light of the potential detrimental effects and challenges of large-volume fluid resuscitations, other methods have increasing importance. During cardiac arrest, active decompression of the chest and impedance of inspiratory airflow during the recoil of the chest work by increasing negative intrathoracic pressure and, hence, increase refilling of the ventricles and increase cardiac preload, with improvement in survival. Conversely, increased frequency of ventilation has detrimental effects on coronary perfusion pressure and survival rates in cardiac arrest and severe shock. Prolonged interruption of chest compressions for delivering single-rescuer ventilation or analyzing rhythm before shock delivery is associated with decreased survival rate. Cardiorespiratory interactions are of profound importance in states of cardiovascular collapse in which increased negative intrathoracic pressure during decompression of the chest has a favorable effect and increased intrathoracic pressure with ventilation has a detrimental effect on survival rate.

Liver laceration related to cardiopulmonary resuscitation

Directory of Open Access Journals (Sweden)

Halil Beydilli

2016-06-01

Full Text Available Cardiopulmonary resuscitation (CPR is recognized as a medical procedure performed to maintain vital functions of a person whose cardiac and respiratory functions have stopped. Chest compression is the most essential component of CPR and it is performed on the lower half of the sternum. During CPR, many complications may occur because of chest compressions, especially chest injuries including sternum and rib fractures. Rarely tracheal injury, rupture of the stomach, or liver or spleen injury may also occur as complications.In this study, we present two cases of liver injury caused by resuscitation. With this article, we want to emphasize the importance of making correct chest compressions. Keywords: Resuscitation complications, Emergency service, Liver laceration, Autopsy

[From fishing trip to the critical care unit : Successful resuscitation after a near drowning accident].

Science.gov (United States)

Kippnich, M; Keller, D; Jokinen, J; Kilgenstein, C; Muellenbach, R M; Markus, C; Roewer, N; Kranke, P

2014-11-01

In the context of the European Resuscitation Council (ERC) guidelines, modifications of the proposed treatment algorithm need to be performed in order to respond to different parameters. In this respect several factors interacting with cardiac arrest are essential and need to be included in the therapy. This case report demonstrates an example of resuscitation in the situation of hypothermia. After a near drowning accident and approximately 30 min underwater, a patient suffering from severe hypothermia initially required resuscitation after the rescue. A return of spontaneous circulation (ROSC) was successfully achieved within a short length of time and after 15 days on the intensive care unit the patient was discharged to a rehabilitation facility without any signs of focal neurological deficits. Section 8 of the ERC guidelines provides additional information for resuscitation under specific conditions. In this case report, hypothermia was one of the main criteria leading to an adjusted pharmacological therapy. Furthermore, selection of the appropriate hospital for an optimal advanced treatment including controlled warming of the patient and management of hypothermia-induced complications had to be evaluated.

CT findings of the brain post cardiopulmonary resuscitation

International Nuclear Information System (INIS)

Imanishi, Masami; Miyamoto, Seiji; Sakaki, Toshisuke; Fukuzumi, Akio; Iwasaki, Satoru; Tabuse, Hisayuki

1999-01-01

The subjects were 88 cases of non-traumatic CPA excluding those with primary brain disease. The subjects were divided into 4 groups according to the duration of cardiac arrest: Group A (less than 15 minutes, 2 cases), Group B (15-30 minutes, 11 cases), Group C (more than 30 minutes, 40 cases), Group D (no resuscitation after cardiac arrest, 35 cases). All cases in Group A were observed to be clear consciousness after resuscitation. Not only the functional outcome but also the survivals rates were poorer as the duration of cardiac arrest increased in Groups B and C compared to Group A. The mortality rate was 85% or higher for cardiac arrest of 15 minutes or longer. Brain edema after resuscitation was examined by head CT in the basal-ganglia and thalamus regions, and in the corticomedullary junction of the cerebrum. In the cases of short duration of cardiac arrest, the basal-ganglia and thalamus regions, and the corticomedullary junction were clearly visible on CT. On the other hand, these areas were poorly or not visible (marked brain edema) in the cases of longer duration of cardiac arrest. The borders of the basal-ganglia and thalamus regions, and the corticomedullary junction were not obscured in any of the cases in Group A. However, the borders of these regions were poorly visible or not visible more frequently as the duration of cardiac arrest increased. In particular, the corticomedullary junction was not visible more frequently after cardiac arrest of long duration. Brain edema is caused and intensified by prolongation of hypoxia, but it is also reported to be caused by external cardiac massage, which increases the intracranial pressure. This was also suggested by the more notable brain edema in the corticomedullary junction than in the basal-ganglia and thalamus regions. These findings of brain edema appeared on head CT within 4 hours after CPR. Findings suggestive of vascular occlusion were also obtained. (K.H.)

Decision to resuscitate or not in patients with chronic diseases

DEFF Research Database (Denmark)

Saltbæk, Lena; Tvedegaard, Erling

2012-01-01

Do-not-resuscitate (DNR) decisions are frequently made without informing the patients. We attempt to determine whether patients and physicians wish to discuss the DNR decision, who they think, should be the final decision maker and whether they agree on the indication for cardiopulmonary...... resuscitation (CPR) in case of cardiac arrest....

Global health and emergency care: a resuscitation research agenda--part 1

NARCIS (Netherlands)

Aufderheide, Tom P.; Nolan, Jerry P.; Jacobs, Ian G.; van Belle, Gerald; Bobrow, Bentley J.; Marshall, John; Finn, Judith; Becker, Lance B.; Bottiger, Bernd; Cameron, Peter; Drajer, Saul; Jung, Julianna J.; Kloeck, Walter; Koster, Rudolph W.; Huei-Ming Ma, Matthew; Shin, Sang Do; Sopko, George; Taira, Breena R.; Timerman, Sergio; Eng Hock Ong, Marcus

2013-01-01

At the 2013 Academic Emergency Medicine global health consensus conference, a breakout session on a resuscitation research agenda was held. Two articles focusing on cardiac arrest and trauma resuscitation are the result of that discussion. This article describes the burden of disease and outcomes,

In-hospital cardiac arrest is associated with use of non-antiarrhythmic QTc-prolonging drugs

DEFF Research Database (Denmark)

De Bruin, Marie L; Langendijk, Pim N J; Koopmans, Richard P

2007-01-01

a case-control study in which patients, for whom intervention of the advanced life support resuscitation team was requested for cardiac arrest between 1995 and 2003 in the Academic Medical Centre, Amsterdam, were compared with controls regarding current use of non-antiarrhythmic QTc-prolonging drugs...

Cardiac Toxicity after definitive Radiotherapy of locally advanced NSCLC

DEFF Research Database (Denmark)

Schytte, Tine; Hansen, Olfred; Stohlberg-Rohr, Thomine

2010-01-01

    Cardiac Toxicity after definitive Radiotherapy of locally advanced NSCLC Tine Schytte, Olfred Hansen, Thomine Stolberg-Rohr* and Carsten Brink*. Dept. Oncology and Radiophysic Lab.* Odense University Hospital, Denmark   Keyword: Radiotherapy, Locally advanced NSCLC, Cardiac toxicity   Backgro......    Cardiac Toxicity after definitive Radiotherapy of locally advanced NSCLC Tine Schytte, Olfred Hansen, Thomine Stolberg-Rohr* and Carsten Brink*. Dept. Oncology and Radiophysic Lab.* Odense University Hospital, Denmark   Keyword: Radiotherapy, Locally advanced NSCLC, Cardiac toxicity......   Background: Lung and oesophageal toxicity have been regarded as main toxicity in definitive radiotherapy (RT) of non-small cell lung cancer (NSCLC), whereas cardiac toxicity has not been offered much concern. This is probably due to the poor prognosis for patients with unresectable NSCLC. In this study we...

Persisting effect of community approaches to resuscitation.

Science.gov (United States)

Nielsen, Anne Møller; Isbye, Dan Lou; Lippert, Freddy Knudsen; Rasmussen, Lars Simon

2014-11-01

On the Danish island of Bornholm an intervention was carried out during 2008-2010 aiming at increasing out-of-hospital cardiac arrest (OHCA) survival. The intervention included mass media focus on resuscitation and widespread educational activities. The aim of this study was to compare the bystander BLS rate and survival after OHCA on Bornholm in a 3-year follow-up period after the intervention took place. Data on OHCA on Bornholm were collected from September 28th, 2010 to September 27th, 2013 and compared to data from the intervention period, September 28th, 2008 to September 27th, 2010. The bystander BLS rate for non-EMS witnessed OHCAs with presumed cardiac aetiology was significantly higher in the follow-up period (70% [95% CI 61-77] vs. 47% [95% CI 37-57], p=0.001). AEDs were deployed in 22 (18%) cases in the follow-up period and a shock was provided in 13 cases. There was no significant change in all-rhythm 30-day survival for non-EMS witnessed OHCAs with presumed cardiac aetiology (6.7% [95% CI 3-13] in the follow-up period; vs. 4.6% [95% CI 1-12], p=0.76). In a 3-year follow-up period after an intervention engaging laypersons in resuscitation through mass education in BLS combined with a media focus on resuscitation, we observed a persistent significant increase in the bystander BLS rate for all OHCAs with presumed cardiac aetiology. There was no significant difference in 30-day survival. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Perceptions of basic, advanced, and pediatric life support training in a United States medical school.

Science.gov (United States)

Pillow, Malford Tyson; Stader, Donald; Nguyen, Matthew; Cao, Dazhe; McArthur, Robert; Hoxhaj, Shkelzen

2014-05-01

Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), and Pediatric Advanced Life Support (PALS) are integral parts of emergency resuscitative care. Although this training is usually reserved for residents, introducing the training in the medical student curriculum may enhance acquisition and retention of these skills. We developed a survey to characterize the perceptions and needs of graduating medical students regarding BLS, ACLS, and PALS training. This was a study of graduating 4th-year medical students at a U.S. medical school. The students were surveyed prior to participating in an ACLS course in March of their final year. Of 152 students, 109 (71.7%) completed the survey; 48.6% of students entered medical school without any prior training and 47.7% started clinics without training; 83.4% of students reported witnessing an average of 3.0 in-hospital cardiac arrests during training (range of 0-20). Overall, students rated their preparedness 2.0 (SD 1.0) for adult resuscitations and 1.7 (SD 0.9) for pediatric resuscitations on a 1-5 Likert scale, with 1 being unprepared. A total of 36.8% of students avoided participating in resuscitations due to lack of training; 98.2%, 91.7%, and 64.2% of students believe that BLS, ACLS, and PALS, respectively, should be included in the medical student curriculum. As per previous studies that have examined this topic, students feel unprepared to respond to cardiac arrests and resuscitations. They feel that training is needed in their curriculum and would possibly enhance perceived comfort levels and willingness to participate in resuscitations. Copyright © 2014 Elsevier Inc. All rights reserved.

Effect of socioemotional stress on the quality of cardiopulmonary resuscitation during advanced life support in a randomized manikin study.

Science.gov (United States)

Bjørshol, Conrad Arnfinn; Myklebust, Helge; Nilsen, Kjetil Lønne; Hoff, Thomas; Bjørkli, Cato; Illguth, Eirik; Søreide, Eldar; Sunde, Kjetil

2011-02-01

The aim of this study was to evaluate whether socioemotional stress affects the quality of cardiopulmonary resuscitation during advanced life support in a simulated manikin model. A randomized crossover trial with advanced life support performed in two different conditions, with and without exposure to socioemotional stress. The study was conducted at the Stavanger Acute Medicine Foundation for Education and Research simulation center, Stavanger, Norway. Paramedic teams, each consisting of two paramedics and one assistant, employed at Stavanger University Hospital, Stavanger, Norway. A total of 19 paramedic teams performed advanced life support twice in a randomized fashion, one control condition without socioemotional stress and one experimental condition with exposure to socioemotional stress. The socioemotional stress consisted of an upset friend of the simulated patient who was a physician, spoke a foreign language, was unfamiliar with current Norwegian resuscitation guidelines, supplied irrelevant clinical information, and repeatedly made doubts about the paramedics' resuscitation efforts. Aural distractions were supplied by television and cell telephone. The primary outcome was the quality of cardiopulmonary resuscitation: chest compression depth, chest compression rate, time without chest compressions (no-flow ratio), and ventilation rate after endotracheal intubation. As a secondary outcome, the socioemotional stress impact was evaluated through the paramedics' subjective workload, frustration, and feeling of realism. There were no significant differences in chest compression depth (39 vs. 38 mm, p = .214), compression rate (113 vs. 116 min⁻¹, p = .065), no-flow ratio (0.15 vs. 0.15, p = .618), or ventilation rate (8.2 vs. 7.7 min⁻¹, p = .120) between the two conditions. There was a significant increase in the subjective workload, frustration, and feeling of realism when the paramedics were exposed to socioemotional stress. In this advanced life

Pediatric advanced life support and sedation of pediatric dental patients

OpenAIRE

Kim, Jongbin

2016-01-01

Programs provided by the Korea Association of Cardiopulmonary Resuscitation include Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), and Korean Advanced Life Support (KALS). However, programs pertinent to dental care are lacking. Since 2015, related organizations have been attempting to develop a Dental Advanced Life Support (DALS) program, which can meet the needs of the dental environment. Generally, for initial management of emergency ...

The impact of post-resuscitation feedback for paramedics on the quality of cardiopulmonary resuscitation.

Science.gov (United States)

Bleijenberg, Eduard; Koster, Rudolph W; de Vries, Hendrik; Beesems, Stefanie G

2017-01-01

The Guidelines place emphasis on high-quality cardiopulmonary resuscitation (CPR). This study aims to measure the impact of post-resuscitation feedback on the quality of CPR as performed by ambulance personnel. Two ambulances are dispatched for suspected cardiac arrest. The crew (driver and paramedic) of the first arriving ambulance is responsible for the quality of CPR. The crew of the second ambulance establishes an intravenous access and supports the first crew. All resuscitation attempts led by the ambulance crew of the study region were reviewed by two research paramedics and structured feedback was given based on defibrillator recording with impedance signal. A 12-months period before introduction of post-resuscitation feedback was compared with a 19-months period after introduction of feedback, excluding a six months run-in interval. Quality parameters were chest compression fraction (CCF), chest compression rate, longest peri-shock pause and longest non-shock pause. In the pre-feedback period 55 cases were analyzed and 69 cases in the feedback period. Median CCF improved significantly in the feedback period (79% vs 86%, presuscitation feedback improves the quality of resuscitation, significantly increasing CCF and decreasing the duration of longest non-shock pauses. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

A 35-year-old pregnant woman presenting with sudden cardiac arrest secondary to peripartum cardiomyopathy.

Science.gov (United States)

Nelson, Matthew; Moorhead, Amy; Yost, Dana; Whorton, Adrian

2012-01-01

We present a case of successful resuscitation from cardiac arrest after 25 minutes of ventricular fibrillation (VF) secondary to peripartum cardiomyopathy. This case highlights a rare disease, but also, more importantly, the successful use of the five links of survival: early access to 9-1-1, early cardiopulmonary resuscitation (CPR), early defibrillation, early advanced life support, and postresuscitative care. We also demonstrate the importance of high-quality resuscitation practices in order to achieve a successful outcome. Manual compressions can be performed at a guidelines-compliant rate. With training, users are able to achieve high compression fractions. Pre/post shock delays can be minimized to further increase compression fraction. Nationally, CPR interruptions are often long. We recommend closer attention to uninterrupted 2-minute cycles of CPR, minimizing delays in CPR through training, and a focus on a closely choreographed approach. User review of transthoracic impedance feedback data should play a vital role in a cardiac arrest quality-improvement program.

Cardiac arrest – cardiopulmonary resuscitation

Directory of Open Access Journals (Sweden)

Basri Lenjani

2014-01-01

Conclusions: All survivors from cardiac arrest have received appropriate medical assistance within 10 min from attack, which implies that if cardiac arrest occurs near an institution health care (with an opportunity to provide the emergent health care the rate of survival is higher.

Resuscitation training.

OpenAIRE

Shepherd, A.

1995-01-01

All physicians, dentists, nurses and health care personnel should be adequately and regularly trained in cardiopulmonary resuscitation. Guidelines for acquiring the necessary skills in basic and advanced life support are now available.

Cardiopulmonary Resuscitation Training for Medical Students in Anesthesiology Rotation in Ardabil Medical University (Iran

Directory of Open Access Journals (Sweden)

Kh Isazadehfar

2009-11-01

Full Text Available Background and purpose: Cardiopulmonary resuscitation (CPR training for undergraduate medical students has been noted to be poor in the past. Attempts have been made The aim of this study is to determine effect of CPR training in the anesthetic ward to improve knowledge and practice undergraduate medical student of CPR.Methods: A 12 month Educational experimental study with self control was done on all undergraduate medical student (n=30 at the medical university of Ardabil in 2006-2007. During I month of program allthis students have undergone CPR training including basic life support (BLS , advanced cardiac life support (ACLS and practical skills. Data were collected via questionnaire, demographic, pre/post knowledge and practice.Results: After training the acceptable score (good and very good about knowledge of BLS, ACLS and practical skill significantly increased %6.7 to %50 (p=0.0001 , %13.3 to %53.4 (p=0.001 and %3.3 to %100 (p=0.001 respectively. A significant relationship between knowledge of ACLS and practical skills was shown (p=0.005.Conclusion: The CPR training course in anesthetic ward leads to a significant increased in skills and knowledge. Adding this course to undergraduate curriculum of medical students especially in operaticallywards (e.g. Anesthetic ward is essential.Keywords: CARDIOPULMONARY RESUSCITATION; TRAINING; BASIC LIFE SUPPORT; ADVANCED CARDIAC LIFE SUPPORT

Advanced life support therapy and on out-of-hospital cardiac arrest patients: Applying signal processing and pattern recognition methods

Directory of Open Access Journals (Sweden)

Trygve Eftestøl

2005-10-01

Full Text Available In the US alone, several hundred thousands die of sudden cardiac arrests each year. Basic life support defined as chest compressions and ventilations and early defibrillation are the only factors proven to increase the survival of patients with out-of-hospital cardiac arrest, and are key elements in the chain of survival defined by the American Heart Association. The current cardiopulmonary resuscitation guidelines treat all patients the same, but studies show need for more individualiza- tion of treatment. This review will focus on ideas on how to strengthen the weak parts of the chain of survival including the ability to measure the effects of therapy, improve time efficiency, and optimize the sequence and quality of the various components of cardiopulmonary resuscitation.

High-quality cardiopulmonary resuscitation: current and future directions.

Science.gov (United States)

Abella, Benjamin S

2016-06-01

Cardiopulmonary resuscitation (CPR) represents the cornerstone of cardiac arrest resuscitation care. Prompt delivery of high-quality CPR can dramatically improve survival outcomes; however, the definitions of optimal CPR have evolved over several decades. The present review will discuss the metrics of CPR delivery, and the evidence supporting the importance of CPR quality to improve clinical outcomes. The introduction of new technologies to quantify metrics of CPR delivery has yielded important insights into CPR quality. Investigations using CPR recording devices have allowed the assessment of specific CPR performance parameters and their relative importance regarding return of spontaneous circulation and survival to hospital discharge. Additional work has suggested new opportunities to measure physiologic markers during CPR and potentially tailor CPR delivery to patient requirements. Through recent laboratory and clinical investigations, a more evidence-based definition of high-quality CPR continues to emerge. Exciting opportunities now exist to study quantitative metrics of CPR and potentially guide resuscitation care in a goal-directed fashion. Concepts of high-quality CPR have also informed new approaches to training and quality improvement efforts for cardiac arrest care.

A survey of nurses' perceived competence and educational needs in performing resuscitation.

Science.gov (United States)

Roh, Young Sook; Issenberg, S Barry; Chung, Hyun Soo; Kim, So Sun; Lim, Tae Ho

2013-05-01

Effective training is needed for high-quality performance of staff nurses, who are often the first responders in initiating resuscitation. There is insufficient evidence to identify specific educational strategies that improve outcomes, including early recognition and rescue of the critical patient. This study was conducted to identify perceived competence and educational needs as well as to examine factors influencing perceived competence in resuscitation among staff nurses to build a resuscitation training curriculum. A convenience sample of 502 staff nurses was recruited from 11 hospitals in a single city. Staff nurses were asked to complete a self-administered questionnaire. On a five-point scale, chest compression was the lowest-rated technical skill (M = 3.33, SD = 0.80), whereas staying calm and focusing on required tasks was the lowest-rated non-technical skill (M = 3.30, SD = 0.80). Work duration, the usefulness of simulation, recent code experience, and recent simulation-based training were significant factors in perceived competence, F(4, 496) = 45.94, p < .001. Simulation-based resuscitation training was the most preferred training modality, and cardiac arrest was the most preferred training topic. Based on this needs assessment, a simulation-based resuscitation training curriculum with cardiac arrest scenarios is suggested to improve the resuscitation skills of staff nurses. Copyright 2013, SLACK Incorporated.

Age × Gender Interaction Effect on Resuscitation Outcomes in Patients With Out-of-Hospital Cardiac Arrest.

Science.gov (United States)

Hagihara, Akihito; Onozuka, Daisuke; Ono, Junko; Nagata, Takashi; Hasegawa, Manabu

2017-08-01

Although an interaction between gender and age has been shown to influence resuscitation outcomes in patients with out-of-hospital cardiac arrest (OHCA), this interaction has not been investigated in Asian populations. In this prospective, observational study, data from all cases of OHCA in Japan between 2005 and 2012 were obtained from the Japanese National Registry. We determined the relative excess risk due to interaction and the ratio of odds ratios (ORs) to assess the interaction effect of gender and age on the incidence of return of spontaneous circulation (ROSC) before hospital arrival, 1-month survival, and neurologically intact survival 1 month after OHCA. Male gender was associated with decreased ROSC and lower 1-month survival rates in patients with OHCA of presumed cardiac origin. Older age was associated with lower 1-month and neurologically intact survival rates in male patients with OHCA of presumed cardiac and noncardiac origin and with increased ROSC in male patients with OHCA of presumed cardiac origin. The relative excess risk due to interaction for ROSC in patients with OHCA of presumed cardiac origin was statistically significant (OR 0.19, 95% confidence interval [CI] 0.06 to 0.32). The ratio of ORs for ROSC was statistically significant in patients with OHCA of presumed cardiac origin (OR 1.25, 95% CI 1.05 to 1.47) and of noncardiac origin (OR 0.40, 95% CI 0.17 to 0.92). In conclusion, the interaction effect between age and gender on ROSC was positive in OHCA cases of presumed cardiac origin and negative in those of noncardiac origin. Copyright © 2017 Elsevier Inc. All rights reserved.

Brain Resuscitation in the Drowning Victim

Science.gov (United States)

Topjian, Alexis A.; Berg, Robert A.; Bierens, Joost J. L. M.; Branche, Christine M.; Clark, Robert S.; Friberg, Hans; Hoedemaekers, Cornelia W. E.; Holzer, Michael; Katz, Laurence M.; Knape, Johannes T. A.; Kochanek, Patrick M.; Nadkarni, Vinay; van der Hoeven, Johannes G.

2013-01-01

Drowning is a leading cause of accidental death. Survivors may sustain severe neurologic morbidity. There is negligible research specific to brain injury in drowning making current clinical management non-specific to this disorder. This review represents an evidence-based consensus effort to provide recommendations for management and investigation of the drowning victim. Epidemiology, brain-oriented prehospital and intensive care, therapeutic hypothermia, neuroimaging/monitoring, biomarkers, and neuroresuscitative pharmacology are addressed. When cardiac arrest is present, chest compressions with rescue breathing are recommended due to the asphyxial insult. In the comatose patient with restoration of spontaneous circulation, hypoxemia and hyperoxemia should be avoided, hyperthermia treated, and induced hypothermia (32–34 °C) considered. Arterial hypotension/hypertension should be recognized and treated. Prevent hypoglycemia and treat hyperglycemia. Treat clinical seizures and consider treating non-convulsive status epilepticus. Serial neurologic examinations should be provided. Brain imaging and serial biomarker measurement may aid prognostication. Continuous electroencephalography and N20 somatosensory evoked potential monitoring may be considered. Serial biomarker measurement (e.g., neuron specific enolase) may aid prognostication. There is insufficient evidence to recommend use of any specific brain-oriented neuroresuscitative pharmacologic therapy other than that required to restore and maintain normal physiology. Following initial stabilization, victims should be transferred to centers with expertise in age-specific post-resuscitation neurocritical care. Care should be documented, reviewed, and quality improvement assessment performed. Preclinical research should focus on models of asphyxial cardiac arrest. Clinical research should focus on improved cardiopulmonary resuscitation, re-oxygenation/reperfusion strategies, therapeutic hypothermia

Advanced Cardiac Life Support.

Science.gov (United States)

Kirkwood Community Coll., Cedar Rapids, IA.

This document contains materials for an advanced college course in cardiac life support developed for the State of Iowa. The course syllabus lists the course title, hours, number, description, prerequisites, learning activities, instructional units, required text, six references, evaluation criteria, course objectives by units, course…

Effects of a mandatory basic life support training programme on the no-flow fraction during in-hospital cardiac resuscitation: an observational study.

Science.gov (United States)

Müller, Michael P; Richter, Torsten; Papkalla, Norbert; Poenicke, Cynthia; Herkner, Carsten; Osmers, Anne; Brenner, Sigrid; Koch, Thea; Schwanebeck, Uta; Heller, Axel R

2014-07-01

Many hospitals have basic life support (BLS) training programmes, but the effects on the quality of chest compressions are unclear. This study aimed to evaluate the no-flow fraction (NFF) during BLS provided by standard care nursing teams over a five-year observation period during which annual participation in the BLS training was mandatory. All healthcare professionals working at Dresden University Hospital were instructed in BLS and automated external defibrillator (AED) use according to the current European Resuscitation Council guidelines on an annual basis. After each cardiac arrest occurring on a standard care ward, AED data were analyzed. The time without chest compressions during the period without spontaneous circulation (i.e., the no-flow fraction) was calculated using thoracic impedance data. For each year of the study period (2008-2012), a total of 1454, 1466, 1487, 1432, and 1388 health care professionals, respectively, participated in the training. The median no-flow fraction decreased significantly from 0.55 [0.42; 0.57] (median [25‰; 75‰]) in 2008 to 0.3 [0.28; 0.35] in 2012. Following revision of the BLS curriculum after publication of the 2010 guidelines, cardiac arrest was associated with a higher proportion of patients achieving ROSC (72% vs. 48%, P=0.025) but not a higher survival rate to hospital discharge (35% vs. 19%, P=0.073). The NFF during in-hospital cardiac resuscitation decreased after establishment of a mandatory annual BLS training for healthcare professionals. Following publication of the 2010 guidelines, more patients achieved ROSC after in-hospital cardiac arrest. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Direct Cardiac Reprogramming: Advances in Cardiac Regeneration

Directory of Open Access Journals (Sweden)

Olivia Chen

2015-01-01

Full Text Available Heart disease is one of the lead causes of death worldwide. Many forms of heart disease, including myocardial infarction and pressure-loading cardiomyopathies, result in irreversible cardiomyocyte death. Activated fibroblasts respond to cardiac injury by forming scar tissue, but ultimately this response fails to restore cardiac function. Unfortunately, the human heart has little regenerative ability and long-term outcomes following acute coronary events often include chronic and end-stage heart failure. Building upon years of research aimed at restoring functional cardiomyocytes, recent advances have been made in the direct reprogramming of fibroblasts toward a cardiomyocyte cell fate both in vitro and in vivo. Several experiments show functional improvements in mouse models of myocardial infarction following in situ generation of cardiomyocyte-like cells from endogenous fibroblasts. Though many of these studies are in an early stage, this nascent technology holds promise for future applications in regenerative medicine. In this review, we discuss the history, progress, methods, challenges, and future directions of direct cardiac reprogramming.

Identifying non-technical skills and barriers for improvement of teamwork in cardiac arrest teams

DEFF Research Database (Denmark)

Andersen, P.O.; Jensen, Michael Kammer; Lippert, A.

2010-01-01

Background: The application of non-technical skills (NTSs) in health care has previously been described in other health-care educational programmes. NTSs are behavioural principles such as leadership, task distribution and communication. The aim of this study was to identify NTSs suitable...... for improving team performance in multi-professional cardiac arrest teams, and to describe barriers to the use and implementation of such NTSs by using a qualitative method. Methods: Individual semi-structured interviews were conducted with 11 Danish Advanced Life Support instructors during the period April...... 2006 to November 2006. Interviews were focussed on barriers and recommendations for teamwork in the cardiac arrest team, optimal policy for improvement of resuscitation training and clinical practice, use of cognitive aids and adoption of European Resuscitation Council (ERC) Guidelines 2005. Interviews...

Cardiopulmonary resuscitation: state of the art in 2011 | Möhr ...

African Journals Online (AJOL)

Failure to recognise the signs of sudden cardiac arrest or impending cardiac arrest will lead to delayed intervention. Cardiopulmonary resuscitation (CPR) must be initiated without delay, irrespective of the level of skill of the caregiver. The 2010 CPR guidelines emphasise the importance of chest compressions, which have ...

Enhancing pediatric safety: assessing and improving resident competency in life-threatening events with a computer-based interactive resuscitation tool

International Nuclear Information System (INIS)

Lerner, Catherine; Gaca, Ana M.; Frush, Donald P.; Ancarana, Anjanette; Hohenhaus, Sue; Seelinger, Terry A.; Frush, Karen

2009-01-01

Though rare, allergic reactions occur as a result of administration of low osmolality nonionic iodinated contrast material to pediatric patients. Currently available resuscitation aids are inadequate in guiding radiologists' initial management of such reactions. To compare radiology resident competency with and without a computer-based interactive resuscitation tool in the management of life-threatening events in pediatric patients. The study was approved by the IRB. Radiology residents (n=19; 14 male, 5 female; 19 certified in basic life support/advanced cardiac life support; 1 certified in pediatric advanced life support) were videotaped during two simulated 5-min anaphylaxis scenarios involving 18-month-old and 8-year-old mannequins (order randomized). No advance warning was given. In half of the scenarios, a computer-based interactive resuscitation tool with a response-driven decision tree was available to residents (order randomized). Competency measures included: calling a code, administering oxygen and epinephrine, and correctly dosing epinephrine. Residents performed significantly more essential interventions with the computer-based resuscitation tool than without (72/76 vs. 49/76, P<0.001). Significantly more residents appropriately dosed epinephrine with the tool than without (17/19 vs. 1/19; P<0.001). More residents called a code with the tool than without (17/19 vs. 14/19; P = 0.08). A learning effect was present: average times to call a code, request oxygen, and administer epinephrine were shorter in the second scenario (129 vs. 93 s, P=0.24; 52 vs. 30 s, P<0.001; 152 vs. 82 s, P=0.025, respectively). All the trainees found the resuscitation tool helpful and potentially useful in a true pediatric emergency. A computer-based interactive resuscitation tool significantly improved resident performance in managing pediatric emergencies in the radiology department. (orig.)

Reliability of Pulse Oximetry during Progressive Hypoxia, Cardiopulmonary Resuscitation, and Recovery in a Piglet Model of Neonatal Hypoxic Cardiac Arrest.

Science.gov (United States)

Hassan, Mohammad Ahmad; Weber, Claudia; Waitz, Markus; Huang, Li; Hummler, Helmut D; Mendler, Marc Robin

2017-01-01

Pulse oximetry is widely used in intensive care and emergency conditions to monitor arterial oxygenation and to guide oxygen therapy. To study the reliability of pulse oximetry in comparison with CO-oximetry in newborn piglets during progressive hypoxia, cardiac arrest, cardiopulmonary resuscitation (CPR), and after return of spontaneous circulation (ROSC). Thirty-three newborn piglets were exposed to hypoxia until asystole occurred and then resuscitated until ROSC. Arterial oxygen saturation was monitored continuously by pulse oximetry (SpO2) with one sensor applied to the wrist of the right forelimb (FL) and another to the thigh of the left hind limb (HL). Arterial functional oxygen saturation (SaO2) was measured at baseline and at predefined intervals during each phase of the experiment. SpO2 was compared with coinciding SaO2 values and bias considered whenever the difference (SpO2 - SaO2) was beyond ±5%. Bias values were lower at the baseline measurements (-3.7 ± 2.3% in FL and -4.1 ± 3.4% in HL) as well as after ROSC (1.5 ± 4.2% in FL and 0.2 ± 4.6% in HL) with higher precision and accuracy than during other experiment phases. During hypoxia induction, cardiac arrest, and CPR, there was a marked decrease in precision and accuracy as well as an increase in bias up to 43 ± 26 and 56 ± 27% in FL and HL, respectively, over a range of SaO2 from 13 to 51%. Pulse oximetry showed increased bias and decreased accuracy and precision during marked hypoxemia in a model of neonatal hypoxic cardiac arrest. © 2017 S. Karger AG, Basel.

Capnography during cardiopulmonary resuscitation: Current evidence and future directions

Directory of Open Access Journals (Sweden)

Bhavani Shankar Kodali

2014-01-01

Full Text Available Capnography continues to be an important tool in measuring expired carbon dioxide (CO 2 . Most recent Advanced Cardiac Life Support (ACLS guidelines now recommend using capnography to ascertain the effectiveness of chest compressions and duration of cardiopulmonary resuscitation (CPR. Based on an extensive review of available published literature, we selected all available peer-reviewed research investigations and case reports. Available evidence suggests that there is significant correlation between partial pressure of end-tidal CO 2 (PETCO 2 and cardiac output that can indicate the return of spontaneous circulation (ROSC. Additional evidence favoring the use of capnography during CPR includes definitive proof of correct placement of the endotracheal tube and possible prediction of patient survival following cardiac arrest, although the latter will require further investigations. There is emerging evidence that PETCO 2 values can guide the initiation of extracorporeal life support (ECLS in refractory cardiac arrest (RCA. There is also increasing recognition of the value of capnography in intensive care settings in intubated patients. Future directions include determining the outcomes based on capnography waveforms PETCO 2 values and determining a reasonable duration of CPR. In the future, given increasing use of capnography during CPR large databases can be analyzed to predict outcomes.

Does lying in the recovery position increase the likelihood of not delivering cardiopulmonary resuscitation?

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Freire-Tellado, Miguel; Navarro-Patón, Rubén; Pavón-Prieto, Maria Del Pilar; Fernández-López, Marta; Mateos-Lorenzo, Javier; López-Fórneas, Ivan

2017-06-01

Resuscitation guidelines endorse unconscious and normally breathing out-of-hospital victims to be placed in the recovery position to secure airway patency, but recently a debate has been opened as to whether the recovery position threatens the cardiac arrest victim's safety assessment and delays the start of cardiopulmonary resuscitation. To compare the assessment of the victim's breathing arrest while placed in the recovery position versus maintaining an open airway with the continuous head tilt and chin lift technique to know whether the recovery position delays the cardiac arrest victim's assessment and the start of cardiopulmonary resuscitation. Basic life support-trained university students were randomly divided into two groups: one received a standardized cardiopulmonary resuscitation refresher course including the recovery position and the other received a modified cardiopulmonary resuscitation course using continuous head tilt and chin lift for unconscious and spontaneously breathing patients. A human simulation test to evaluate the victim's breathing assessment was performed a week later. In total, 59 participants with an average age of 21.9 years were included. Only 14 of 27 (51.85%) students in the recovery position group versus 23 of 28 (82.14%) in the head tilt and chin lift group p=0.006 (OR 6.571) detected breathing arrest within 2min. The recovery position hindered breathing assessment, delayed breathing arrest identification and the initiation of cardiac compressions, and significantly increased the likelihood of not starting cardiopulmonary resuscitation when compared to the results shown when the continuous head tilt and chin lift technique was used. Copyright © 2017 Elsevier B.V. All rights reserved.

Smaller self-inflating bags produce greater guideline consistent ventilation in simulated cardiopulmonary resuscitation.

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Nehme, Ziad; Boyle, Malcolm J

2009-02-20

Suboptimal bag ventilation in cardiopulmonary resuscitation (CPR) has demonstrated detrimental physiological outcomes for cardiac arrest patients. In light of recent guideline changes for resuscitation, there is a need to identify the efficacy of bag ventilation by prehospital care providers. The objective of this study was to evaluate bag ventilation in relation to operator ability to achieve guideline consistent ventilation rate, tidal volume and minute volume when using two different capacity self-inflating bags in an undergraduate paramedic cohort. An experimental study using a mechanical lung model and a simulated adult cardiac arrest to assess the ventilation ability of third year Monash University undergraduate paramedic students. Participants were instructed to ventilate using 1600 ml and 1000 ml bags for a length of two minutes at the correct rate and tidal volume for a patient undergoing CPR with an advanced airway. Ventilation rate and tidal volume were recorded using an analogue scale with mean values calculated. Ethics approval was granted. Suboptimal ventilation with the use of conventional 1600 ml bag was common, with 77% and 97% of participants unable to achieve guideline consistent ventilation rates and tidal volumes respectively. Reduced levels of suboptimal ventilation arouse from the use of the smaller bag with a 27% reduction in suboptimal tidal volumes (p = 0.015) and 23% reduction in suboptimal minute volumes (p = 0.045). Smaller self-inflating bags reduce the incidence of suboptimal tidal volumes and minute volumes and produce greater guideline consistent results for cardiac arrest patients.

Introducing systematic dispatcher-assisted cardiopulmonary resuscitation (telephone-CPR) in a non-Advanced Medical Priority Dispatch System (AMPDS): implementation process and costs.

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Dami, Fabrice; Fuchs, Vincent; Praz, Laurent; Vader, John-Paul

2010-07-01

In order to improve the quality of our Emergency Medical Services (EMS), to raise bystander cardiopulmonary resuscitation rates and thereby meet what is becoming a universal standard in terms of quality of emergency services, we decided to implement systematic dispatcher-assisted or telephone-CPR (T-CPR) in our medical dispatch center, a non-Advanced Medical Priority Dispatch System. The aim of this article is to describe the implementation process, costs and results following the introduction of this new "quality" procedure. This was a prospective study. Over an 8-week period, our EMS dispatchers were given new procedures to provide T-CPR. We then collected data on all non-traumatic cardiac arrests within our state (Vaud, Switzerland) for the following 12 months. For each event, the dispatchers had to record in writing the reason they either ruled out cardiac arrest (CA) or did not propose T-CPR in the event they did suspect CA. All emergency call recordings were reviewed by the medical director of the EMS. The analysis of the recordings and the dispatchers' written explanations were then compared. During the 12-month study period, a total of 497 patients (both adults and children) were identified as having a non-traumatic cardiac arrest. Out of this total, 203 cases were excluded and 294 cases were eligible for T-CPR. Out of these eligible cases, dispatchers proposed T-CPR on 202 occasions (or 69% of eligible cases). They also erroneously proposed T-CPR on 17 occasions when a CA was wrongly identified (false positive). This represents 7.8% of all T-CPR. No costs were incurred to implement our study protocol and procedures. This study demonstrates it is possible, using a brief campaign of sensitization but without any specific training, to implement systematic dispatcher-assisted cardiopulmonary resuscitation in a non-Advanced Medical Priority Dispatch System such as our EMS that had no prior experience with systematic T-CPR. The results in terms of T-CPR delivery

The Safar Center for Resuscitation Research: Searching for Breakthroughs in the New Millennium

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P. M. Kochanek

2006-01-01

Full Text Available This review, written on the occasion of the 70th anniversary of the Institute for General Reanimatology of the Russian Academy of Medical Sciences, provides an update of recent research in the field of resuscitation medicine carried out at the Safar Center for Resuscitation Research at the University of Pittsburgh School of Medicine. Current and recent studies describing bench to bedside investigation in the areas of traumatic brain injury (TBI, cardiopulmonary arrest, hemorrhagic shock, and ultra-novel approaches to resuscitation are discussed. Investigation in TBI across a variety of topics by many investigators including mechanism of neuronal death, oxidative and nitrative stress, proteomics, adenosine, serotonin, novel magnetic resonance imaging application, inflicted childhood neurotrauma, and TBI rehabilitation is addressed. Research discussed in the program of cardiopulmonary arrest includes optimization of the use of mild hypothermia and novel investigation in experimental asphyxial cardiac arrest. In the program on hemorrhagic shock, our recent work on the application of mild hypothermia to prolong the «golden hour» is presented. Finally, a brief overview of our studies of a novel approach to the resuscitation of exsan-guination cardiac arrest using emergency preservation for resuscitation (EPR is provided.

Increased susceptibility to cardiovascular effects of dihydrocapcaicin in resuscitated rats. Cardiovascular effects of dihydrocapsaicin

DEFF Research Database (Denmark)

Fosgerau, Keld; Ristagno, Giuseppe; Jayatissa, Magdalena Niepsuj

2010-01-01

Survivors of a cardiac arrest often have persistent cardiovascular derangements following cardiopulmonary resuscitation including decreased cardiac output, arrhythmias and morphological myocardial damage. These cardiovascular derangements may lead to an increased susceptibility towards the extern...

Reliability of pulse oximetry during cardiopulmonary resuscitation in a piglet model of neonatal cardiac arrest.

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Hassan, Mohammad Ahmad; Mendler, Marc; Maurer, Miriam; Waitz, Markus; Huang, Li; Hummler, Helmut D

2015-01-01

Pulse oximetry is widely used in intensive care and emergency conditions to monitor arterial oxygenation and to guide oxygen therapy. To study the reliability of pulse oximetry in comparison with CO-oximetry in newborn piglets during cardiopulmonary resuscitation (CPR). In a prospective cohort study in 30 healthy newborn piglets, cardiac arrest was induced, and thereafter each piglet received CPR for 20 min. Arterial oxygen saturation was monitored continuously by pulse oximetry (SpO2). Arterial blood was analyzed for functional oxygenation (SaO2) every 2 min. SpO2 was compared with coinciding SaO2 values and bias considered whenever the difference (SpO2 - SaO2) was beyond ±5%. Bias values were decreased at the baseline measurements (mean: 2.5 ± 4.6%) with higher precision and accuracy compared with values across the experiment. Two minutes after cardiac arrest, there was a marked decrease in precision and accuracy as well as an increase in bias up to 13 ± 34%, reaching a maximum of 45.6 ± 28.3% after 10 min over a mean SaO2 range of 29-58%. Pulse oximetry showed increased bias and decreased accuracy and precision during CPR in a model of neonatal cardiac arrest. We recommend further studies to clarify the exact mechanisms of these false readings to improve reliability of pulse oximetry during the marked desaturation and hypoperfusion found during CPR. © 2014 S. Karger AG, Basel.

Recognising out-of-hospital cardiac arrest during emergency calls increases bystander cardiopulmonary resuscitation and survival

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Viereck, Søren; Møller, Thea Palsgaard; Ersbøll, Annette Kjær

2017-01-01

BACKGROUND: Initiation of early bystander cardiopulmonary resuscitation (CPR) depends on bystanders' or medical dispatchers' recognition of out-of-hospital cardiac arrest (OHCA). The primary aim of our study was to investigate if OHCA recognition during the emergency call was associated...... with bystander CPR, return of spontaneous circulation (ROSC), and 30-day survival. Our secondary aim was to identify patient-, setting-, and dispatcher-related predictors of OHCA recognition. METHODS: We performed an observational study of all OHCA patients' emergency calls in the Capital Region of Denmark from...... the association between OHCA recognition and bystander CPR, ROSC, and 30-day survival. Univariable logistic regression analyses were applied to identify predictors of OHCA recognition. RESULTS: We included 779 emergency calls in the analyses. During the emergency calls, 70.1% (n=534) of OHCAs were recognised...

Commence, continue, withhold or terminate?: a systematic review of decision-making in out-of-hospital cardiac arrest.

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Anderson, Natalie E; Gott, Merryn; Slark, Julia

2017-04-01

When faced with an out-of-hospital cardiac arrest patient, prehospital and emergency resuscitation providers have to decide when to commence, continue, withhold or terminate resuscitation efforts. Such decisions may be made difficult by incomplete information, clinical, resourcing or scene challenges and ethical dilemmas. This systematic integrative review identifies all research papers examining resuscitation providers' perspectives on resuscitation decision-making for out-of-hospital cardiac arrest patients. A total of 14 studies fulfilled the inclusion criteria: nine quantitative, four qualitative and one mixed-methods design. Five themes were identified, describing factors informing resuscitation provider decision-making: the arrest event; patient characteristics; the resuscitation scene; resuscitation provider perspectives; and medicolegal concerns. Established prognostic factors are generally considered important, but there is a lack of resuscitation provider consensus on other factors, indicating that decision-making is influenced by the perspective of resuscitation providers themselves. Resuscitation decision-making research typically draws conclusions from evaluation of cardiac arrest registry data or clinical notes, but these may not capture all salient factors. Future research should explore resuscitation provider perspectives to better understand these important decisions and the clinical, ethical, emotional and cognitive demands placed on resuscitation providers.

Ambulance cardiopulmonary resuscitation: outcomes and associated factors in out-of-hospital cardiac arrest.

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Rosell Ortiz, Fernando; García Del Águila, Javier; Fernández Del Valle, Patricia; J Mellado-Vergel, Francisco; Vergara-Pérez, Santiago; R Ruiz-Montero, María; Martínez-Lara, Manuela; J Gómez-Jiménez, Francisco; Gonzáez-Lobato, Ismael; García-Escudero, Guillermo; Ruiz-Bailén, Manuel; Caballero-García, Auxiliadora; Vivar-Díaz, Itziar; Olavarría-Govantes, Luis

2018-06-01

To assess factors associated with survival of out-of-hospital cardiac arrest (OHCA) in patients who underwent cardiopulmonary resuscitation (CPR) during ambulance transport. Retrospective analysis of a registry of OHCA cases treated between 2008 and 2014. We included patients who had not recovered circulation at the time it was decided to transport to a hospital and who were rejected as non-heart-beating donors. Multivariate analysis was used to explore factors associated with the use of ambulance CPR, survival, and neurologic outcome. Out of a total of 7241 cases, 259 (3.6%) were given CPR during emergency transport. The mean (SD) age was 51.6 (23.6) years; 27 (10.1%) were aged 16 years or younger. The following variables were associated with the use of CPR during transport: age 16 years or under (odds ratio [OR], 6.48; 95% CI, 3.91-10.76); P<.001)], witnessed OHCA (OR, 1.62; 95% CI, 1.16-2.26; P=.004), cardiac arrest outside the home (OR, 3.17; 95% CI, 2.38-4.21; P<.001), noncardiac cause (OR, 1.47; 95% CI, 1.07-2.02; P=.019], initially shockable rhythm (OR, 1.67; 95% CI, 1.17-2.37; P=.004), no prior basic life support (OR, 3.48; 95% CI, 2.58-4.70; P<.001), and orotracheal intubation (OR, 1.93; 95% CI, 1.24-2.99; P=.003). One patient (0.38%) survived to discharge with good neurologic outcome. Ambulance CPR by a physician on board is applied in few OHCA cases. Young patient age, cardiac arrest outside the home, the presence of a witness, lack of a shockable rhythm on responder arrival, lack of basic life support prior to responder arrival, noncardiac cause, and orotracheal intubation are associated with the use of ambulance CPR, a strategy that can be considered futile.

Improved performance of maternal-fetal medicine staff after maternal cardiac arrest simulation-based training.

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Fisher, Nelli; Eisen, Lewis A; Bayya, Jyothshna V; Dulu, Alina; Bernstein, Peter S; Merkatz, Irwin R; Goffman, Dena

2011-09-01

To determine the impact of simulation-based maternal cardiac arrest training on performance, knowledge, and confidence among Maternal-Fetal Medicine staff. Maternal-Fetal Medicine staff (n = 19) participated in a maternal arrest simulation program. Based on evaluation of performance during initial simulations, an intervention was designed including: basic life support course, advanced cardiac life support pregnancy modification lecture, and simulation practice. Postintervention evaluative simulations were performed. All simulations included a knowledge test, confidence survey, and debriefing. A checklist with 9 pregnancy modification (maternal) and 16 critical care (25 total) tasks was used for scoring. Postintervention scores reflected statistically significant improvement. Maternal-Fetal Medicine staff demonstrated statistically significant improvement in timely initiation of cardiopulmonary resuscitation (120 vs 32 seconds, P = .042) and cesarean delivery (240 vs 159 seconds, P = .017). Prompt cardiopulmonary resuscitation initiation and pregnancy modifications application are critical in maternal and fetal survival during cardiac arrest. Simulation is a useful tool for Maternal-Fetal Medicine staff to improve skills, knowledge, and confidence in the management of this catastrophic event. Published by Mosby, Inc.

Use of cardiocerebral resuscitation or AHA/ERC 2005 Guidelines is associated with improved survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis.

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Salmen, Marcus; Ewy, Gordon A; Sasson, Comilla

2012-01-01

To determine whether the use of cardiocerebral resuscitation (CCR) or AHA/ERC 2005 Resuscitation Guidelines improved patient outcomes from out-of-hospital cardiac arrest (OHCA) compared to older guidelines. Systematic review and meta-analysis. MEDLINE, EMBASE, Web of Science and the Cochrane Library databases. We also hand-searched study references and consulted experts. Design: randomised controlled trials and observational studies. OHCA patients, age >17 years. 'Control' protocol versus 'Study' protocol. 'Control' protocol defined as AHA/ERC 2000 Guidelines for cardiopulmonary resuscitation (CPR). 'Study' protocol defined as AHA/ERC 2005 Guidelines for CPR, or a CCR protocol. Survival to hospital discharge. High-quality or medium-quality studies, as measured by the Newcastle Ottawa Scale using predefined categories. Twelve observational studies met inclusion criteria. All the three studies using CCR demonstrated significantly improved survival compared to use of AHA 2000 Guidelines, as did five of the nine studies using AHA/ERC 2005 Guidelines. Pooled data demonstrate that use of a CCR protocol has an unadjusted OR of 2.26 (95% CI 1.64 to 3.12) for survival to hospital discharge among all cardiac arrest patients. Among witnessed ventricular fibrillation/ventricular tachycardia (VF/VT) patients, CCR increased survival by an OR of 2.98 (95% CI 1.92 to 4.62). Studies using AHA/ERC 2005 Guidelines showed an overall trend towards increased survival, but significant heterogeneity existed among these studies. We demonstrate an association with improved survival from OHCA when CCR protocols or AHA/ERC 2005 Guidelines are compared to use of older guidelines. In the subgroup of patients with witnessed VF/VT, there was a threefold increase in OHCA survival when CCR was used. CCR appears to be a promising resuscitation protocol for Emergency Medical Services providers in increasing survival from OHCA. Future research will need to be conducted to directly compare AHA/ERC 2010

A comparison of Selective Aortic Arch Perfusion and Resuscitative Endovascular Balloon Occlusion of the Aorta for the management of hemorrhage-induced traumatic cardiac arrest: A translational model in large swine.

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Ed B G Barnard

2017-07-01

Full Text Available Survival rates remain low after hemorrhage-induced traumatic cardiac arrest (TCA. Noncompressible torso hemorrhage (NCTH is a major cause of potentially survivable trauma death. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA at the thoracic aorta (Zone 1 can limit subdiaphragmatic blood loss and allow for IV fluid resuscitation when intrinsic cardiac activity is still present. Selective Aortic Arch Perfusion (SAAP combines thoracic aortic balloon hemorrhage control with intra-aortic oxygenated perfusion to achieve return of spontaneous circulation (ROSC when cardiac arrest has occurred.Male Yorkshire Landrace cross swine (80.0 ± 6.0 kg underwent anesthesia, instrumentation for monitoring, and splenectomy. TCA was induced by laparoscopic liver lobe resection combined with arterial catheter blood withdrawal to achieve a sustained systolic blood pressure <10 mmHg, cardiac arrest. After 3 min of arrest, swine were allocated to one of three interventions: (1 REBOA plus 4 units of IV fresh whole blood (FWB, (2 SAAP with oxygenated lactated Ringer's (LR, 1,600 mL/2 min, or (3 SAAP with oxygenated FWB 1,600 mL/2 min. Primary endpoint was survival to the end of 60 min of resuscitation, a simulated prehospital phase. Thirty animals were allocated to 3 groups (10 per group-5 protocol exclusions resulted in a total of 35 animals being used. Baseline measurements and time to cardiac arrest were not different amongst groups. ROSC was achieved in 0/10 (0%, 95% CI 0.00-30.9 REBOA, 6/10 (60%, 95% CI 26.2-87.8 SAAP-LR and 10/10 (100%, 95% CI 69.2-100.0 SAAP-FWB animals, p < 0.001. Survival to end of simulated 60-minute prehospital resuscitation was 0/10 (0%, 95% CI 0.00-30.9 for REBOA, 1/10 (10%, 95% CI 0.25-44.5 for SAAP-LR and 9/10 (90%, 95% CI 55.5-99.7 for SAAP-FWB, p < 0.001. Total FWB infusion volume was similar for REBOA (2,452 ± 0 mL and SAAP-FWB (2,250 ± 594 mL. This study was undertaken in laboratory conditions, and as such may have

Autonomous CaMKII Activity as a Drug Target for Histological and Functional Neuroprotection after Resuscitation from Cardiac Arrest

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Guiying Deng

2017-01-01

Full Text Available The Ca2+/calmodulin-dependent protein kinase II (CaMKII is a major mediator of physiological glutamate signaling, but its role in pathological glutamate signaling (excitotoxicity remains less clear, with indications for both neuro-toxic and neuro-protective functions. Here, the role of CaMKII in ischemic injury is assessed utilizing our mouse model of cardiac arrest and cardiopulmonary resuscitation (CA/CPR. CaMKII inhibition (with tatCN21 or tatCN19o at clinically relevant time points (30 min after resuscitation greatly reduces neuronal injury. Importantly, CaMKII inhibition also works in combination with mild hypothermia, the current standard of care. The relevant drug target is specifically Ca2+-independent “autonomous” CaMKII activity generated by T286 autophosphorylation, as indicated by substantial reduction in injury in autonomy-incompetent T286A mutant mice. In addition to reducing cell death, tatCN19o also protects the surviving neurons from functional plasticity impairments and prevents behavioral learning deficits, even at extremely low doses (0.01 mg/kg, further highlighting the clinical potential of our findings.

[Real-time feedback systems for improvement of resuscitation quality].

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Lukas, R P; Van Aken, H; Engel, P; Bohn, A

2011-07-01

The quality of chest compression is a determinant of survival after cardiac arrest. Therefore, the European Resuscitation Council (ERC) 2010 guidelines on resuscitation strongly focus on compression quality. Despite its impact on survival, observational studies have shown that chest compression quality is not reached by professional rescue teams. Real-time feedback devices for resuscitation are able to measure chest compression during an ongoing resuscitation attempt through a sternal sensor equipped with a motion and pressure detection system. In addition to the electrocardiograph (ECG) ventilation can be detected by transthoracic impedance monitoring. In cases of quality deviation, such as shallow chest compression depth or hyperventilation, feedback systems produce visual or acoustic alarms. Rescuers can thereby be supported and guided to the requested quality in chest compression and ventilation. Feedback technology is currently available both as a so-called stand-alone device and as an integrated feature in a monitor/defibrillator unit. Multiple studies have demonstrated sustainable enhancement in the education of resuscitation due to the use of real-time feedback technology. There is evidence that real-time feedback for resuscitation combined with training and debriefing strategies can improve both resuscitation quality and patient survival. Chest compression quality is an independent predictor for survival in resuscitation and should therefore be measured and documented in further clinical multicenter trials.

Burst stimulation improves hemodynamics during resuscitation after prolonged ventricular fibrillation.

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Walcott, Gregory; Melnick, Sharon; Killingsworth, Cheryl; Ideker, Raymond

2009-02-01

Although return of spontaneous circulation (ROSC) is frequently achieved during resuscitation for sudden cardiac arrest, systolic blood pressure can then decrease, requiring additional myocardial support. Previous studies have shown that a series of 1-ms electrical pulses delivered through the defibrillation patches during ventricular fibrillation (VF) can stimulate the autonomic nervous system to increase myocardial function following defibrillation. We hypothesized that a similar series of electrical pulses could increase myocardial function and blood pressure during the early post-resuscitation period. Six swine were studied that underwent 6-7 min. Each animal received 5, 10, 15, or 20 pulse packets consisting of 6 10 A, 1-ms pulses every 3-4 s in random order whenever systolic blood pressure became less than 50 mmHg. All four sets of pulse packets were delivered to each animal. Systolic blood pressure and cardiac function (left ventricular +dP/dt) were increased to pre-stimulation levels or above by all four sets of pulse packets. The increases were significantly greater for the longer than the shorter number of pulse packets. The mean+/-SD duration of the time that the systolic pressure remained above 50 mmHg following pulse delivery was 4.2+/-2.5 min. Electrical stimulation during regular rhythm following prolonged VF and resuscitation can increase blood pressure and cardiac function to above prestimulation levels.

The National Resuscitation Council, Singapore, and 34 years of resuscitation training: 1983 to 2017.

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Anantharaman, Venkataraman

2017-07-01

Training in the modern form of cardiopulmonary resuscitation (CPR) started in Singapore in 1983. For the first 15 years, the expansion of training programmes was mainly owing to the interest of a few individuals. Public training in the skill was minimal. In an area of medical care where the greatest opportunity for benefit lies in employing core resuscitation skills in the prehospital environment, very little was being done to address such a need. In 1998, a group of physicians, working together with the Ministry of Health, set up the National Resuscitation Council (NRC). Over the years, the NRC has created national guidelines on resuscitation and reviewed them at five-yearly intervals. Provider training manuals are now available for most programmes. The NRC has set up an active accreditation system for monitoring and maintaining standards of life support training. This has led to a large increase in the number of training centres, as well as recognition and adoption of the council's guidelines in the country. The NRC has also actively promoted the use of bystander CPR through community-based programmes, resulting in a rise in the number of certified providers. Improving the chain of survival, through active community-based training programmes, will likely lead to more lives being saved from sudden cardiac arrest. Copyright: © Singapore Medical Association.

Neurology of cardiopulmonary resuscitation.

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Mulder, M; Geocadin, R G

2017-01-01

This chapter aims to provide an up-to-date review of the science and clinical practice pertaining to neurologic injury after successful cardiopulmonary resuscitation. The past two decades have seen a major shift in the science and practice of cardiopulmonary resuscitation, with a major emphasis on postresuscitation neurologic care. This chapter provides a nuanced and thoughtful historic and bench-to-bedside overview of the neurologic aspects of cardiopulmonary resuscitation. A particular emphasis is made on the anatomy and pathophysiology of hypoxic-ischemic encephalopathy, up-to-date management of survivors of cardiopulmonary resuscitation, and a careful discussion on neurologic outcome prediction. Guidance to practice evidence-based clinical care when able and thoughtful, pragmatic suggestions for care where evidence is lacking are also provided. This chapter serves as both a useful clinical guide and an updated, thorough, and state-of-the-art reference on the topic for advanced students and experienced practitioners in the field. © 2017 Elsevier B.V. All rights reserved.

Revolving back to the basics in cardiopulmonary resuscitation.

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Roppolo, L P; Wigginton, J G; Pepe, P E

2009-05-01

Since the 1970s, most of the research and debate regarding interventions for cardiopulmonary arrest have focused on advanced life support (ALS) therapies and early defibrillation strategies. During the past decade, however, international guidelines for cardiopulmonary resuscitation (CPR) have not only emphasized the concept of uninterrupted chest compressions, but also improvements in the timing, rate and quality of those compressions. In essence, it has been a ''revolution'' in resuscitation medicine in terms of ''coming full circle'' to the 1960s when basic CPR was first developed. Recent data have indicated the need for minimally-interrupted chest compressions with an accompanying emphasis toward removing rescue ventilation altogether in sudden cardiac arrest, at least in the few minutes after a sudden unheralded collapse. In other studies, transient delays in defibrillation attempts and ALS interventions are even recommended so that basic CPR can be prioritized to first restore and maintain better coronary artery perfusion. New devices have now been developed to modify, in real-time, the performance of basic CPR, during both training and an actual resuscitative effort. Several new adjuncts have been created to augment chest compressions or enhance venous return and evolving technology may now be able to identify ventricular fibrillation (VF) without interrupting chest compressions. A renewed focus on widespread CPR training for the average person has also returned to center stage with ground-breaking training initiatives including validated video-based adult learning courses that can reliably teach and enable long term retention of basic CPR skills and automated external defibrillator (AED) use.

Smaller self-inflating bags produce greater guideline consistent ventilation in simulated cardiopulmonary resuscitation

Directory of Open Access Journals (Sweden)

Boyle Malcolm J

2009-02-01

Full Text Available Abstract Background Suboptimal bag ventilation in cardiopulmonary resuscitation (CPR has demonstrated detrimental physiological outcomes for cardiac arrest patients. In light of recent guideline changes for resuscitation, there is a need to identify the efficacy of bag ventilation by prehospital care providers. The objective of this study was to evaluate bag ventilation in relation to operator ability to achieve guideline consistent ventilation rate, tidal volume and minute volume when using two different capacity self-inflating bags in an undergraduate paramedic cohort. Methods An experimental study using a mechanical lung model and a simulated adult cardiac arrest to assess the ventilation ability of third year Monash University undergraduate paramedic students. Participants were instructed to ventilate using 1600 ml and 1000 ml bags for a length of two minutes at the correct rate and tidal volume for a patient undergoing CPR with an advanced airway. Ventilation rate and tidal volume were recorded using an analogue scale with mean values calculated. Ethics approval was granted. Results Suboptimal ventilation with the use of conventional 1600 ml bag was common, with 77% and 97% of participants unable to achieve guideline consistent ventilation rates and tidal volumes respectively. Reduced levels of suboptimal ventilation arouse from the use of the smaller bag with a 27% reduction in suboptimal tidal volumes (p = 0.015 and 23% reduction in suboptimal minute volumes (p = 0.045. Conclusion Smaller self-inflating bags reduce the incidence of suboptimal tidal volumes and minute volumes and produce greater guideline consistent results for cardiac arrest patients.

Are regional variations in activity of dispatcher-assisted cardiopulmonary resuscitation associated with out-of-hospital cardiac arrests outcomes? A nation-wide population-based cohort study.

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Nishi, Taiki; Kamikura, Takahisa; Funada, Akira; Myojo, Yasuhiro; Ishida, Tetsuya; Inaba, Hideo

2016-01-01

Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) impacts the rates of bystander CPR (BCPR) and survival after out-of-hospital cardiac arrests (OHCAs). This study aimed to elucidate whether regional variations in indexes for BCPR and emergency medical service (EMS) may be associated with OHCA outcomes. We conducted a population-based observational study involving 157,093 bystander-witnessed, resuscitation-attempted OHCAs without physician involvement between 2007 and 2011. For each index of BCPR and EMS, we classified the 47 prefectures into the following three groups: advanced, intermediate, and developing regions. Nominal logit analysis followed by multivariable logistic regression including OHCA backgrounds was employed to examine the association between neurologically favourable 1-month survival, and regional classifications based on BCPR- and EMS-related indexes. Logit analysis including all regional classifications revealed that the number of BLS training course participants per population or bystander's own performance of BCPR without DA-CPR was not associated with the survival. Multivariable logistic regression including the OHCA backgrounds known to be associated with survival (BCPR provision, arrest aetiology, initial rhythm, patient age, time intervals of witness-to-call and call-to-arrival at patient), the following regional classifications based on DA-CPR but not on EMS were associated with survival: sensitivity of DA-CPR [adjusted odds ratio (95% confidence intervals) for advanced region; those for intermediate region, with developing region as reference, 1.277 (1.131-1.441); 1.162 (1.058-1.277)]; the proportion of bystanders to follow DA-CPR [1.749 (1.554-1.967); 1.280 (1.188-1.380)]. Good outcomes of bystander-witnessed OHCAs correlate with regions having higher sensitivity of DA-CPR and larger proportion of bystanders to follow DA-CPR. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Cardiopulmonary Resuscitation: Unusual Techniques for Unusual Situations

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Vidhu Bhatnagar

2018-01-01

Full Text Available Background: The cardiopulmonary resuscitation (CPR in prone position has been dealt with in 2010 American Heart Association (AHA guidelines but have not been reviewed in 2015 guidelines. The guidelines for patients presenting with cardiac arrest under general anesthesia in lateral decubitus position and regarding resuscitation in confined spaces like airplanes are also not available in AHA guidelines. This article is an attempt to highlight the techniques adopted for resuscitation in these unusual situations. Aims: This study aims to find out the methodology and efficacy in nonconventional CPR approaches such as CPR in prone, CPR in lateral position, and CPR in confined spaces. Methods: We conducted a literature search using MeSH search strings such as CPR + Prone position, CPR + lateral Position, and CPR + confined spaces. Results: No randomized controlled trials are available. The literature search gives a handful of case reports, some simulation- and manikin-based studies but none can qualify for class I evidence. The successful outcome of CPR performed in prone position has shown compressions delivered on the thoracic spine with the same rate and force as they were delivered during supine position. A hard surface is required under the patient to provide uniform force and sternal counter pressure. Two rescuer technique for providing successful chest compression in lateral position has been documented in the few case reports published. Over the head CPR and straddle (STR, CPR has been utilized for CPR in confined spaces. Ventilation in operating rooms was taken care by an advanced airway in situ. Conclusion: A large number of studies of high quality are required to be conducted to determine the efficacy of CPR in such positions.

Advanced vs. Basic Life Support in the Treatment of Out-of-Hospital Cardiopulmonary Arrest in the Resuscitation Outcomes Consortium.

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Kurz, Michael Christopher; Schmicker, Robert H; Leroux, Brian; Nichol, Graham; Aufderheide, Tom P; Cheskes, Sheldon; Grunau, Brian; Jasti, Jamie; Kudenchuk, Peter; Vilke, Gary M; Buick, Jason; Wittwer, Lynn; Sahni, Ritu; Straight, Ronald; Wang, Henry E

2018-04-30

Prior observational studies suggest no additional benefit from advanced life support (ALS) when compared with providing basic life support (BLS) for patients with out-of-hospital cardiac arrest (OHCA). We compared the association of ALS care with OHCA outcomes using prospective clinical data from the Resuscitation Outcomes Consortium (ROC). Included were consecutive adults OHCA treated by participating emergency medical services (EMS) agencies between June 1, 2011, and June 30, 2015. We defined BLS as receipt of cardiopulmonary resuscitation (CPR) and/or automated defibrillation and ALS as receipt of an advanced airway, manual defibrillation, or intravenous drug therapy. We compared outcomes among patients receiving: 1) BLS-only; 2) BLS + late ALS; 3) BLS + early ALS; and 4) ALS-first care. Using multivariable logistic regression, we evaluated the associations between level of care and return of spontaneous circulation (ROSC), survival to hospital discharge, and survival with good functional status, adjusting for age, sex, witnessed arrest, bystander CPR, shockable initial rhythm, public location, EMS response time, CPR quality, and ROC site. Among 35,065 patients with OHCA, characteristics were median age 68 years (IQR 56-80), male 63.9%, witnessed arrest 43.8%, bystander CPR 50.6%, and shockable initial rhythm 24.2%. Care delivered was: 4.0% BLS-only, 31.5% BLS + late ALS, 17.2% BLS + early ALS, and 47.3% ALS-first. ALS care with or without initial BLS care was independently associated with increased adjusted ROSC and survival to hospital discharge unless delivered greater than 6 min after BLS arrival (BLS + late ALS). Regardless of when it was delivered, ALS care was not associated with significantly greater functional outcome. ALS care was associated with survival to hospital discharge when provided initially or within six minutes of BLS arrival. ALS care, with or without initial BLS care, was associated with increased ROSC, however it was

Advance care planning preferences among dialysis patients and factors influencing their decisions

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Al-Jahdali Hamdan

2009-01-01

Full Text Available To determine the resuscitation preferences of hemodialysis (HD Saudi patients, we con-ducted a cross-sectional, observational descriptive questionnaire study in two major tertiary hospitals in Saudi Arabia from March to December 2007. We enrolled all the patients on HD for two years or more, and excluded the patients who were transplant candidates, confused, or demented. The questionnaire was com-posed of 4 sections. The first 3 sections were concerned with demographic data, education levels, employ-ment, family size, number of children, and functionality status besides knowledge about cardiopulmonary resuscitation (CPR, mechanical ventilation, and ICU admission. The fourth section contained different sce-narios and questions on personal and preferences such as end of life decisions, medical interventions, CPR, ICU admission, and the decision maker in these events. A total of 100 patients (53% males, 67% Saudis, and 85% married were enrolled in the study. The mean duration on dialysis was 6.0 years (± 4.1. More than 70% of the patients viewed themselves as above average in the religiosity score, and 44% disclosed a good life quality. More than 95% had little or no knowledge about cardiac resuscitation, intubation, and mechanical ventilation. The majority of the patients authorized their treating physician to decide for them about cardiac resuscitation in case they did not make advanced directives and only 22% believed that this decision should be made by their family members. If their physician believed their condition was hopeless, 77% preferred to stay at home. We conclude that the majority of our patients had limited awareness about cardiac resuscitation measures. The majority of the patients trust their physicians to decide about the futility of resuscitation. Patients were able to decide reasonably well when they are well informed.

Advance care planning preferences among dialysis patients and factors influencing their decisions

International Nuclear Information System (INIS)

AlJahdali, Hamdan H.; Bahroon, Salim; Babgi, Yaser; Tamim, Hani; AlGhamdi, Saeed M.; AlSayyari, Abdullah A.

2009-01-01

To determine the resuscitation preferences of hemodialysis (HD) Saudi patients, we conducted a cross-sectional, observational descriptive questionnaire study in two major tertiary hospitals in Saudi Arabia from March to December 2007. We enrolled all the patients on HD for two years or more, and excluded the patients who were transplant candidates, confused, or demented. The questionnaire was composed of 4 sections. The first 3 sections were concerned with demographic data, education levels, employment, family size, number of children, and functionality status besides knowledge about cardiopulmonary resuscitation (CPR), mechanical ventilation, and ICU admission. The fourth section contained different scenarios and questions on personal and preferences such as end of life decisions, medical interventions, CPR, ICU admission, and the decision maker in these events. A total of 100 patients (53% males, 67% Saudis, and 85% married) were enrolled in the study. The mean duration on dialysis was 6.0 years (+- 4.1). More than 70% of the patients viewed themselves as above average in the religiosity score, and 44% disclosed a good life quality. More than 95% had little or no knowledge about cardiac resuscitation, intubation, and mechanical ventilation. The majority of the patients authorized their treating physician to decide for them about cardiac resuscitation in case they did not make advanced directives and only 22% believed that this decision should be made by their family members. If their physician believed their condition was hopeless, 77% preferred to stay at home. We conclude that the majority of our patients had limited awareness about cardiac resuscitation measures. The majority of the patients trust their physicians to decide about the futility of resuscitation. Patients were able to decide reasonably well when they are well informed. (author)

Brain computed tomographic findings in post-cardiopulmonary resuscitation patients

International Nuclear Information System (INIS)

Ishida, Tsuguharu; Yoshinaga, Kazumasa; Horibe, Takashi; Kokubu, Kiyokazu; Kokura, Yoshihiro; Matsui, Konosuke; Inamoto, Kazuo.

1986-01-01

We retrospectively assessed the brain computed tomographic (CT) findings in 22 post-cardiopulmonary resuscitation (CPR) patients excluding neonatal cases. On the basis of the CT findings, the patients were divided into two groups. Eight patients (36.4 %) had bilateral abnormal lowdensity areas in the basal ganglia (Group I). The remaining 14 patients (63.6 %) had no abnormalities in that area (Group II). In Group I, the incidence of primary cardiac arrest and duration of advanced life support (ALS) was significantly different (p < 0.05) from Group II. Sex, age, duration of basic life support (BLS), time elapsed from initiation of BLS to initial CT and from initiation of ALS to initial CT was not significantly different between the two groups. Outcome was very poor in both groups and no significant difference was noted between them. We conclude that primary cardiac arrest and long duration of ALS were predictors of abnormal bilateral low-density areas in the basal ganglia in post-CPR patients. However, their appearance was not related to outcome. (author)

Extracorporeal membrane oxygenation for refractory cardiac arrest

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Steven A Conrad

2017-01-01

Full Text Available Extracorporeal cardiopulmonary resuscitation (ECPR is the use of rapid deployment venoarterial (VA extracorporeal membrane oxygenation to support systemic circulation and vital organ perfusion in patients in refractory cardiac arrest not responding to conventional cardiopulmonary resuscitation (CPR. Although prospective controlled studies are lacking, observational studies suggest improved outcomes compared with conventional CPR when ECPR is instituted within 30-60 min following cardiac arrest. Adult and pediatric patients with witnessed in-hospital and out-of-hospital cardiac arrest and good quality CPR, failure of at least 15 min of conventional resuscitation, and a potentially reversible cause for arrest are candidates. Percutaneous cannulation where feasible is rapid and can be performed by nonsurgeons (emergency physicians, intensivists, cardiologists, and interventional radiologists. Modern extracorporeal systems are easy to prime and manage and are technically easy to manage with proper training and experience. ECPR can be deployed in the emergency department for out-of-hospital arrest or in various inpatient units for in-hospital arrest. ECPR should be considered for patients with refractory cardiac arrest in hospitals with an existing extracorporeal life support program, able to provide rapid deployment of support, and with resources to provide postresuscitation evaluation and management.

Tension pneumoperitoneum after bystander cardiopulmonary resuscitation: A case report

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Sherry Johnson

2018-01-01

Conclusion: The Veress needle, usually used for insufflating the abdomen during laparoscopy, can also be an effective tool to decompress the abdomen when presented with tension pneumoperitoneum. Abdominal visceral injuries are rare following CPR but do occur and will likely require an invasive intervention. Surviving cardiac arrest as a young person and living without deficits outweighs the risk of a surgical correction for a visceral injury. While resuscitation measures are critical for survival, medical personnel need to be aware of potential complications from resuscitative efforts and potential management strategies.

Association of Bystander Cardiopulmonary Resuscitation and Survival According to Ambulance Response Times After Out-of-Hospital Cardiac Arrest.

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Rajan, Shahzleen; Wissenberg, Mads; Folke, Fredrik; Hansen, Steen Møller; Gerds, Thomas A; Kragholm, Kristian; Hansen, Carolina Malta; Karlsson, Lena; Lippert, Freddy K; Køber, Lars; Gislason, Gunnar H; Torp-Pedersen, Christian

2016-12-20

Bystander-initiated cardiopulmonary resuscitation (CPR) increases patient survival after out-of-hospital cardiac arrest, but it is unknown to what degree bystander CPR remains positively associated with survival with increasing time to potential defibrillation. The main objective was to examine the association of bystander CPR with survival as time to advanced treatment increases. We studied 7623 out-of-hospital cardiac arrest patients between 2005 and 2011, identified through the nationwide Danish Cardiac Arrest Registry. Multiple logistic regression analysis was used to examine the association between time from 911 call to emergency medical service arrival (response time) and survival according to whether bystander CPR was provided (yes or no). Reported are 30-day survival chances with 95% bootstrap confidence intervals. With increasing response times, adjusted 30-day survival chances decreased for both patients with bystander CPR and those without. However, the contrast between the survival chances of patients with versus without bystander CPR increased over time: within 5 minutes, 30-day survival was 14.5% (95% confidence interval [CI]: 12.8-16.4) versus 6.3% (95% CI: 5.1-7.6), corresponding to 2.3 times higher chances of survival associated with bystander CPR; within 10 minutes, 30-day survival chances were 6.7% (95% CI: 5.4-8.1) versus 2.2% (95% CI: 1.5-3.1), corresponding to 3.0 times higher chances of 30-day survival associated with bystander CPR. The contrast in 30-day survival became statistically insignificant when response time was >13 minutes (bystander CPR vs no bystander CPR: 3.7% [95% CI: 2.2-5.4] vs 1.5% [95% CI: 0.6-2.7]), but 30-day survival was still 2.5 times higher associated with bystander CPR. Based on the model and Danish out-of-hospital cardiac arrest statistics, an additional 233 patients could potentially be saved annually if response time was reduced from 10 to 5 minutes and 119 patients if response time was reduced from 7 (the median

Epinephrine in Out-of-hospital Cardiac Arrest: Helpful or Harmful?

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Shao, Huan; Li, Chun-Sheng

2017-09-05

Epinephrine is the primary drug administered during cardiopulmonary resuscitation (CPR) to reverse cardiac arrest. The evidence for the use of adrenaline in out-of-hospital cardiac arrest (OHCA) and in-hospital resuscitation is inconclusive. We conducted a systematic review on the clinical efficacy of adrenaline in adult OHCA patients to evaluate whether epinephrine provides any overall benefit for patients. The EMBASE and PubMed databases were searched with the key words "epinephrine," "cardiac arrest," and variations of these terms. Data from clinical randomized trials, meta-analyses, guidelines, and recent reviews were selected for review. Sudden cardiac arrest causes 544,000 deaths in China each year, with survival occurring in CPR. There is currently insufficient evidence to support or reject epinephrine administration during resuscitation. We believe that epinephrine may have a role in resuscitation, as administration of epinephrine during CPR increases the probability of restoring cardiac activity with pulses, which is an essential intermediate step toward long-term survival. The administration of adrenaline was associated with improved short-term survival (ROSC). However, it appears that the use of adrenaline is associated with no benefit on survival to hospital discharge or survival with favorable neurological outcome after OHCA, and it may have a harmful effect. Larger placebo-controlled, double-blind, randomized control trials are required to definitively establish the effect of epinephrine.

Resuscitation Outcomes Consortium (ROC) PRIMED cardiac arrest trial methods part 1: rationale and methodology for the impedance threshold device (ITD) protocol.

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Aufderheide, Tom P; Kudenchuk, Peter J; Hedges, Jerris R; Nichol, Graham; Kerber, Richard E; Dorian, Paul; Davis, Daniel P; Idris, Ahamed H; Callaway, Clifton W; Emerson, Scott; Stiell, Ian G; Terndrup, Thomas E

2008-08-01

The primary aim of this study is to compare survival to hospital discharge with a modified Rankin score (MRS)CPR) plus an active impedance threshold device (ITD) versus standard CPR plus a sham ITD in patients with out-of-hospital cardiac arrest. Secondary aims are to compare functional status and depression at discharge and at 3 and 6 months post-discharge in survivors. Prospective, double-blind, randomized, controlled, clinical trial. Patients with non-traumatic out-of-hospital cardiac arrest treated by emergency medical services (EMS) providers. EMS systems participating in the Resuscitation Outcomes Consortium. Based on a one-sided significance level of 0.025, power=0.90, a survival with MRSCPR and sham ITD, and two interim analyses, a maximum of 14,742 evaluable patients are needed to detect a 6.69% survival with MRSCPR and active ITD (1.36% absolute survival difference). If the ITD demonstrates the hypothesized improvement in survival, it is estimated that 2700 deaths from cardiac arrest per year would be averted in North America alone.

Quality of cardio-pulmonary resuscitation (CPR) during paediatric resuscitation training: time to stop the blind leading the blind.

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Arshid, Muhammad; Lo, Tsz-Yan Milly; Reynolds, Fiona

2009-05-01

Recent evidence suggested that the quality of cardio-pulmonary resuscitation (CPR) during adult advanced life support training was suboptimal. This study aimed to assess the CPR quality of a paediatric resuscitation training programme, and to determine whether it was sufficiently addressed by the trainee team leaders during training. CPR quality of 20 consecutive resuscitation scenario training sessions was audited prospectively using a pre-designed proforma. A consultant intensivist and a senior nurse who were also Advanced Paediatric Life Support (APLS) instructors assessed the CPR quality which included ventilation frequency, chest compression rate and depth, and any unnecessary interruption in chest compressions. Team leaders' response to CPR quality and elective change of compression rescuer during training were also recorded. Airway patency was not assessed in 13 sessions while ventilation rate was too fast in 18 sessions. Target compression rate was not achieved in only 1 session. The median chest compression rate was 115 beats/min. Chest compressions were too shallow in 10 sessions and were interrupted unnecessarily in 13 sessions. More than 50% of training sessions did not have elective change of the compression rescuer. 19 team leaders failed to address CPR quality during training despite all team leaders being certified APLS providers. The quality of CPR performance was suboptimal during paediatric resuscitation training and team leaders-in-training had little awareness of this inadequacy. Detailed CPR quality assessment and feedback should be integrated into paediatric resuscitation training to ensure optimal performance in real life resuscitations.

Simulation in resuscitation teaching and training, an evidence based practice review.

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Sahu, Sandeep; Lata, Indu

2010-10-01

In the management of a patient in cardiac arrest, it is sometimes the least experienced provider giving chest compressions, intubating the patient, and running the code during the most crucial moment in that patient's life. Traditional methods of educating residents and medical students using lectures and bedside teaching are no longer sufficient. Today's generation of trainees grew up in a multimedia environment, learning on the electronic method of learning (online, internet) instead of reading books. It is unreasonable to expect the educational model developed 50 years ago to be able to adequately train the medical students and residents of today. One area that is difficult to teach is the diagnosis and management of the critically ill patient, specifically who require resuscitation for cardiac emergencies and cardiac arrest. Patient simulation has emerged as an educational tool that allows the learner to practice patient care, away from the bedside, in a controlled and safe environment, giving the learner the opportunity to practice the educational principles of deliberate practice and self-refection. We performed a qualitative literature review of the uses of simulators in resuscitation training with a focus on their current and potential applications in cardiac arrest and emergencies.

ERC initiatives to reduce the burden of cardiac arrest: the European Cardiac Arrest Awareness Day.

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Georgiou, Marios; Lockey, Andrew S

2013-09-01

The rate of survival from out-of-hospital cardiac arrest in Europe remains unacceptably low and could be increased by better bystander cardiopulmonary resuscitation (CPR) rates. The European Resuscitation Council has announced that there will be a European Cardiac Arrest Awareness Day every year on the 16th of October. This is to coincide with the goals of the Written Declaration passed by the European Parliament in June 2012 that emphasised the importance of equal access to CPR and automated external defibrillator (AED) training. The topic of this year's Awareness Day is 'Children Saving Lives' and it is hoped that all national resuscitation councils will promote awareness of the benefits of training all children in CPR and AED use and lobby for legislative change to ensure that all children receive this training. Children are not just the adults of tomorrow - they are the lifesavers of today and tomorrow. Copyright © 2013 Elsevier Ltd. All rights reserved.

[Cardiopulmonary resuscitation: the essential of 2015 guidelines].

Science.gov (United States)

Maudet, Ludovic; Carron, Pierre-Nicolas; Trueb, Lionel

2016-02-10

Cardiopulmonary resuscitation (CPR) guidelines have been updated in October 2015. The 2010 guidelines are reaffirmed: immediate call for help via the local dispatch center, high quality CPR (frequency between 100 and 120/min, compression depth between 5 and 6 cm) and early defibrillation improve patient's survival chances. This article reviews the essential elements of resuscitation and recommended advanced measures.

[Nursing process in advanced cardiopulmonary resuscitation].

Science.gov (United States)

Lucio Peña, Gerardo; Fuentes Leonardo, Ana María

2002-01-01

The process male nurse is a systematic and organized method to offer effective and efficient cares guided to the achievement of solving real problems of health, reducing the incidence and the duration. It is organized and systematic for that consists of five sequential and interrelated steps: Valuation, diagnostic, planning, execution and evaluation, in which are carried out interrelated actions, thought to maximize the long term results. The nurse process is based on the notion that the success of the cares is measured by the degree of effectiveness and the degree of satisfaction and the patient's progress. Applying this method in the Advanced Cardiac Live Support (ACLS) the identification of a cardiovascular or cardiopulmonary urgency was achieved that implies advanced treatment of the air road, defibrillation and appropriate medications to the circumstances. The ACLS challenges the nurses in charge from the patient's attention to make decisions quick low pressure and in dramatic scenes. Reason why it develops the flowing process male nurse in the advanced cardiopulmonary reanimation due to the incidence of these events in the National Institute of Cardiology Ignacio Chávez, which should guarantee the benefit of services in basic and advanced cardiopulmonary reanimation for personal with a high formation level in all the units of intensive cares and services of hospitalization in integrated form and stratified this way to avoid that it progresses to situations that cause the death or leave irreversible sequels since in the central nervous system the time it is a factor critical for the treatment of this events.

Study of the impact of training of registered nurses in cardiopulmonary resuscitation in a tertiary care centre on patient mortality

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Mayureshkumar Pareek

2018-01-01

Full Text Available Background and Aims: Nurses should have cardiopulmonary resuscitation (CPR knowledge and skills to be able to implement effective interventions during in-hospital cardiac arrest. The aim of this descriptive study was to assess mortality impact after nurses' CPR training with pre-CPR training data at our institute. Methods: Training regarding CPR was given to nurses, and CPR mortality 1-year before basic life support (BLS and advanced cardiac life support (ACLS training were collected and compared with post-training 1-year CPR mortality. Results: A total of 632 adult patients suffering in-hospital cardiac arrest over the study period. CPR was attempted in 294 patients during the pre-BLS/ACLS training period and in 338 patients in the post-BLS/ACLS training period. In the pre-BLS/ACLS training period, 58 patients (19.7% had return of spontaneous circulation (ROSC, while during the post-BLS/ACLS training period, 102 patients (30.1% had ROSC (P = 0.003. Sixteen of the 58 patients (27.5% who achieved ROSC during the pre-BLS/ACLS training period survived to hospital discharge, compared 54 out of 102 patients (52.9% in the post-BLS/ACLS training period (P < 0.0001. There was no significant association between either the age or sex with the outcomes in the study. Conclusion: Training nurses in cardiopulmonary resuscitation resulted in a significant improvement in survival to hospital discharge after in-hospital cardiac arrest.

Management of cardiac arrest caused by coronary artery spasm: epinephrine/adrenaline versus nitrates.

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Kiss, Gabor; Corre, Olivier; Gueret, Gildas; Nguyen Ba, Vinh; Gilard, Martine; Boschat, Jaques; Arvieux, Charles Chistian

2009-01-01

Cardiopulmonary resuscitation guidelines imply the use of epinephrine/adrenaline during cardiopulmonary arrest. However, in cardiac arrest situations resulting from coronary artery spasm (CAS), the use of epinephrine/adrenaline could be deleterious. A 49-year-old patient underwent an emergency coronarography with an attempt to stent the coronary arteries. Radiologic imaging revealed a positive methylergonovine maleate (Methergine, Novartis Pharmaceuticals, East Hanover, NJ) test, with subocclusive CAS in several coronary vessels leading to electromechanical dissociation. Cardiopulmonary resuscitation was performed, and intracoronary boluses of isosorbide dinitrate were given to treat CAS. Epinephrine/adrenaline was not administered during resuscitation. Spontaneous circulation was obtained after cardioversion for ventricular fibrillation, and the patient progressively regained consciousness. Resuscitation guidelines do not specify the use of trinitrate derivatives in cardiac arrest situations caused by CAS. The pros and cons of the use of nitrates and epinephrine/adrenaline during cardiac arrest caused by CAS are analyzed in this case report.

Usefulness of emergency ultrasound in nontraumatic cardiac arrest.

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Volpicelli, Giovanni

2011-02-01

Treatment of nontraumatic cardiac arrest in the hospital setting depends on the recognition of heart rhythm and differential diagnosis of the underlying condition while maintaining a constant oxygenated blood flow by ventilation and chest compression. Diagnostic process relies only on patient's history, physical findings, and active electrocardiography. Ultrasound is not currently scheduled in the resuscitation guidelines. Nevertheless, the use of real-time ultrasonography during resuscitation has the potential to improve diagnostic accuracy and allows the physician a greater confidence in deciding aggressive life-saving therapeutic procedures. This article reviews the current opinions and literature about the use of emergency ultrasound during resuscitation of nontraumatic cardiac arrest. Cardiac and lung ultrasound have a great potential in identifying the reversible mechanical causes of pulseless electrical activity or asystole. Brief examination of the heart can even detect a real cardiac standstill regardless of electrical activity displayed on the monitor, which is a crucial prognostic indicator. Moreover, ultrasound can be useful to verify and monitor the tracheal tube placement. Limitation to the use of ultrasound is the need to minimize the no-flow intervals during mechanical cardiopulmonary resuscitation. However, real-time ultrasound can be successfully applied during brief pausing of chest compression and first pulse-check. Finally, lung sonographic examination targeted to the detection of signs of pulmonary congestion has the potential to allow hemodynamic noninvasive monitoring before and after mechanical cardiopulmonary maneuvers. Copyright © 2011 Elsevier Inc. All rights reserved.

Protocol compliance and time management in blunt trauma resuscitation.

NARCIS (Netherlands)

Spanjersberg, W.R.; Bergs, E.A.; Mushkudiani, N.; Klimek, M.; Schipper, I.B.

2009-01-01

OBJECTIVES: To study advanced trauma life support (ATLS) protocol adherence prospectively in trauma resuscitation and to analyse time management of daily multidisciplinary trauma resuscitation at a level 1 trauma centre, for both moderately and severely injured patients. PATIENTS AND METHODS: All

Genetic, clinical and pharmacological determinants of out-of-hospital cardiac arrest: rationale and outline of the AmsteRdam Resuscitation Studies (ARREST) registry

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Blom, M T; van Hoeijen, D A; Bardai, A; Berdowski, J; Souverein, P C; De Bruin, M L; Koster, R W; de Boer, A; Tan, H L

2014-01-01

Introduction Out-of-hospital cardiac arrest (OHCA) is a major public health problem. Recognising the complexity of the underlying causes of OHCA in the community, we aimed to establish the clinical, pharmacological, environmental and genetic factors and their interactions that may cause OHCA. Methods and analysis We set up a large-scale prospective community-based registry (AmsteRdam Resuscitation Studies, ARREST) in which we prospectively include all resuscitation attempts from OHCA in a large study region in the Netherlands in collaboration with Emergency Medical Services. Of all OHCA victims since June 2005, we prospectively collect medical history (through hospital and general practitioner), and current and previous medication use (through community pharmacy). In addition, we include DNA samples from OHCA victims with documented ventricular tachycardia/fibrillation during the resuscitation attempt since July 2007. Various study designs are employed to analyse the data of the ARREST registry, including case–control, cohort, case only and case-cross over designs. Ethics and dissemination We describe the rationale, outline and potential results of the ARREST registry. The design allows for a stable and reliable collection of multiple determinants of OHCA, while assuring that the patient, lay-caregiver or medical professional is not hindered in any way. Such comprehensive data collection is required to unravel the complex basis of OHCA. Results will be published in peer-reviewed journals and presented at relevant scientific symposia. PMID:25332818

Updates in small animal cardiopulmonary resuscitation.

Science.gov (United States)

Fletcher, Daniel J; Boller, Manuel

2013-07-01

For dogs and cats that experience cardiopulmonary arrest, rates of survival to discharge are 6% to 7%, as compared with survival rates of 20% for people. The introduction of standardized cardiopulmonary resuscitation guidelines and training in human medicine has led to substantial improvements in outcome. The Reassessment Campaign on Veterinary Resuscitation initiative recently completed an exhaustive literature review and generated a set of evidence-based, consensus cardiopulmonary resuscitation guidelines in 5 domains: preparedness and prevention, basic life support, advanced life support, monitoring, and postcardiac arrest care. This article reviews some of the most important of these new guidelines. Copyright © 2013 Elsevier Inc. All rights reserved.

Cardiac Arrest Secondary to Lightning Strike: Case Report and Review of the Literature.

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Rotariu, Elena L; Manole, Mioara D

2017-08-01

Lightning strike injuries, although less common than electrical injuries, have a higher morbidity rate because of critical alterations of the circulatory system, respiratory system, and central nervous system. Most lightning-related deaths occur immediately after injury because of arrhythmia or respiratory failure. We describe the case of a pediatric patient who experienced cardiorespiratory arrest secondary to a lightning strike, where the Advanced Cardiac Life Support and Basic Life Support chain of survival was well executed, leading to return of spontaneous circulation and intact neurological survival. We review the pathophysiology of lightning injuries, prognostic factors of favorable outcome after cardiac arrest, including bystander cardiopulmonary resuscitation, shockable rhythm, and automatic external defibrillator use, and the importance of temperature management after cardiac arrest.

The influence of scenario-based training and real-time audiovisual feedback on out-of-hospital cardiopulmonary resuscitation quality and survival from out-of-hospital cardiac arrest.

Science.gov (United States)

Bobrow, Bentley J; Vadeboncoeur, Tyler F; Stolz, Uwe; Silver, Annemarie E; Tobin, John M; Crawford, Scott A; Mason, Terence K; Schirmer, Jerome; Smith, Gary A; Spaite, Daniel W

2013-07-01

We assess whether an initiative to optimize out-of-hospital provider cardiopulmonary resuscitation (CPR) quality is associated with improved CPR quality and increased survival from out-of-hospital cardiac arrest. This was a before-after study of consecutive adult out-of-hospital cardiac arrest. Data were obtained from out-of-hospital forms and defibrillators. Phase 1 included 18 months with real-time audiovisual feedback disabled (October 2008 to March 2010). Phase 2 included 16 months (May 2010 to September 2011) after scenario-based training of 373 professional rescuers and real-time audiovisual feedback enabled. The effect of interventions on survival to hospital discharge was assessed with multivariable logistic regression. Multiple imputation of missing data was used to analyze the effect of interventions on CPR quality. Analysis included 484 out-of-hospital cardiac arrest patients (phase 1 232; phase 2 252). Median age was 68 years (interquartile range 56-79); 66.5% were men. CPR quality measures improved significantly from phase 1 to phase 2: Mean chest compression rate decreased from 128 to 106 chest compressions per minute (difference -23 chest compressions; 95% confidence interval [CI] -26 to -19 chest compressions); mean chest compression depth increased from 1.78 to 2.15 inches (difference 0.38 inches; 95% CI 0.28 to 0.47 inches); median chest compression fraction increased from 66.2% to 83.7% (difference 17.6%; 95% CI 15.0% to 20.1%); median preshock pause decreased from 26.9 to 15.5 seconds (difference -11.4 seconds; 95% CI -15.7 to -7.2 seconds), and mean ventilation rate decreased from 11.7 to 9.5/minute (difference -2.2/minute; 95% CI -3.9 to -0.5/minute). All-rhythms survival increased from phase 1 to phase 2 (20/231, 8.7% versus 35/252, 13.9%; difference 5.2%; 95% CI -0.4% to 10.8%), with an adjusted odds ratio of 2.72 (95% CI 1.15 to 6.41), controlling for initial rhythm, witnessed arrest, age, minimally interrupted cardiac resuscitation

Prolonged closed cardiac massage using LUCAS device in out-of-hospital cardiac arrest with prolonged transport time

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Edouard Matevossian

2009-04-01

Full Text Available Edouard Matevossian1, Dietrich Doll4, Jakob Säckl1, Inga Sinicina5, Jürgen Schneider2, Gerhard Simon3, Norbert Hüser11Department of Surgery, 2Department of Anesthesiology and Intensive-Care Medicine; 3Department of Radiology, Technische Universität of Munich, Germany; 4Department of Visceral, Vascular and Thoracic Surgery, Philips University of Marburg, Marburg, Germany; 5Institute of Clinical Forensic Medicine, Ludwig-Maximilian University of Munich, Munich, GermanyAbstract: Saving more human lives through more effective reanimation measures is the goal of the new international guidelines on cardiopulmonary resuscitation as the decisive aspect for survival after cardiovascular arrest is that basic resuscitation should start immediately. According to the updated guidelines, the greatest efficacy in cardiac massage is only achieved when the right compression point, an adequate compression depth, vertical pressure, the correct frequency, and equally long phases of compression and decompression are achieved. The very highest priority is placed on restoring continuous circulation. Against this background, standardized continuous chest compression with active decompression has contributed to a favorable outcome in this case. The hydraulically operated and variably adjustable automatic Lund University Cardiac Arrest System (LUCAS device (Jolife, Lund, Sweden undoubtedly meets these requirements. This case report describes a 44-year-old patient who – approximately 15 min after the onset of clinical death due to apparent ventricular fibrillation – received cardiopulmonary resuscitation, initially by laypersons and then by the emergency medical team (manual chest compressions followed by situation-adjusted LUCAS compressions. Sinus rhythm was restored after more than 90 min of continuous resuscitation, with seven defibrillations. Interventional diagnostic workup did not reveal a causal morphological correlate for the condition on coronary

Take Heart America: A comprehensive, community-wide, systems-based approach to the treatment of cardiac arrest.

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Lick, Charles J; Aufderheide, Tom P; Niskanen, Robert A; Steinkamp, Janet E; Davis, Scott P; Nygaard, Susan D; Bemenderfer, Kim K; Gonzales, Louis; Kalla, Jeffrey A; Wald, Sarah K; Gillquist, Debbie L; Sayre, Michael R; Osaki Holm, Susie Y; Oski Holm, Susie Y; Oakes, Dana A; Provo, Terry A; Racht, Ed M; Olsen, John D; Yannopoulos, Demetris; Lurie, Keith G

2011-01-01

To determine out-of-hospital cardiac arrest survival rates before and after implementation of the Take Heart America program (a community-based initiative that sequentially deployed all of the most highly recommended 2005 American Heart Association resuscitation guidelines in an effort to increase out-of-hospital cardiac arrest survival). Out-of-hospital cardiac arrest patients in Anoka County, MN, and greater St. Cloud, MN, from November 2005 to June 2009. Two sites in Minnesota with a combined population of 439,692 people (greater St. Cloud and Anoka County) implemented: 1) widespread cardiopulmonary resuscitation and automated external defibrillator skills training in schools and businesses; 2) retraining of all emergency medical services personnel in methods to enhance circulation, including minimizing cardiopulmonary resuscitation interruptions, performing cardiopulmonary resuscitation before and after single-shock defibrillation, and use of an impedance threshold device; 3) additional deployment of automated external defibrillators in schools and public places; and 4) protocols for transport to and treatment by cardiac arrest centers for therapeutic hypothermia, coronary artery evaluation and treatment, and electrophysiological evaluation. More than 28,000 people were trained in cardiopulmonary resuscitation and automated external defibrillator use in the two sites. Bystander cardiopulmonary resuscitation rates increased from 20% to 29% (p = .086, odds ratio 1.7, 95% confidence interval 0.96-2.89). Three cardiac arrest centers were established, and hypothermia therapy for admitted out-of-hospital cardiac arrest victims increased from 0% to 45%. Survival to hospital discharge for all patients after out-of-hospital cardiac arrest in these two sites improved from 8.5% (nine of 106, historical control) to 19% (48 of 247, intervention phase) (p = .011, odds ratio 2.60, confidence interval 1.19-6.26). A financial analysis revealed that the cardiac arrest centers

Relationship between chest compression rates and outcomes from cardiac arrest.

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Idris, Ahamed H; Guffey, Danielle; Aufderheide, Tom P; Brown, Siobhan; Morrison, Laurie J; Nichols, Patrick; Powell, Judy; Daya, Mohamud; Bigham, Blair L; Atkins, Dianne L; Berg, Robert; Davis, Dan; Stiell, Ian; Sopko, George; Nichol, Graham

2012-06-19

Guidelines for cardiopulmonary resuscitation recommend a chest compression rate of at least 100 compressions per minute. Animal and human studies have reported that blood flow is greatest with chest compression rates near 120/min, but few have reported rates used during out-of-hospital (OOH) cardiopulmonary resuscitation or the relationship between rate and outcome. The purpose of this study was to describe chest compression rates used by emergency medical services providers to resuscitate patients with OOH cardiac arrest and to determine the relationship between chest compression rate and outcome. Included were patients aged ≥ 20 years with OOH cardiac arrest treated by emergency medical services providers participating in the Resuscitation Outcomes Consortium. Data were abstracted from monitor-defibrillator recordings during cardiopulmonary resuscitation. Multiple logistic regression analysis assessed the association between chest compression rate and outcome. From December 2005 to May 2007, 3098 patients with OOH cardiac arrest were included in this study. Mean age was 67 ± 16 years, and 8.6% survived to hospital discharge. Mean compression rate was 112 ± 19/min. A curvilinear association between chest compression rate and return of spontaneous circulation was found in cubic spline models after multivariable adjustment (P=0.012). Return of spontaneous circulation rates peaked at a compression rate of ≈ 125/min and then declined. Chest compression rate was not significantly associated with survival to hospital discharge in multivariable categorical or cubic spline models. Chest compression rate was associated with return of spontaneous circulation but not with survival to hospital discharge in OOH cardiac arrest.

Cardiac Intensive Care Unit Management of Patients After Cardiac Arrest: Now the Real Work Begins.

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Randhawa, Varinder K; Grunau, Brian E; Debicki, Derek B; Zhou, Jian; Hegazy, Ahmed F; McPherson, Terry; Nagpal, A Dave

2018-02-01

Survival with a good quality of life after cardiac arrest continues to be abysmal. Coordinated resuscitative care does not end with the effective return of spontaneous circulation (ROSC)-in fact, quite the contrary is true. Along with identifying and appropriately treating the precipitating cause, various components of the post-cardiac arrest syndrome also require diligent observation and management, including post-cardiac arrest neurologic injury and myocardial dysfunction, systemic ischemia-reperfusion phenomenon with potential consequent multiorgan failure, and the various sequelae of critical illness. There is growing evidence that an early invasive approach to coronary reperfusion with percutaneous coronary intervention, together with active targeted temperature management and optimization of hemodynamic, ventilator, and metabolic parameters, may improve survival and neurologic outcomes in cardiac arrest survivors. Neuroprognostication is complex, as are survivorship issues and long-term rehabilitation. Our paramedics, emergency physicians, and resuscitation specialists are all to be congratulated for ever-increasing success with ROSC… but now the real work begins. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Round-the-table teaching: a novel approach to resuscitation education.

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McGarvey, Kathryn; Scott, Karen; O'Leary, Fenton

2014-10-01

Effective cardiopulmonary resuscitation saves lives. Health professionals who care for acutely unwell children need to be prepared to care for a child in arrest. Hospitals must ensure that their staff have the knowledge, confidence and ability to respond to a child in cardiac arrest. RESUS4KIDS is a programme designed to teach paediatric resuscitation to health care professionals who care for acutely unwell children. The programme is delivered in two components: an e-learning component for pre-learning, followed by a short, practical, face-to-face course that is taught using the round-the-table teaching approach. Round-the-table teaching is a novel, evidence-based small group teaching approach designed to teach paediatric resuscitation skills and knowledge. Round-the-table teaching uses a structured approach to managing a collapsed child, and ensures that each participant has the opportunity to practise the essential resuscitation skills of airway manoeuvres, bag mask ventilation and cardiac compressions. Round-the-table teaching is an engaging, non-threatening approach to delivering interdisciplinary paediatric resuscitation education. The methodology ensures that all participants have the opportunity to practise each of the different essential skills associated with the Danger, Response, Send for help, Airway, Breathing, Circulation, Defibrillation or rhythm recognition (DRSABCD) approach to the collapsed child. Round-the-table teaching is based on evidence-based small group teaching methods. The methodology of round-the-table teaching can be applied to any topic where participants must demonstrate an understanding of a sequential approach to a clinical skill. Round-the-table teaching uses a structured approach to managing a collapsed child. © 2014 The Authors. The Clinical Teacher published by Association for the Study of Medical Education and John Wiley & Sons Ltd.

A Novel Use of a Metronome in Dispatcher-assisted Cardiopulmonary Resuscitation.

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Ateyyah, Khalid A; Cady, Charles E; Poltrock, James T; Pirrallo, Ronald G

2015-01-01

Abstract Early, high-quality cardiopulmonary resuscitation (CPR) is the key to increasing the likelihood of successful resuscitation in cardiac arrest. The use of dispatch-assisted (DA) CPR can increase the likelihood of bystander CPR. We describe a case in which a metronome was introduced to guide DA-CPR. The wife of a 52-year-old male activated 9-1-1 after her husband suffered a cardiac arrest. During her 9-1-1 call she received CPR instructions and heard a metronome over the phone while following the instructions. Return of spontaneous circulation of the patient occurred during paramedic on scene care. The patient was transported to hospital and discharged 6 days later with no neurological deficit. This case supports the use of a metronome by emergency medical dispatchers during the provision of DA-CPR to improve bystander CPR.

Cardiac autonomic modulation impairments in advanced breast cancer patients.

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Arab, Claudia; Vanderlei, Luiz Carlos Marques; da Silva Paiva, Laércio; Fulghum, Kyle Levi; Fristachi, Carlos Elias; Nazario, Afonso Celso Pinto; Elias, Simone; Gebrim, Luiz Henrique; Ferreira Filho, Celso; Gidron, Yori; Ferreira, Celso

2018-05-02

To compare cardiac autonomic modulation in early- versus advanced-stage breast cancer patients before any type of cancer treatment and investigate associated factors. This cross-sectional study included women (30-69 years old) with primary diagnosis of breast cancer and women with benign breast tumors. We evaluated cardiac modulation by heart rate variability and assessed factors of anxiety, depression, physical activity, and other relevant medical variables. Patients were divided into three groups based on TNM staging of cancer severity: early-stage cancer (n = 42), advanced-stage cancer (n = 37), or benign breast tumors to serve as a control (n = 37). We analyzed heart rate variability in time and frequency domains. The advanced-stage cancer group had lower vagal modulation than early-stage and benign groups; also, the advance-stage group had lower overall heart rate variability when compared to benign conditions. Heart rate variability was influenced by age, menopausal status, and BMI. Heart rate variability seems to be a promising, non-invasive tool for early diagnosis of autonomic dysfunction in breast cancer and detection of cardiovascular impairments at cancer diagnosis. Cardiac autonomic modulation is inversely associated with breast cancer staging.

Estimating cost-effectiveness of mass cardiopulmonary resuscitation training strategies to improve survival from cardiac arrest in private locations.

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Swor, Robert; Compton, Scott

2004-01-01

Most cardiopulmonary resuscitation (CPR) trainees are young, and most cardiac arrests occur in private residences witnessed by older individuals. To estimate the cost-effectiveness of a CPR training program targeted at citizens over the age of 50 years compared with that of current nontargeted public CPR training. A model was developed using cardiac arrest and known demographic data from a single suburban zip code (population 36,325) including: local data (1997-1999) regarding cardiac arrest locations (public vs. private); incremental survival with CPR (historical survival rate 7.8%, adjusted odds ratio for CPR 2.0); arrest bystander demographics obtained from bystander telephone interviews; zip code demographics regarding population age and distribution; and 12.50 dollars per student for the cost of CPR training. Published rates of CPR training programs by age were used to estimate the numbers typically trained. Several assumptions were made: 1) there would be one bystander per. arrest; 2) the bystander would always perform CPR if trained; 3) cardiac arrest would be evenly distributed in the population; and 4) CPR training for a proportion of the population would proportionally increase CPR provision. Rates of arrest, bystanders by age, number of CPR trainees needed to result in increased arrest survival, and training cost per life saved for a one-year study period were calculated. There were 24.3 cardiac arrests per year, with 21.9 (90%) occurring in homes. In 66.5% of the home arrests, the bystander was more than 50 years old. To yield one additional survivor using the current CPR training strategy, 12,306 people needed to be trained (3,510 bystanders aged 50 years), which resulted in CPR provision to 7.14 additional patients. The training cost per life saved for a bystander aged 50 years was 785,040 dollars. Using a strategy of training only those cost of 53,383 dollars per life saved. Using these assumptions, current CPR training strategy is not a cost

Naloxone and epinephrine are equally effective for cardiopulmonary resuscitation in a rat asphyxia model.

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Chen, M-H; Xie, L; Liu, T-W; Song, F-Q; He, T

2006-10-01

It is not known whether naloxone is as efficacious as epinephrine during cardiopulmonary resuscitation (CPR). The aim of the study was to compare the effects of naloxone and epinephrine on the outcomes of CPR following asphyxial cardiac arrest in rats. Cardiac arrest was induced with asphyxia by clamping the tracheal tubes. Twenty-four Sprague-Dawley rats were randomized prospectively into a saline group (treated with normal saline, 1 ml intravenously, n = 8), an epinephrine group (treated with epinephrine, 0.04 mg/kg intravenously, n = 8) or a naloxone group (treated with naloxone, 1 mg/kg intravenously, n = 8) in a blind fashion during resuscitation after asphyxial cardiac arrest. After 5 min of untreated cardiac arrest, conventional manual CPR was started and each drug was administered at the same time. The rates of restoration of spontaneous circulation (ROSC) were one of eight (12.5%), seven of eight (87.5%) and seven of eight (87.5%) in the saline, epinephrine and naloxone groups, respectively. The rates of ROSC in the epinephrine and naloxone groups were equal and significantly greater than that in the saline group (P = 0.01 and P = 0.01, respectively). The administration of naloxone or epinephrine alone may increase the resuscitation rate, and both drugs are equally effective for CPR in a rat asphyxia model. However, the mechanism by which naloxone produces its efficacy during CPR remains unclear and further experimentation will be necessary.

The Stop-Only-While-Shocking algorithm reduces hands-off time by 17% during cardiopulmonary resuscitation

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Hansen, Lars Koch; Mohammed, Anna; Pedersen, Magnus

2016-01-01

INTRODUCTION: Reducing hands-off time during cardiopulmonary resuscitation (CPR) is believed to increase survival after cardiac arrests because of the sustaining of organ perfusion. The aim of our study was to investigate whether charging the defibrillator before rhythm analyses and shock delivery...... significantly reduced hands-off time compared with the European Resuscitation Council (ERC) 2010 CPR guideline algorithm in full-scale cardiac arrest scenarios. METHODS: The study was designed as a full-scale cardiac arrest simulation study including administration of drugs. Participants were randomized...... compressions. RESULTS: Sample size was calculated with an α of 0.05 and 80% power showed that we should test four scenarios with each algorithm. Twenty-nine physicians participated in 11 scenarios. Hands-off time was significantly reduced 17% using the SOWS algorithm compared with ERC2010 [22.1% (SD 2.3) hands...

Association of National Initiatives to Improve Cardiac Arrest Management With Rates of Bystander Intervention and Patient Survival After Out-of-Hospital Cardiac Arrest

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Wissenberg, Mads; Lippert, Freddy K; Folke, Fredrik

2013-01-01

resuscitation was attempted were identified between 2001 and 2010 in the nationwide Danish Cardiac Arrest Registry. Of 29 111 patients with cardiac arrest, we excluded those with presumed noncardiac cause of arrest (n = 7390) and those with cardiac arrests witnessed by emergency medical services personnel (n...

Cardiopulmonary resuscitation by trained responders versus lay persons and outcomes of out-of-hospital cardiac arrest: A community observational study.

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Park, Yoo Mi; Shin, Sang Do; Lee, Yu Jin; Song, Kyoung Jun; Ro, Young Sun; Ahn, Ki Ok

2017-09-01

The study aims to compare bystander processes of care (cardiopulmonary resuscitation (CPR) and defibrillation) and outcomes for witnessed presumed cardiac etiology in OHCA patients in whom initial resuscitation was provided by dedicated trained responder (TR) versus lay person (LP) bystanders. Data on witnessed and presumed cardiac OHCA in adults (15 years or older) from 2011 to 2015 in a metropolitan city with 10 million persons were collected, excluding cases in which the information on TRs, bystander CPR, defibrillation, and clinical outcomes was unknown. Exposure variables were TRs who were legally designated with CPR education and response and LPs who were bystanders who witnessed the OHCA by chance. The primary/secondary/tertiary outcomes were a good cerebral performance category (CPC) of 1 or 2, survival to discharge, and bystander defibrillation. A multivariable logistic regression analysis was used to calculate the adjusted odds ratio (AOR) with 95% confidence intervals (CIs), adjusting for potential confounders. Of 20,984 OHCA events, 6475 cases were ultimately analyzed. The TR group constituted 6.4% of the cases, and the patients showed significantly better survival and a good CPC. From the multivariable logistic regression analysis of the outcomes, by comparing the TR group with the LP group, the AOR (95% CIs) was 1.49 (1.04-2.15) for a good CPC, 1.59 (1.20-2.11) for survival to discharge, and 10.02 (7.04-14.26) for bystander defibrillation. The TR group witnessed a relatively low proportion of OHCA but was associated with better survival outcomes and good neurological recovery through higher CPR rates and defibrillation of adults older than 15 years with witnessed OHCA in a metropolitan city. Copyright © 2017 Elsevier B.V. All rights reserved.

Is hospital care of major importance for outcome after out-of-hospital cardiac arrest? Experience acquired from patients with out-of-hospital cardiac arrest resuscitated by the same Emergency Medical Service and admitted to one of two hospitals over a 16-year period in the municipality of Göteborg.

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Engdahl, J; Abrahamsson, P; Bång, A; Lindqvist, J; Karlsson, T; Herlitz, J

2000-02-01

To describe patient characteristics, hospital investigations and interventions and early mortality among patients being hospitalized after out-of-hospital cardiac arrest in two hospitals. Municipality of Göteborg, Sweden. All patients suffering an out-of-hospital cardiac arrest who were successfully resuscitated and admitted to hospital between 1 October 1980 and 31 December 1996. All patients were resuscitated by the same Emergency Medical Service and admitted alive to one of the two city hospitals in Göteborg. Of 579 patients admitted to Sahlgrenska Hospital, 253 (44%) were discharged alive and of 459 patients admitted to Ostra Hospital, 152 (33%) were discharged alive (P percentage of patients admitted to Sahlgrenska Hospital underwent coronary angiography (P < 0.001), electrophysiological testing (P < 0.001), Holter recording (P < 0.001), echocardiography (P = 0.004), percutaneous transluminal coronary angioplasty (PTCA, P = 0.009), implantation of automatic implantable cardioverter defibrillator (AICD, P = 0.03) and exercise stress tests (P = 0.003). Inhabitants in the catchment area of Ostra Hospital had a less favourable socio-economic profile. Survival after out-of-hospital cardiac arrest may be affected by the course of hospital management. Other variables that might influence survival are socio-economic factors and cardiorespiratory status on admission to hospital. Further investigation is called for as more patients are being hospitalised alive after out-of-hospital cardiac arrest.

A survey of attitudes and factors associated with successful cardiopulmonary resuscitation (CPR knowledge transfer in an older population most likely to witness cardiac arrest: design and methodology

Directory of Open Access Journals (Sweden)

Brehaut Jamie C

2008-11-01

Full Text Available Abstract Background Overall survival rates for out-of-hospital cardiac arrest rarely exceed 5%. While bystander cardiopulmonary resuscitation (CPR can increase survival for cardiac arrest victims by up to four times, bystander CPR rates remain low in Canada (15%. Most cardiac arrest victims are men in their sixties, they usually collapse in their own home (85% and the event is witnessed 50% of the time. These statistics would appear to support a strategy of targeted CPR training for an older population that is most likely to witness a cardiac arrest event. However, interest in CPR training appears to decrease with advancing age. Behaviour surrounding CPR training and performance has never been studied using well validated behavioural theories. Methods/Design The overall goal of this study is to conduct a survey to better understand the behavioural factors influencing CPR training and performance in men and women 55 years of age and older. The study will proceed in three phases. In phase one, semi-structured qualitative interviews will be conducted and recorded to identify common categories and themes regarding seeking CPR training and providing CPR to a cardiac arrest victim. The themes identified in the first phase will be used in phase two to develop, pilot-test, and refine a survey instrument based upon the Theory of Planned Behaviour. In the third phase of the project, the final survey will be administered to a sample of the study population over the telephone. Analyses will include measures of sampling bias, reliability of the measures, construct validity, as well as multiple regression analyses to identify constructs and beliefs most salient to seniors' decisions about whether to attend CPR classes or perform CPR on a cardiac arrest victim. Discussion The results of this survey will provide valuable insight into factors influencing the interest in CPR training and performance among a targeted group of individuals most susceptible to

Lay bystanders' perspectives on what facilitates cardiopulmonary resuscitation and use of automated external defibrillators in real cardiac arrests

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Malta Hansen, Carolina; Rosenkranz, Simone Mørk; Folke, Fredrik

2017-01-01

is crucial in improving survival, cannot cause substantial harm, and that the AED will provide guidance through CPR; prior hands-on training in AED use; during CPR performance, teamwork (ie, support), using the AED voice prompt and a ventilation mask, as well as demonstrating leadership and feeling a moral......BACKGROUND: Many patients who suffer an out-of-hospital cardiac arrest will fail to receive bystander intervention (cardiopulmonary resuscitation [CPR] or defibrillation) despite widespread CPR training and the dissemination of automated external defibrillators (AEDs). We sought to investigate what......, until data saturation. We used cross-sectional indexing (using software), and inductive in-depth thematic analyses, to identify those factors that facilitated CPR and AED use. In addition to prior hands-on CPR training, the following were described as facilitators: prior knowledge that intervention...

Development and validation of risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team.

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Harrison, David A; Patel, Krishna; Nixon, Edel; Soar, Jasmeet; Smith, Gary B; Gwinnutt, Carl; Nolan, Jerry P; Rowan, Kathryn M

2014-08-01

The National Cardiac Arrest Audit (NCAA) is the UK national clinical audit for in-hospital cardiac arrest. To make fair comparisons among health care providers, clinical indicators require case mix adjustment using a validated risk model. The aim of this study was to develop and validate risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team in UK hospitals. Risk models for two outcomes-return of spontaneous circulation (ROSC) for greater than 20min and survival to hospital discharge-were developed and validated using data for in-hospital cardiac arrests between April 2011 and March 2013. For each outcome, a full model was fitted and then simplified by testing for non-linearity, combining categories and stepwise reduction. Finally, interactions between predictors were considered. Models were assessed for discrimination, calibration and accuracy. 22,479 in-hospital cardiac arrests in 143 hospitals were included (14,688 development, 7791 validation). The final risk model for ROSC>20min included: age (non-linear), sex, prior length of stay in hospital, reason for attendance, location of arrest, presenting rhythm, and interactions between presenting rhythm and location of arrest. The model for hospital survival included the same predictors, excluding sex. Both models had acceptable performance across the range of measures, although discrimination for hospital mortality exceeded that for ROSC>20min (c index 0.81 versus 0.72). Validated risk models for ROSC>20min and hospital survival following in-hospital cardiac arrest have been developed. These models will strengthen comparative reporting in NCAA and support local quality improvement. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Development and validation of risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team☆

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Harrison, David A.; Patel, Krishna; Nixon, Edel; Soar, Jasmeet; Smith, Gary B.; Gwinnutt, Carl; Nolan, Jerry P.; Rowan, Kathryn M.

2014-01-01

Aim The National Cardiac Arrest Audit (NCAA) is the UK national clinical audit for in-hospital cardiac arrest. To make fair comparisons among health care providers, clinical indicators require case mix adjustment using a validated risk model. The aim of this study was to develop and validate risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team in UK hospitals. Methods Risk models for two outcomes—return of spontaneous circulation (ROSC) for greater than 20 min and survival to hospital discharge—were developed and validated using data for in-hospital cardiac arrests between April 2011 and March 2013. For each outcome, a full model was fitted and then simplified by testing for non-linearity, combining categories and stepwise reduction. Finally, interactions between predictors were considered. Models were assessed for discrimination, calibration and accuracy. Results 22,479 in-hospital cardiac arrests in 143 hospitals were included (14,688 development, 7791 validation). The final risk model for ROSC > 20 min included: age (non-linear), sex, prior length of stay in hospital, reason for attendance, location of arrest, presenting rhythm, and interactions between presenting rhythm and location of arrest. The model for hospital survival included the same predictors, excluding sex. Both models had acceptable performance across the range of measures, although discrimination for hospital mortality exceeded that for ROSC > 20 min (c index 0.81 versus 0.72). Conclusions Validated risk models for ROSC > 20 min and hospital survival following in-hospital cardiac arrest have been developed. These models will strengthen comparative reporting in NCAA and support local quality improvement. PMID:24830872

Data supporting the use of end-tidal carbon dioxide (ETCO2 measurement to guide management of cardiac arrest: A systematic review

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Edison F. Paiva

2018-06-01

Full Text Available The data presented in this article are related to the research article, “The Use of End-Tidal Carbon Dioxide (ETCO2 Measurement to Guide Management of Cardiac Arrest: A Systematic Review” [1]. This article is a systematic review and meta-analysis of existing data on the subject of whether any level of end-tidal carbon dioxide (ETCO2 measured during cardiopulmonary resuscitation (CPR correlates with return of spontaneous circulation (ROSC or survival in adult patients experiencing cardiac arrest in any setting. These data are made publicly available to enable critical or extended analyses. Keywords: Cardiac arrest, End tidal carbon dioxide, Prognostication, Advanced cardiac life support, Capnography, Systematic review, Meta-analysis

Dispatcher-assisted bystander cardiopulmonary resuscitation and survival in out-of-hospital cardiac arrest.

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Hagihara, Akihito; Onozuka, Daisuke; Shibuta, Hidetoshi; Hasegawa, Manabu; Nagata, Takashi

2018-04-19

Bystander cardiopulmonary resuscitation (CPR) is critical to the survival of patients with out-of-hospital cardiac arrest (OHCA). However, it is unknown whether bystander CPR with or without dispatcher assistance is more effective or why. Thus, we evaluated the association between dispatcher-assisted bystander CPR (vs. bystander CPR without dispatcher assistance) and survival of patients with OHCA. This is a retrospective, nonrandomized, observational study using national registry data for all OHCAs. We performed a propensity analysis. Patients with OHCA of cardiac origin were 18-100 years of age and received bystander chest compression in Japan between 2005 and 2014. Outcome measures were bystander rescue breathing, return of spontaneous circulation (ROSC) before hospital arrival, and survival and Cerebral Performance Category (CPC) 1 or 2 at 1 month after the event. During the study period, 1,176,351 OHCAs occurred, and 87,400 cases met the inclusion criteria. Among propensity-matched patients, a negative association was observed between dispatcher-assisted bystander CPR and outcome measures in a fully-adjusted model [odds ratio (OR) (95% CI) for ROSC = 0.87 (0.78-0.97), P < 0.05; OR (95% CI) for 1-month survival = 0.81 (0.65-1.00), P < 0.05; OR (95% CI) for CPC 1 or 2 = 0.64 (0.43-0.93), P < 0.05]. OR of survival for dispatcher-assisted bystander CPR tended to decrease as the emergency medical services response time increased. Survival benefit was less for dispatcher-assisted bystander CPR with dispatcher assistance than without dispatcher assistance. Low quality is hypothesized to be the cause of the reduced benefit. Copyright © 2017 Elsevier B.V. All rights reserved.

The art of providing resuscitation in Greek mythology.

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Siempos, Ilias I; Ntaidou, Theodora K; Samonis, George

2014-12-01

We reviewed Greek mythology to accumulate tales of resuscitation and we explored whether these tales could be viewed as indirect evidence that ancient Greeks considered resuscitation strategies similar to those currently used. Three compendia of Greek mythology: The Routledge Handbook of Greek Mythology, The Greek Myths by Robert Graves, and Greek Mythology by Ioannis Kakridis were used to find potentially relevant narratives. Thirteen myths that may suggest resuscitation (including 1 case of autoresuscitation) were identified. Methods to attempt mythological resuscitation included use of hands (which may correlate with basic life support procedures), a kiss on the mouth (similar to mouth-to-mouth resuscitation), application of burning torches (which might recall contemporary use of external defibrillators), and administration of drugs (a possible analogy to advanced life support procedures). A careful assessment of relevant myths demonstrated that interpretations other than medical might be more credible. Although several narratives of Greek mythology might suggest modern resuscitation techniques, they do not clearly indicate that ancient Greeks presaged scientific methods of resuscitation. Nevertheless, these elegant tales reflect humankind's optimism that a dying human might be restored to life if the appropriate procedures were implemented. Without this optimism, scientific improvement in the field of resuscitation might not have been achieved.

Optimizing survival outcomes for adult patients with nontraumatic cardiac arrest [digest].

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Jung, Julianna; Zaurova, Milana

2016-10-22

Patient survival after cardiac arrest can be improved significantly with prompt and effective resuscitative care. This systematic review analyzes the basic life support factors that improve survival outcome, including chest compression technique and rapid defibrillation of shockable rhythms. For patients who are successfully resuscitated, comprehensive postresuscitation care is essential. Targeted temperature management is recommended for all patients who remain comatose, in addition to careful monitoring of oxygenation, hemodynamics, and cardiac rhythm. Management of cardiac arrest in circumstances such as pregnancy, pulmonary embolism, opioid overdose and other toxicologic causes, hypothermia, and coronary ischemia are also reviewed. [Points & Pearls is a digest of Emergency Medicine Practice].

Advances in cardiac magnetic resonance imaging of congenital heart disease

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Driessen, Mieke M.P. [University of Utrecht, University Medical Center Utrecht, Department of Radiology, PO Box 85500, Utrecht (Netherlands); University of Utrecht, University Medical Center Utrecht, Department of Cardiology, PO Box 85500, Utrecht (Netherlands); The Interuniversity Cardiology Institute of the Netherlands (ICIN) - Netherlands Heart Institute, PO Box 19258, Utrecht (Netherlands); Breur, Johannes M.P.J. [Wilhelmina Children' s Hospital, University Medical Center Utrecht, Department of Pediatric Cardiology, PO Box 85500, Utrecht (Netherlands); Budde, Ricardo P.J.; Oorschot, Joep W.M. van; Leiner, Tim [University of Utrecht, University Medical Center Utrecht, Department of Radiology, PO Box 85500, Utrecht (Netherlands); Kimmenade, Roland R.J. van; Sieswerda, Gertjan Tj [University of Utrecht, University Medical Center Utrecht, Department of Cardiology, PO Box 85500, Utrecht (Netherlands); Meijboom, Folkert J. [University of Utrecht, University Medical Center Utrecht, Department of Cardiology, PO Box 85500, Utrecht (Netherlands); Wilhelmina Children' s Hospital, University Medical Center Utrecht, Department of Pediatric Cardiology, PO Box 85500, Utrecht (Netherlands)

2015-01-01

Due to advances in cardiac surgery, survival of patients with congenital heart disease has increased considerably during the past decades. Many of these patients require repeated cardiovascular magnetic resonance imaging to assess cardiac anatomy and function. In the past decade, technological advances have enabled faster and more robust cardiovascular magnetic resonance with improved image quality and spatial as well as temporal resolution. This review aims to provide an overview of advances in cardiovascular magnetic resonance hardware and acquisition techniques relevant to both pediatric and adult patients with congenital heart disease and discusses the techniques used to assess function, anatomy, flow and tissue characterization. (orig.)

Sudden Cardiac Death in Children. Part 2

Directory of Open Access Journals (Sweden)

Ye.V. Pshenichnaya

2013-03-01

Full Text Available This article deals with the dysplastic changes in musculo-valve structures of the heart, arrhythmias and conduction disorders, associated with a risk of sudden cardiac death. The diagnostic criteria for sudden cardiac death, the events of cardio-pulmonary resuscitation, prevention of life-threatening conditions in children are provided.

Cardiac arrest caused by sibutramine obtained over the Internet: a case of a young woman without pre-existing cardiovascular disease successfully resuscitated using extracorporeal membrane oxygenation.

Science.gov (United States)

Bunya, Naofumi; Sawamoto, Keigo; Uemura, Shuji; Kyan, Ryoko; Inoue, Hiroyuki; Nishida, Junichi; Kouzu, Hidemichi; Kokubu, Nobuaki; Miura, Tetsuji; Narimatsu, Eichi

2017-07-01

Sibutramine is a weight loss agent that was withdrawn from the market in the USA and European Union because it increases adverse events in patients with cardiovascular diseases. However, non-prescription weight loss pills containing sibutramine can be still easily purchased over the Internet. A 21-year-old woman without history of cardiovascular diseases developed cardiac arrest. She was a user of a weight loss pills, containing sibutramine and hypokalemia-inducing agents, imported from Thailand over the Internet. She was successfully resuscitated without any neurological deficits by using extracorporeal membrane oxygenation for refractory ventricular fibrillation. This case indicates that sibutramine can cause cardiac arrest even in subjects without pre-existing cardiovascular disease when combined with agents that promote QT prolongation.

Bystander defibrillation for out-of-hospital cardiac arrest in Public vs Residential Locations

DEFF Research Database (Denmark)

Hansen, Steen Møller; Hansen, Carolina Malta; Folke, Fredrik

2017-01-01

Importance: Bystander-delivered defibrillation (hereinafter referred to as bystander defibrillation) of patients with out-of-hospital cardiac arrests (OHCAs) remains limited despite the widespread dissemination of automated external defibrillators (AEDs). Objective: To examine calendar changes...... in bystander defibrillation and subsequent survival according to a public or a residential location of the cardiac arrest after nationwide initiatives in Denmark to facilitate bystander-mediated resuscitative efforts, including bystander defibrillation. Design, Setting, and Participants: This nationwide study......, 2016. Exposures: Nationwide initiatives to facilitate bystander resuscitative efforts, including bystander defibrillation, consisted of resuscitation training of Danish citizens, dissemination of on-site AEDs, foundation of an AED registry linked to emergency medical dispatch centers, and dispatcher...

Cardiopulmonary resuscitation in palliative care cancer patients.

Science.gov (United States)

Kjørstad, Odd Jarle; Haugen, Dagny Faksvåg

2013-02-19

The criteria for refraining from cardiopulmonary resuscitation in palliative care cancer patients are based on patients' right to refuse treatment and the duty of the treating personnel not to exacerbate their suffering and not to administer futile treatment. When is cardiopulmonary resuscitation futile in these patients? Systematic literature searches were conducted in PubMed for the period 1989-2010 on the results of in-hospital cardiopulmonary resuscitation in advanced cancer patients and on factors that affected the results of CPR when special mention was made of cancer. The searches yielded 333 hits and 18 included articles: four meta-analyses, eight retrospective clinical studies, and six review articles. Cancer patients had a poorer post-CPR survival than non-cancer patients. Survival declined with increasing extent of the cancer disease. Widespread and therapy-resistant cancer disease coupled with a performance status lower than WHO 2 or a PAM score (Pre-Arrest Morbidity Index) of above 8 was regarded as inconsistent with survival after cardiopulmonary resuscitation. Cardiopulmonary resuscitation is futile for in-hospital cancer patients with widespread incurable disease and poor performance status.

Two-year survival and neurodevelopmental outcomes after cardiopulmonary resuscitation in neonatal patients after complex cardiac surgery.

Science.gov (United States)

Hansen, Gregory; Joffe, Ari R; Nettel-Aguirre, Alberto; Robertson, Charlene M T; Biggs, Wayne S G; Ross, David B; Rebeyka, Ivan M

2011-03-01

To examine survival and neurodevelopmental outcomes in neonates having post-operative cardiopulmonary resuscitation (CPR). This inception cohort study included all neonates (6 weeks old or less) who received postoperative CPR (Group 1) after cardiac surgery from 1996 to 2005, matched for heart defect, year of surgery, chromosomal abnormality, and socioeconomic status to two neonates who did not receive postoperative CPR (Group 2). Two-year neurodevelopment was prospectively assessed with Bayley Scales of Infant Development II and Adaptive Behavior Assessment System II. Pre-, intra-, and post-operative variables were collected prospectively. Cardiac arrest variables were collected retrospectively. Predictors of mortality were analyzed by univariate analysis and conditional multiple logistic regression. There were 29 patients in Group 1, and 58 patients in Group 2. In survivors, there were no significant differences between Groups 1 and 2 in outcomes [mean (SD)] of mental developmental index [84.5 (12.2) vs. 81.0 (18.9)], psychomotor developmental index [82.8 (13.8) vs. 80.1 (21.9)], General Adaptive Composite [84.6 (15.3) vs. 84.3 (19.2)], Motor scale [8.4 (3.2) vs. 8.0 (3.8)], or delay on any of these scales. Two-year mortality [58.6% Group 1; 8.6% Group 2], was associated on conditional multiple logistic regression with CPR (OR 26.6; 95% CI, 5.4, 129.5). In Group 1, on multiple logistic regression, 2-year mortality was associated with minutes of chest compressions (OR 1.04, 95% CI, 1.01, 1.08). Among neonates having cardiac surgery, CPR is associated with greater mortality. There is no evidence that CPR survivors have different 2-year neurodevelopmental outcomes than those neonates not having CPR. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Development of Reliable and Validated Tools to Evaluate Technical Resuscitation Skills in a Pediatric Simulation Setting: Resuscitation and Emergency Simulation Checklist for Assessment in Pediatrics.

Science.gov (United States)

Faudeux, Camille; Tran, Antoine; Dupont, Audrey; Desmontils, Jonathan; Montaudié, Isabelle; Bréaud, Jean; Braun, Marc; Fournier, Jean-Paul; Bérard, Etienne; Berlengi, Noémie; Schweitzer, Cyril; Haas, Hervé; Caci, Hervé; Gatin, Amélie; Giovannini-Chami, Lisa

2017-09-01

To develop a reliable and validated tool to evaluate technical resuscitation skills in a pediatric simulation setting. Four Resuscitation and Emergency Simulation Checklist for Assessment in Pediatrics (RESCAPE) evaluation tools were created, following international guidelines: intraosseous needle insertion, bag mask ventilation, endotracheal intubation, and cardiac massage. We applied a modified Delphi methodology evaluation to binary rating items. Reliability was assessed comparing the ratings of 2 observers (1 in real time and 1 after a video-recorded review). The tools were assessed for content, construct, and criterion validity, and for sensitivity to change. Inter-rater reliability, evaluated with Cohen kappa coefficients, was perfect or near-perfect (>0.8) for 92.5% of items and each Cronbach alpha coefficient was ≥0.91. Principal component analyses showed that all 4 tools were unidimensional. Significant increases in median scores with increasing levels of medical expertise were demonstrated for RESCAPE-intraosseous needle insertion (P = .0002), RESCAPE-bag mask ventilation (P = .0002), RESCAPE-endotracheal intubation (P = .0001), and RESCAPE-cardiac massage (P = .0037). Significantly increased median scores over time were also demonstrated during a simulation-based educational program. RESCAPE tools are reliable and validated tools for the evaluation of technical resuscitation skills in pediatric settings during simulation-based educational programs. They might also be used for medical practice performance evaluations. Copyright © 2017 Elsevier Inc. All rights reserved.

Prognostic value of relative adrenal insufficiency after out-of-hospital cardiac arrest.

Science.gov (United States)

Pene, Frédéric; Hyvernat, Hervé; Mallet, Vincent; Cariou, Alain; Carli, Pierre; Spaulding, Christian; Dugue, Marie-Annick; Mira, Jean-Paul

2005-05-01

To assess the prevalence of relative adrenal insufficiency in patients successfully resuscitated after cardiac arrest, and its prognostic role in post-resuscitation disease. A prospective observational single-center study in a medical intensive care unit. 64 patients hospitalised in the intensive care unit after successful resuscitation for out-of-hospital cardiac arrest. A corticotropin-stimulation test was performed between 12 and 24 h following admission: serum cortisol level was measured before and 60 min after administration of tetracosactide 250 microg. Patients with an incremental response less than 9 microg/dl were considered to have relative adrenal insufficiency (non-responders). Variables were expressed as medians and interquartile ranges. 33 patients (52%) had relative adrenal insufficiency. Baseline cortisol level was higher in non-responders than in responders (41 [27.2-55.5] vs. 22.8 [15.7-35.1] microg/dl respectively, P=0.001). A long interval before initiation of cardiopulmonary resuscitation was associated with relative adrenal insufficiency (5 [3-10] vs. 3 [3-5] min, P=0.03). Of the 38 patients with post-resuscitation shock, 13 died of irreversible multiorgan failure. The presence of relative adrenal insufficiency was identified as a poor prognostic factor of shock-related mortality (log-rank P=0.02). A trend towards higher mortality in non-responders was identified in a multivariate logistic regression analysis (odds ratio 6.77, CI 95% 0.94-48.99, P=0.058). Relative adrenal insufficiency occurs frequently after successful resuscitation of out-of-hospital cardiac arrest, and appears to be associated with a poor prognosis in cases of post-resuscitation shock. The role of corticosteroid supplementation should be evaluated in this setting.

Simulation exercise to improve retention of cardiopulmonary resuscitation priorities for in-hospital cardiac arrests: A randomized controlled trial.

Science.gov (United States)

Sullivan, Nancy J; Duval-Arnould, Jordan; Twilley, Marida; Smith, Sarah P; Aksamit, Deborah; Boone-Guercio, Pam; Jeffries, Pamela R; Hunt, Elizabeth A

2015-01-01

Traditional American Heart Association (AHA) cardiopulmonary resuscitation (CPR) curriculum focuses on teams of two performing quality chest compressions with rescuers on their knees but does not include training specific to In-Hospital Cardiac Arrests (IHCA), i.e. patient in hospital bed with large resuscitation teams and sophisticated technology available. A randomized controlled trial was conducted with the primary goal of evaluating the effectiveness and ideal frequency of in-situ training on time elapsed from call for help to; (1) initiation of chest compressions and (2) successful defibrillation in IHCA. Non-intensive care unit nurses were randomized into four groups: standard AHA training (C) and three groups that participated in 15 min in-situ IHCA training sessions every two (2M), three (3M) or six months (6M). Curriculum included specific choreography for teams to achieve immediate chest compressions, high chest compression fractions and rapid defibrillation while incorporating use of a backboard, stepstool. More frequent training was associated with decreased median (IQR) seconds to: starting compressions: [C: 33(25-40) vs. 6M: 21(15-26) vs. 3M: 14(10-20) vs. 2M: 13(9-20); p training sessions: [C:5%(1/18) vs. 6M: 23%(4/17) vs. 3M: 56%(9/16) vs. 2M: 73%(11/15); p training sessions conducted every 3 months are effective in improving timely initiation of chest compressions and defibrillation in IHCA. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

European cardiovascular nurses' and allied professionals' knowledge and practical skills regarding cardiopulmonary resuscitation.

Science.gov (United States)

Pettersen, Trond R; Mårtensson, Jan; Axelsson, Åsa; Jørgensen, Marianne; Strömberg, Anna; Thompson, David R; Norekvål, Tone M

2018-04-01

Cardiopulmonary resuscitation (CPR) remains a cornerstone in the treatment of cardiac arrest, and is directly linked to survival rates. Nurses are often first responders and need to be skilled in the performance of cardiopulmonary resuscitation. As cardiopulmonary resuscitation skills deteriorate rapidly, the purpose of this study was to investigate whether there was an association between participants' cardiopulmonary resuscitation training and their practical cardiopulmonary resuscitation test results. This comparative study was conducted at the 2014 EuroHeartCare meeting in Stavanger ( n=133) and the 2008 Spring Meeting on Cardiovascular Nursing in Malmö ( n=85). Participants performed cardiopulmonary resuscitation for three consecutive minutes CPR training manikins from Laerdal Medical®. Data were collected with a questionnaire on demographics and participants' level of cardiopulmonary resuscitation training. Most participants were female (78%) nurses (91%) from Nordic countries (77%), whose main role was in nursing practice (63%), and 71% had more than 11 years' experience ( n=218). Participants who conducted cardiopulmonary resuscitation training once a year or more ( n=154) performed better regarding ventilation volume than those who trained less (859 ml vs. 1111 ml, p=0.002). Those who had cardiopulmonary resuscitation training offered at their workplace ( n=161) also performed better regarding ventilation volume (889 ml vs. 1081 ml, p=0.003) and compression rate per minute (100 vs. 91, p=0.04) than those who had not. Our study indicates a positive association between participants' performance on the practical cardiopulmonary resuscitation test and the frequency of cardiopulmonary resuscitation training and whether cardiopulmonary resuscitation training was offered in the workplace. Large ventilation volumes were the most common error at both measuring points.

The feasibility of inducing mild therapeutic hypothermia after cardiac resuscitation using iced saline infusion via an intraosseous needle.

Science.gov (United States)

Mader, Timothy J; Walterscheid, Joshua K; Kellogg, Adam R; Lodding, Cynthia C

2010-01-01

This study was done, using a swine model of prolonged ventricular fibrillation out-of-hospital cardiac arrest, to determine the feasibility of inducing therapeutic hypothermia after successful resuscitation by giving an intraosseous infusion of iced saline. This study was IACUC approved. Liter bags of normal saline, after being refrigerated for at least 24h, were placed in an ice filled cooler. Female Yorkshire swine weighing between 27 and 35 kg were sedated and instrumented under general anesthesia. A temperature probe was inserted 10 cm into the esophagus. Ventricular fibrillation was electrically induced and allowed to continue untreated for 10 min. Animals were randomized to one of two resuscitation schemes for the primary study (N=53). One group had central intravenous access for drug delivery and the other had an intraosseous needle inserted into the proximal tibia for drug administration. Animals in which spontaneous circulation was restored were immediately cooled, for this secondary study, by means of a rapid, pump-assisted infusion of 1L of iced saline either through the intraosseous needle (n=8), the central access (n=6), or a peripheral intravenous catheter (n=7) in a systematic, non-randomized fashion. Room, animal, and saline temperatures were recorded at initiation and upon completion of infusion. The data were analyzed descriptively using Stata SE v8.1 for Macintosh. The baseline characteristics of all three groups were mathematically the same. The average ambient room temperature during the experimental sessions was 25.5 degrees C (SD=1.3 degrees C). There were no statistically significant differences between the three groups with regard to saline temperature, rate of infusion, or decrease in core body temperature. The decrease in core temperature for the intraosseous group was 2.8 degrees C (95% CI=1.8, 3.8) over the infusion period. Mild therapeutic hypothermia can be effectively induced in swine after successful resuscitation of prolonged

GLP-1 analogues for neuroprotection after out-of-hospital cardiac arrest

DEFF Research Database (Denmark)

Wiberg, Sebastian; Hassager, Christian; Thomsen, Jakob Hartvig

2016-01-01

one-to-one fashion to a 6-hour and 15-minute infusion of either Exenatide or placebo. Patients are eligible for inclusion if resuscitated from cardiac arrest with randomization from 20 minutes to 240 minutes after return of spontaneous circulation. The co-primary endpoint is feasibility, defined......Background: Attenuating the neurological damage occurring after out-of-hospital cardiac arrest is an ongoing research effort. This dual-centre study investigates the neuroprotective effects of the glucagon-like-peptide-1 analogue Exenatide administered within 4 hours from the return of spontaneous...... circulation to comatose patients resuscitated from out-of-hospital cardiac arrest. Methods/design: This pilot study will randomize a total of 120 unconscious patients with sustained return of spontaneous circulation after out-of-hospital cardiac arrest undergoing targeted temperature management in a blinded...

A multimedia intervention on cardiopulmonary resuscitation and advance directives.

Science.gov (United States)

Yamada, R; Galecki, A T; Goold, S D; Hogikyan, R V

1999-09-01

To assess the effects of a multimedia educational intervention about advance directives (ADs) and cardiopulmonary resuscitation (CPR) on the knowledge, attitude and activity toward ADs and life-sustaining treatments of elderly veterans. Prospective randomized controlled, single blind study of educational interventions. General medicine clinic of a university-affiliated Veterans Affairs Medical Center (VAMC). One hundred seventeen Veterans, 70 years of age or older, deemed able to make medical care decisions. The control group (n = 55) received a handout about ADs in use at the VAMC. The experimental group (n = 62) received the same handout, with an additional handout describing procedural aspects and outcomes of CPR, and they watched a videotape about ADs. Patients' attitudes and actions toward ADs, CPR and life-sustaining treatments were recorded before the intervention, after it, and 2 to 4 weeks after the intervention through self-administered questionnaires. Only 27.8% of subjects stated that they knew what an AD is in the preintervention questionnaire. This proportion improved in both the experimental and control (87.2% experimental, 52.5% control) subject groups, but stated knowledge of what an AD is was higher in the experimental group (odds ratio = 6.18, p CPR. This improved after the intervention in the experimental group (OR = 4.27, p =.004), but did not persist at follow-up. In the postintervention questionnaire, few subjects in either group stated that they discussed CPR or ADs with their physician on that day (OR = 0.97, p = NS). We developed a convenient means of educating elderly male patients regarding CPR and advance directives that improved short-term knowledge but did not stimulate advance care planning.

Bystander-witnessed cardiac arrest is associated with reported agonal breathing and leads to less frequent bystander CPR.

Science.gov (United States)

Brinkrolf, P; Metelmann, B; Scharte, C; Zarbock, A; Hahnenkamp, K; Bohn, A

2018-04-18

Although the importance of bystander cardiopulmonary resuscitation has been shown in multiple studies, the rate of bystander cardiopulmonary resuscitation is still relatively low in many countries. Little is known on bystanders' perceptions influencing the decision to start cardiopulmonary resuscitation. Our study aims to determine such factors. Semi-structured telephone interviews with bystanders of out-of-hospital cardiac arrests between December 2014 and April 2016 were performed in a prospective manner. This single-center survey was conducted in the city of Münster, Germany. The bystander's sex and age, the perception of the victim's breathing and initial condition were correlated with the share of bystander cardiopulmonary resuscitation in the corresponding group. 101 telephone interviews were performed with 57 male and 44 female participants showing a mean age of 52.7 (SD ± 16.3). In case of apnoea 38 out of 46 bystanders (82.6%) started cardiopulmonary resuscitation; while in case of descriptions indicating agonal breathing 19 out of 35 bystanders (54.3%) started cardiopulmonary resuscitation (p = .007). If the patient was found unconscious 47 out of 63 bystanders (74.7%) performed cardiopulmonary resuscitation, while in cases of witnessed cardiac arrest 19 out of 38 bystanders (50%) attempted cardiopulmonary resuscitation (p = .012). Witnessed change of consciousness is an independent factor significantly lowering the probability of starting cardiopulmonary resuscitation (regression coefficient -1.489, p bystander-CPR was started. These data reinforce the importance of teaching the recognition of early cardiac arrest. Copyright © 2018 Elsevier B.V. All rights reserved.

A review of simulation-enhanced, team-based cardiopulmonary resuscitation training for undergraduate students.

Science.gov (United States)

Onan, Arif; Simsek, Nurettin; Elcin, Melih; Turan, Sevgi; Erbil, Bülent; Deniz, Kaan Zülfikar

2017-11-01

Cardiopulmonary resuscitation training is an essential element of clinical skill development for healthcare providers. The International Liaison Committee on Resuscitation has described issues related to cardiopulmonary resuscitation and emergency cardiovascular care education. Educational interventions have been initiated to try to address these issues using a team-based approach and simulation technologies that offer a controlled, safe learning environment. The aim of the study is to review and synthesize published studies that address the primary question "What are the features and effectiveness of educational interventions related to simulation-enhanced, team-based cardiopulmonary resuscitation training?" We conducted a systematic review focused on educational interventions pertaining to cardiac arrest and emergencies that addressed this main question. The findings are presented together with a discussion of the effectiveness of various educational interventions. In conclusion, student attitudes toward interprofessional learning and simulation experiences were more positive. Research reports emphasized the importance of adherence to established guidelines, adopting a holistic approach to training, and that preliminary training, briefing, deliberate practices, and debriefing should help to overcome deficiencies in cardiopulmonary resuscitation training. Copyright © 2017 Elsevier Ltd. All rights reserved.

Estradiol improves cardiac and hepatic function after trauma-hemorrhage: role of enhanced heat shock protein expression.

Science.gov (United States)

Szalay, László; Shimizu, Tomoharu; Suzuki, Takao; Yu, Huang-Ping; Choudhry, Mashkoor A; Schwacha, Martin G; Rue, Loring W; Bland, Kirby I; Chaudry, Irshad H

2006-03-01

Although studies indicate that 17beta-estradiol administration after trauma-hemorrhage (T-H) improves cardiac and hepatic functions, the underlying mechanisms remain unclear. Because the induction of heat shock proteins (HSPs) can protect cardiac and hepatic functions, we hypothesized that these proteins contribute to the salutary effects of estradiol after T-H. To test this hypothesis, male Sprague-Dawley rats ( approximately 300 g) underwent laparotomy and hemorrhagic shock (35-40 mmHg for approximately 90 min) followed by resuscitation with four times the shed blood volume in the form of Ringer lactate. 17beta-estradiol (1 mg/kg body wt) was administered at the end of the resuscitation. Five hours after T-H and resuscitation there was a significant decrease in cardiac output, positive and negative maximal rate of left ventricular pressure. Liver function as determined by bile production and indocyanine green clearance was also compromised after T-H and resuscitation. This was accompanied by an increase in plasma alanine aminotransferase (ALT) levels and liver perfusate lactic dehydrogenase levels. Furthermore, circulating levels of TNF-alpha, IL-6, and IL-10 were also increased. In addition to decreased cardiac and hepatic function, there was an increase in cardiac HSP32 expression and a reduction in HSP60 expression after T-H. In the liver, HSP32 and HSP70 were increased after T-H. There was no change in heart HSP70 and liver HSP60 after T-H and resuscitation. Estradiol administration at the end of T-H and resuscitation increased heart/liver HSPs expression, ameliorated the impairment of heart/liver functions, and significantly prevented the increase in plasma levels of ALT, TNF-alpha, and IL-6. The ability of estradiol to induce HSPs expression in the heart and the liver suggests that HSPs, in part, mediate the salutary effects of 17beta-estradiol on organ functions after T-H.

Randomized controlled trial of a video decision support tool for cardiopulmonary resuscitation decision making in advanced cancer.

Science.gov (United States)

Volandes, Angelo E; Paasche-Orlow, Michael K; Mitchell, Susan L; El-Jawahri, Areej; Davis, Aretha Delight; Barry, Michael J; Hartshorn, Kevan L; Jackson, Vicki Ann; Gillick, Muriel R; Walker-Corkery, Elizabeth S; Chang, Yuchiao; López, Lenny; Kemeny, Margaret; Bulone, Linda; Mann, Eileen; Misra, Sumi; Peachey, Matt; Abbo, Elmer D; Eichler, April F; Epstein, Andrew S; Noy, Ariela; Levin, Tomer T; Temel, Jennifer S

2013-01-20

Decision making regarding cardiopulmonary resuscitation (CPR) is challenging. This study examined the effect of a video decision support tool on CPR preferences among patients with advanced cancer. We performed a randomized controlled trial of 150 patients with advanced cancer from four oncology centers. Participants in the control arm (n = 80) listened to a verbal narrative describing CPR and the likelihood of successful resuscitation. Participants in the intervention arm (n = 70) listened to the identical narrative and viewed a 3-minute video depicting a patient on a ventilator and CPR being performed on a simulated patient. The primary outcome was participants' preference for or against CPR measured immediately after exposure to either modality. Secondary outcomes were participants' knowledge of CPR (score range of 0 to 4, with higher score indicating more knowledge) and comfort with video. The mean age of participants was 62 years (standard deviation, 11 years); 49% were women, 44% were African American or Latino, and 47% had lung or colon cancer. After the verbal narrative, in the control arm, 38 participants (48%) wanted CPR, 41 (51%) wanted no CPR, and one (1%) was uncertain. In contrast, in the intervention arm, 14 participants (20%) wanted CPR, 55 (79%) wanted no CPR, and 1 (1%) was uncertain (unadjusted odds ratio, 3.5; 95% CI, 1.7 to 7.2; P advanced cancer who viewed a video of CPR were less likely to opt for CPR than those who listened to a verbal narrative.

Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest.

Science.gov (United States)

Hasegawa, Kohei; Hiraide, Atsushi; Chang, Yuchiao; Brown, David F M

2013-01-16

It is unclear whether advanced airway management such as endotracheal intubation or use of supraglottic airway devices in the prehospital setting improves outcomes following out-of-hospital cardiac arrest (OHCA) compared with conventional bag-valve-mask ventilation. To test the hypothesis that prehospital advanced airway management is associated with favorable outcome after adult OHCA. Prospective, nationwide, population-based study (All-Japan Utstein Registry) involving 649,654 consecutive adult patients in Japan who had an OHCA and in whom resuscitation was attempted by emergency responders with subsequent transport to medical institutions from January 2005 through December 2010. Favorable neurological outcome 1 month after an OHCA, defined as cerebral performance category 1 or 2. Of the eligible 649,359 patients with OHCA, 367,837 (57%) underwent bag-valve-mask ventilation and 281,522 (43%) advanced airway management, including 41,972 (6%) with endotracheal intubation and 239,550 (37%) with use of supraglottic airways. In the full cohort, the advanced airway group incurred a lower rate of favorable neurological outcome compared with the bag-valve-mask group (1.1% vs 2.9%; odds ratio [OR], 0.38; 95% CI, 0.36-0.39). In multivariable logistic regression, advanced airway management had an OR for favorable neurological outcome of 0.38 (95% CI, 0.37-0.40) after adjusting for age, sex, etiology of arrest, first documented rhythm, witnessed status, type of bystander cardiopulmonary resuscitation, use of public access automated external defibrillator, epinephrine administration, and time intervals. Similarly, the odds of neurologically favorable survival were significantly lower both for endotracheal intubation (adjusted OR, 0.41; 95% CI, 0.37-0.45) and for supraglottic airways (adjusted OR, 0.38; 95% CI, 0.36-0.40). In a propensity score-matched cohort (357,228 patients), the adjusted odds of neurologically favorable survival were significantly lower both for

In-hospital resuscitation evaluated by in situ simulation: a prospective simulation study

DEFF Research Database (Denmark)

Mondrup, Frederik; Brabrand, Mikkel; Folkestad, Lars

2011-01-01

, and to examine differences in the resuscitation performance between the first responders and the cardiac arrest team. METHOD: S: A prospective observational study of 16 unannounced simulated cardiopulmonary arrest scenarios was conducted. The participants of the study involved all health care personel on duty...

Avanceret genoplivning af voksne

DEFF Research Database (Denmark)

Lippert, F.K.; Lauritsen, T.L.; Torp-Pedersen, C.

2008-01-01

International and European Resuscitation Council (ERC) Guidelines for Resuscitation 2005 implicate major changes in resuscitation, including new universal treatment algorithms. This brief summary of Guidelines 2005 for advanced resuscitation of adult cardiac arrest victims is based upon the ERC...

Emergency feasibility in medical intensive care unit of extracorporeal life support for refractory cardiac arrest.

Science.gov (United States)

Mégarbane, Bruno; Leprince, Pascal; Deye, Nicolas; Résière, Dabor; Guerrier, Gilles; Rettab, Samia; Théodore, Jonathan; Karyo, Souheil; Gandjbakhch, Iradj; Baud, Frédéric J

2007-05-01

To report the feasibility, complications, and outcomes of emergency extracorporeal life support (ECLS) in refractory cardiac arrests in medical intensive care unit (ICU). Prospective cohort study in the medical ICU in a university hospital in collaboration with the cardiosurgical team of a neighboring hospital. Seventeen patients (poisonings: 12/17) admitted over a 2-year period for cardiac arrest unresponsive to cardiopulmonary resuscitation (CPR) and advanced cardiac life support, without return of spontaneous circulation. ECLS femoral implantation under continuous cardiac massage, using a centrifugal pump connected to a hollow-fiber membrane oxygenator. Stable ECLS was achieved in 14 of 17 patients. Early complications included massive transfusions (n=8) and the need for surgical revision at the cannulation site for bleeding (n=1). Four patients (24%) survived at medical ICU discharge. Deaths resulted from multiorgan failure (n=8), thoracic bleeding(n=2), severe sepsis (n=2), and brain death (n=1). Massive hemorrhagic pulmonary edema during CPR (n=5) and major capillary leak syndrome (n=6) were observed. Three cardiotoxic-poisoned patients (18%, CPR duration: 30, 100, and 180 min) were alive at 1-year follow-up without sequelae. Two of these patients survived despite elevated plasma lactate concentrations before cannulation (39.0 and 20.0 mmol/l). ECLS was associated with a significantly lower ICU mortality rate than that expected from the Simplified Acute Physiology Score II (91.9%) and lower than the maximum Sequential Organ Failure Assessment score (>90%). Emergency ECLS is feasible in medical ICU and should be considered as a resuscitative tool for selected patients suffering from refractory cardiac arrest.

Adherence to AHA Guidelines When Adapted for Augmented Reality Glasses for Assisted Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial.

Science.gov (United States)

Siebert, Johan N; Ehrler, Frederic; Gervaix, Alain; Haddad, Kevin; Lacroix, Laurence; Schrurs, Philippe; Sahin, Ayhan; Lovis, Christian; Manzano, Sergio

2017-05-29

The American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) are nowadays recognized as the world's most authoritative resuscitation guidelines. Adherence to these guidelines optimizes the management of critically ill patients and increases their chances of survival after cardiac arrest. Despite their availability, suboptimal quality of CPR is still common. Currently, the median hospital survival rate after pediatric in-hospital cardiac arrest is 36%, whereas it falls below 10% for out-of-hospital cardiac arrest. Among emerging information technologies and devices able to support caregivers during resuscitation and increase adherence to AHA guidelines, augmented reality (AR) glasses have not yet been assessed. In order to assess their potential, we adapted AHA Pediatric Advanced Life Support (PALS) guidelines for AR glasses. The study aimed to determine whether adapting AHA guidelines for AR glasses increased adherence by reducing deviation and time to initiation of critical life-saving maneuvers during pediatric CPR when compared with the use of PALS pocket reference cards. We conducted a randomized controlled trial with two parallel groups of voluntary pediatric residents, comparing AR glasses to PALS pocket reference cards during a simulation-based pediatric cardiac arrest scenario-pulseless ventricular tachycardia (pVT). The primary outcome was the elapsed time in seconds in each allocation group, from onset of pVT to the first defibrillation attempt. Secondary outcomes were time elapsed to (1) initiation of chest compression, (2) subsequent defibrillation attempts, and (3) administration of drugs, as well as the time intervals between defibrillation attempts and drug doses, shock doses, and number of shocks. All these outcomes were assessed for deviation from AHA guidelines. Twenty residents were randomized into 2 groups. Time to first defibrillation attempt (mean: 146 s) and adherence to AHA guidelines in terms of time to other

Unexpected fatal neurological deterioration after successful cardio-pulmonary resuscitation and therapeutic hypothermia.

NARCIS (Netherlands)

Bergman, R.; Tjan, D.H.; Adriaanse, M.W.; Vugt, R. van; Zanten, A.R. van

2008-01-01

A 77-year-old woman was admitted to the intensive care unit after successful cardiopulmonary resuscitation for out-of-hospital cardiac arrest due to pulseless electrical activity. She was treated with mild therapeutic hypothermia to minimise secondary anoxic brain damage. After a 24 h period of

The effects of music on the cardiac resuscitation education of nursing students.

Science.gov (United States)

Tastan, Sevinc; Ayhan, Hatice; Unver, Vesile; Cinar, Fatma Ilknur; Kose, Gulsah; Basak, Tulay; Cinar, Orhan; Iyigun, Emine

2017-03-01

The purpose of this study is to examine the effects of music on the appropriate performance of the rate and depth of chest compression for nursing students. This randomized controlled study was conducted in the School of Nursing in Turkey between November 2014 and January 2015. The study's participants were second-year nursing school students with no previous formal cardiac resuscitation training (n=77). Participants were randomly assigned to one of two groups: an intervention group with music and a control group without music. During practical training, the intervention group performed chest compressions with music. The outcomes of this study were collected twice. The first evaluation was conducted one day after CPR education, and the second evaluation was conducted six weeks after the initial training. The first evaluation shows that the participants in the intervention group had an average rate of 107.33±7.29 chest compressions per minute, whereas the rate for the control group was 121.47±12.91. The second evaluation shows that the rates of chest compression for the intervention and control groups were 106.24±8.72 and 100.71±9.54, respectively. The results of this study show that a musical piece enables students to remember the ideal rhythm for chest compression. Performing chest compression with music can easily be integrated into CPR education because it does not require additional technology and is cheap. Copyright © 2016 Elsevier Ltd. All rights reserved.

ABC versus CAB for cardiopulmonary resuscitation: a prospective, randomized simulator-based trial.

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Marsch, Stephan; Tschan, Franziska; Semmer, Norbert K; Zobrist, Roger; Hunziker, Patrick R; Hunziker, Sabina

2013-09-06

After years of advocating ABC (Airway-Breathing-Circulation), current guidelines of cardiopulmonary resuscitation (CPR) recommend CAB (Circulation-Airway-Breathing). This trial compared ABC with CAB as initial approach to CPR from the arrival of rescuers until the completion of the first resuscitation cycle. 108 teams, consisting of two physicians each, were randomized to receive a graphical display of either the ABC algorithm or the CAB algorithm. Subsequently teams had to treat a simulated cardiac arrest. Data analysis was performed using video recordings obtained during simulations. The primary endpoint was the time to completion of the first resuscitation cycle of 30 compressions and two ventilations. The time to execution of the first resuscitation measure was 32 ± 12 seconds in ABC teams and 25 ± 10 seconds in CAB teams (P = 0.002). 18/53 ABC teams (34%) and none of the 55 CAB teams (P = 0.006) applied more than the recommended two initial rescue breaths which caused a longer duration of the first cycle of 30 compressions and two ventilations in ABC teams (31 ± 13 vs.23 ± 6 sec; P = 0.001). Overall, the time to completion of the first resuscitation cycle was longer in ABC teams (63 ± 17 vs. 48 ± 10 sec; P ABC with an earlier start of CPR and a shorter time to completion of the first 30:2 resuscitation cycle. These findings endorse the change from ABC to CAB in international resuscitation guidelines.

Comparison of continuous compression with regular ventilations versus 30:2 compressions-ventilations strategy during mechanical cardiopulmonary resuscitation in a porcine model of cardiac arrest.

Science.gov (United States)

Yang, Zhengfei; Liu, Qingyu; Zheng, Guanghui; Liu, Zhifeng; Jiang, Longyuan; Lin, Qing; Chen, Rui; Tang, Wanchun

2017-09-01

A compression-ventilation (C:V) ratio of 30:2 is recommended for adult cardiopulmonary resuscitation (CPR) by the current American Heart Association (AHA) guidelines. However, continuous chest compression (CCC) is an alternative strategy for CPR that minimizes interruption especially when an advanced airway exists. In this study, we investigated the effects of 30:2 mechanical CPR when compared with CCC in combination with regular ventilation in a porcine model. Sixteen male domestic pigs weighing 39±2 kg were utilized. Ventricular fibrillation was induced and untreated for 7 min. The animals were then randomly assigned to receive CCC combined with regular ventilation (CCC group) or 30:2 CPR (VC group). Mechanical chest compression was implemented with a miniaturized mechanical chest compressor. At the same time of beginning of precordial compression, the animals were mechanically ventilated at a rate of 10 breaths-per-minute in the CCC group or with a 30:2 C:V ratio in the VC group. Defibrillation was delivered by a single 150 J shock after 5 min of CPR. If failed to resuscitation, CPR was resumed for 2 min before the next shock. The protocol was stopped if successful resuscitation or at a total of 15 min. The resuscitated animals were observed for 72 h. Coronary perfusion pressure, end-tidal carbon dioxide and carotid blood flow in the VC group were similar to those achieved in the CCC group during CPR. No significant differences were observed in arterial blood gas parameters between two groups at baseline, VF 6 min, CPR 4 min and 30, 120 and 360 min post-resuscitation. Although extravascular lung water index of both groups significantly increased after resuscitation, no distinct difference was found between CCC and VC groups. All animals were successfully resuscitated and survived for 72 h with favorable neurologic outcomes in both groups. However, obviously more numbers of rib fracture were observed in CCC animals in comparison with VC animals. There was no

The administration of dextrose during in-hospital cardiac arrest is associated with increased mortality and neurologic morbidity.

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Peng, Teng J; Andersen, Lars W; Saindon, Brian Z; Giberson, Tyler A; Kim, Won Young; Berg, Katherine; Novack, Victor; Donnino, Michael W

2015-04-10

Dextrose may be used during cardiac arrest resuscitation to prevent or reverse hypoglycemia. However, the incidence of dextrose administration during cardiac arrest and the association of dextrose administration with survival and other outcomes are unknown. We used the Get With The Guidelines®-Resuscitation national registry to identify adult patients with an in-hospital cardiac arrest between the years 2000 and 2010. To assess the adjusted effects of dextrose administration on survival, we used multivariable regression models with adjustment for multiple patient, event, and hospital characteristics. We performed additional analyses to examine the effects of dextrose on neurological outcome and return of spontaneous circulation. Among the 100,029 patients included in our study, 4,189 (4.2%) received dextrose during cardiac arrest resuscitation. The rate of dextrose administration increased during the study period (odds ratio 1.11, 95% confidence interval (CI) 1.09-1.12 per year, P dextrose during resuscitation had lower rates of survival compared with patients who did not receive dextrose (relative risk 0.88, 95% CI 0.80-0.98, P = 0.02). Administration of dextrose was associated with worse neurological outcome (relative risk 0.88, 95% CI 0.79-0.99, P = 0.03) but an increased chance of return of spontaneous circulation (relative risk 1.07, 95% CI 1.04-1.10, P dextrose during resuscitation in patients with in-hospital cardiac arrest was found to be associated with a significantly decreased chance of survival and a decreased chance of good neurological outcome.

A Magnetic Resonance Imaging-Conditional External Cardiac Defibrillator for Resuscitation Within the Magnetic Resonance Imaging Scanner Bore.

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Schmidt, Ehud J; Watkins, Ronald D; Zviman, Menekhem M; Guttman, Michael A; Wang, Wei; Halperin, Henry A

2016-10-01

Subjects undergoing cardiac arrest within a magnetic resonance imaging (MRI) scanner are currently removed from the bore and then from the MRI suite, before the delivery of cardiopulmonary resuscitation and defibrillation, potentially increasing the risk of mortality. This precludes many higher-risk (acute ischemic and acute stroke) patients from undergoing MRI and MRI-guided intervention. An MRI-conditional cardiac defibrillator should enable scanning with defibrillation pads attached and the generator ON, enabling application of defibrillation within the seconds of MRI after a cardiac event. An MRI-conditional external defibrillator may improve patient acceptance for MRI procedures. A commercial external defibrillator was rendered 1.5 Tesla MRI-conditional by the addition of novel radiofrequency filters between the generator and commercial disposable surface pads. The radiofrequency filters reduced emission into the MRI scanner and prevented cable/surface pad heating during imaging, while preserving all the defibrillator monitoring and delivery functions. Human volunteers were imaged using high specific absorption rate sequences to validate MRI image quality and lack of heating. Swine were electrically fibrillated (n=4) and thereafter defibrillated both outside and inside the MRI bore. MRI image quality was reduced by 0.8 or 1.6 dB, with the generator in monitoring mode and operating on battery or AC power, respectively. Commercial surface pads did not create artifacts deeper than 6 mm below the skin surface. Radiofrequency heating was within US Food and Drug Administration guidelines. Defibrillation was completely successful inside and outside the MRI bore. A prototype MRI-conditional defibrillation system successfully defibrillated in the MRI without degrading the image quality or increasing the time needed for defibrillation. It can increase patient acceptance for MRI procedures. © 2016 American Heart Association, Inc.

Resuscitation of patients suffering from sudden cardiac arrests in nursing homes is not futile

DEFF Research Database (Denmark)

Søholm, Helle; Bro-Jeppesen, John; Lippert, Freddy K

2014-01-01

and prognosis after OHCA in NH. METHODS: Consecutive Emergency Medical Service (EMS) attended OHCA-patients in Copenhagen during 2007-2011 were included. Utstein-criteria for pre-hospital data and review of individual patient charts for in-hospital post-resuscitation care were collected. RESULTS: A total...... survival rates as non-NH-patients when adjusting for known prognostic factors and pre-existing co-morbidity. A policy of not attempting resuscitation in nursing homes at all may therefore not be justified....

Disseminating cardiopulmonary resuscitation training by distributing 35,000 personal manikins among school children

DEFF Research Database (Denmark)

Isbye, Dan L; Rasmussen, Lars S; Ringsted, Charlotte

2007-01-01

BACKGROUND: Because most cardiac arrests occur at home, widespread training is needed to increase the incidence of cardiopulmonary resuscitation (CPR) by lay persons. The aim of this study was to evaluate the effect of mass distribution of CPR instructional materials among schoolchildren. METHODS...... AND RESULTS: We distributed 35,002 resuscitation manikins to pupils (12 to 14 years of age) at 806 primary schools. Using the enclosed 24-minute instructional DVD, they trained in CPR and subsequently used the kit to train family and friends (second tier). They completed a questionnaire on who had trained...... in CPR using the kit. Teachers also were asked to evaluate the project. The incidence of bystander CPR in out-of-hospital cardiac arrest in the months following the project was compared with the previous year. In total, 6947 questionnaires (19.8%) were returned. The 6947 kits had been used to train 17...

Protocol compliance and time management in blunt trauma resuscitation.

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Spanjersberg, W R; Bergs, E A; Mushkudiani, N; Klimek, M; Schipper, I B

2009-01-01

To study advanced trauma life support (ATLS) protocol adherence prospectively in trauma resuscitation and to analyse time management of daily multidisciplinary trauma resuscitation at a level 1 trauma centre, for both moderately and severely injured patients. All victims of severe blunt trauma were consecutively included. Patients with a revised trauma score (RTS) of 12 were resuscitated by a "minor trauma" team and patients with an RTS of less than 12 were resuscitated by a "severe trauma" team. Digital video recordings were used to analyse protocol compliance and time management during initial assessment. From 1 May to 1 September 2003, 193 resuscitations were included. The "minor trauma" team assessed 119 patients, with a mean injury severity score (ISS) of 7 (range 1-45). Overall protocol compliance was 42%, ranging from 0% for thoracic percussion to 93% for thoracic auscultation. The median resuscitation time was 45.9 minutes (range 39.7-55.9). The "severe team" assessed 74 patients, with a mean ISS of 22 (range 1-59). Overall protocol compliance was 53%, ranging from 4% for thoracic percussion to 95% for thoracic auscultation. Resuscitation took 34.8 minutes median (range 21.6-44.1). Results showed the current trauma resuscitation to be ATLS-like, with sometimes very low protocol compliance rates. Timing of secondary survey and radiology and thus time efficiency remains a challenge in all trauma patients. To assess the effect of trauma resuscitation protocols on outcome, protocol adherence needs to be improved.

Experimental design for study of cardiopulmonary resuscitation in dogs.

Science.gov (United States)

Barsan, W G; Levy, R C

1981-03-01

Many different designs for studies of various aspects of cardiopulmonary resuscitation (CPR) in dogs are described in the literature. No single technique is generally accepted. We present a systematized approach to the study of CPR in the canine model. Cardiac output, arterial blood pressure, and electrocardiogram were recorded for three different methods. The methods studied were closed chest compression, closed chest compression with an automatic gas-powered chest compressor, and open chest manual cardiac massage. Cardiac output for both types of external chest compression were less than 17% of control in all cases. With open chest cardiac massage, systemic arterial blood pressures were in the 50 mm Hg to 100 mm Hg range and cardiac output of up to 70% of control was achieved. Using a metronome to obtain compression rate and the arterial blood pressure to guide the efficacy of compression, consistent levels of cardiac output could be achieved for up to 30 minutes using open chest cardiac massage. Closed chest massage in man results in a cardiac output of 25% to 30% of normal when performed under optimal conditions. A cardiac output of 25% to 30% of control cannot be achieved in large dogs with external chest compression, and hence is not a good model to stimulate CPR in man.

Análise crítica das novas recomendações para reanimação cardiopulmonar The new guidelines for cardiopulmonary resuscitation: a critical analysis

Directory of Open Access Journals (Sweden)

Liliane Zorzela

2007-05-01

Full Text Available OBJETIVO: Descrever as novas recomendações da American Heart Association (AHA, baseado em evidências científicas organizadas pelo Comitê Internacional de Reanimação, endossado e disseminado por entidades norte-americanas e européias. FONTES DOS DADOS: Os guias para suporte básico e avançado de vida em pediatria publicados nas revistas Circulation em novembro de 2005 foram revisados, bem como as subseqüentes publicações sobre o mesmo tópico usando as palavras-chave cardiac arrest, basic life support, advanced life support, cardiopulmonary resuscitation e pediatric resuscitation, através dos métodos de busca PubMed e MEDLINE. SÍNTESE DOS DADOS: As maiores alterações foram na área de suporte básico de vida. O novo guia enfatiza a relação compressão torácica/ventilação para os profissionais da saúde treinados, que passa a ser 15:2 em todas as idades, exceto neonatos. É ressaltada a importância das compressões torácicas fortes e rápidas e a necessidade de se evitar a hiperventilação durante e após a parada cardiorrespiratória. O uso de megadoses de adrenalina foi retirado, bem como outras orientações. CONCLUSÃO: O guia mais recente de reanimação em pediatria da AHA tem como foco principal o atendimento básico pré-hospitalar. Está baseado na melhor evidência científica disponível, porém futuras pesquisas são necessárias para corroborar essas mudanças e trazer novas evidências para os futuros protocolos.OBJECTIVE: To describe the new American Heart Association (AHA guidelines for pediatric life support, based on the scientific evidence evaluated by the International Liaison Committee on Resuscitation, and endorsed and disseminated by North American resuscitation councils. SOURCES: The guidelines for basic and advanced life support published in Circulation in November 2005 were reviewed together with subsequent publications on the same topics, identified in PubMed and MEDLINE using the keywords

Adrenaline for out-of-hospital cardiac arrest resuscitation: a systematic review and meta-analysis of randomized controlled trials.

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Lin, Steve; Callaway, Clifton W; Shah, Prakesh S; Wagner, Justin D; Beyene, Joseph; Ziegler, Carolyn P; Morrison, Laurie J

2014-06-01

The evidence for adrenaline in out-of-hospital cardiac arrest (OHCA) resuscitation is inconclusive. We systematically reviewed the efficacy of adrenaline for adult OHCA. We searched in MEDLINE, EMBASE, and Cochrane Library from inception to July 2013 for randomized controlled trials (RCTs) evaluating standard dose adrenaline (SDA) to placebo, high dose adrenaline (HDA), or vasopressin (alone or combination) in adult OHCA patients. Meta-analyses were performed using random effects modeling. Subgroup analyses were performed stratified by cardiac rhythm and by number of drug doses. The primary outcome was survival to discharge and the secondary outcomes were return of spontaneous circulation (ROSC), survival to admission, and neurological outcome. Fourteen RCTs (n=12,246) met inclusion criteria: one compared SDA to placebo (n=534), six compared SDA to HDA (n=6174), six compared SDA to an adrenaline/vasopressin combination (n=5202), and one compared SDA to vasopressin alone (n=336). There was no survival to discharge or neurological outcome differences in any comparison group, including subgroup analyses. SDA showed improved ROSC (RR 2.80, 95%CI 1.78-4.41, padrenaline. There was no benefit of adrenaline in survival to discharge or neurological outcomes. There were improved rates of survival to admission and ROSC with SDA over placebo and HDA over SDA. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Traumatic Pancreatitis: A Rare Complication of Cardiopulmonary Resuscitation.

Science.gov (United States)

Aziz, Muhammad

2017-08-17

An elderly gentleman was successfully revived after undergoing cardiopulmonary resuscitation (CPR) for cardiac arrest. Post CPR, the patient developed acute pancreatitis which was likely complication of inappropriately delivered chest compressions which caused further complications and resulted in the death of the patient. This case underlines the importance of quality chest compressions that includes correct placement of hands by the operator giving chest compressions to avoid lethal injuries to the receiver.

Circumstances and causes of out-of-hospital cardiac arrest in sudden death survivors

NARCIS (Netherlands)

de Vreede-Swagemakers, J. J.; Gorgels, A. P.; Dubois-Arbouw, W. I.; Dalstra, J.; Daemen, M. J.; van Ree, J. W.; Stijns, R. E.; Wellens, H. J.

1998-01-01

To study the circumstances and medical profile of out-of-hospital sudden cardiac arrest (SCA) patients in whom resuscitation was attempted by the ambulance service, and to identify causes of SCA in survivors and factors that influence resuscitation success rate. During a five year period (1991-95)

Cardiopulmonary resuscitation in the elderly: analysis of the events in the emergency department

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Augusto Tricerri

2013-10-01

Full Text Available With the increasing number of old people in all western countries and increasing life expectancy at birth, many seniors spend the last period of their life with various afflictions that may lead to cardiac arrest. Bystander cardiopulmonary resuscitation (CPR increases survival rates. Octogenarians are the fastest growing segment of the population and despite empirical evidence that CPR is of questionable effectiveness in seniors with comorbidities, it is still the only treatment among life-sustaining ones. Cardiopulmonary resuscitation is frequently unsuccessful, but if survival is achieved, a fairly good quality of life can be expected. Various papers analyzed the effect of CPR in hospitalized patients or in cardiac arrest occurring at home or in public places, while less is known about events occurring in the emergency room (ER. We performed a retrospective analysis of cardiac arrest events occurred in ER within 54 months: we analyzed 415,001 records of ER visits (from 01/01/1999 to 30/06/2003 in San Giovanni Addolorata Hospital. Data were analyzed in terms of age and outcome. We identified 475 records with the outcome of death in ER or death on arrival. Out of them, we selected 290 medical records which had sufficient data to be analyzed. Of the 290 patients evaluated, 225 died in ER, 18 were deemed to die on arrival, and 47 survived the cardiac arrest and were admitted to intensive care unit (ICU. The overall mortality was 0.11%, while the incidence of the selected events was 0.072%. The mean age of the analyzed population was 71.3 years. The only possible diagnosis was often cardiac arrest, though most of the times we could specify and group the diagnosis even better. The analysis of the procedures showed that cardiac arrest treated by direct current (DC shock was similarly distributed in different age groups, and no difference was detectable between the two groups. The mean age of the patients who underwent tracheal intubation (TI was

Is increased positive end-expiratory pressure the culprit? Autoresuscitation in a 44-year-old man after prolonged cardiopulmonary resuscitation: a case report.

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Hagmann, Henning; Oelmann, Katrin; Stangl, Robert; Michels, Guido

2016-12-20

The phenomenon of autoresuscitation is rare, yet it is known to most emergency physicians. However, the pathophysiology of the delayed return of spontaneous circulation remains enigmatic. Among other causes hyperinflation of the lungs and excessively high positive end-expiratory pressure have been suggested, but reports including cardiopulmonary monitoring during cardiopulmonary resuscitation are scarce to support this hypothesis. We report a case of autoresuscitation in a 44-year-old white man after 80 minutes of advanced cardiac life support accompanied by continuous capnometry and repeated evaluation by ultrasound and echocardiography. After prolonged cardiopulmonary resuscitation, refractory electromechanical dissociation on electrocardiogram and ventricular akinesis were recorded. In addition, a precipitous drop in end-tidal partial pressure of carbon dioxide was noted and cardiopulmonary resuscitation was discontinued. Five minutes after withdrawal of all supportive measures his breathing resumed and a perfusing rhythm ensued. Understanding the underlying pathophysiology of autoresuscitation is hampered by a lack of reports including extensive cardiopulmonary monitoring during cardiopulmonary resuscitation in a preclinical setting. In this case, continuous capnometry was combined with repetitive ultrasound evaluation, which ruled out most assumed causes of autoresuscitation. Our observation of a rapid decline in end-tidal partial pressure of carbon dioxide supports the hypothesis of increased intrathoracic pressure. Continuous capnometry can be performed easily during cardiopulmonary resuscitation, also in a preclinical setting. Knowledge of the pathophysiologic mechanisms may lead to facile interventions to be incorporated into cardiopulmonary resuscitation algorithms. A drop in end-tidal partial pressure of carbon dioxide, for example, might prompt disconnection of the ventilation to allow left ventricular filling. Further reports and research on this topic

Resuscitating the tracheostomy patient in the ED.

Science.gov (United States)

Long, Brit; Koyfman, Alex

2016-06-01

Emergency physicians must be masters of the airway. The patient with tracheostomy can present with complications, and because of anatomy, airway and resuscitation measures can present several unique challenges. Understanding tracheostomy basics, features, and complications will assist in the emergency medicine management of these patients. The aim of this review is to provide an overview of the basics and features of the tracheostomy, along with an approach to managing tracheostomy complications. This review provides background on the reasons for tracheostomy placement, basics of tracheostomy, and tracheostomy tube features. Emergency physicians will be faced with complications from these airway devices, including tracheostomy obstruction, decannulation or tube dislodgement, stenosis, tracheoinnominate fistula, and tracheoesophageal fistula. Critical patients should be evaluated in the resuscitation bay, and consultation with ENT should be completed while the patient is in the department. This review provides several algorithms for management of complications. Understanding these complications and an approach to airway management during cardiac arrest resuscitation is essential to optimizing patient care. Tracheostomy patients can present unique challenges for emergency physicians. Knowledge of the basics and features of tracheostomy tubes can assist physicians in managing life-threatening complications including tube obstruction, decannulation, bleeding, stenosis, and fistula. Copyright © 2016 Elsevier Inc. All rights reserved.

Sodium nitroprusside enhanced cardiopulmonary resuscitation improves short term survival in a porcine model of ischemic refractory ventricular fibrillation.

Science.gov (United States)

Yannopoulos, Demetris; Bartos, Jason A; George, Stephen A; Sideris, George; Voicu, Sebastian; Oestreich, Brett; Matsuura, Timothy; Shekar, Kadambari; Rees, Jennifer; Aufderheide, Tom P

2017-01-01

Sodium nitroprusside (SNP) enhanced CPR (SNPeCPR) demonstrates increased vital organ blood flow and survival in multiple porcine models. We developed a new, coronary occlusion/ischemia model of prolonged resuscitation, mimicking the majority of out-of-hospital cardiac arrests presenting with shockable rhythms. SNPeCPR will increase short term (4-h) survival compared to standard 2015 Advanced Cardiac Life Support (ACLS) guidelines in an ischemic refractory ventricular fibrillation (VF), prolonged CPR model. Sixteen anesthetized pigs had the ostial left anterior descending artery occluded leading to ischemic VF arrest. VF was untreated for 5min. Basic life support was performed for 10min. At minute 10 (EMS arrival), animals received either SNPeCPR (n=8) or standard ACLS (n=8). Defibrillation (200J) occurred every 3min. CPR continued for a total of 45min, then the balloon was deflated simulating revascularization. CPR continued until return of spontaneous circulation (ROSC) or a total of 60min, if unsuccessful. SNPeCPR animals received 2mg of SNP at minute 10 followed by 1mg every 5min until ROSC. Standard ACLS animals received 0.5mg epinephrine every 5min until ROSC. Primary endpoints were ROSC and 4-h survival. All SNPeCPR animals (8/8) achieved sustained ROSC versus 2/8 standard ACLS animals within one hour of resuscitation (p=0.04). The 4-h survival was significantly improved with SNPeCPR compared to standard ACLS, 7/8 versus 1/8 respectively, p=0.0019. SNPeCPR significantly improved ROSC and 4-h survival compared with standard ACLS CPR in a porcine model of prolonged ischemic, refractory VF cardiac arrest. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

A survey on training in pediatric cardiopulmonary resuscitation in Latin America, Spain, and Portugal.

Science.gov (United States)

López-Herce, Jesús; Carrillo, Angel

2011-09-01

To determine how training in pediatric cardiopulmonary resuscitation is provided in the Iberoamerican countries. Survey. Latin America, Spain, and Portugal. Experts in pediatric cardiopulmonary resuscitation education. A questionnaire was sent to experts in pediatric cardiopulmonary resuscitation training in 21 countries in Latin America, Spain, and Portugal; we received 15 replies. Pediatric cardiopulmonary resuscitation training is not included in medical undergraduate or nursing training in any of these countries and pediatric residents receive systematic cardiopulmonary resuscitation training in only four countries. Basic pediatric life support courses, pediatric advanced life support courses, and pediatric cardiopulmonary resuscitation instructors courses are given in 13 of 15, 14 of 15, and 11 of 15 respondent countries, respectively. Course duration and the number of hours of practical training were variable: basic life support, 5 hrs (range, 4-8 hrs); practical training, 4 hrs (range, 2-5 hrs); advanced life support, 18 hrs (range, 10-30 hrs); and practical training, 14 hrs (range, 5-18 hrs). Only nine countries (60%) had a national group that organized pediatric cardiopulmonary resuscitation training. Thirteen countries (86.6%) had fewer than five centers offering pediatric cardiopulmonary resuscitation training. Respondents considered the main obstacles to the expansion of training in pediatric cardiopulmonary resuscitation to be the shortage of instructors (28.5%), students' lack of financial resources (21.4%), and deficiencies in educational organization (21.4%). Pediatric cardiopulmonary resuscitation training is not uniform across the majority of Iberoamerican countries, with poor organization and little institutional involvement. National groups should be created in each country to plan and coordinate pediatric cardiopulmonary resuscitation training and to coordinate with other Iberoamerican countries.

C.A.U.S.E.: Cardiac arrest ultra-sound exam--a better approach to managing patients in primary non-arrhythmogenic cardiac arrest.

Science.gov (United States)

Hernandez, Caleb; Shuler, Klaus; Hannan, Hashibul; Sonyika, Chionesu; Likourezos, Antonios; Marshall, John

2008-02-01

Cardiac arrest is a condition frequently encountered by physicians in the hospital setting including the Emergency Department, Intensive Care Unit and medical/surgical wards. This paper reviews the current literature involving the use of ultrasound in resuscitation and proposes an algorithmic approach for the use of ultrasound during cardiac arrest. At present there is the need for a means of differentiating between various causes of cardiac arrest, which are not a direct result of a primary ventricular arrhythmia. Identifying the cause of pulseless electrical activity or asystole is important as the underlying cause is what guides management in such cases. This approach, incorporating ultrasound to manage cardiac arrest aids in the diagnosis of the most common and easily reversible causes of cardiac arrest not caused by primary ventricular arrhythmia, namely; severe hypovolemia, tension pneumothorax, cardiac tamponade, and massive pulmonary embolus. These four conditions are addressed in this paper using four accepted emergency ultrasound applications to be performed during resuscitation of a cardiac arrest patient with the aim of determining the underlying cause of a cardiac arrest. Identifying the underlying cause of cardiac arrest represents the one of the greatest challenges of managing patients with asystole or PEA and accurate determination has the potential to improve management by guiding therapeutic decisions. We include several clinical images demonstrating examples of cardiac tamponade, massive pulmonary embolus, and severe hypovolemia secondary to abdominal aortic aneurysm. In conclusion, this protocol has the potential to reduce the time required to determine the etiology of a cardiac arrest and thus decrease the time between arrest and appropriate therapy.

Factors associated with delayed defibrillation in cardiopulmonary resuscitation: A prospective simulation study.

Directory of Open Access Journals (Sweden)

Christoph Castan

Full Text Available Early defibrillation is an important factor of survival in cardiac arrest. However, novice resuscitators often struggle with cardiac arrest patients. We investigated factors leading to delayed defibrillation performed by final-year medical students within a simulated bystander cardiac arrest situation.Final-year medical students received a refresher lecture and basic life support training before being confronted with a simulated cardiac arrest situation in a simulation ambulance. The scenario was analyzed for factors leading to delayed defibrillation. We compared the time intervals the participants needed for various measures with a benchmark set by experienced resuscitators. After training, the participants were interviewed regarding challenges and thoughts during the scenario.The median time needed for defibrillation was 158 s (n = 49, interquartile range: 107-270 s, more than six-fold of the benchmark time. The major part of total defibrillation time (49%; median, n = 49 was between onset of ventricular fibrillation and beginning to prepare the defibrillator, more specifically the time between end of preparation of the defibrillator and actual delivery of the shock, with a mean proportion of 26% (n = 49, SD = 17% of the overall time needed for defibrillation (maximum 67%. Self-reported reasons for this delay included uncertainty about the next step to take, as reported by 73% of the participants. A total of 35% were unsure about which algorithm to follow. Diagnosing the patient was subjectively difficult for 35% of the participants. Overall, 53% of the participants felt generally confused.Our study shows that novice resuscitators rarely achieve guideline-recommended defibrillation times. The most relative delays were observed when participants had to choose what to do next or which algorithm to follow, and thus i.e. performed extensive airway management before a life-saving defibrillation. Our data provides a first insight in the process of

Minimal invasive treatment of life-threatening bleeding caused by cardiopulmonary resuscitation-associated liver injury: a case report.

Science.gov (United States)

Næss, Pål Aksel; Engeseth, Kristian; Grøtta, Ole; Andersen, Geir Øystein; Gaarder, Christine

2016-05-29

Life-threatening bleeding caused by liver injury due to chest compressions is a rare complication in otherwise successful cardiopulmonary resuscitation. Surgical intervention has been suggested to achieve bleeding control; however, reported mortality is high. In this report, we present a brief literature review and a case report in which use of a less invasive strategy was followed by an uneventful recovery. A 37-year-old white woman was admitted after out-of-hospital cardiac arrest. Bystander cardiopulmonary resuscitation was immediately performed, followed by advanced cardiopulmonary resuscitation that included tracheal intubation, mechanical chest compressions, and external defibrillation with return of spontaneous circulation. Upon hospital admission, the patient's blood pressure was 94/45 mmHg and her heart rate was 110 beats per minute. Her electrocardiogram showed no signs of ST-segment elevations or Q-wave development. Coronary angiography revealed a proximal thrombotic occlusion of the left anterior descending coronary artery. Successful recanalization, after thrombus aspiration and balloon dilation followed by stent implant, was verified with normalized anterograde flow. Immediately after the patient's arrival in the intensive cardiac care unit, a drop in her blood pressure to 60/30 mmHg and a hemoglobin concentration of 4.5 g/dl were noticed. Transfusion was started, and bedside abdominal ultrasound examination revealed free intraperitoneal fluid. Computed tomography of the abdomen revealed liver injury with active extravasation from the cranial surface of the right lobe and a massive hemoperitoneum. The patient was coagulopathic and acidotic with a body temperature of 33.5 °C. A minimally invasive treatment strategy, including angiography and selective trans-catheter arterial embolization, were performed in combination with percutaneous evacuation of 4.5 L of intraperitoneal blood. After completion of these procedures, the patient was

The importance of cardiopulmonary resuscitation quality.

Science.gov (United States)

Abella, Benjamin S

2013-06-01

Cardiopulmonary resuscitation (CPR) is a fundamental component of initial care for the victim of cardiac arrest. In the past few years, increasing quantitative evidence has demonstrated that survival from cardiac arrest is dependent on the quality of delivered CPR. This review will focus on this body of evidence and on a range of practical approaches to improving CPR performance. A number of strategies to improve CPR quality have been evaluated recently, during both prehospital and in-hospital cardiac arrest care. These strategies have included the use of real-time CPR sensing and feedback, the employment of physiologic monitoring such as end-tidal CO(2) measurement and the use of metronome prompting. The use of mechanical CPR devices to avoid the challenges of manual CPR performance has also represented a topic of great current interest. Additional approaches have focused on both prearrest training (e.g. high-fidelity simulation education and CPR refreshers) and postarrest training (e.g. debriefing). A number of strategies have been evaluated to improve CPR performance. While many questions remain surrounding the relative value of each approach, it is likely that combinations of these methods may be useful in a variety of care settings to improve care for cardiac arrest victims.

Successful cardiopulmonary resuscitation following cardiopulmonary arrest in a geriatric chinchilla.

Science.gov (United States)

Fernandez, Christina M; Peyton, Jamie L; Miller, Mona; Johnson, Eric G; Kovacic, Jan P

2013-01-01

To describe the successful application of CPR in a geriatric chinchilla employing basic and advanced life support measures during cardiopulmonary arrest (CPA). A 13-year-old female intact chinchilla presented to a general and multispecialty referral hospital for a dental procedure. During recovery from anesthesia the patient suffered CPA and CPR was initiated. Noninvasive positive pressure mask ventilation was initiated and external chest compressions were performed. An 18-Ga needle was introduced into the medullary cavity of the right humerus as an intraosseous catheter and provided access for administration of drugs and fluids. After return of spontaneous circulation was noted mannitol was administered via the intraosseous catheter to alleviate suspected increased intracranial pressure. Clinical improvement was noted shortly after administration. Monitoring during the recovery period showed a normal sinus cardiac rhythm and a SpO₂ of 100% while on supplemental oxygen. Neurologic function continued to improve over the following hours. Oxygen therapy was provided via an oxygen cage, and administration of antimicirobials, gastrointestinal protectants, and nutritional supplementation were part of the post resuscitation care. Oxygen therapy was discontinued after 24 hours, during which time normal behaviors were observed and neurologic status was considered appropriate. The patient was discharged 48 hours after CPA. Published reports from clinical practice on the outcomes of CPR for exotic small mammals are limited. This report details the successful outcome of the use of combined basic and advanced life support measures for the provision of CPR in a chinchilla. This report also highlights the utility of an intraosseous catheter for administration of drugs and fluids novel to this species during resuscitation and recovery. To the authors' knowledge this is the first published report of successful CPR following CPA in a geriatric chinchilla. © Veterinary Emergency

Latin American Consensus for Pediatric Cardiopulmonary Resuscitation 2017: Latin American Pediatric Critical Care Society Pediatric Cardiopulmonary Resuscitation Committee.

Science.gov (United States)

López-Herce, Jesús; Almonte, Enma; Alvarado, Manuel; Bogado, Norma Beatriz; Cyunel, Mariana; Escalante, Raffo; Finardi, Christiane; Guzmán, Gustavo; Jaramillo-Bustamante, Juan C; Madrid, Claudia C; Matamoros, Martha; Moya, Luis Augusto; Obando, Grania; Reboredo, Gaspar; López, Lissette R; Scheu, Christian; Valenzuela, Alejandro; Yerovi, Rocío; Yock-Corrales, Adriana

2018-03-01

To develop a Latin American Consensus about Pediatric Cardiopulmonary Resuscitation. To clarify, reinforce, and adapt some specific recommendations for pediatric patients and to stimulate the implementation of these recommendations in clinical practice. Expert consensus recommendations with Delphi methodology. Latin American countries. Experts in pediatric cardiopulmonary resuscitation from 19 Latin American countries. Delphi methodology for expert consensus. The goal was to reach consensus with all the participating experts for every recommendation. An agreement of at least 80% of the participating experts had to exist in order to deliver a recommendation. Two Delphi voting rounds were sent out electronically. The experts were asked to score between 1 and 9 their level of agreement for each recommendation. The score was then classified into three groups: strong agreement (score 7-9), moderate agreement (score 4-6), and disagreement (score 1-3). Nineteen experts from 19 countries participated in both voting rounds and in the whole process of drafting the recommendations. Sixteen recommendations about organization of cardiopulmonary resuscitation, prevention, basic resuscitation, advanced resuscitation, and postresuscitation measures were approved. Ten of them had a consensus of 100%. Four of them were agreed by all the participants except one (94.7% consensus). One recommendation was agreed by all except two experts (89.4%), and finally, one was agreed by all except three experts (84.2%). All the recommendations reached a level of agreement. This consensus adapts 16 international recommendations to Latin America in order to improve the practice of cardiopulmonary resuscitation in children. Studies should be conducted to analyze the effectiveness of the implementation of these recommendations.

Recognising out-of-hospital cardiac arrest during emergency calls increases bystander cardiopulmonary resuscitation and survival.

Science.gov (United States)

Viereck, Søren; Møller, Thea Palsgaard; Ersbøll, Annette Kjær; Bækgaard, Josefine Stokholm; Claesson, Andreas; Hollenberg, Jacob; Folke, Fredrik; Lippert, Freddy K

2017-06-01

Initiation of early bystander cardiopulmonary resuscitation (CPR) depends on bystanders' or medical dispatchers' recognition of out-of-hospital cardiac arrest (OHCA). The primary aim of our study was to investigate if OHCA recognition during the emergency call was associated with bystander CPR, return of spontaneous circulation (ROSC), and 30-day survival. Our secondary aim was to identify patient-, setting-, and dispatcher-related predictors of OHCA recognition. We performed an observational study of all OHCA patients' emergency calls in the Capital Region of Denmark from 01/01/2013-31/12/2013. OHCAs were collected from the Danish Cardiac Arrest Registry and the Mobile Critical Care Unit database. Emergency call recordings were identified and evaluated. Multivariable logistic regression analyses were applied to all OHCAs and witnessed OHCAs only to analyse the association between OHCA recognition and bystander CPR, ROSC, and 30-day survival. Univariable logistic regression analyses were applied to identify predictors of OHCA recognition. We included 779 emergency calls in the analyses. During the emergency calls, 70.1% (n=534) of OHCAs were recognised; OHCA recognition was positively associated with bystander CPR (odds ratio [OR]=7.84, 95% confidence interval [CI]: 5.10-12.05) in all OHCAs; and ROSC (OR=1.86, 95% CI: 1.13-3.06) and 30-day survival (OR=2.80, 95% CI: 1.58-4.96) in witnessed OHCA. Predictors of OHCA recognition were addressing breathing (OR=1.76, 95% CI: 1.17-2.66) and callers located by the patient's side (OR=2.16, 95% CI: 1.46-3.19). Recognition of OHCA during emergency calls was positively associated with the provision of bystander CPR, ROSC, and 30-day survival in witnessed OHCA. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Resuscitation at the limits of viability--an Irish perspective.

LENUS (Irish Health Repository)

Khan, R A

2012-02-01

BACKGROUND: Advances in neonatal care continue to lower the limit of viability. Decision making in this grey zone remains a challenging process. OBJECTIVE: To explore the opinions of healthcare providers on resuscitation and outcome in the less than 28-week preterm newborn. DESIGN\\/METHODS: An anonymous postal questionnaire was sent to health care providers working in maternity units in the Republic of Ireland. Questions related to neonatal management of the extreme preterm infant, and estimated survival and long-term outcome. RESULTS: The response rate was 55% (74% obstetricians and 70% neonatologists). Less than 1% would advocate resuscitation at 22 weeks, 10% of health care providers advocate resuscitation at 23 weeks gestation, 80% of all health care providers would resuscitate at 24 weeks gestation. 20% of all health care providers would advocate cessation of resuscitation efforts on 22-25 weeks gestation at 5 min of age. 65% of Neonatologists and 54% trainees in Paediatrics would cease resuscitation at 10 min of age. Obstetricians were more pessimistic about survival and long term outcome in newborns delivered between 23 and 27 weeks when compared with neonatologists. This difference was also observed in trainees in paediatrics and obstetrics. CONCLUSION: Neonatologists, trainees in paediatrics and neonatal nurses are generally more optimistic about outcome than their counterparts in obstetrical care and this is reflected in a greater willingness to provide resuscitation efforts at the limits of viability.

The key changes in pediatric and neonatal cardiopulmonary resuscitation.

Science.gov (United States)

Sung, Dyi-Shiang; Hsieh, Kai-Sheng

2007-01-01

The American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) were changed in 2005. There were some key changes in the recommendations for pediatric basic and advanced life support, and neonatal resuscitation. The key changes included: emphasis on effective compressions (push hard, push fast, allow full chest recoil and minimize interruptions in compressions), a single compression-ventilation ratio (30:2) CPR for all groups of ages (except neonate), confirmation of effective ventilations, medication given and defibrillator charged without interruption of CPR, not recommended to routine tracheal suction the vigorous meconium-stained baby in newborn resuscitation, etc. We illustrate the major key changes and hope everyone is well trained to perform high quality CPR.

[Cardiac arrest in spectators in German football stadiums. Precautionary measures, frequency and short-term outcome].

Science.gov (United States)

Luiz, T; Preisegger, T; Rombach, D; Madler, C

2014-09-01

Provision of medical care is an important element of safety precautions for visitors of sports arenas. The organizational requirements are especially high if cardiac arrest occurs; how this scenario is managed may thus serve as the ultimate indicator of the quality of stadium medical care. The objectives of this study were to analyze the structures and the resources available for the medical care of spectators in German professional soccer stadiums and to identify the frequency and the primary resuscitation success of cardiac arrest. In 2011 a questionnaire-based survey was performed among the clubs of the first and second German soccer leagues regarding medical care of spectators during the seasons 2008/2009 and 2009/2010. The focus was on the qualifications of emergency teams, the equipment and the incidence of cardiac arrest. A total of 15 stadiums were included (38%) in the survey. The mean number of physicians and emergency medical technicians on site was 0.6/10,000 seats and 16/10,000 seats, respectively. Of the latter, a mean of 82% (minimum 20% and maximum 100%) had received training with automatic external defibrillators. In 87% of the stadiums regular advanced life support training (ALS) was required. The mean number of defibrillators per stadium was 2.8/10,000 seats (minimum 1.3 and maximum 3.8) including 1.7 automatic defibrillators (minimum 0.4 and maximum 2.8). For patient transport, a mean of 0.65 ALS ambulance vehicles per 10,000 seats (minimum 0.14 and maximum 1.46) were available on site. In all stadiums staff members were connected via mobile radio communication with the stadium medical control room. A total of 52 cardiac arrests (=0.25/100,000 spectators) were recorded of which 96% of the patients were transported to hospitals with spontaneous circulation. Cardiac arrests are not a rare occurrence in German soccer stadiums. The participating stadiums are overall well prepared for such incidents in terms of organization, staff and technology and

Resuscitation speed affects brain injury in a large animal model of traumatic brain injury and shock

DEFF Research Database (Denmark)

Sillesen, Martin; Jin, Guang; Johansson, Pär I

2014-01-01

as lesion size (3285.44¿±¿130.81 mm3 vs. 2509.41¿±¿297.44 mm3, p¿=¿0.04). This was also associated with decreased cardiac output (NS: 4.37¿±¿0.12 l/min vs. 6.35¿±¿0.10 l/min, p¿brain compared......BackgroundOptimal fluid resuscitation strategy following combined traumatic brain injury (TBI) and hemorrhagic shock (HS) remain controversial and the effect of resuscitation infusion speed on outcome is not well known. We have previously reported that bolus infusion of fresh frozen plasma (FFP......) protects the brain compared with bolus infusion of 0.9% normal saline (NS). We now hypothesize reducing resuscitation infusion speed through a stepwise infusion speed increment protocol using either FFP or NS would provide neuroprotection compared with a high speed resuscitation protocol.Methods23...

A prospective study to determine the circumstances, incidence and outcome of cardiopulmonary resuscitation in a referral hospital in India, in relation to various factors

Directory of Open Access Journals (Sweden)

Muralidhar Joshi

2015-01-01

Full Text Available Background and Aims: Cardiac arrest has multifactorial aetiology and the outcome depends on timely and correct interventions. We decided to investigate the circumstances, incidence and outcome of cardiopulmonary resuscitation (CPR at a tertiary hospital in India, in relation to various factors, including extensive basic life support and advanced cardiac life support training programme for all nurses and doctors. Methods: It has been over a decade and a half with periodical updates and implementation of newer guidelines prepared by various societies across the world about CPR for both in-hospital and out-of hospital cardiac arrests (IHCA and OHCA. We conducted a prospective study wherein all cardiac arrests reported in the hospital consecutively for 12 months were registered for the study and followed their survival up to 1-year. Statistical analysis was performed by using Chi-square test for significant differences in proportions applied to various parameters of the study. Results: The main outcome measures were; (following CPR return of spontaneous circulation, survival for 24 h, survival from 24 h to 6 weeks or discharge, alive at 1-year. For survivors, an assessment was made about their cerebral performance and overall performance and accordingly graded. All these data were tabulated. Totally 419 arrests were reported in the hospital, out of which 413 were in-hospital arrests. Out of this 260 patients were considered for resuscitation, we had about 27 survivors at the end of 1-year follow-up (10.38%. Conclusion: We conclude by saying there are many factors involved in good clinical outcomes following IHCAs and these variable factors need to be researched further.

An atypical case of successful resuscitation of an accidental profound hypothermia patient, occurring in a temperate climate.

LENUS (Irish Health Repository)

Coleman, E

2010-03-01

Cases of accidental profound hypothermia occur most frequently in cold, northern climates. We describe an atypical case, occurring in a temperate climate, where a hypothermic cardiac-arrested patient was successfully resuscitated using extracorporeal circulation (ECC).

[Public access defibrillation: successful cardiopulmonary resuscitation due to automatic external defibrillator at traffic accident].

Science.gov (United States)

Wanke, S; Reuter, H; Pfister, R; Michels, G

2014-03-01

A 65-year-old man collapsed after he stepped out of his car after a traffic accident. Fortunately, two police officers on a routine patrol in the area were quickly on the scene and started cardiopulmonary resuscitation. A passerby noticed that the patient was in distress and that an automatic defibrillator was nearby. He attached the electrodes of the defibrillator to the chest of the patient in accordance with instructions on the defibrillator and terminated the ventricular fibrillation (200 joule, biphasic). Emergency cardiac catheterization revealed a subtotal stenosis proximally in the right coronary artery, which was successfully treated with a stent. Based on the ideal basic life support, the immediate care by emergency mobile system and coronary angioplasty with successful revascularisation the patient could be released without any neurological deficit. This case illustrates that laypersons can use automatic external defibrillator in case of cardiac resuscitation sufficiently and quickly. © Georg Thieme Verlag KG Stuttgart · New York.

Improving the quality of cardiopulmonary resuscitation by training dedicated cardiac arrest teams incorporating a mechanical load-distributing device at the emergency department.

Science.gov (United States)

Ong, Marcus Eng Hock; Quah, Joy Li Juan; Annathurai, Annitha; Noor, Noorkiah Mohamed; Koh, Zhi Xiong; Tan, Kenneth Boon Kiat; Pothiawala, Sohil; Poh, Ah Ho; Loy, Chye Khiaw; Fook-Chong, Stephanie

2013-04-01

Determine if implementing cardiac arrest teams trained with a 'pit-crew' protocol incorporating a load-distributing band mechanical CPR device (Autopulse™ ZOLL) improves the quality of CPR, as determined by no-flow ratio (NFR) in the first 10min of resuscitation. A phased, prospective, non-randomized, before-after cohort evaluation. Data collection was from April 2008 to February 2011. There were 100 before and 148 after cases. Continuous video and chest compression data of all study subjects were analyzed. All non-traumatic, collapsed patients aged 18 years and above presenting to the emergency department were eligible. Primary outcome was NFR. Secondary outcomes were return of spontaneous circulation (ROSC), survival to hospital admission and neurological outcome at discharge. After implementation, mean total NFR for the first 5min decreased from 0.42 to 0.27 (decrease=0.15, 95% CI 0.10-0.19, pCPR ratio increased from 46.4% to 88.4% (increase=41.9%, 95% CI 36.9-46.9, pTraining cardiac arrest teams in a 'pit-crew' protocol may improve the quality of CPR at the ED. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

[New Insights into Maternal Cardiopulmonary Resuscitation--Significance of Simulation Research and Training].

Science.gov (United States)

Komasawa, Nobuyasu; Fujiwara, Shunsuke; Majima, Nozomi; Minami, Toshiaki

2015-08-01

Pregnancy-related mortality, estimated to occur in approximately 1: 50,000 deliveries, is rare in developed countries. The 2010 American Heart Association (AHA) Guidelines for Resuscitation emphasize the importance of high-quality chest compression as a key determinant of successful cardiopulmonary resuscitation. During pregnancy, the uterus can compress the inferior vena cava, impeding venous return and thereby reducing stroke volume and cardiac output. To maximize the effectiveness of chest compressions in pregnancy, the AHA guidelines recommend the 27-30 degrees left-lateral tilt (LLT) position. When CPR is performed on parturients in the LLT position, chest compressions will probably be more effective if performed with the operator standing on the left side of the patient. The videolaryngoscope Pentax-AWS Airwayscope (AWS) was found to be an effective tool for airway management during chest compressions in 27 LLT simulations, suggesting that the AWS may be a useful device for airway management during maternal resuscitation.

Prolonged successful cerebro cardiopulmonary resuscitation. A case report

International Nuclear Information System (INIS)

Medina, Libardo A; Sanchez, Robinson; Gomez, Maria T; Cabrales, Jaime R; Echeverri, Dario

2010-01-01

We present the case of a 57 year old patient patient who underwent a diagnostic coronariography that showed three-vessel coronary disease. He presented cardiorespiratory arrest immediately at the end of the procedure; basic and advanced resuscitation maneuvers were started during a two hours period. During the resuscitation, primary angioplasty and stent implantation in the circumflex artery was performed. The patient recovered spontaneous circulation and was transferred to the coronary care unit. On the second day, a successful myocardial revascularization was performed and was discharged 16 days after the event without evident neurological deficit.

The role of simulation in teaching pediatric resuscitation: current perspectives

Directory of Open Access Journals (Sweden)

Lin Y

2015-03-01

Full Text Available Yiqun Lin,1 Adam Cheng2 1KidSIM-ASPIRE Simulation Research Program, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada; 2KidSIM-ASPIRE Research Program, Department of Pediatrics, Division of Emergency Medicine, University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada Abstract: The use of simulation for teaching the knowledge, skills, and behaviors necessary for effective pediatric resuscitation has seen widespread growth and adoption across pediatric institutions. In this paper, we describe the application of simulation in pediatric resuscitation training and review the evidence for the use of simulation in neonatal resuscitation, pediatric advanced life support, procedural skills training, and crisis resource management training. We also highlight studies supporting several key instructional design elements that enhance learning, including the use of high-fidelity simulation, distributed practice, deliberate practice, feedback, and debriefing. Simulation-based training is an effective modality for teaching pediatric resuscitation concepts. Current literature has revealed some research gaps in simulation-based education, which could indicate the direction for the future of pediatric resuscitation research. Keywords: simulation, pediatric resuscitation, medical education, instructional design, crisis resource management, health care

Exhaled CO2 Parameters as a Tool to Assess Ventilation-Perfusion Mismatching during Neonatal Resuscitation in a Swine Model of Neonatal Asphyxia

Science.gov (United States)

Li, Elliott Shang-shun; Cheung, Po-Yin; O'Reilly, Megan; LaBossiere, Joseph; Lee, Tze-Fun; Cowan, Shaun; Bigam, David L.; Schmölzer, Georg Marcus

2016-01-01

Background End-tidal CO2 (ETCO2), partial pressure of exhaled CO2 (PECO2), and volume of expired CO2 (VCO2) can be continuously monitored non-invasively to reflect pulmonary ventilation and perfusion status. Although ETCO2 ≥14mmHg has been shown to be associated with return of an adequate heart rate in neonatal resuscitation and quantifying the PECO2 has the potential to serve as an indicator of resuscitation quality, there is little information regarding capnometric measurement of PECO2 and ETCO2 in detecting return of spontaneous circulation (ROSC) and survivability in asphyxiated neonates receiving cardiopulmonary resuscitation (CPR). Methods Seventeen newborn piglets were anesthetized, intubated, instrumented, and exposed to 45-minute normocapnic hypoxia followed by apnea to induce asphyxia. Protocolized resuscitation was initiated when heart rate decreased to 25% of baseline. Respiratory and hemodynamic parameters including ETCO2, PECO2, VCO2, heart rate, cardiac output, and carotid artery flow were continuously measured and analyzed. Results There were no differences in respiratory and hemodynamic parameters between surviving and non-surviving piglets prior to CPR. Surviving piglets had significantly higher ETCO2, PECO2, VCO2, cardiac index, and carotid artery flow values during CPR compared to non-surviving piglets. Conclusion Surviving piglets had significantly better respiratory and hemodynamic parameters during resuscitation compared to non-surviving piglets. In addition to optimizing resuscitation efforts, capnometry can assist by predicting outcomes of newborns requiring chest compressions. PMID:26766424

Exhaled CO2 Parameters as a Tool to Assess Ventilation-Perfusion Mismatching during Neonatal Resuscitation in a Swine Model of Neonatal Asphyxia.

Directory of Open Access Journals (Sweden)

Elliott Shang-shun Li

Full Text Available End-tidal CO2 (ETCO2, partial pressure of exhaled CO2 (PECO2, and volume of expired CO2 (VCO2 can be continuously monitored non-invasively to reflect pulmonary ventilation and perfusion status. Although ETCO2 ≥14 mmHg has been shown to be associated with return of an adequate heart rate in neonatal resuscitation and quantifying the PECO2 has the potential to serve as an indicator of resuscitation quality, there is little information regarding capnometric measurement of PECO2 and ETCO2 in detecting return of spontaneous circulation (ROSC and survivability in asphyxiated neonates receiving cardiopulmonary resuscitation (CPR.Seventeen newborn piglets were anesthetized, intubated, instrumented, and exposed to 45-minute normocapnic hypoxia followed by apnea to induce asphyxia. Protocolized resuscitation was initiated when heart rate decreased to 25% of baseline. Respiratory and hemodynamic parameters including ETCO2, PECO2, VCO2, heart rate, cardiac output, and carotid artery flow were continuously measured and analyzed.There were no differences in respiratory and hemodynamic parameters between surviving and non-surviving piglets prior to CPR. Surviving piglets had significantly higher ETCO2, PECO2, VCO2, cardiac index, and carotid artery flow values during CPR compared to non-surviving piglets.Surviving piglets had significantly better respiratory and hemodynamic parameters during resuscitation compared to non-surviving piglets. In addition to optimizing resuscitation efforts, capnometry can assist by predicting outcomes of newborns requiring chest compressions.

Comparison of the effects of sternal and tibial intraosseous administered resuscitative drugs on return of spontaneous circulation in a swine model of cardiac arrest.

Science.gov (United States)

O'Sullivan, Mara; Martinez, Andre; Long, Audrey; Johnson, Michelle; Blouin, Dawn; Johnson, Arthur D; Burgert, James M

2016-01-01

Compare vasopressin, amiodarone, and epinephrine administration by sternal intraosseous (SIO), tibial intraosseous (TIO), and intravenous (IV) routes in a swine model of cardiac arrest. Prospective, randomized, between subjects, experimental design. Laboratory. Male Yorkshire-cross swine (N = 35), seven per group. Swine were randomized to SIO, TIO, IV, cardiopulmonary resuscitation (CPR) with defibrillation, or CPR-only groups. Ventricular fibrillation (VF) was induced under general anesthesia. Mechanical CPR began 2 minutes postarrest. Vasopressin (40 U) was administered to the SIO, TIO, and IV groups 4 minutes postarrest. Defibrillation was performed and amiodarone (300 mg) was administered 6 minutes postarrest. Defibrillation was repeated, and epinephrine (1 mg) was administered 10 minutes postarrest. Defibrillation was repeated every 2 minutes and epinephrine repeated every 4 minutes until return of spontaneous circulation (ROSC) or 26 postarrest minutes elapsed. Rate of ROSC, time to ROSC, and odds of ROSC. There were no significant differences in rate of ROSC between the SIO and TIO (p = 0.22) or IV groups (p = 1.0). Time to ROSC was five times less in the SIO group than the TIO group (p = 0.003) but not compared to IV (p = 0.125). Time to ROSC in the IV group was significantly less than the TIO group (p = 0.04). Odds of ROSC for the SIO group were five times higher compared to the TIO group but same as IV. Odds of ROSC in the IV group were higher than the TIO group. There was a statistically significant delay in the time to ROSC and a clinically significant difference in odds of ROSC when resuscitative drugs, including lipophilic amiodarone, were administered by the TIO route compared to the SIO and IV routes in a swine model of sudden cardiac arrest. Further investigations are warranted to isolate the mechanism behind these findings.

Evolution of Burn Resuscitation in Operation Iraqi Freedom

National Research Council Canada - National Science Library

Chung, Kevin K; Blackbourne, Lorne H; Wolf, Steven E; White, Chrsitopher E; Renz, Evan M; Cancio, Leopoldo C; Holcomb, John B; Barillo, David J

2006-01-01

... of the burn resuscitation. Critical advances in air evacuation of the war wounded, thorough prewar planning, and sustained burn care education of deployed personnel have proven vital in the optimal care of our injured soldiers...

Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: a prospective observational study.

Science.gov (United States)

Sakamoto, Tetsuya; Morimura, Naoto; Nagao, Ken; Asai, Yasufumi; Yokota, Hiroyuki; Nara, Satoshi; Hase, Mamoru; Tahara, Yoshio; Atsumi, Takahiro

2014-06-01

A favorable neurological outcome is likely to be achieved in out-of-hospital cardiac arrest (OHCA) patients with ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) on the initial electrocardiogram (ECG). However, in patients without pre-hospital restoration of spontaneous circulation despite the initial VF/VT, the outcome is extremely low by conventional cardiopulmonary resuscitation (CPR). Extracorporeal CPR (ECPR) may enhance cerebral blood flow and recovery of neurological function. We prospectively examined how ECPR for OHCA with VF/VT would affect neurological outcomes. The design of this trial was a prospective, observational study. We compared differences of outcome at 1 and 6 months after OHCA between ECPR group (26 hospitals) and non-ECPR group (20 hospitals). Primary endpoints were the rate of favorable outcomes defined by the Glasgow-Pittsburgh Cerebral Performance and Overall Performance Categories (CPC) 1 or 2 at 1 and 6 months after OHCA. Based on intention-to-treat analysis, CPC 1 or 2 were 12.3% (32/260) in the ECPR group and 1.5% (3/194) in the non-ECPR group at 1 month (P<0.0001), and 11.2% (29/260) and 2.6% (5/194) at 6 months (P=0.001), respectively. By per protocol analysis, CPC 1 or 2 were 13.7% (32/234) in the ECPR group and 1.9% (3/159) in the non-ECPR group at 1 month (P<0.0001), and 12.4% (29/234) and 3.1% (5/159) at 6 months (P=0.002), respectively. In OHCA patients with VF/VT on the initial ECG, a treatment bundle including ECPR, therapeutic hypothermia and IABP was associated with improved neurological outcome at 1 and 6 months after OHCA. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The US Department of Defense Hemorrhage and Resuscitation Research and Development Program.

Science.gov (United States)

Pusateri, Anthony E; Dubick, Michael A

2015-08-01

Data from recent conflicts demonstrate the continuing need for research and development focusing on hemorrhage control, fluid resuscitation, blood products, transfusion, and pathophysiologic responses to traumatic hemorrhage. The US Department of Defense Hemorrhage and Resuscitation Research and Development Program brings together US Department of Defense efforts and is coordinated with efforts of our other federal government, industry, international, and university-based partners. Military medical research has led to advances in both military and civilian trauma care. A sustained effort will be required to continue to advance the care of severely injured trauma patients.

Adrenaline, terlipressin, and corticoids versus adrenaline in the treatment of experimental pediatric asphyxial cardiac arrest.

Science.gov (United States)

González, Rafael; Urbano, Javier; Botrán, Marta; López, Jorge; Solana, Maria J; García, Ana; Fernández, Sarah; López-Herce, Jesús

2014-07-01

To analyze if treatment with adrenaline (epinephrine) plus terlipressin plus corticoids achieves higher return of spontaneous circulation than adrenaline in an experimental infant animal model of asphyxial cardiac arrest. Prospective randomized animal study. Experimental department in a University Hospital. Forty-nine piglets were studied. Cardiac arrest was induced by at least 10 minutes of removal of mechanical ventilation and was followed by manual external chest compressions and mechanical ventilation. After 3 minutes of resuscitation, piglets that did not achieve return of spontaneous circulation were randomized to two groups: adrenaline 0.02 mg kg every 3 minutes (20 animals) and adrenaline 0.02 mg kg every 3 minutes plus terlipressin 20 μg kg every 6 minutes plus hydrocortisone 30 mg kg one dose (22 animals). Resuscitation was discontinued when return of spontaneous circulation was achieved or after 24 minutes. Return of spontaneous circulation was achieved in 14 piglets (28.5%), 14.2% with only cardiac massage and ventilation. Return of spontaneous circulation was achieved in 25% of piglets treated with adrenaline and in 9.1% of those treated with adrenaline plus terlipressin plus hydrocortisone (p = 0.167). Return of spontaneous circulation was achieved in 45.4% of animals with pulseless electric activity, 20% with asystole, and 0% with ventricular fibrillation (p = 0.037). Shorter duration of cardiac arrest, higher mean blood pressure and EtCO2 and lower PaCO2 before resuscitation, and higher mean blood pressure during resuscitation were associated with higher return of spontaneous circulation. Treatment with adrenaline plus terlipressin plus corticoids does not achieve higher return of spontaneous circulation than that with adrenaline in an infant animal model of asphyxial cardiac arrest.

The use of a metronome during cardiopulmonary resuscitation in the emergency room of a university hospital

OpenAIRE

Botelho,Renata Maria de Oliveira; Campanharo,Cássia Regina Vancini; Lopes,Maria Carolina Barbosa Teixeira; Okuno,Meiry Fernanda Pinto; Góis,Aécio Flávio Teixeira de; Batista,Ruth Ester Assayag

2016-01-01

ABSTRACT Objective: to compare the rate of return of spontaneous circulation (ROSC) and death after cardiac arrest, with and without the use of a metronome during cardiopulmonary resuscitation (CPR). Method: case-control study nested in a cohort study including 285 adults who experienced cardiac arrest and received CPR in an emergency service. Data were collected using In-hospital Utstein Style. The control group (n=60) was selected by matching patients considering their neurological condit...

Strategies for Small Volume Resuscitation: Hyperosmotic-Hyperoncotic Solutions, Hemoglobin Based Oxygen Carriers and Closed-Loop Resuscitation

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Kramer, George C.; Wade, Charles E.; Dubick, Michael A.; Atkins, James L.

2004-01-01

Introduction: Logistic constraints on combat casualty care preclude traditional resuscitation strategies which can require volumes and weights 3 fold or greater than hemorrhaged volume. We present a review of quantitative analyses of clinical and animal data on small volume strategies using 1) hypertonic-hyperosmotic solutions (HHS); 2) hemoglobin based oxygen carriers (HBOCs) and 3) closed-loop infusion regimens.Methods and Results: Literature searches and recent queries to industry and academic researchers have allowed us to evaluate the record of 81 human HHS studies (12 trauma trials), 19 human HBOCs studies (3trauma trials) and two clinical studies of closed-loop resuscitation.There are several hundreds animal studies and at least 82 clinical trials and reports evaluating small volume7.2%-7.5% hypertonic saline (HS) most often combined with colloids, e.g., dextran (HSD) or hetastarch(HSS). HSD and HSS data has been published for 1,108 and 392 patients, respectively. Human studies have documented volume sparing and hemodynamic improvements. Meta-analyses suggest improved survival for hypotensive trauma patients treated with HSD with significant reductions in mortality found for patients with blood pressure surgery. HSD and HSS have received regulatory approval in 14 and 3 countries, respectively, with 81,000+ units sold. The primary reported use was head injury and trauma resuscitation. Complications and reported adverse events are surprisingly rare and not significantly different from other solutions.HBOCs are potent volume expanders in addition to oxygen carriers with volume expansion greater than standard colloids. Several investigators have evaluated small volume hyperoncotic HBOCs or HS-HBOC formulations for hypotensive and normotensive resuscitation in animals. A consistent finding in resuscitation with HBOCs is depressed cardiac output. There is some evidence that HBOCs more efficiently unload oxygen from plasma hemoglobin as well as facilitate RBC

Analysis of bystander CPR quality during out-of-hospital cardiac arrest using data derived from automated external defibrillators.

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Fernando, Shannon M; Vaillancourt, Christian; Morrow, Stanley; Stiell, Ian G

2018-07-01

Little is known regarding the quality of cardiopulmonary resuscitation (CPR) performed by bystanders in out-of-hospital cardiac arrest (OHCA). We sought to determine quality of bystander CPR provided during OHCA using CPR quality data stored by Automated External Defibrillators (AEDs). We used the Resuscitation Outcomes Consortium database to identify OHCA cases of presumed cardiac etiology where an AED was utilized. We then matched AED data to each case identified. AED data was analyzed using manufacturer software in order to determine overall measures of bystander CPR quality, changes in bystander CPR quality over time, and adherence to existing 2010 Resuscitation Quality Guidelines. 100 cases of OHCA of presumed cardiac etiology involving bystander CPR and with corresponding AED data. Mean age was 62.3 years, and 75% were male. Bystanders demonstrated high-quality CPR over all minutes of resuscitation, with a chest compression fraction of 76%, a compression depth of 5.3 cm, and a compression rate of 111.2 compressions/min. Mean perishock pause was 26.8 s. Adherence rates to 2010 Resuscitation Guidelines for compression rate and depth were found to be 66% and 55%, respectively. CPR quality was lowest in the first minute, resulting from increased delay to rhythm analysis (mean 40.7 s). In cases involving shock delivery, latency from initiation of AED to shock delivery was 59.2 s. We found that bystanders perform high-quality CPR, with strong adherence rates to existing Resuscitation Guidelines. High-quality CPR is maintained over the first five minutes of resuscitation, but was lowest in the first minute. Copyright © 2018 Elsevier B.V. All rights reserved.

A comparison of the universal TOR Guideline to the absence of prehospital ROSC and duration of resuscitation in predicting futility from out-of-hospital cardiac arrest.

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Drennan, Ian R; Case, Erin; Verbeek, P Richard; Reynolds, Joshua C; Goldberger, Zachary D; Jasti, Jamie; Charleston, Mark; Herren, Heather; Idris, Ahamed H; Leslie, Paul R; Austin, Michael A; Xiong, Yan; Schmicker, Robert H; Morrison, Laurie J

2017-02-01

The Universal Termination of Resuscitation (TOR) Guideline accurately identifies potential out-of-hospital cardiac arrest (OHCA) survivors. However, implementation is inconsistent with some Emergency Medical Service (EMS) agencies using absence of return of spontaneous circulation (ROSC) as sole criterion for termination. To compare the performance of the Universal TOR Guideline with the single criterion of no prehospital ROSC. Second, to determine factors associated with survival for patients transported without a ROSC. Lastly, to compare the impact of time to ROSC as a marker of futility to the Universal TOR Guideline. Retrospective, observational cohort study. Non-traumatic, adult (≥18 years) OHCA patients of presumed cardiac etiology treated by EMS providers. ROC-PRIMED and ROC-Epistry post ROC-PRIMED databases between 2007 and 2011. Primary outcome was survival to hospital discharge and the secondary outcome was functional survival. We used multivariable regression to evaluate factors associated with survival in patients transported without a ROSC. 36,543 treated OHCAs occurred of which 9467 (26%) were transported to hospital without a ROSC. Patients transported without a ROSC who met the Universal TOR Guideline for transport had a survival of 3.0% (95% CI 2.5-3.4%) compared to 0.7% (95% CI 0.4-0.9%) in patients who met the Universal TOR Guideline for termination. The Universal TOR Guideline identified 99% of survivors requiring continued resuscitation and transportation to hospital including early identification of survivors who sustained a ROSC after extended durations of CPR. Using absence of ROSC as a sole predictor of futility misses potential survivors. The Universal TOR Guideline remains a strong predictor of survival. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Benefits of cardiac sonography performed by a non-expert sonographer in patients with non-traumatic cardiopulmonary arrest.

Science.gov (United States)

Zengin, Suat; Yavuz, Erdal; Al, Behçet; Cindoruk, Şener; Altunbaş, Gökhan; Gümüşboğa, Hasan; Yıldırım, Cuma

2016-05-01

The purpose of this study was to evaluate a rapid cardiac ultrasound assessment performed by trained non-expert sonographers integrated into the advanced cardiac life support (ACLS). This study was prospectively performed in 179 patients (104 males and 75 females) who underwent cardiopulmonary resuscitation (CPR) in an emergency department (ED) during two calendar years (2013 and 2014). Two senior doctors, who had received emergency cardiac ultrasonography training, performed cardiac ultrasound through the apical, subxiphoid, or parasternal windows. Ultrasound evaluation and pulse controls were performed simultaneously. SPSS 18.0 was used for statistical analysis. A total of 63.7% (114) of the cardiopulmonary arrest incidents occurred out of the hospital. Only 13 patients had a femoral pulse during the initial evaluation, while 166 showed no femoral pulse. Initial monitoring showed a regular rhythm in 53 patients, ventricular fibrillation in 18 patients, and no rhythms in 108 patients. The first evaluation with ultrasound detected an effective heart rate in 26 patients and ventricular fibrillation in 14 patients, while no effective heart rate was observed in 139 patients. In addition, ultrasound revealed pericardial tamponade in seven patients and right ventricular enlargement in four cases. Global hypokinesia was detected in four patients and hypovolemia was observed in another four patients. The use of real-time ultrasonography during resuscitation with real-time femoral pulse check can help facilitate the distinguishing of pea-type arrest, ascertain the cause of the arrest, infer a suitable treatment, and optimize medical management decisions regarding CPR termination. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Implementation of a High-Performance Cardiopulmonary Resuscitation Protocol at a Collegiate Emergency Medical Services Program

Science.gov (United States)

Stefos, Kathryn A.; Nable, Jose V.

2016-01-01

Out-of-hospital cardiac arrest (OHCA) is a significant public health issue. Although OHCA occurs relatively infrequently in the collegiate environment, educational institutions with on-campus emergency medical services (EMS) agencies are uniquely positioned to provide high-quality resuscitation care in an expedient fashion. Georgetown University's…

Fluid resuscitation practices in cardiac surgery patients in the USA: a survey of health care providers

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Solomon Aronson

2017-10-01

Full Text Available Abstract Background Fluid resuscitation during cardiac surgery is common with significant variability in clinical practice. Our goal was to investigate current practice patterns of fluid volume expansion in patients undergoing cardiac surgeries in the USA. Methods We conducted a cross-sectional online survey of 124 cardiothoracic surgeons, cardiovascular anesthesiologists, and perfusionists. Survey questions were designed to assess clinical decision-making patterns of intravenous (IV fluid utilization in cardiovascular surgery for five types of patients who need volume expansion: (1 patients undergoing cardiopulmonary bypass (CPB without bleeding, (2 patients undergoing CPB with bleeding, (3 patients undergoing acute normovolemic hemodilution (ANH, (4 patients requiring extracorporeal membrane oxygenation (ECMO or use of a ventricular assist device (VAD, and (5 patients undergoing either off-pump coronary artery bypass graft (OPCABG surgery or transcatheter aortic valve replacement (TAVR. First-choice fluid used in fluid boluses for these five patient types was requested. Descriptive statistics were performed using Kruskal-Wallis test and follow-up tests, including t tests, to evaluate differences among respondent groups. Results The most commonly preferred indicators of volume status were blood pressure, urine output, cardiac output, central venous pressure, and heart rate. The first choice of fluid for patients needing volume expansion during CPB without bleeding was crystalloids, whereas 5% albumin was the most preferred first choice of fluid for bleeding patients. For volume expansion during ECMO or VAD, the respondents were equally likely to prefer 5% albumin or crystalloids as a first choice of IV fluid, with 5% albumin being the most frequently used adjunct fluid to crystalloids. Surgeons, as a group, more often chose starches as an adjunct fluid to crystalloids for patients needing volume expansion during CPB without bleeding. Surgeons

Communication between members of the cardiac arrest team--a postal survey.

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Pittman, J; Turner, B; Gabbott, D A

2001-05-01

Effective communication enhances team building and is perceived to improve the quality of team performance. A recent publication from the Resuscitation Council (UK) has highlighted this fact and recommended that cardiac arrest team members make contact daily. We wished to identify how often members of this team communicate prior to a cardiopulmonary arrest. A questionnaire on cardiac arrest team composition, leadership, communication and debriefing was distributed nationally to Resuscitation Training Officers (RTOs) and their responses analysed. One hundred and thirty (55%) RTOs replied. Physicians and anaesthetists were the most prominent members of the team. The Medical Senior House Officer is usually nominated as the team leader. Eighty-seven centres (67%) have no communication between team members prior to attending a cardiopulmonary arrest. In 33%, communication occurs but is either informal or fortuitous. The RTOs felt that communication is important to enhance team dynamics and optimise task allocation. Only 7% achieve a formal debrief following a cardiac arrest. Communication between members of the cardiac arrest team before and after a cardiac arrest is poor. Training and development of these skills may improve performance and should be prioritised. Team leadership does not necessarily reflect experience or training.

Testosterone receptor blockade after trauma-hemorrhage improves cardiac and hepatic functions in males.

Science.gov (United States)

Remmers, D E; Wang, P; Cioffi, W G; Bland, K I; Chaudry, I H

1997-12-01

Although studies have shown that testosterone receptor blockade with flutamide after hemorrhage restores the depressed immune function, it remains unknown whether administration of flutamide following trauma and hemorrhage and resuscitation has any salutary effects on the depressed cardiovascular and hepatocellular functions. To study this, male rats underwent a laparotomy (representing trauma) and were then bled and maintained at a mean arterial pressure (MAP) of 40 mmHg until the animals could not maintain this pressure. Ringer lactate was given to maintain a MAP of 40 mmHg until 40% of the maximal shed blood volume was returned in the form of Ringer lactate. The rats were then resuscitated with four times the shed blood volume in the form of Ringer lactate over 60 min. Flutamide (25 mg/kg) or an equal volume of the vehicle propanediol was injected subcutaneously 15 min before the end of resuscitation. Various in vivo heart performance parameters (e.g., maximal rate of the pressure increase or decrease), cardiac output, and hepatocellular function (i.e., the maximum velocity and the overall efficiency of indocyanine green clearance) were determined at 20 h after resuscitation. Additionally, hepatic microvascular blood flow (HMBF) was determined using a laser Doppler flowmeter. The results indicate that left ventricular performance, cardiac output, HMBF, and hepatocellular function decreased significantly at 20 h after the completion of trauma, hemorrhage, and resuscitation. Administration of the testosterone receptor blocker flutamide, however, significantly improved cardiac performance, HMBF, and hepatocellular function. Thus flutamide appears to be a novel and useful adjunct for improving cardiovascular and hepatocellular functions in males following trauma and hemorrhagic shock.

Development of a formative assessment tool for measurement of performance in multi-professional resuscitation teams

DEFF Research Database (Denmark)

Andersen, Peter Oluf; Jensen, Michael Kammer; Lippert, Anne

2010-01-01

Treating cardiac arrest is linked to the mutual performance of several health-care individuals' task coordination. Non-technical skills, including communication, leadership and team interaction, could improve sequencing the tasks in the cardiac arrest algorithm. Non-technical skills have been...... a part of crew resource management training, created to improve safety in aviation. This study aimed, first, to establish crew resource management and non-technical skill-based learning objectives and behavioural markers for the performance of multi-professional resuscitation teams; second, to develop...

Adequate performance of cardiopulmonary resuscitation techniques during simulated cardiac arrest over and under protective equipment in football.

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Waninger, Kevin N; Goodbred, Andrew; Vanic, Keith; Hauth, John; Onia, Joshua; Stoltzfus, Jill; Melanson, Scott

2014-07-01

To investigate (1) cardiopulmonary resuscitation (CPR) adequacy during simulated cardiac arrest of equipped football players and (2) whether protective football equipment impedes CPR performance measures. Exploratory crossover study performed on Laerdal SimMan 3 G interactive manikin simulator. Temple University/St Luke's University Health Network Regional Medical School Simulation Laboratory. Thirty BCLS-certified ATCs and 6 ACLS-certified emergency department technicians. Subjects were given standardized rescuer scenarios to perform three 2-minute sequences of compression-only CPR. Baseline CPR sequences were captured on each subject. Experimental conditions included 2-minute sequences of CPR either over protective football shoulder pads or under unlaced pads. Subjects were instructed to adhere to 2010 American Heart Association guidelines (initiation of compressions alone at 100/min to 51 mm). Dependent variables included average compression depth, average compression rate, percentage of time chest wall recoiled, and percentage of hands-on contact during compressions. Differences between subject groups were not found to be statistically significant, so groups were combined (n = 36) for analysis of CPR compression adequacy. Compression depth was deeper under shoulder pads than over (P = 0.02), with mean depths of 36.50 and 31.50 mm, respectively. No significant difference was found with compression rate or chest wall recoil. Chest compression depth is significantly decreased when performed over shoulder pads, while there is no apparent effect on rate or chest wall recoil. Although the clinical outcomes from our observed 15% difference in compression depth are uncertain, chest compression under the pads significantly increases the depth of compressions and more closely approaches American Heart Association guidelines for chest compression depth in cardiac arrest.

The use of the laryngeal tube disposable (LT-D) by paramedics during out-of-hospital resuscitation-an observational study concerning ERC guidelines 2005.

Science.gov (United States)

Wiese, C H R; Semmel, T; Müller, J U; Bahr, J; Ocker, H; Graf, B M

2009-02-01

In the current guidelines of the European Resuscitation Council (ERC), tracheal intubation, as an instrument for securing the airway during resuscitation, has become less important for persons not trained in this method. For those persons, different supraglottic airway devices are recommended by the ERC. The present investigation deals with the application of the laryngeal tube disposable (LT-D) during pre-hospital resuscitation by paramedics. During a period of 2 years (2006-2008), we registered all cardiac arrest situations in which the LT-D had been applied according to the ERC guidelines 2005. Therefore, we investigated one emergency medical system in Germany. During the defined period, 92 resuscitation attempts, recorded on standardised data sheets, were included. The LT-D was used in 46% of all cardiac arrest situations. Overall, the LT-D was successfully inserted in more than 90% of all cases on first attempt. In 95% of all cases, no problems concerning ventilation of the patient were described. As an alternative airway device recommended by the ERC in 2005, the LT-D may enable airway control rapidly and effectively. Additionally, by using the LT-D, a reduced "no-flow-time" and a better outcome may be possible.

Bystander Efforts and 1-Year Outcomes in Out-of-Hospital Cardiac Arrest.

Science.gov (United States)

Kragholm, Kristian; Wissenberg, Mads; Mortensen, Rikke N; Hansen, Steen M; Malta Hansen, Carolina; Thorsteinsson, Kristinn; Rajan, Shahzleen; Lippert, Freddy; Folke, Fredrik; Gislason, Gunnar; Køber, Lars; Fonager, Kirsten; Jensen, Svend E; Gerds, Thomas A; Torp-Pedersen, Christian; Rasmussen, Bodil S

2017-05-04

The effect of bystander interventions on long-term functional outcomes among survivors of out-of-hospital cardiac arrest has not been extensively studied. We linked nationwide data on out-of-hospital cardiac arrests in Denmark to functional outcome data and reported the 1-year risks of anoxic brain damage or nursing home admission and of death from any cause among patients who survived to day 30 after an out-of-hospital cardiac arrest. We analyzed risks according to whether bystander cardiopulmonary resuscitation (CPR) or defibrillation was performed and evaluated temporal changes in bystander interventions and outcomes. Among the 2855 patients who were 30-day survivors of an out-of-hospital cardiac arrest during the period from 2001 through 2012, a total of 10.5% had brain damage or were admitted to a nursing home and 9.7% died during the 1-year follow-up period. During the study period, among the 2084 patients who had cardiac arrests that were not witnessed by emergency medical services (EMS) personnel, the rate of bystander CPR increased from 66.7% to 80.6% (Pbystander defibrillation increased from 2.1% to 16.8% (Pbystander CPR was associated with a risk of brain damage or nursing home admission that was significantly lower than that associated with no bystander resuscitation (hazard ratio, 0.62; 95% confidence interval [CI], 0.47 to 0.82), as well as a lower risk of death from any cause (hazard ratio, 0.70; 95% CI, 0.50 to 0.99) and a lower risk of the composite end point of brain damage, nursing home admission, or death (hazard ratio, 0.67; 95% CI, 0.53 to 0.84). The risks of these outcomes were even lower among patients who received bystander defibrillation as compared with no bystander resuscitation. In our study, we found that bystander CPR and defibrillation were associated with risks of brain damage or nursing home admission and of death from any cause that were significantly lower than those associated with no bystander resuscitation. (Funded by Tryg

Comprehensive cardiopulmonary life support (CCLS for cardiopulmonary resuscitation by trained paramedics and medics inside the hospital

Directory of Open Access Journals (Sweden)

Rakesh Garg

2017-01-01

Full Text Available The cardiopulmonary resuscitation (CPR guideline of comprehensive cardiopulmonary life support (CCLS for management of the patient with cardiopulmonary arrest in adults provides an algorithmic step-wise approach for optimal outcome of the patient inside the hospital by trained medics and paramedics. This guideline has been developed considering the infrastructure of healthcare delivery system in India. This is based on evidence in the international and national literature. In the absence of data from the Indian population, the extrapolation has been made from international data, discussed with Indian experts and modified accordingly to ensure their applicability in India. The CCLS guideline emphasise the need to recognise patients at risk for cardiac arrest and their timely management before a cardiac arrest occurs. The basic components of CPR include chest compressions for blood circulation; airway maintenance to ensure airway patency; lung ventilation to enable oxygenation and defibrillation to convert a pathologic 'shockable' cardiac rhythm to one capable to maintaining effective blood circulation. CCLS emphasises incorporation of airway management, drugs, and identification of the cause of arrest and its correction, while chest compression and ventilation are ongoing. It also emphasises the value of organised team approach and optimal post-resuscitation care.

Location of cardiac arrest in a city center: strategic placement of automated external defibrillators in public locations

DEFF Research Database (Denmark)

Folke, Fredrik; Lippert, Freddy Knudsen; Nielsen, Søren Loumann

2009-01-01

BACKGROUND: Public-access defibrillation with automated external defibrillators (AEDs) is being implemented in many countries worldwide with considerable financial implications. The potential benefit and economic consequences of focused or unfocused AED deployment are unknown. METHODS AND RESULTS......: All cardiac arrests in public in Copenhagen, Denmark, from 1994 through 2005 were geographically located, as were 104 public AEDs placed by local initiatives. In accordance with European Resuscitation Council and American Heart Association (AHA) guidelines, areas with a high incidence of cardiac...... arrests were defined as those with 1 cardiac arrest every 2 or 5 years, respectively. There were 1274 cardiac arrests in public locations. According to the European Resuscitation Council or AHA guidelines, AEDs needed to be deployed in 1.2% and 10.6% of the city area, providing coverage for 19.5% (n=249...

Resuscitation on television: realistic or ridiculous? A quantitative observational analysis of the portrayal of cardiopulmonary resuscitation in television medical drama.

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Harris, Dylan; Willoughby, Hannah

2009-11-01

Patients' preferences for cardiopulmonary resuscitation (CPR) relate to their perception about the likelihood of success of the procedure. There is evidence that the lay public largely base their perceptions about CPR on their experience of the portrayal of CPR in the media. The medical profession has generally been critical of the portrayal of CPR on medical drama programmes although there is no recent evidence to support such views. To compare the patient characteristics, cause and success rates of cardiopulmonary resuscitation (CPR) on medical television drama with published resuscitation statistics. Observational study. 88 episodes of television medical drama were reviewed (26 episodes of Casualty, Casualty, 25 episodes of Holby City, 23 episodes of Grey's Anatomy and 14 episodes of ER) screened between July 2008 and April 2009. The patient's age and sex, medical history, presumed cause of arrest, use of CPR and immediate and long term survival rate were recorded. Immediate survival and survival to discharge following CPR. There were a total of 76 cardio-respiratory arrests and 70 resuscitation attempts in the episodes reviewed. The immediate success rate (46%) did not differ significantly from published real life figures (p=0.48). The resuscitation process appeared to follow current guidelines. Survival (or not) to discharge was rarely shown. The average age of patients was 36 years and contrary to reality there was not an age related difference in likely success of CPR in patients less than 65 compared with those 65 and over (p=0.72). The most common cause of cardiac arrest was trauma with only a minor proportion of arrests due to cardio-respiratory causes such as myocardial infarction. Whilst the immediate success rate of CPR in medical television drama does not significantly differ from reality the lack of depiction of poorer medium to long term outcomes may give a falsely high expectation to the lay public. Equally the lay public may perceive that the

The prevalence of chest compression leaning during in-hospital cardiopulmonary resuscitation

Science.gov (United States)

Fried, David A.; Leary, Marion; Smith, Douglas A.; Sutton, Robert M.; Niles, Dana; Herzberg, Daniel L.; Becker, Lance B.; Abella, Benjamin S.

2011-01-01

Objective Successful resuscitation from cardiac arrest requires the delivery of high-quality chest compressions, encompassing parameters such as adequate rate, depth, and full recoil between compressions. The lack of compression recoil (“leaning” or “incomplete recoil”) has been shown to adversely affect hemodynamics in experimental arrest models, but the prevalence of leaning during actual resuscitation is poorly understood. We hypothesized that leaning varies across resuscitation events, possibly due to rescuer and/or patient characteristics and may worsen over time from rescuer fatigue during continuous chest compressions. Methods This was an observational clinical cohort study at one academic medical center. Data were collected from adult in-hospital and Emergency Department arrest events using monitor/defibrillators that record chest compression characteristics and provide real-time feedback. Results We analyzed 112,569 chest compressions from 108 arrest episodes from 5/2007 to 2/2009. Leaning was present in 98/108 (91%) cases; 12% of all compressions exhibited leaning. Leaning varied widely across cases: 41/108 (38%) of arrest episodes exhibited 20% compression leaning. When evaluating blocks of continuous compressions (>120 sec), only 4/33 (12%) had an increase in leaning over time and 29/33 (88%) showed a decrease (presuscitation care and exhibited a wide distribution, with most leaning within a subset of resuscitations. Leaning decreased over time during continuous chest compression blocks, suggesting that either leaning may not be a function of rescuer fatiguing, or that it may have been mitigated by automated feedback provided during resuscitation episodes. PMID:21482010

The System-Wide Effect of Real-Time Audiovisual Feedback and Postevent Debriefing for In-Hospital Cardiac Arrest: The Cardiopulmonary Resuscitation Quality Improvement Initiative.

Science.gov (United States)

Couper, Keith; Kimani, Peter K; Abella, Benjamin S; Chilwan, Mehboob; Cooke, Matthew W; Davies, Robin P; Field, Richard A; Gao, Fang; Quinton, Sarah; Stallard, Nigel; Woolley, Sarah; Perkins, Gavin D

2015-11-01

To evaluate the effect of implementing real-time audiovisual feedback with and without postevent debriefing on survival and quality of cardiopulmonary resuscitation quality at in-hospital cardiac arrest. A two-phase, multicentre prospective cohort study. Three UK hospitals, all part of one National Health Service Acute Trust. One thousand three hundred and ninety-five adult patients who sustained an in-hospital cardiac arrest at the study hospitals and were treated by hospital emergency teams between November 2009 and May 2013. During phase 1, quality of cardiopulmonary resuscitation and patient outcomes were measured with no intervention implemented. During phase 2, staff at hospital 1 received real-time audiovisual feedback, whereas staff at hospital 2 received real-time audiovisual feedback supplemented by postevent debriefing. No intervention was implemented at hospital 3 during phase 2. The primary outcome was return of spontaneous circulation. Secondary endpoints included other patient-focused outcomes, such as survival to hospital discharge, and process-focused outcomes, such as chest compression depth. Random-effect logistic and linear regression models, adjusted for baseline patient characteristics, were used to analyze the effect of the interventions on study outcomes. In comparison with no intervention, neither real-time audiovisual feedback (adjusted odds ratio, 0.62; 95% CI, 0.31-1.22; p=0.17) nor real-time audiovisual feedback supplemented by postevent debriefing (adjusted odds ratio, 0.65; 95% CI, 0.35-1.21; p=0.17) was associated with a statistically significant improvement in return of spontaneous circulation or any process-focused outcome. Despite this, there was evidence of a system-wide improvement in phase 2, leading to improvements in return of spontaneous circulation (adjusted odds ratio, 1.87; 95% CI, 1.06-3.30; p=0.03) and process-focused outcomes. Implementation of real-time audiovisual feedback with or without postevent debriefing did not

Assessment of nursing records on cardiopulmonary resuscitation based on the utstein model

Directory of Open Access Journals (Sweden)

Daiane Lopes Grisante

2014-01-01

Full Text Available Cross-sectional study that assessed the quality of nursing records on cardiopulmonary resuscitation. Forty-two patients’ charts were reviewed in an intensive care unit, using the Utstein protocol. There was a predominance of men (54.8%, aged from 21-70 years old (38.1%, correction of acquired heart diseases (42.7%, with more than one pre-existing device (147. As immediate cause of cardiac arrest, hypotension predominated (48.3% and as the initial rhythm, bradycardia (37.5%. Only the time of death and time of arrest were recorded in 100% of the sample. Professional training in Advanced Life Support was not recorded. The causes of arrest and initial rhythm were recorded in 69% and 76.2% of the sample. Chest compressions, patent airway obtainment and defibrillation were recorded in less than 16%. Records were considered of low quality and may cause legal sanctions to professionals and do not allow the comparison of the effectiveness of the maneuvers with other centers.

2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: pediatric basic life support.

Science.gov (United States)

2006-05-01

This publication presents the 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of the pediatric patient and the 2005 American Academy of Pediatrics/AHA guidelines for CPR and ECC of the neonate. The guidelines are based on the evidence evaluation from the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, hosted by the American Heart Association in Dallas, Texas, January 23-30, 2005. The "2005 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" contain recommendations designed to improve survival from sudden cardiac arrest and acute life-threatening cardiopulmonary problems. The evidence evaluation process that was the basis for these guidelines was accomplished in collaboration with the International Liaison Committee on Resuscitation (ILCOR). The ILCOR process is described in more detail in the "International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations." The recommendations in the "2005 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" confirm the safety and effectiveness of many approaches, acknowledge that other approaches may not be optimal, and recommend new treatments that have undergone evidence evaluation. These new recommendations do not imply that care involving the use of earlier guidelines is unsafe. In addition, it is important to note that these guidelines will not apply to all rescuers and all victims in all situations. The leader of a resuscitation attempt may need to adapt application of the guidelines to unique circumstances. The following are the major pediatric advanced life support changes in the 2005 guidelines: There is further caution about the use of endotracheal tubes. Laryngeal mask airways are acceptable when used by experienced

Comparison of not for resuscitation (NFR) forms across five Victorian health services.

Science.gov (United States)

Levinson, M; Mills, A; Hutchinson, A M; Heriot, G; Stephenson, G; Gellie, A

2014-07-01

Within Australian hospitals, cardiac and respiratory arrests result in a resuscitation attempt unless the patient is documented as not for resuscitation. To examine the consistency of policies and documentation for withholding in-hospital resuscitation across health services. An observational, qualitative review of hospital policy and documentation was conducted in June 2013 in three public and two private sector hospitals in metropolitan Melbourne. Not for resuscitation (NFR) forms were evaluated for physical characteristics, content, authorisation and decision-making. Hospital policies were coded for alerts, definition of futility and burden of treatment and management of discussions and dissent. There was a lack of standardisation, with each site using its own unique NFR form and accompanying site-specific policies. Differences were found in who could authorise the decision, what was included on the form, the role of patients and families, and how discussions were managed and dissent resolved. Futility and burden of treatment were not defined independently. These inconsistencies across sites contribute to a lack of clarity regarding the decision to withhold resuscitation, and have implications for staff employed across multiple hospitals. NFR forms should be reviewed and standardised so as to be clear, uniform and consistent with the legislative framework. We propose a two-stage process of documentation. Stage 1 facilitates discussion of patient-specific goals of care and consideration of limitations of treatment. Stage 2 serves to communicate a NFR order. Decisions to withhold resuscitation are inherently complex but could be aided by separating the decision-making process from the communication of the decision, resulting in improved end-of-life care. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

Disseminating cardiopulmonary resuscitation training by distributing 9,200 personal manikins.

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de Paiva, Edison Ferreira; Padilha, Roberto de Queiroz; Sgobero, Jenny Karol Gomes Sato; Ganem, Fernando; Cardoso, Luiz Francisco

2014-08-01

Community members should be trained so that witnesses of cardiac arrests are able to trigger the emergency system and perform adequate resuscitation. In this study, the authors evaluated the results of cardiopulmonary resuscitation (CPR) training of communities in four Brazilian cities, using personal resuscitation manikins. In total, 9,200 manikins were distributed in Apucarana, Itanhaém, Maringá, and São Carlos, which are cities where the populations range from 80,000 to 325,000 inhabitants. Elementary and secondary school teachers were trained on how to identify a cardiac arrest, trigger the emergency system, and perform chest compressions. The teachers were to transfer the training to their students, who would then train their families and friends. In total, 49,131 individuals were trained (6.7% of the population), but the original strategy of using teachers and students as multipliers was responsible for only 27.9% of the training. A total of 508 teachers were trained, and only 88 (17.3%) transferred the training to the students. Furthermore, the students have trained only 45 individuals of the population. In Maringá and São Carlos, the strategy was changed and professionals in the primary health care system were prepared and used as multipliers. This strategy proved extremely effective, especially in Maringá, where 39,041 individuals were trained (79.5% of the total number of trainings). Community health care providers were more effective in passing the training to students than the teachers (odds ratio [OR] = 7.12; 95% confidence interval [CI] = 4.74 to 10.69; p CPR using personal manikins by professionals in the primary health care system seems to be a more efficient strategy for training the community than creating a training network in the schools. © 2014 by the Society for Academic Emergency Medicine.

Evaluation of Cardiopulmonary Resuscitation (CPR) for Patient Outcomes and their Predictors

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Singh, Swati; Grewal, Anju; Gautam, Parshotam L; Luthra, Neeru; Tanwar, Gayatri; Kaur, Amarpreet

2016-01-01

Introduction Cardiac arrest continues to be a common cause of in-hospital deaths. Even small improvements in survival can translate into thousands of lives saved every year. Aim The aim of our prospective observational study was to elicit the outcomes and predictors of in-hospital cardiopulmonary resuscitation among adult patients. Settings and Design All in-hospital adult patients (age >14) who suffered cardiac arrest & were attended by a Code Blue Team between 1st January 2012 & 30th April 2013 were part of the study. Materials and Methods The cardiopulmonary resuscitation (CPR) was assessed in terms of: Response time, Presenting initial rhythm, Time to first defibrillation, Duration of CPR and Outcome (Return of spontaneous circulation (ROSC), Glasgow outcome scale (GOS) at discharge). Statistical Analysis Age, GOS and mean response time were analysed using t-test and ANOVA. Logistic regression was applied to determine the significance of the various factors in determining mortality. Results ROSC was achieved in 44% of a total of 127 patients included in our study. Asystole/Pulseless electrical activity (PEA) was the most common presenting rhythm (87.5%). The survival to discharge was seen in 7.1% patients of whom only 3.9% patients had good neurological outcome. Regression and survival analysis depicted achievement of ROSC during CPR, absence of co-morbidities and shorter response time of code blue team as predictors of good outcome. Conclusion We found poor outcome of CPR after in-hospital cardiac arrest. This was mainly attributed to an initial presenting rhythm of Asystole/PEA in most cases and delayed response times. PMID:26894150

Cardiopulmonary resuscitation decisions in the emergency department: An ethnography of tacit knowledge in practice.

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Brummell, Stephen P; Seymour, Jane; Higginbottom, Gina

2016-05-01

Despite media images to the contrary, cardiopulmonary resuscitation in emergency departments is often unsuccessful. The purpose of this ethnographic study was to explore how health care professionals working in two emergency departments in the UK, make decisions to commence, continue or stop resuscitation. Data collection involved participant observation of resuscitation attempts and in-depth interviews with nurses, medical staff and paramedics who had taken part in the attempts. Detailed case examples were constructed for comparative analysis. Findings show that emergency department staff use experience and acquired tacit knowledge to construct a typology of cardiac arrest categories that help them navigate decision making. Categorisation is based on 'less is more' heuristics which combine explicit and tacit knowledge to facilitate rapid decisions. Staff then work as a team to rapidly assimilate and interpret information drawn from observations of the patient's body and from technical, biomedical monitoring data. The meaning of technical data is negotiated during staff interaction. This analysis was informed by a theory of 'bodily' and 'technical' trajectory alignment that was first developed from an ethnography of death and dying in intensive care units. The categorisation of cardiac arrest situations and trajectory alignment are the means by which staff achieve consensus decisions and determine the point at which an attempt should be withdrawn. This enables them to construct an acceptable death in highly challenging circumstances. Copyright © 2016 Elsevier Ltd. All rights reserved.

Anaphylactic shock and cardiac arrest caused by thiamine infusion

DEFF Research Database (Denmark)

Juel, Jacob; Pareek, Manan; Langfrits, Christian Sigvald

2013-01-01

intoxication and developed cardiac arrest due to anaphylactic shock following intravenous thiamine infusion. The patient was successfully resuscitated after 15 min and repeated epinephrine administrations. He was discharged in good health after 14 days. This case report emphasises both the importance...

Resuscitation and Obstetrical Care to Reduce Intrapartum-Related Neonatal Deaths: A MANDATE Study.

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Kamath-Rayne, Beena D; Griffin, Jennifer B; Moran, Katelin; Jones, Bonnie; Downs, Allan; McClure, Elizabeth M; Goldenberg, Robert L; Rouse, Doris; Jobe, Alan H

2015-08-01

To evaluate the impact of neonatal resuscitation and basic obstetric care on intrapartum-related neonatal mortality in low and middle-income countries, using the mathematical model, Maternal and Neonatal Directed Assessment of Technology (MANDATE). Using MANDATE, we evaluated the impact of interventions for intrapartum-related events causing birth asphyxia (basic neonatal resuscitation, advanced neonatal care, increasing facility birth, and emergency obstetric care) when implemented in home, clinic, and hospital settings of sub-Saharan African and India for 2008. Total intrapartum-related neonatal mortality (IRNM) was acute neonatal deaths from intrapartum-related events plus late neonatal deaths from ongoing intrapartum-related injury. Introducing basic neonatal resuscitation in all settings had a large impact on decreasing IRNM. Increasing facility births and scaling up emergency obstetric care in clinics and hospitals also had a large impact on decreasing IRNM. Increasing prevalence and utilization of advanced neonatal care in hospital settings had limited impact on IRNM. The greatest improvement in IRNM was seen with widespread advanced neonatal care and basic neonatal resuscitation, scaled-up emergency obstetric care in clinics and hospitals, and increased facility deliveries, resulting in an estimated decrease in IRNM to 2.0 per 1,000 live births in India and 2.5 per 1,000 live births in sub-Saharan Africa. With more deliveries occurring in clinics and hospitals, the scale-up of obstetric care can have a greater effect than if modeled individually. Use of MANDATE enables health leaders to direct resources towards interventions that could prevent intrapartum-related deaths. A lack of widespread implementation of basic neonatal resuscitation, increased facility births, and emergency obstetric care are missed opportunities to save newborn lives.

Computational simulation of passive leg-raising effects on hemodynamics during cardiopulmonary resuscitation.

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Shin, Dong Ah; Park, Jiheum; Lee, Jung Chan; Shin, Sang Do; Kim, Hee Chan

2017-03-01

The passive leg-raising (PLR) maneuver has been used for patients with circulatory failure to improve hemodynamic responsiveness by increasing cardiac output, which should also be beneficial and may exert synergetic effects during cardiopulmonary resuscitation (CPR). However, the impact of the PLR maneuver on CPR remains unclear due to difficulties in monitoring cardiac output in real-time during CPR and a lack of clinical evidence. We developed a computational model that couples hemodynamic behavior during standard CPR and the PLR maneuver, and simulated the model by applying different angles of leg raising from 0° to 90° and compression rates from 80/min to 160/min. The simulation results showed that the PLR maneuver during CPR significantly improves cardiac output (CO), systemic perfusion pressure (SPP) and coronary perfusion pressure (CPP) by ∼40-65% particularly under the recommended range of compression rates between 100/min and 120/min with 45° of leg raise, compared to standard CPR. However, such effects start to wane with further leg lifts, indicating the existence of an optimal angle of leg raise for each person to achieve the best hemodynamic responses. We developed a CPR-PLR model and demonstrated the effects of PLR on hemodynamics by investigating changes in CO, SPP, and CPP under different compression rates and angles of leg raising. Our computational model will facilitate study of PLR effects during CPR and the development of an advanced model combined with circulatory disorders, which will be a valuable asset for further studies. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Bystander Defibrillation for Out-of-Hospital Cardiac Arrest in Public vs Residential Locations.

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Hansen, Steen Møller; Hansen, Carolina Malta; Folke, Fredrik; Rajan, Shahzleen; Kragholm, Kristian; Ejlskov, Linda; Gislason, Gunnar; Køber, Lars; Gerds, Thomas A; Hjortshøj, Søren; Lippert, Freddy; Torp-Pedersen, Christian; Wissenberg, Mads

2017-05-01

Bystander-delivered defibrillation (hereinafter referred to as bystander defibrillation) of patients with out-of-hospital cardiac arrests (OHCAs) remains limited despite the widespread dissemination of automated external defibrillators (AEDs). To examine calendar changes in bystander defibrillation and subsequent survival according to a public or a residential location of the cardiac arrest after nationwide initiatives in Denmark to facilitate bystander-mediated resuscitative efforts, including bystander defibrillation. This nationwide study identified 18 688 patients in Denmark with first-time OHCA from June 1, 2001, to December 31, 2012, using the Danish Cardiac Arrest Registry. Patients had a presumed cardiac cause of arrest that was not witnessed by emergency medical services personnel. Data were analyzed from April 1, 2015, to December 10, 2016. Nationwide initiatives to facilitate bystander resuscitative efforts, including bystander defibrillation, consisted of resuscitation training of Danish citizens, dissemination of on-site AEDs, foundation of an AED registry linked to emergency medical dispatch centers, and dispatcher-assisted guidance of bystander resuscitation efforts. The proportion of patients who received bystander defibrillation according to the location of the cardiac arrest and their subsequent 30-day survival. Of the 18 688 patients with OHCAs (67.8% men and 32.2% women; median [interquartile range] age, 72 [62-80] years), 4783 (25.6%) had a cardiac arrest in a public location and 13 905 (74.4%) in a residential location. The number of registered AEDs increased from 141 in 2007 to 7800 in 2012. The distribution of AED location was consistently skewed in favor of public locations. Bystander defibrillation increased in public locations from 3 of 245 (1.2%; 95% CI, 0.4%-3.5%) in 2001 to 78 of 510 (15.3%; 95% CI, 12.4%-18.7%) in 2012 (P bystander defibrillation increased in public locations from 8.3% (95% CI, 1.5%-35.4%) in 2001/2002 to 57

Resuscitation by hyperbaric exposure from a venous gas emboli following laparoscopic surgery

DEFF Research Database (Denmark)

Kjeld, Thomas; Hansen, Egon G; Holler, Nana G

2012-01-01

Venous gas embolism is common after laparoscopic surgery but is only rarely of clinical relevance. We present a 52 year old woman undergoing laparoscopic treatment for liver cysts, who also underwent cholecystectomy. She was successfully extubated. However, after a few minutes she developed cardiac......, could have contributed to the formation of the intravascular gas emboli. We conclude that persistent resuscitation followed by hyperbaric oxygen treatment after venous gas emboli contributed to the elimination of intravascular bubbles and the favourable outcome for the patient....... arrest due to a venous carbon dioxide (CO2) embolism as identified by transthoracic echocardiography and aspiration of approximately 7 ml of gas from a central venous catheter. She was resuscitated and subsequently treated with hyperbaric oxygen to reduce the size of remaining gas bubbles. Subsequently...

Coronary Catheterization Laboratory Role for Post-Resuscitation Care Without ST Elevation Myocardial Infarction.

Science.gov (United States)

Kumar, Kris; Lotun, Kapildeo

2018-05-07

Out of hospital cardiac arrest management of patients with non-ST myocardial infarction per current American Heart Association and European Resuscitation Council guidelines leave the decision in regard to early angiography up to the physician operators. Guidelines are clear on the positive impact of early intervention on survival and improvement on left ventricular function in patients presenting with cardiac arrest and ST elevation myocardial infarction on electrocardiogram. This review aims to analyze the data that current guidelines are based upon in regards to out of hospital cardiac arrest with electrocardiogram findings of non-ST elevation myocardial infarction as well as other clinical trials that support early angiography and reperfusion strategies as well as future studies that are in trial to study the role of the coronary catheterization laboratory in cardiac arrest. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Tidal Volume Delivery and Endotracheal Tube Leak during Cardiopulmonary Resuscitation in Intubated Newborn Piglets with Hypoxic Cardiac Arrest Exposed to Different Modes of Ventilatory Support.

Science.gov (United States)

Mendler, Marc R; Weber, Claudia; Hassan, Mohammad A; Huang, Li; Mayer, Benjamin; Hummler, Helmut D

2017-01-01

There are few data available on the interaction of inflations, chest compressions (CC), and delivery of tidal volumes in newborn infants undergoing resuscitation in the presence of endotracheal tube (ET) leaks. To determine the effects of different respiratory support strategies along with CC on changes in tidal volume and ET leaks in hypoxic newborn piglets with cardiac arrest. Asphyxiated newborn piglets, intubated with weight-adapted uncuffed ET, were randomized into three groups and resuscitated according to ILCOR 2010 guidelines: (1) T-piece resuscitator (TPR) group = peak inspiratory pressure (PIP)/positive end-expiratory pressure (PEEP) 25/5 cm H2O, rate 30/min, inflations interposed between CC (3:1 ratio); (2) self- inflating bag (SIB) group = PIP 25 cm H2O without PEEP, rate 30/min, inflations interposed between CC (3:1 ratio), and (3) ventilator group = PIP/PEEP of 25/5 cm H2O, rate 30/min. CC were applied with a rate of 120/min without synchrony to inflations. We observed a significant increase of leak (average increase 11.4%) when CC was added to respiratory support (p = 0.0001). Expired tidal volume was larger in the SIB group than in the two other modes which both applied PEEP. However, tidal volumes caused by CC only were larger in the two groups with PEEP than in the SIB group (without PEEP). There is interaction between lung inflations and CC affecting leak and delivery of tidal volume, which may be influenced by the mode/device used for respiratory support. Leak is larger in the presence of PEEP. However, CC cause additional tidal volume which is larger in the presence of PEEP. © 2016 S. Karger AG, Basel.

Extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation or uncontrolled donation after the circulatory determination of death following out-of-hospital refractory cardiac arrest-An ethical analysis of an unresolved clinical dilemma.

Science.gov (United States)

Dalle Ave, Anne L; Shaw, David M; Gardiner, Dale

2016-11-01

The availability of extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation (E-CPR), for use in refractory out-of hospital cardiac arrest (OHCA), is increasing. In parallel, some countries have developed uncontrolled donation after circulatory determination of death (uDCDD) programs using ECMO to preserve organs for transplantation purposes. When facing a refractory OHCA, how does the medical team choose between initiating ECMO as part of an E-CPR protocol or ECMO as part of a uDCDD protocol? To answer these questions we conducted a literature review on E-CPR compared to uDCDD protocols using ECMO and analyzed the raised ethical issues. Our analysis reveals that the inclusion criteria in E-CPR and uDCDD protocols are similar. There may be a non-negligible risk of including patients in a uDCDD protocol, when the patient might have been saved by the use of E-CPR. In order to avoid the fatal error of letting a saveable patient die, safeguards are necessary. We recommend: (1) the development of internationally accepted termination of resuscitation guidelines that would have to be satisfied prior to inclusion of patients in any uDCDD protocol, (2) the choice regarding modalities of ongoing resuscitation during transfer should be focused on the primary priority of attempting to save the life of patients, (3) only centers of excellence in life-saving resuscitation should initiate or maintain uDCDD programs, (4) E-CPR should be clinically considered first before the initiation of any uDCDD protocol, and (5) there should be no discrimination in the availability of access to E-CPR. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

An advisory statement from the Pediatric Working Group of the International Liaison Committee on Resuscitation.

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Kattwinkel, J; Niermeyer, S; Nadkarni, V; Tibballs, J; Phillips, B; Zideman, D; Van Reempts, P; Osmond, M

1999-04-01

The International Liaison Committee on Resuscitation (ILCOR), with representation from North America, Europe, Australia, New Zealand, Africa, and South America, was formed in 1992 to provide a forum for liaison between resuscitation organizations in the developed world. This consensus document on resuscitation extends previously published ILCOR advisory statements on resuscitation to address the unique and changing physiology of the newly born infant within the first few hours after birth and the techniques for providing advanced life support. After careful review of the international resuscitation literature and after discussion of key and controversial issues, consensus was reached on almost all aspects of neonatal resuscitation, and areas of controversy and high priority for additional research were delineated. Consensus on resuscitation for the newly born infant included the following principles: Common or controversial medications (epinephrine, volume expansion, naloxone, bicarbonate), special resuscitation circumstances affecting care of the newly born, continuing care of the newly born after resuscitation, and ethical considerations for initiation and discontinuation of resuscitation are discussed. There was agreement that insufficient data exist to recommend changes to current guidelines regarding the use of 21% versus 100% oxygen, neuroprotective interventions such as cerebral hypothermia, use of a laryngeal mask versus endotracheal tube, and use of high-dose epinephrine. Areas of controversy are identified, as is the need for additional research to improve the scientific justification of each component of current and future resuscitation guidelines.

Real-Time Mobile Device-Assisted Chest Compression During Cardiopulmonary Resuscitation.

Science.gov (United States)

Sarma, Satyam; Bucuti, Hakiza; Chitnis, Anurag; Klacman, Alex; Dantu, Ram

2017-07-15

Prompt administration of high-quality cardiopulmonary resuscitation (CPR) is a key determinant of survival from cardiac arrest. Strategies to improve CPR quality at point of care could improve resuscitation outcomes. We tested whether a low cost and scalable mobile phone- or smart watch-based solution could provide accurate measures of compression depth and rate during simulated CPR. Fifty health care providers (58% intensive care unit nurses) performed simulated CPR on a calibrated training manikin (Resusci Anne, Laerdal) while wearing both devices. Subjects received real-time audiovisual feedback from each device sequentially. Primary outcome was accuracy of compression depth and rate compared with the calibrated training manikin. Secondary outcome was improvement in CPR quality as defined by meeting both guideline-recommend compression depth (5 to 6 cm) and rate (100 to 120/minute). Compared with the training manikin, typical error for compression depth was mobile device feedback (60% vs 50%; p = 0.3). Sessions that did not meet guideline recommendations failed primarily because of inadequate compression depth (46 ± 2 mm). In conclusion, a mobile device application-guided CPR can accurately track compression depth and rate during simulation in a practice environment in accordance with resuscitation guidelines. Copyright © 2017 Elsevier Inc. All rights reserved.

Usefulness of Serum B-Type Natriuretic Peptide Levels in Comatose Patients Resuscitated from Out-of-Hospital Cardiac Arrest to Predict Outcome

DEFF Research Database (Denmark)

Frydland, Martin; Kjaergaard, Jesper; Erlinge, David

2016-01-01

N-terminal pro-B-type natriuretic (NT-proBNP) is expressed in the heart and brain, and serum levels are elevated in acute heart and brain diseases. We aimed to assess the possible association between serum levels and neurological outcome and death in comatose patients resuscitated from out......-of-hospital cardiac arrest (OHCA). Of the 939 comatose OHCA patients enrolled and randomized in the Targeted Temperature Management (TTM) trial to TTM at 33°C or 36°C for 24 hours, 700 were included in the biomarker substudy. Of these, 647 (92%) had serum levels of NT-proBNP measured 24, 48, and 72 hours after return...... of spontaneous circulation (ROSC). Neurological outcome was evaluated by the Cerebral Performance Category (CPC) score and modified Rankin Scale (mRS) at 6 months. Six hundred thirty-eight patients (99%) had serum NT-proBNP levels ≥125 pg/ml. Patients with TTM at 33°C had significantly lower NT-proBNP serum...

Obstacles delaying the prompt deployment of piston-type mechanical cardiopulmonary resuscitation devices during emergency department resuscitation: a video-recording and time-motion study.

Science.gov (United States)

Huang, Edward Pei-Chuan; Wang, Hui-Chih; Ko, Patrick Chow-In; Chang, Anna Marie; Fu, Chia-Ming; Chen, Jiun-Wei; Liao, Yen-Chen; Liu, Hung-Chieh; Fang, Yao-De; Yang, Chih-Wei; Chiang, Wen-Chu; Ma, Matthew Huei-Ming; Chen, Shyr-Chyr

2013-09-01

The quality of cardiopulmonary resuscitation (CPR) is important to survival after cardiac arrest. Mechanical devices (MD) provide constant CPR, but their effectiveness may be affected by deployment timeliness. To identify the timeliness of the overall and of each essential step in the deployment of a piston-type MD during emergency department (ED) resuscitation, and to identify factors associated with delayed MD deployment by video recordings. Between December 2005 and December 2008, video clips from resuscitations with CPR sessions using a MD in the ED were reviewed using time-motion analyses. The overall deployment timeliness and the time spent on each essential step of deployment were measured. There were 37 CPR recordings that used a MD. Deployment of MD took an average 122.6 ± 57.8s. The 3 most time-consuming steps were: (1) setting the device (57.8 ± 38.3s), (2) positioning the patient (33.4 ± 38.0 s), and (3) positioning the device (14.7 ± 9.5s). Total no flow time was 89.1 ± 41.2s (72.7% of total time) and associated with the 3 most time-consuming steps. There was no difference in the total timeliness, no-flow time, and no-flow ratio between different rescuer numbers, time of day of the resuscitation, or body size of patients. Rescuers spent a significant amount of time on MD deployment, leading to long no-flow times. Lack of familiarity with the device and positioning strategy were associated with poor performance. Additional training in device deployment strategies are required to improve the benefits of mechanical CPR. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Association of public health initiatives with outcomes for out-of-hospital cardiac arrest at home and in public locations

DEFF Research Database (Denmark)

Christopher B., Fordyce; Carolina M., Hansen; Kragholm, Kristian

2017-01-01

Importance  Little is known about the influence of comprehensive public health initiatives according to out-of-hospital cardiac arrest (OHCA) location, particularly at home, where resuscitation efforts and outcomes have historically been poor.Objective  To describe temporal trends in bystander...... cardiopulmonary resuscitation (CPR) and first-responder defibrillation for OHCAs stratified by home vs public location and their association with survival and neurological outcomes.Design, Setting, and Participants  This observational study reviewed 8269 patients with OHCAs (5602 [67.7%] at home and 2667 [32.......3%] in public) for whom resuscitation was attempted using data from the Cardiac Arrest Registry to Enhance Survival (CARES) from January 1, 2010, through December 31, 2014. The setting was 16 counties in North Carolina.Exposures  Patients were stratified by home vs public OHCA. Public health initiatives...

Singapore Paediatric Resuscitation Guidelines 2016.

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Ong, Gene Yong Kwang; Chan, Irene Lai Yeen; Ng, Agnes Suah Bwee; Chew, Su Yah; Mok, Yee Hui; Chan, Yoke Hwee; Ong, Jacqueline Soo May; Ganapathy, Sashikumar; Ng, Kee Chong

2017-07-01

We present the revised 2016 Singapore paediatric resuscitation guidelines. The International Liaison Committee on Resuscitation's Pediatric Taskforce Consensus Statements on Science and Treatment Recommendations, as well as the updated resuscitation guidelines from the American Heart Association and European Resuscitation Council released in October 2015, were debated and discussed by the workgroup. The final recommendations for the Singapore Paediatric Resuscitation Guidelines 2016 were derived after carefully reviewing the current available evidence in the literature and balancing it with local clinical practice. Copyright: © Singapore Medical Association.

Surviving out-of-hospital cardiac arrest: just a matter of defibrillators?

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Zorzi, Alessandro; Gasparetto, Nicola; Stella, Federica; Bortoluzzi, Andrea; Cacciavillani, Luisa; Basso, Cristina

2014-08-01

Out-of-hospital sudden cardiac arrest (OHCA) is a leading cause of death all over the world. Although the outcome of OHCA resulting from 'nonshockable' rhythms (asystole and pulseless electrical activity) is poor regardless of resuscitation efforts, 'shockable' rhythms such as ventricular tachycardia or fibrillation may carry a good prognosis if early defibrillation is performed. At present, simplified cardiopulmonary resuscitation techniques (hands-only cardiopulmonary resuscitation) and automated external defibrillators (AEDs) offer lay people the possibility to provide lifesaving treatment to OHCA victims in the critical minutes before the arrival of the emergency medical system. Programs aimed at increasing provision of cardiopulmonary resuscitation and use of AEDs by lay people have been set up in different countries, including Italy, and have contributed to improve survival rates. However, success of these programs critically depends on appropriate planning and design, and on cultural predisposition of witnesses to undertake immediate measures of resuscitation in the case of OHCA. Placement of a large number of AEDs may carry high costs and little benefits if it is uncoordinated and not preceded by educational campaigns to spread widely the 'culture of resuscitation' in the population.

Termination of resuscitation in the prehospital setting: A comparison of decisions in clinical practice vs. recommendations of a termination rule.

Science.gov (United States)

Verhaert, Dominique V M; Bonnes, Judith L; Nas, Joris; Keuper, Wessel; van Grunsven, Pierre M; Smeets, Joep L R M; de Boer, Menko Jan; Brouwer, Marc A

2016-03-01

Of the proposed algorithms that provide guidance for in-field termination of resuscitation (TOR) decisions, the guidelines for cardiopulmonary resuscitation (CPR) refer to the basic and advanced life support (ALS)-TOR rules. To assess the potential consequences of implementation of the ALS-TOR rule, we performed a case-by-case evaluation of our in-field termination decisions and assessed the corresponding recommendations of the ALS-TOR rule. Cohort of non-traumatic out-of-hospital cardiac arrest (OHCA)-patients who were resuscitated by the ALS-practising emergency medical service (EMS) in the Nijmegen area (2008-2011). The ALS-TOR rule recommends termination in case all following criteria are met: unwitnessed arrest, no bystander CPR, no shock delivery, no return of spontaneous circulation (ROSC). Of the 598 cases reviewed, resuscitative efforts were terminated in the field in 46% and 15% survived to discharge. The ALS-TOR rule would have recommended in-field termination in only 6% of patients, due to high percentages of witnessed arrests (73%) and bystander CPR (54%). In current practice, absence of ROSC was the most important determinant of termination [aOR 35.6 (95% CI 18.3-69.3)]. Weaker associations were found for: unwitnessed and non-public arrests, non-shockable initial rhythms and longer EMS-response times. While designed to optimise hospital transportations, application of the ALS-TOR rule would almost double our hospital transportation rate to over 90% of OHCA-cases due to the favourable arrest circumstances in our region. Prior to implementation of the ALS-TOR rule, local evaluation of the potential consequences for the efficiency of triage is to be recommended and initiatives to improve field-triage for ALS-based EMS-systems are eagerly awaited. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

HOW DO KNOWLEDGE AND SELF-EFFICACY OF INTERNSHIP NURSING STUDENTS IN PERFORMING CARDIOPULMONARY RESUSCITATION?

Directory of Open Access Journals (Sweden)

Selly Desiani

2017-10-01

Full Text Available Background: Cardiopulmonary Resuscitation (CPR is the emergency first aid in cardiac arrest. CPR delivery is influenced by knowledge and self-efficacy. Internship students can be the first responder of cardiac arrest in hospital and expected on having knowledge and high self-efficacy of CPR early. But there is no data on self-efficacy of internship students in performing CPR. Objective: The purpose of this research was to identify knowledge and self-efficacy of internship students in performing CPR. Methods: The method in this research was descriptive quantitative with cross-sectional approach on 76 internship students selected by simple random sampling. Knowledge questionnaire and Resuscitation Self-Efficacy Scale instrument were used in this research, with validity score 0.56-0.84 (α=0.91. Data were analysed by distribution frequency. Results: The results showed that 49 respondents (64.5% had moderate knowledge and 73 respondents (96.1% had high self-efficacy. The lowest domain in knowledge was conceptual knowledge, while in self-efficacy were reporting, debriefing and recording. Conclusions: Therefore, it becomes important to increase information on the conceptual knowledge and enhances training on the self-efficacy domain: reporting; debriefing and recording.

Basic life support knowledge of secondary school students in cardiopulmonary resuscitation training using a song.

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Fonseca Del Pozo, Francisco Javier; Valle Alonso, Joaquin; Canales Velis, Nancy Beatriz; Andrade Barahona, Mario Miguel; Siggers, Aidan; Lopera, Elisa

2016-07-20

To examine the effectiveness of a "cardiopulmonary resuscitation song" in improving the basic life support skills of secondary school students. This pre-test/post-test control design study enrolled secondary school students from two middle schools randomly chosen in Córdoba, Andalucia, Spain. The study included 608 teenagers. A random sample of 87 students in the intervention group and 35 in the control group, aged 12-14 years were selected. The intervention included a cardiopulmonary resuscitation song and video. A questionnaire was conducted at three-time points: pre-intervention, one month and eight months post-intervention. On global knowledge of cardiopulmonary resuscitation, there were no significant differences between the intervention group and the control group in the trial pre-intervention and at the month post-intervention. However, at 8 months there were significant differences with a p-value = 0.000 (intervention group, 95% CI: 6.39 to 7.13 vs. control group, 95% CI: 4.75 to 5.92), F(1,120)=16.644, p=0.000). In addition, significant differences about students' basic life support knowledge about chest compressions at eight months post-intervention (F(1,120)=15.561, p=0.000) were found. Our study showed that incorporating the song component in the cardiopulmonary resuscitation teaching increased its effectiveness and the ability to remember the cardiopulmonary resuscitation algorithm. Our study highlights the need for different methods in the cardiopulmonary resuscitation teaching to facilitate knowledge retention and increase the number of positive outcomes after sudden cardiac arrest.

External cardiac compression may be harmful in some scenarios of pulseless electrical activity.

Science.gov (United States)

Hogan, T S

2012-10-01

Pulseless electrical activity occurs when organised or semi-organised electrical activity of the heart persists but the product of systemic vascular resistance and the increase in systemic arterial flow generated by the ejection of the left venticular stroke volume is not sufficient to produce a clinically detectable pulse. Pulseless electrical activity encompasses a very heterogeneous variety of severe circulatory shock states ranging in severity from pseudo-cardiac arrest to effective cardiac arrest. Outcomes of cardiopulmonary resuscitation for pulseless electrical activity are generally poor. Impairment of cardiac filling is the limiting factor to cardiac output in many scenarios of pulseless electrical activity, including extreme vasodilatory shock states. There is no evidence that external cardiac compression can increase cardiac output when impaired cardiac filling is the limiting factor to cardiac output. If impaired cardiac filling is the limiting factor to cardiac output and the heart is effectively ejecting all the blood returning to it, then external cardiac compression can only increase cardiac output if it increases venous return and cardiac filling. Repeated cardiac compression asynchronous with the patient's cardiac cycle and raised mean intrathoracic pressure due to chest compression can be expected to reduce rather than to increase cardiac filling and therefore to reduce rather than to increase cardiac output in such circumstances. The hypothesis is proposed that the performance of external cardiac compression will have zero or negative effect on cardiac output in pulseless electrical activity when impaired cardiac filling is the limiting factor to cardiac output. External cardiac compression may be both directly and indirectly harmful to significant sub-groups of patients with pulseless electrical activity. We have neither evidence nor theory to provide comfort that external cardiac compression is not harmful in many scenarios of pulseless

External cardiac compression may be harmful in some scenarios of pulseless electrical activity.

LENUS (Irish Health Repository)

Hogan, T S

2012-10-01

Pulseless electrical activity occurs when organised or semi-organised electrical activity of the heart persists but the product of systemic vascular resistance and the increase in systemic arterial flow generated by the ejection of the left venticular stroke volume is not sufficient to produce a clinically detectable pulse. Pulseless electrical activity encompasses a very heterogeneous variety of severe circulatory shock states ranging in severity from pseudo-cardiac arrest to effective cardiac arrest. Outcomes of cardiopulmonary resuscitation for pulseless electrical activity are generally poor. Impairment of cardiac filling is the limiting factor to cardiac output in many scenarios of pulseless electrical activity, including extreme vasodilatory shock states. There is no evidence that external cardiac compression can increase cardiac output when impaired cardiac filling is the limiting factor to cardiac output. If impaired cardiac filling is the limiting factor to cardiac output and the heart is effectively ejecting all the blood returning to it, then external cardiac compression can only increase cardiac output if it increases venous return and cardiac filling. Repeated cardiac compression asynchronous with the patient\\'s cardiac cycle and raised mean intrathoracic pressure due to chest compression can be expected to reduce rather than to increase cardiac filling and therefore to reduce rather than to increase cardiac output in such circumstances. The hypothesis is proposed that the performance of external cardiac compression will have zero or negative effect on cardiac output in pulseless electrical activity when impaired cardiac filling is the limiting factor to cardiac output. External cardiac compression may be both directly and indirectly harmful to significant sub-groups of patients with pulseless electrical activity. We have neither evidence nor theory to provide comfort that external cardiac compression is not harmful in many scenarios of pulseless

Pericardial effusion with cardiac tamponade caused by a central ...

African Journals Online (AJOL)

With more and more extreme premature and very low-birth weight babies being resuscitated, umbilical central venous catheterisation is now being used more frequently in neonatal intensive care. One of the life-threatening complications is pericardial effusion and cardiac tamponade; however, it is potentially reversible ...

Role of permissive hypotension, hypertonic resuscitation and the global increased permeability syndrome in patients with severe hemorrhage: adjuncts to damage control resuscitation to prevent intra-abdominal hypertension.

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Duchesne, Juan C; Kaplan, Lewis J; Balogh, Zsolt J; Malbrain, Manu L N G

2015-01-01

Secondary intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are closely related to fluid resuscitation. IAH causes major deterioration of the cardiac function by affecting preload, contractility and afterload. The aim of this review is to discuss the different interactions between IAH, ACS and resuscitation, and to explore a new hypothesis with regard to damage control resuscitation, permissive hypotension and global increased permeability syndrome. Review of the relevant literature via PubMed search. The recognition of the association between the development of ACS and resuscitation urged the need for new approach in traumatic shock management. Over a decade after wide spread application of damage control surgery damage control resuscitation was developed. DCR differs from previous resuscitation approaches by attempting an earlier and more aggressive correction of coagulopathy, as well as metabolic derangements like acidosis and hypothermia, often referred to as the 'deadly triad' or the 'bloody vicious cycle'. Permissive hypotension involves keeping the blood pressure low enough to avoid exacerbating uncontrolled haemorrhage while maintaining perfusion to vital end organs. The potential detrimental mechanisms of early, aggressive crystalloid resuscitation have been described. Limitation of fluid intake by using colloids, hypertonic saline (HTS) or hyperoncotic albumin solutions have been associated with favourable effects. HTS allows not only for rapid restoration of circulating intravascular volume with less administered fluid, but also attenuates post-injury oedema at the microcirculatory level and may improve microvascular perfusion. Capillary leak represents the maladaptive, often excessive, and undesirable loss of fluid and electrolytes with or without protein into the interstitium that generates oedema. The global increased permeability syndrome (GIPS) has been articulated in patients with persistent systemic inflammation failing

2015 revised Utstein-style recommended guidelines for uniform reporting of data from drowning-related resuscitation: An ILCOR advisory statement.

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Idris, Ahamed H; Bierens, Joost J L M; Perkins, Gavin D; Wenzel, Volker; Nadkarni, Vinay; Morley, Peter; Warner, David S; Topjian, Alexis; Venema, Allart M; Branche, Christine M; Szpilman, David; Morizot-Leite, Luiz; Nitta, Masahiko; Løfgren, Bo; Webber, Jonathon; Gräsner, Jan-Thorsten; Beerman, Stephen B; Youn, Chun Song; Jost, Ulrich; Quan, Linda; Dezfulian, Cameron; Handley, Anthony J; Hazinski, Mary Fran

2017-09-01

Utstein-style guidelines use an established consensus process, endorsed by the international resuscitation community, to facilitate and structure resuscitation research and publication. The first "Guidelines for Uniform Reporting of Data From Drowning" were published over a decade ago. During the intervening years, resuscitation science has advanced considerably, thus making revision of the guidelines timely. In particular, measurement of cardiopulmonary resuscitation elements and neurological outcomes reporting have advanced substantially. The purpose of this report is to provide updated guidelines for reporting data from studies of resuscitation from drowning. An international group with scientific expertise in the fields of drowning research, resuscitation research, emergency medical services, public health, and development of guidelines met in Potsdam, Germany, to determine the data that should be reported in scientific articles on the subject of resuscitation from drowning. At the Utstein-style meeting, participants discussed data elements in detail, defined the data, determined data priority, and decided how data should be reported, including scoring methods and category details. The template for reporting data from drowning research was revised extensively, with new emphasis on measurement of quality of resuscitation, neurological outcomes, and deletion of data that have proved to be less relevant or difficult to capture. The report describes the consensus process, rationale for selecting data elements to be reported, definitions and priority of data, and scoring methods. These guidelines are intended to improve the clarity of scientific communication and the comparability of scientific investigations. Copyright © 2017 European Resuscitation Council, American Heart Association, Inc. Published by Elsevier B.V. All rights reserved.

Sudden cardiac death in the young

Science.gov (United States)

Ackerman, Michael; Atkins, Dianne L; Triedman, John K

2016-01-01

Although the occurrence of sudden cardiac death (SCD) in a young person is a rare event, it is traumatic and often widely publicized. In recent years, SCD in this population has been increasingly seen as a public health and safety issue. This review presents current knowledge relevant to the epidemiology of SCD and to strategies for prevention, resuscitation and identification of those at greatest risk. Areas of active research and controversy include the development of best practices in screening, risk stratification approaches and post-mortem evaluation, and identification of modifiable barriers to providing better outcomes after resuscitation of young SCD victims. Institution of a national registry of SCD in the young will provide data that will help to answer these questions. PMID:26951821

Electronic learning in advanced resuscitation training: The perspective of the candidate.

Science.gov (United States)

Lockey, Andrew S; Dyal, Laura; Kimani, Peter K; Lam, Jenny; Bullock, Ian; Buck, Dominic; Davies, Robin P; Perkins, Gavin D

2015-12-01

Studies have shown that blended approaches combining e-learning with face-to-face training reduces costs whilst maintaining similar learning outcomes. The preferences in learning approach for healthcare providers to this new style of learning have not been comprehensively studied. The aim of this study is to evaluate the acceptability of blended learning to advanced resuscitation training. Participants taking part in the traditional and blended electronic advanced life support (e-ALS) courses were invited to complete a written evaluation of the course. Participants' views were captured on a 6-point Likert scale and in free text written comments covering the content, delivery and organisation of the course. Proportional-odds cumulative logit models were used to compare quantitative responses. Thematic analysis was used to synthesise qualitative feedback. 2848 participants from 31 course centres took part in the study (2008-2010). Candidates consistently scored content delivered face-to-face over the same content delivered over the e-learning platform. Candidates valued practical hands on training which included simulation highly. Within the e-ALS group, a common theme was a feeling of "time pressure" and they "preferred the face-to-face teaching". However, others felt that e-ALS "suited their learning style", was "good for those recertifying", and allowed candidates to "use the learning materials at their own pace". The e-ALS course was well received by most, but not all participants. The majority felt the e-learning module was beneficial. There was universal agreement that the face-to-face training was invaluable. Individual learning styles of the candidates affected their reaction to the course materials. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

3:1 compression to ventilation ratio versus continuous chest compression with asynchronous ventilation in a porcine model of neonatal resuscitation.

Science.gov (United States)

Schmölzer, Georg M; O'Reilly, Megan; Labossiere, Joseph; Lee, Tze-Fun; Cowan, Shaun; Nicoll, Jessica; Bigam, David L; Cheung, Po-Yin

2014-02-01

In contrast to the resuscitation guidelines of children and adults, guidelines on neonatal resuscitation recommend synchronized 90 chest compressions with 30 manual inflations (3:1) per minute in newborn infants. The study aimed to determine if chest compression with asynchronous ventilation improves the recovery of bradycardic asphyxiated newborn piglets compared to 3:1 Compression:Ventilation cardiopulmonary resuscitation (CPR). Term newborn piglets (n=8/group) were anesthetized, intubated, instrumented and exposed to 45-min normocapnic hypoxia followed by asphyxia. Protocolized resuscitation was initiated when heart rate decreased to 25% of baseline. Piglets were randomized to receive resuscitation with either 3:1 compressions to ventilations (3:1C:V CPR group) or chest compressions with asynchronous ventilations (CCaV) or sham. Continuous respiratory parameters (Respironics NM3(®)), cardiac output, mean systemic and pulmonary artery pressures, and regional blood flows were measured. Piglets in 3:1C:V CPR and CCaV CPR groups had similar time to return of spontaneous circulation, survival rates, hemodynamic and respiratory parameters during CPR. The systemic and regional hemodynamic recovery in the subsequent 4h was similar in both groups and significantly lower compared to sham-operated piglets. Newborn piglets resuscitated by CCaV had similar return of spontaneous circulation, survival, and hemodynamic recovery compared to those piglets resuscitated by 3:1 Compression:Ventilation ratio. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Ventricular Fibrillation-Induced Cardiac Arrest Results in Regional Cardiac Injury Preferentially in Left Anterior Descending Coronary Artery Territory in Piglet Model

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Giridhar Kaliki Venkata

2016-01-01

Full Text Available Objective. Decreased cardiac function after resuscitation from cardiac arrest (CA results from global ischemia of the myocardium. In the evolution of postarrest myocardial dysfunction, preferential involvement of any coronary arterial territory is not known. We hypothesized that there is no preferential involvement of any coronary artery during electrical induced ventricular fibrillation (VF in piglet model. Design. Prospective, randomized controlled study. Methods. 12 piglets were randomized to baseline and electrical induced VF. After 5 min, the animals were resuscitated according to AHA PALS guidelines. After return of spontaneous circulation (ROSC, animals were observed for an additional 4 hours prior to cardiac MRI. Data (mean ± SD was analyzed using unpaired t-test; p value ≤ 0.05 was considered statistically significant. Results. Segmental wall motion (mm; baseline versus postarrest group in segment 7 (left anterior descending (LAD was 4.68±0.54 versus 3.31±0.64, p=0.0026. In segment 13, it was 3.82±0.96 versus 2.58±0.82, p=0.02. In segment 14, it was 2.42±0.44 versus 1.29±0.99, p=0.028. Conclusion. Postarrest myocardial dysfunction resulted in segmental wall motion defects in the LAD territory. There were no perfusion defects in the involved segments.

Management of simulated maternal cardiac arrest by residents: didactic teaching versus electronic learning.

Science.gov (United States)

Hards, Andrea; Davies, Sharon; Salman, Aliya; Erik-Soussi, Magda; Balki, Mrinalini

2012-09-01

Successful resuscitation of a pregnant woman undergoing cardiac arrest and survival of the fetus require prompt, high-quality cardiopulmonary resuscitation. The objective of this observational study was to assess management of maternal cardiac arrest by anesthesia residents using high-fidelity simulation and compare subsequent performance following either didactic teaching or electronic learning (e-learning). Twenty anesthesia residents were randomized to receive either didactic teaching (Didactic group, n = 10) or e-learning (Electronic group, n = 10) on maternal cardiac arrest. Baseline management skills were tested using high-fidelity simulation, with repeat simulation testing one month after their teaching intervention. The time from cardiac arrest to start of perimortem Cesarean delivery (PMCD) was measured, and the technical and nontechnical skills scores between the two teaching groups were compared. The median [interquartile range] time to PMCD decreased after teaching, from 4.5 min [3.4 to 5.1 min] to 3.5 min [2.5 to 4.0 min] (P = 0.03), although the change within each group was not statistically significant (Didactic group 4.9 to 3.8 min, P = 0.2; Electronic group 3.9 to 2.5 min, P = 0.07; Didactic group vs Electronic group, P = 1.0). Even after teaching, only 65% of participants started PMCD within four minutes. Technical and nontechnical skills scores improved after teaching in both groups, and there were no differences between the groups. There are gaps in the knowledge and implementation of resuscitation protocols and the recommended modifications for pregnancy among residents. Teaching can improve performance during management of maternal cardiac arrest. Electronic learning and didactic teaching offer similar benefits.

Early neonatal mortality and neurological outcomes of neonatal resuscitation in a resource-limited setting on the Thailand-Myanmar border: A descriptive study.

Directory of Open Access Journals (Sweden)

Sophie Janet

Full Text Available Of the 4 million neonatal deaths worldwide yearly, 98% occur in low and middle-income countries. Effective resuscitation reduces mortality and morbidity but long-term outcomes in resource-limited settings are poorly described. This study reports on newborn neurological outcomes following resuscitation at birth in a resource-limited setting where intensive newborn care including intubation is unavailable.Retrospective analysis of births records from 2008 to 2015 at Shoklo Malaria Research Unit (SMRU on the Thailand-Myanmar border.From 21,225 newbonrs delivered, 15,073 (71% met the inclusion criteria (liveborn, singleton, ≥28 weeks' gestation, delivered in SMRU. Neonatal resuscitation was performed in 460 (3%; 422 basic, 38 advanced cases. Overall early neonatal mortality was 6.6 deaths per 1000 live births (95% CI 5.40-8.06. Newborns receiving basic and advanced resuscitation presented an adjusted rate for death of 1.30 (95%CI 0.66-2.55; p = 0.442, and 6.32 (95%CI 3.01-13.26; p<0.001 respectively, compared to newborns given routine care. Main factors related to increased need for resuscitation were breech delivery, meconium, and fetal distress (p<0.001. Neurodevelopmental follow-up to one year was performed in 1,608 (10.5% of the 15,073 newborns; median neurodevelopmental scores of non-resuscitated newborns and those receiving basic resuscitation were similar (64 (n = 1565 versus 63 (n = 41; p = 0.732, while advanced resuscitation scores were significantly lower (56 (n = 5; p = 0.017.Newborns requiring basic resuscitation at birth have normal neuro-developmental outcomes at one year of age compared to low-risk newborns. Identification of risk factors (e.g., breech delivery associated with increased need for neonatal resuscitation may facilitate allocation of staff to high-risk deliveries. This work endorses the use of basic resuscitation in low-resource settings, and supports on-going staff training to maintain bag-and-mask ventilation skills.

Teamwork during resuscitation.

Science.gov (United States)

Weinstock, Peter; Halamek, Louis P

2008-08-01

Effective resuscitation requires the integration of several cognitive, technical, and behavioral skills. Because resuscitation is performed by teams of health care professionals, these individuals must be able to work together in a coordinated and efficient manner, making teamwork a critical skill for care of patients in distress. Despite the importance of teamwork in health care, little consensus exists as to what it is, how it can most effectively be learned, and how it should be assessed. This article reviews current knowledge on the measurement, training, and importance of teamwork in pediatric resuscitation.

Successful resuscitation of hypermagnesaemic asystolic cardiac arrest with the use of early transvenous cardiac pacemaker: a case report

OpenAIRE

Miller, M A; Crystal, C S; Helphenstine, J; Young, S E

2006-01-01

A 63 year old woman presented to the emergency department (ED) with 1 week of progressive dyspnoea, constipation, and generalized weakness. She had undergone spinal fustion surgery 10 days previously, and had a history of chronic renal insufficiency. The patient had been using milk of magnesia and magnesium citrate in unknown amounts to alleviate her constipation over this time frame. During her ED stay she became progressively hypotensive and bradycardic, and despite aggressive resuscitative...

Effect of a checklist on advanced trauma life support workflow deviations during trauma resuscitations without pre-arrival notification

NARCIS (Netherlands)

Kelleher, D.C.; Jagadeesh Chandra Bose, R.P.; Waterhouse, L.J.; Carter, E.A.; Burd, R.S.

2014-01-01

Background Trauma resuscitations without pre-arrival notification are often initially chaotic, which can potentially compromise patient care. We hypothesized that trauma resuscitations without pre-arrival notification are performed with more variable adherence to ATLS protocol and that

[A brief history of resuscitation - the influence of previous experience on modern techniques and methods].

Science.gov (United States)

Kucmin, Tomasz; Płowaś-Goral, Małgorzata; Nogalski, Adam

2015-02-01

Cardiopulmonary resuscitation (CPR) is relatively novel branch of medical science, however first descriptions of mouth-to-mouth ventilation are to be found in the Bible and literature is full of descriptions of different resuscitation methods - from flagellation and ventilation with bellows through hanging the victims upside down and compressing the chest in order to stimulate ventilation to rectal fumigation with tobacco smoke. The modern history of CPR starts with Kouwenhoven et al. who in 1960 published a paper regarding heart massage through chest compressions. Shortly after that in 1961Peter Safar presented a paradigm promoting opening the airway, performing rescue breaths and chest compressions. First CPR guidelines were published in 1966. Since that time guidelines were modified and improved numerously by two leading world expert organizations ERC (European Resuscitation Council) and AHA (American Heart Association) and published in a new version every 5 years. Currently 2010 guidelines should be obliged. In this paper authors made an attempt to present history of development of resuscitation techniques and methods and assess the influence of previous lifesaving methods on nowadays technologies, equipment and guidelines which allow to help those women and men whose life is in danger due to sudden cardiac arrest. © 2015 MEDPRESS.

Extracorporeal life support in pediatric cardiac patients

Directory of Open Access Journals (Sweden)

Matteo Di NARDO

2016-10-01

Full Text Available Extracorporeal Life Support (ECLS is a valuable tool in the management of neonates and older children with severe cardiac or respiratory failure. In this review, we focus on ECLS when used for neonatal and pediatric cardiac disease. Strict selection of patients and timely deployment are necessary to optimize outcomes. Although every attempt should be made to deploy ECLS urgently rather than emergently, extracorporeal cardiopulmonary resuscitation (ECPR is being increasingly used and reasonable survival rates have been achieved after initiation of ECLS during active compressions of the chest following in-hospital cardiac arrest. Contraindications to ECLS are falling over time, although lethal chromosomal abnormalities, severe irreversible brain injury, and extremely low gestational age and weight (<32 weeks gestation or <1.5 kg remain firm contraindications.

Predictive performance of universal termination of resuscitation rules in an Asian community: are they accurate enough?

Science.gov (United States)

Chiang, Wen-Chu; Ko, Patrick Chow-In; Chang, Anna Marie; Liu, Sot Shih-Hung; Wang, Hui-Chih; Yang, Chih-Wei; Hsieh, Ming-Ju; Chen, Shey-Ying; Lai, Mei-Shu; Ma, Matthew Huei-Ming

2015-04-01

Prehospital termination of resuscitation (TOR) rules have not been widely validated outside of Western countries. This study evaluated the performance of TOR rules in an Asian metropolitan with a mixed-tier emergency medical service (EMS). We analysed the Utstein registry of adult, non-traumatic out-of-hospital cardiac arrests (OHCAs) in Taipei to test the performance of TOR rules for advanced life support (ALS) or basic life support (BLS) providers. ALS and BLS-TOR rules were tested in OHCAs among three subgroups: (1) resuscitated by ALS, (2) by BLS and (3) by mixed ALS and BLS. Outcome definition was in-hospital death. Sensitivity, specificity, positive predictive value (PPV), negative predictive value and decreased transport rate (DTR) among various provider combinations were calculated. Of the 3489 OHCAs included, 240 were resuscitated by ALS, 1727 by BLS and 1522 by ALS and BLS. Overall survival to hospital discharge was 197 patients (5.6%). Specificity and PPV of ALS-TOR and BLS-TOR for identifying death ranged from 70.7% to 81.8% and 95.1% to 98.1%, respectively. Applying the TOR rules would have a DTR of 34.2-63.9%. BLS rules had better predictive accuracy and DTR than ALS rules among all subgroups. Application of the ALS and BLS TOR rules would have decreased OHCA transported to the hospital, and BLS rules are reasonable as the universal criteria in a mixed-tier EMS. However, 1.9-4.9% of those who survived would be misclassified as non-survivors, raising concern of compromising patient safety for the implementation of the rules. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Chest compression-only versus conventional cardiopulmonary resuscitation for bystander-witnessed out-of-hospital cardiac arrest of medical origin: A propensity score-matched cohort from 143,500 patients.

Science.gov (United States)

Kitamura, Tetsuhisa; Kiyohara, Kosuke; Nishiyama, Chika; Kiguchi, Takeyuki; Kobayashi, Daisuke; Kawamura, Takashi; Iwami, Taku

2018-05-01

Current cardiopulmonary resuscitation (CPR) guidelines do not define the optimal type of CPR (chest compression-only CPR [CCCPR] or conventional CPR with rescue breathing [CCRB]) to be performed by bystanders when they witness someone collapse. Using a nationwide database of 1.17 million patients who underwent out-of-hospital cardiac arrest (OHCA) in Japan, we enrolled consecutive bystander-witnessed OHCAs of medical origin with resuscitation attempts from January 2005 through December 2014. Multivariable logistic regression analysis was used to assess the association between the type of bystander CPR and the OHCA outcome after one-to-one propensity score matching for CCCPR versus CCRB. The primary outcome measure was one-month survival with a favorable neurological outcome, defined as a cerebral performance category of 1 or 2. Among 143,500 eligible patients with bystander-witnessed OHCAs receiving bystander-initiated CPR, 71.4% received CCCPR and 28.6% received CCRB. In the univariate analysis, the proportion of one-month survival cases with favorable neurological outcome was lower in the CCCPR group than the CCRB group (5.6% [5749/102,487] vs. 6.5% [2682/41,013], odds ratio [OR]; 0.85 [95% confidence interval {CI}; 0.81-0.89]). However, in the multivariate analysis, the CCCPR group showed a more favorable neurological outcome than the CCRB group (adjusted OR 1.12, 95% CI; 1.06-1.19). In the propensity-matched cohort, the CCCPR group also showed a more favorable neurological outcome than the CCRB group (7.2% [2894/40,096] vs. 6.5% [2610/40,096], adjusted OR 1.14, 95% CI; 1.09-1.22). CCCPR is an acceptable resuscitation technique for lay-rescuers responding to bystander witnessed OHCA of presumed medical origin. Copyright © 2018 Elsevier B.V. All rights reserved.

Effect of lipid emulsion during resuscitation of a patient with cardiac arrest after overdose of chlorpromazine and mirtazapine.

Science.gov (United States)

Matsumoto, Hisatake; Ohnishi, Mitsuo; Takegawa, Ryosuke; Hirose, Tomoya; Hattori, Yuji; Shimazu, Takeshi

2015-10-01

No specific treatment exists for poisoning with most fat-soluble drugs. Intravenous lipid emulsion (ILE) may be effective therapy against such drugs, but effects of ILE treatment are unclear. A 24-year-old woman with depression seen sleeping in the morning was found comatose in the evening, and an emerging lifesaving technologies service was called. After emerging lifesaving technologies departure to hospital, she stopped breathing, became pulseless, and cardiopulmonary life support was started immediately. Electrocardiographic monitoring showed asystole during resuscitation even after arrival at hospital. Empty packaging sheets of 60-tablet chlorpromazine (CPZ) (50 mg/tablet) and 66-tablet mirtazapine (MZP) (15 mg/tablet) found at the scene suggested drug-related cardiopulmonary arrest. Along with conventional administration of adrenaline (total dose, 5 mg), 20% Intralipid 100 mLwas given intravenously 8 minutes after hospital arrival and readministered 27 minutes after hospital arrival because of continued asystole. Return of spontaneous circulation occurred 29 minutes after arrival (70 minutes after cardiac arrest). The patient recovered without any major complications and was transferred to another hospital for psychiatric treatment 70 days after admission. Concentrations of CPZ and MZP were still high when return of spontaneous circulation was achieved with ILE. This case suggested the possible benefit of ILE in treating life threatening cardiotoxicity from CPZ and MZP overdose.

Major Differences in Advanced Life Support Training Strategies Among Danish Hospitals - A Nationwide Study

DEFF Research Database (Denmark)

Glerup Lauridsen, Kasper; Mygind-Klausen, Troels; Stærk, Mathilde

2017-01-01

Introduction: Advanced life support (ALS) training may increase survival from in-hospital cardiac arrest. Efficient ALS training includes practice of both technical and non-technical skills in a realistic setting with frequent retraining to avoid decay in ALS skills. ALS training strategies among...... hospitals are currently unknown. This study aimed to investigate ALS training strategies in Danish hospitals.Methods: We included all public, somatic hospitals in Denmark with a cardiac arrest team (n=46). Online questionnaires were distributed to resuscitation officers in each hospital. Questionnaires...... inquired information on: A) Course duration and retraining interval, B) Training methods and setting, C) Scenario training and practicing non-technical skills.Results: In total, 44 hospitals replied (response rate: 96%). ALS training was conducted in 43 hospitals (98%). Median (range) ALS course duration...

An unanticipated cardiac arrest and unusual post-resuscitation psycho-behavioural phenomena/near death experience in a patient with pregnancy induced hypertension and twin pregnancy undergoing elective lower segment caesarean section

Directory of Open Access Journals (Sweden)

Mridul M Panditrao

2010-01-01

Full Text Available A case report of a primigravida, who was admitted with severe pregnancy induced hypertension (BP 160/122 mmHg and twin pregnancy, is presented here. Antihypertensive therapy was initiated. Elective LSCS under general anaesthesia was planned. After the birth of both the babies, intramyometrial injections of Carboprost and Pitocin were administered. Immediately, she suffered cardiac arrest. Cardio pulmonary resucitation (CPR was started and within 3 minutes, she was successfully resuscitated. The patient initially showed peculiar psychological changes and with passage of time, certain psycho-behavioural patterns emerged which could be attributed to near death experiences, as described in this case report.

Evaluation of a cardiopulmonary resuscitation curriculum in a low resource environment.

Science.gov (United States)

Chang, Mary P; Lyon, Camila B; Janiszewski, David; Aksamit, Deborah; Kateh, Francis; Sampson, John

2015-11-07

To evaluate whether a 2-day International Liaison Committee on Resuscitation (ILCOR) Universal Algorithm-based curriculum taught in a tertiary care hospital in Liberia increases local health care provider knowledge and skill comfort level. A combined basic and advanced cardiopulmonary resuscitation (CPR) curriculum was developed for low-resource settings that included lectures and low-fidelity manikin-based simulations. In March 2014, the curriculum was taught to healthcare providers in a tertiary care hospital in Liberia. In a quality assurance review, participants were evaluated for knowledge and comfort levels with resuscitation before and after the workshop. They were also videotaped during simulation sessions and evaluated on standardized performance metrics. Fifty-two hospital staff completed both pre-and post-curriculum surveys. The median score was 45% pre-curriculum and 82% post-curriculum (presuscitation in this low-resource setting.

The impact of airway management on quality of cardiopulmonary resuscitation: an observational study in patients during cardiac arrest.

Science.gov (United States)

Yeung, Joyce; Chilwan, Mehboob; Field, Richard; Davies, Robin; Gao, Fang; Perkins, Gavin D

2014-07-01

Minimising interruptions in chest compressions is associated with improved survival from cardiac arrest. Current in-hospital guidelines recommend continuous chest compressions after the airway is secured on the premise that this will reduce no flow time. The aim of this study was to determine the effect of advanced airway use on the no flow ratio and other measures of CPR quality. Consecutive adult patients who sustained an in-hospital cardiac arrest were enrolled in this prospective observational study. The quality of CPR was measured using the Q-CPR device (Phillips, UK) before and after an advanced airway device (endotracheal tube [ET] or laryngeal mask airway [LMA]) was inserted. Patients receiving only bag-mask ventilation were used as the control cohort. The primary outcome was no flow ratio (NFR). Secondary outcomes were chest compression rate, depth, compressions too shallow, compressions with leaning, ventilation rate, inflation time, change in impedance and time required to successfully insert airway device. One hundred patients were enrolled in the study (2008-2011). Endotracheal tube and LMA placement took similar durations (median 15.8 s (IQR 6.8-19.4) vs. LMA median 8.0s (IQR 5.5-15.9), p=0.1). The use of an advanced airway was associated with improved no flow ratios (endotracheal tube placement (n=50) improved NFR from baseline median 0.24 IQR 0.17-0.40) to 0.15 to (IQR 0.09-0.28), p=0.012; LMA (n=25) from median 0.28 (IQR 0.23-0.40) to 0.13 (IQR 0.11- 0.19), p=0.0001). There was no change in NFR in patients managed solely with bag valve mask (BVM) (n=25) (median 0.29 (IQR 0.18-0.59) vs. median 0.26 (IQR 0.12-0.37), p=0.888). There was no significant difference in time taken to successfully insert the airway device between the two groups. The use of an advanced airway (ETT or LMA) during in-hospital cardiac arrest was associated with improved no flow ratio. Further studies are required to determine the effect of airway devices on overall patient

Neural injury after use of vasopressin and adrenaline during porcine cardiopulmonary resuscitation.

Science.gov (United States)

Halvorsen, Peter; Sharma, Hari Shanker; Basu, Samar; Wiklund, Lars

2015-03-01

Our aim was to investigate cerebral and cardiac tissue injury subsequent to use of vasopressin and adrenaline in combination compared with vasopressin alone during cardiopulmonary resuscitation (CPR). In a randomized, prospective, laboratory animal study 28 anesthetized piglets were subject to a 12-min untreated cardiac arrest and subsequent CPR. After 1 min of CPR, 10 of the piglets received 0.4 U/kg of arg(8)-vasopressin (V group), and 10 piglets received 0.4 U/kg of arg(8)-vasopressin, 1 min later followed by 20 µg/kg body weight of adrenaline, and another 1 min later continuous administration (10 µg/kg/min) of adrenaline (VA group). After 8 min of CPR, the piglets were defibrillated and monitored for another 3 h. Then they were killed and the brain immediately removed pending histological analysis. During CPR, the VA group had higher mean blood pressure and cerebral cortical blood flow (CCBF) but similar coronary perfusion pressure. After restoration of spontaneous circulation there was no difference in the pressure variables, but CCBF tended to be (36% ± 16%) higher in the V group. Neuronal injury and signs of a disrupted blood-brain barrier (BBB) were greater, 20% ± 4% and 21% ± 4%, respectively, in the VA group. In a background study of repeated single doses of adrenaline every third minute after 5 min arrest but otherwise the same protocol, histological measurements showed even worse neural injury and disruption of the BBB. Combined use of vasopressin and adrenaline caused greater signs of cerebral and cardiac injury than use of vasopressin alone during experimental cardiopulmonary resuscitation.

Improving outcomes from out-of-hospital cardiac arrest in young children and adolescents.

Science.gov (United States)

Atkins, Dianne L; Berger, Stuart

2012-03-01

Out-of-hospital cardiac arrest (OHCA) is an unusual but devastating occurrence in a young person. Years of life-lost are substantial and long-term health care costs of survivors can be high. However, there have been noteworthy improvements in cardiopulmonary resuscitation (CPR) standards, out-of hospital care, and postcardiac arrest therapies that have resulted in a several-fold improvement in resuscitation outcomes. Recent interest and research in resuscitation of children has the promise of generating improvements in the outcomes of these patients. Integrated and coordinated care in the out-of-hospital and hospital settings are required. This article will review the epidemiology of OHCA, the 2010 CPR guidelines, and developments in public access defibrillation for children.

[Improving myocardial mechanics parameters of severe burn rabbits with oral fluid resuscitation].

Science.gov (United States)

Ruan, Jing; Zhang, Bing-qian; Wang, Guang; Luo, Zhong-hua; Zheng, Qing-yi; Zheng, Jian-sheng; Huang, Yue-sheng; Xiao, Rong

2008-08-01

To investigate the protective effect of oral fluid resuscitation on cardiac function in severe burn rabbits. One hundred and fifty rabbits were randomly divided into normal control group (NC group, n = 6, without treatment), burn group (B group, n = 42, without fluid therapy), immediate oral fluid resuscitation group (C group, n = 42), delayed oral fluid resuscitation group (D group, n = 30) and delayed and rapid oral fluid resuscitation group (E group, n = 30). The rabbits in B, C, D, E groups were subjected to 40% TBSA full-thickness burn, then were treated with fluid therapy immediately after burn (C group), at 6 hour after burn (D, E groups). The myocardial mechanics parameters including mean arterial pressure (MAP), left ventricular systolic pressure (LVSP), left ventricular end diastolic pressure (LVEDP), LV +/- dp/dt max were observed at 2, 6, 8, 12, 24, 36 and 48 post burn hour (PBH). Urine output was also examined. The level of LVSP, LV +/- dp/dt max in B roup were significantly lower than those in NC group. The level of LVSP, LV +/- dp/dt max in the C and E group were singnificantly increased during 24 hour after burn. The level of LV + dp/dt max and LV-dp/dt max in C group peaked at 8 PBH (892 +/- 116 kPa/s) and at 6PBH (724 +/- 149 kPa/s) respectively. The levels of LV +/- dp/dt max, LVSP in D group at each time point were similar to B group (P > 0.05). Both the levels of LV +/- dp/dt max in E group peaked at 8 PBH. The level of LVEDP was no obvious difference between B and other groups at each time point (P > 0.05). The changes of MAP and urine output on 24 PBH in each group were similar to above indices. Effective oral fluid therapy in severe burn rabbits during 24 hours after burn can ameliorate myocardial mechanics parameters. The amount of fluid resuscitation can be estimated according to relevant formula for delayed fluid resuscitation in burn rabbits.

Myocardial infarction is a frequent cause of exercise-related resuscitated out-of-hospital cardiac arrest in a general non-athletic population

DEFF Research Database (Denmark)

Søholm, Helle; Kjaergaard, Jesper; Thomsen, Jakob Hartvig

2014-01-01

-athletic population. METHODS: Consecutive patients with OHCA were admitted with return of spontaneous circulation (ROSC) or on-going resuscitation at hospital arrival (2002-2011). Patient charts were reviewed for post-resuscitation data. Exercise was defined as moderate/vigorous physical activity. RESULTS: A total...

Conflicting perspectives compromising discussions on cardiopulmonary resuscitation.

LENUS (Irish Health Repository)

Groarke, J

2010-09-01

Healthcare professionals, patients and their relatives are expected to discuss resuscitation together. This study aims to identify the differences in the knowledge base and understanding of these parties. Questionnaires examining knowledge and opinion on resuscitation matters were completed during interviews of randomly selected doctors, nurses and the general public. 70% doctors, 24% nurses and 0% of a public group correctly estimated survival to discharge following in-hospital resuscitation attempts. Deficiencies were identified in doctor and nurse knowledge of ethics governing resuscitation decisions. Public opinion often conflicts with ethical guidelines. Public understanding of the nature of cardiopulmonary arrests and resuscitation attempts; and of the implications of a \\'Do Not Attempt Resuscitation (DNAR)\\' order is poor. Television medical dramas are the primary source of resuscitation knowledge. Deficiencies in healthcare professionals\\' knowledge of resuscitation ethics and outcomes may compromise resuscitation decisions. Educational initiatives to address deficiencies are necessary. Parties involved in discussion on resuscitation do not share the same knowledge base reducing the likelihood of meaningful discussion. Public misapprehensions surrounding resuscitation must be identified and corrected during discussion.

Positive end-expiratory pressure improves survival in a rodent model of cardiopulmonary resuscitation using high-dose epinephrine.

LENUS (Irish Health Repository)

McCaul, Conán

2009-10-01

Multiple interventions have been tested in models of cardiopulmonary resuscitation (CPR) to optimize drug use, chest compressions, and ventilation. None has studied the effects of positive end-expiratory pressure (PEEP) on outcome. We hypothesized that because PEEP can reverse pulmonary atelectasis, lower pulmonary vascular resistance, and potentially improve cardiac output, its use during CPR would increase survival.

Paediatric traumatic cardiac arrest: a Delphi study to establish consensus on definition and management.

Science.gov (United States)

Rickard, Annette C; Vassallo, James; Nutbeam, Tim; Lyttle, Mark D; Maconochie, Ian K; Enki, Doyo G; Smith, Jason E

2018-04-28

Paediatric traumatic cardiac arrest (TCA) is associated with low survival and poor outcomes. The mechanisms that underlie TCA are different from medical cardiac arrest; the approach to treatment of TCA may therefore also need to differ to optimise outcomes. The aim of this study was to explore the opinion of subject matter experts regarding the diagnosis and treatment of paediatric TCA, and to reach consensus on how best to manage this group of patients. An online Delphi study was conducted over three rounds, with the aim of achieving consensus (defined as 70% agreement) on statements related to the diagnosis and management of paediatric TCA. Participants were invited from paediatric and adult emergency medicine, paediatric anaesthetics, paediatric ICU and paediatric surgery, as well as Paediatric Major Trauma Centre leads and representatives from the Resuscitation Council UK. Statements were informed by literature reviews and were based on elements of APLS resuscitation algorithms as well as some concepts used in the management of adult TCA; they ranged from confirmation of cardiac arrest to the indications for thoracotomy. 73 experts completed all three rounds between June and November 2016. Consensus was reached on 14 statements regarding the diagnosis and management of paediatric TCA; oxygenation and ventilatory support, along with rapid volume replacement with warmed blood, improve survival. The duration of cardiac arrest and the lack of a response to intervention, along with cardiac standstill on ultrasound, help to guide the decision to terminate resuscitation. This study has given a consensus-based framework to guide protocol development in the management of paediatric TCA, though further work is required in other key areas including its acceptability to clinicians. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Chest compression rates and survival following out-of-hospital cardiac arrest.

Science.gov (United States)

Idris, Ahamed H; Guffey, Danielle; Pepe, Paul E; Brown, Siobhan P; Brooks, Steven C; Callaway, Clifton W; Christenson, Jim; Davis, Daniel P; Daya, Mohamud R; Gray, Randal; Kudenchuk, Peter J; Larsen, Jonathan; Lin, Steve; Menegazzi, James J; Sheehan, Kellie; Sopko, George; Stiell, Ian; Nichol, Graham; Aufderheide, Tom P

2015-04-01

Guidelines for cardiopulmonary resuscitation recommend a chest compression rate of at least 100 compressions/min. A recent clinical study reported optimal return of spontaneous circulation with rates between 100 and 120/min during cardiopulmonary resuscitation for out-of-hospital cardiac arrest. However, the relationship between compression rate and survival is still undetermined. Prospective, observational study. Data is from the Resuscitation Outcomes Consortium Prehospital Resuscitation IMpedance threshold device and Early versus Delayed analysis clinical trial. Adults with out-of-hospital cardiac arrest treated by emergency medical service providers. None. Data were abstracted from monitor-defibrillator recordings for the first five minutes of emergency medical service cardiopulmonary resuscitation. Multiple logistic regression assessed odds ratio for survival by compression rate categories (compression fraction and depth, first rhythm, and study site. Compression rate data were available for 10,371 patients; 6,399 also had chest compression fraction and depth data. Age (mean±SD) was 67±16 years. Chest compression rate was 111±19 per minute, compression fraction was 0.70±0.17, and compression depth was 42±12 mm. Circulation was restored in 34%; 9% survived to hospital discharge. After adjustment for covariates without chest compression depth and fraction (n=10,371), a global test found no significant relationship between compression rate and survival (p=0.19). However, after adjustment for covariates including chest compression depth and fraction (n=6,399), the global test found a significant relationship between compression rate and survival (p=0.02), with the reference group (100-119 compressions/min) having the greatest likelihood for survival. After adjustment for chest compression fraction and depth, compression rates between 100 and 120 per minute were associated with greatest survival to hospital discharge.

Defining the Intrinsic Cardiac Risks of Operations to Improve Preoperative Cardiac Risk Assessments.

Science.gov (United States)

Liu, Jason B; Liu, Yaoming; Cohen, Mark E; Ko, Clifford Y; Sweitzer, Bobbie J

2018-02-01

Current preoperative cardiac risk stratification practices group operations into broad categories, which might inadequately consider the intrinsic cardiac risks of individual operations. We sought to define the intrinsic cardiac risks of individual operations and to demonstrate how grouping operations might lead to imprecise estimates of perioperative cardiac risk. Elective operations (based on Common Procedural Terminology codes) performed from January 1, 2010 to December 31, 2015 at hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program were studied. A composite measure of perioperative adverse cardiac events was defined as either cardiac arrest requiring cardiopulmonary resuscitation or acute myocardial infarction. Operations' intrinsic cardiac risks were derived from mixed-effects models while controlling for patient mix. Resultant risks were sorted into low-, intermediate-, and high-risk categories, and the most commonly performed operations within each category were identified. Intrinsic operative risks were also examined using a representative grouping of operations to portray within-group variation. Sixty-six low, 30 intermediate, and 106 high intrinsic cardiac risk operations were identified. Excisional breast biopsy had the lowest intrinsic cardiac risk (overall rate, 0.01%; odds ratio, 0.11; 95% CI, 0.02 to 0.25) relative to the average, whereas aorto-bifemoral bypass grafting had the highest (overall rate, 4.1%; odds ratio, 6.61; 95% CI, 5.54 to 7.90). There was wide variation in the intrinsic cardiac risks of operations within the representative grouping (median odds ratio, 1.40; interquartile range, 0.88 to 2.17). A continuum of intrinsic cardiac risk exists among operations. Grouping operations into broad categories inadequately accounts for the intrinsic cardiac risk of individual operations.

An unsuccessful resuscitation:

African Journals Online (AJOL)

Keywords: Breaking bad news, resuscitation, communication, emergency ... Twelve family members whose loved ones had died in the emergency room and ... There was no effective follow-up of the families and the doctors also ... be available for staff involved in unsuccessful resuscitations. .... ed with the healing process.

The value of arterial blood gas parameters for prediction of mortality in survivors of out-of-hospital cardiac arrest

Directory of Open Access Journals (Sweden)

Katharina Isabel von Auenmueller

2017-01-01

Full Text Available Context: Sudden cardiac death is one of the leading causes of death in Europe, and early prognostication remains challenging. There is a lack of valid parameters for the prediction of survival after cardiac arrest. Aims: This study aims to investigate if arterial blood gas parameters correlate with mortality of patients after out-of-hospital cardiac arrest. Materials and Methods: All patients who were admitted to our hospital after resuscitation following out-of-hospital cardiac arrest between January 1, 2008, and December 31, 2013, were included in this retrospective study. The patient's survival 5 days after resuscitation defined the study end-point. For the statistical analysis, the mean, standard deviation, Student's t-test, Chi-square test, and logistic regression analyses were used (level of significance P< 0.05. Results: Arterial blood gas samples were taken from 170 patients. In particular, pH < 7.0 (odds ratio [OR]: 7.20; 95% confidence interval [CI]: 3.11–16.69; P< 0.001 and lactate ≥ 5.0 mmol/L (OR: 6.79; 95% CI: 2.77–16.66; P< 0.001 showed strong and independent correlations with mortality within the first 5 days after hospital admission. Conclusion: Our study results indicate that several arterial blood gas parameters correlate with mortality of patients after out-of-hospital resuscitation. The most relevant parameters are pH and lactate because they are strongly and independently associated with mortality within the first 5 days after resuscitation. Despite this correlation, none of these parameters by oneself is strong enough to allow an early prognostication. Still, these parameters can contribute as part of a multimodal approach to assessing the patients' prognosis.

[Mild therapeutic hypothermia in cardiogenic shock : Retrospective analysis of 80 patients with preclinical cardiac arrest due to cardiac causes].

Science.gov (United States)

Adler, C; Pfister, R; Baldus, S; Reuter, H

2017-02-01

The mortality in patients with cardiogenic shock after out-of-hospital cardiac arrest (OHCA) remains high despite advances in resuscitation and early revascularization strategies. The use of mild therapeutic hypothermia (MTH) for improvement of survival and neurological outcome in patients with cardiogenic shock is currently subject to renewed discussion. The aim of this study was the detection of risk factors for mortality and morbidity in patients under MTH in cardiogenic shock following preclinical resuscitation for OHCA. A total of 80 consecutive patients in cardiogenic shock after successful resuscitation (mean age 60 ± 3.2 years) treated with MTH were retrospectively analyzed. Patients were cooled to 33 °C for 24 h using an endovascular cooling device. Neurological outcome was assessed after 2 months based on the Glasgow-Pittsburgh cerebral performance category (CPC) and correlated with various blood parameter values. After 2 months 31 patients (39 %) showed a good neurological recovery with CPC scores of 1-2, 20 patients (25 %) had a poor neurological outcome with CPC scores of 3-4 and 29 (36 %) patients enrolled in the trial died (CPC 5). Patients with a poor outcome showed significantly higher mean serum levels for lactate, creatinine and urea. In addition, these patients showed a continuous increase of serum neuron-specific enolase (NSE) values in contrast to patients with a good outcome (∆ NSE from admission to day 1, CPC 1 and 2: - 10.6 ± 3 µg/l and CPC 3-5: 33 ± 12 µg/l, p = 0.02). Changes in the course of serum creatinine, urea and NSE levels within the first 72 h after OHCA could provide valuable additional information for the early assessment of the neurological prognosis in patients treated with MTH.

Outcome among patients suffering from in-hospital cardiac arrest

Directory of Open Access Journals (Sweden)

Trpković Sladjana

2014-01-01

Full Text Available Introduction. In relation to pre-hospital treatment of patients with cardiac arrest (CA in the field where resuscitation is often started by nonprofessionals, resuscitation in hospital is most commonly performed by well-trained personnel. Objective. The aim was to define the factors associated with an improved outcome among patients suffering from the inhospital CA (IHCA. Methods. The prospective study included a total of 100 patients in the Emergency Center over two-year period. The patterns by the Utstein-Style guidelines recorded the following: age, sex, reason for hospital admission, comorbidity, cause and origin of CA, continuous monitoring, time of arrival of the medical emergency team and time of delivery of the first defibrillation shock (DC. Results. Most patients (61% had cardiac etiology. Return of spontaneous circulation (ROSC was achieved in 58% of patients. ROSC was more frequently achieved in younger patients (57.69±11.37, (p<0.05, non-surgical patients (76.1%, (p<0.01 and in patients who were in continuous monitoring (66.7% (p<0.05. The outcome of CPR was significantly better in patients who received advanced life support (ALS (76.6% (p<0.01. Time until the delivery of the first DC shock was significantly shorter in patients who achieved ROSC (1.67±1.13 min, (p<0.01. A total of 5% of IHCA patients survived to hospital discharge. Conclusion. In our study, the outcome of CPR was better in patients who were younger and with non-surgical diseases, which are prognostic factors that we cannot control. Factors associated with better outcome of IHCA patients were: continuous monitoring, shorter time until the delivery of the first DC and ALS. This means that better education of medical staff, better organization and up-to-dated technical equipment are needed.

Termination of resuscitation in the prehospital setting: A comparison of decisions in clinical practice vs. recommendations of a termination rule

NARCIS (Netherlands)

Verhaert, D.V.; Bonnes, J.L.; Nas, J.; Keuper, W.; Grunsven, P.M. van; Smeets, J.L.; Boer, M.J. de; Brouwer, M.A.

2016-01-01

BACKGROUND: Of the proposed algorithms that provide guidance for in-field termination of resuscitation (TOR) decisions, the guidelines for cardiopulmonary resuscitation (CPR) refer to the basic and advanced life support (ALS)-TOR rules. To assess the potential consequences of implementation of the

In-hospital pediatric cardiac arrest in Honduras.

Science.gov (United States)

Matamoros, Martha; Rodriguez, Roger; Callejas, Allison; Carranza, Douglas; Zeron, Hilda; Sánchez, Carlos; Del Castillo, Jimena; López-Herce, Jesús

2015-01-01

The objective of this study was to analyze the characteristic and the prognostic factors of in-hospital pediatric cardiac arrest (CA) in a public hospital Honduras. A prospective observational study was performed on pediatric in-hospital CA as a part of a multicenter international study. One hundred forty-six children were studied. The primary end point was survival at hospital discharge. Univariate and multivariate logistic regression analyses were performed to assess the influence of each factor on mortality. Cardiac arrest occurred in the emergency department in 66.9%. Respiratory diseases and sepsis were predominant causes of CA. Return of spontaneous circulation was achieved in 60% of patients, and 22.6% survived to hospital discharge. The factors related with mortality were nonrespiratory cause of CA (odds ratio [OR], 2.55; P = 0.045), adrenaline administration (OR, 4.96; P = 0.008), and a duration of cardiopulmonary resuscitation more than 10 minutes (OR, 3.40; P = 0.012). In-hospital CA in children in a developing country has low survival. Patients with nonrespiratory causes and those who need adrenaline administration and prolonged resuscitation had worse prognosis.

Family presence at resuscitation attempts.

Science.gov (United States)

Jaques, Helen

UK resuscitation guidelines suggest that parents and carers should be allowed to be present during a resuscitation attempt in hospital but no guidance is available regarding family presence when resuscitation takes place out of hospital. A new research study has suggested that relatives who were offered the opportunity to witness resuscitation were less likely to develop symptoms of post-traumatic stress disorder than those who were not given the chance. This article summarises the results of this study and provides an expert commentary on its conclusions.

Heart Rate Variability Analysis in an Experimental Model of Hemorrhagic Shock and Resuscitation in Pigs.

Directory of Open Access Journals (Sweden)

Edgard Salomão

Full Text Available The analysis of heart rate variability (HRV has been shown as a promising non-invasive technique for assessing the cardiac autonomic modulation in trauma. The aim of this study was to evaluate HRV during hemorrhagic shock and fluid resuscitation, comparing to traditional hemodynamic and metabolic parameters.Twenty anesthetized and mechanically ventilated pigs were submitted to hemorrhagic shock (60% of estimated blood volume and evaluated for 60 minutes without fluid replacement. Surviving animals were treated with Ringer solution and evaluated for an additional period of 180 minutes. HRV metrics (time and frequency domain as well as hemodynamic and metabolic parameters were evaluated in survivors and non-survivors animals.Seven of the 20 animals died during hemorrhage and initial fluid resuscitation. All animals presented an increase in time-domain HRV measures during haemorrhage and fluid resuscitation restored baseline values. Although not significantly, normalized low-frequency and LF/HF ratio decreased during early stages of haemorrhage, recovering baseline values later during hemorrhagic shock, and increased after fluid resuscitation. Non-surviving animals presented significantly lower mean arterial pressure (43±7 vs 57±9 mmHg, P<0.05 and cardiac index (1.7±0.2 vs 2.6±0.5 L/min/m2, P<0.05, and higher levels of plasma lactate (7.2±2.4 vs 3.7±1.4 mmol/L, P<0.05, base excess (-6.8±3.3 vs -2.3±2.8 mmol/L, P<0.05 and potassium (5.3±0.6 vs 4.2±0.3 mmol/L, P<0.05 at 30 minutes after hemorrhagic shock compared with surviving animals.The HRV increased early during hemorrhage but none of the evaluated HRV metrics was able to discriminate survivors from non-survivors during hemorrhagic shock. Moreover, metabolic and hemodynamic variables were more reliable to reflect hemorrhagic shock severity than HRV metrics.

[THEORETICAL BACKGROUND OF FINDING ORGANS FOR TRANSPLANTATION AMONG NON-HEART BEATING DONORS UNDER UNSUCCESSFUL EXTRACORPOREAL RESUSCITATION (LITERATURE REVIEW)].

Science.gov (United States)

Khodeli, N; Chkhaidze, Z; Partsakhashvili, D; Pilishvili, O; Kordzaia, D

2016-05-01

The number of patients who are in the "Transplant Waiting List" is increasing each year. At the same time, as a result of the significant shortage of donor organs, part of the patients dies without waiting till surgery. According to the Maastricht classification for non-heart beating donors, the patients, who had cardiac arrest outside the hospital (in the uncontrolled by medical staff conditions) should be considered as a potential donors of category II. For these patients, the most effective resuscitation is recommended. The extracorporeal life support (ECLS) considers the connection to a special artificial perfusion system for the restoration of blood circulation out-of-hospital with further transportation to the hospital. If restoration of independent cardiac activity does not occur, in spite of the full range of resuscitative measures, these patients may be regarded as potential donors. The final decision should be received in the hospital, by the council of physicians, lawyers and patient's family members. Until the final decision, the prolongation of ECLS and maintaining adequate systemic and organic circulation is recommended.

Complete maternal and fetal recovery after prolonged cardiac arrest.

Science.gov (United States)

Selden, B S; Burke, T J

1988-04-01

A case of complete maternal and fetal recovery after prolonged cardiac arrest from massive lidocaine overdose is presented. A 27-year-old woman at 15 weeks gestation had a complete neurologic recovery after 22 minutes of CPR, including 19 minutes of electromechanical dissociation and asystole, with normal fetal heart function and fetal motion confirmed by ultrasound immediately after resuscitation. The patient delivered a healthy and neurologically normal infant at 40 weeks gestation. This is the longest cardiac arrest in early pregnancy reported in the medical literature with normal maternal and fetal outcome.

Prognostic factors of the results of cardiopulmonary resuscitation in a cardiology hospital

Directory of Open Access Journals (Sweden)

Timerman Ari

2001-01-01

Full Text Available OBJECTIVE: To analyze the early and late results of cardiopulmonary resuscitation in a cardiology hospital and to try to detect prognostic determinants of both short- and long-term survival. METHODS: A series of 557 patients who suffered cardiorespiratory arrest (CRA at the Dante Pazzanese Cardiology Institute over a period of 5 years was analyzed to examine factors predicting successful resuscitation and long-term survival. RESULTS: Ressuscitation maneuvers were tried in 536 patients; 281 patients (52.4% died immediately, and 164 patients (30.6% survived for than 24 hours. The 87 patients who survived for more than 1 month after CRA were compared with nonsurvivors. Coronary disease, cardiomyopathy, and valvular disease had a better prognosis. Primary arrhythmia occurred in 73.5% of the >1-month survivor group and heart failure occurred in 12.6% of this group. In those patients in whom the initial mechanism of CRA was ventricular fibrillation, 33.3% survived for more than 1 month, but of those with ventricular asystole only 4.3% survived. None of the 10 patients with electromechanical dissociation survived. There was worse prognosis in patients included in the extreme age groups (zero to 10 years and 70 years or more. The best results occurred when the cardiac arrest took place in the catheterization laboratories. The worst results occurred in the intensive care unit and the hemodialysis room. CONCLUSION: The results in our series may serve as a helpful guide to physicians with the difficult task of deciding when not to resuscitate or when to stop resuscitation efforts.

Temporal variations in dispatcher-assisted and bystander-initiated resuscitation efforts.

Science.gov (United States)

Yamashita, Akira; Maeda, Tetsuo; Myojo, Yasuhiro; Wato, Yukihiro; Ohta, Keisuke; Inaba, Hideo

2018-04-03

To investigate temporal variations in dispatcher-assisted and bystander-initiated resuscitation efforts and their association with survival after bystander-witnessed out-of-hospital cardiac arrests (OHCAs). We retrospectively analyzed the neurologically favorable 1-month survival and the parameters related to dispatcher assisted cardiopulmonary resuscitation (DA-CPR) and bystander CPR (BCPR) for 227,524 OHCA patients between 2007 and 2013 in Japan. DA-CPR sensitivity for OHCAs, bystander's compliance to DA-CPR assessed by the proportion of bystanders who follow DA-CPR, and performance of BCPR measured by the rate of bystander-initiated CPR in patients without DA-CPR were calculated as indices of resuscitation efforts. Performance of BCPR was only similar to temporal variations in the survival (correlation between hourly paired values, R 2 =0.263, P=0.01): a lower survival rate (3.4% vs 4.2%) and performance of BCPR (23.1% vs 30.8%) during night-time (22:00-5:59) than during non-night-time. In subgroup analyses based on interaction tests, all three indices deteriorated during night-time when OHCAs were witnessed by non-family (adjusted odds ratio, 0.73-0.82), particularly in non-elderly patients. The rate of public access defibrillation for these OHCAs markedly decreased during night-time (adjusted odds ratio, 0.49) with delayed emergency calls and BCPR initiation. Multivariable logistic regression analyses revealed that the survival rate of non-family-witnessed OHCAs was 1.83-fold lower during night-time than during non-night-time. Dispatcher-assisted and bystander-initiated resuscitation efforts are low during night-time in OHCAs witnessed by non-family. A divisional alert system to recruit well-trained individuals is needed in order to improve the outcomes of night-time OHCAs witnessed by non-family bystanders. Copyright © 2018 Elsevier Inc. All rights reserved.

F-MARC: promoting the prevention and management of sudden cardiac arrest in football.

Science.gov (United States)

Kramer, Efraim Benjamin; Dvorak, J; Schmied, C; Meyer, T

2015-05-01

Sudden cardiac death is the most common cause of unnatural death in football. To prevent and urgently manage sudden cardiac arrest on the football field-of-play, F-MARC (FIFA Medical and Research Centre) has been fully committed to a programme of research, education, standardisation and practical implementation. This strategy has detected football players at medical risk during mandatory precompetition medical assessments. Additionally, FIFA has (1) sponsored internationally accepted guidelines for the interpretation of an athlete's ECG, (2) developed field-of-play-specific protocols for the recognition, response, resuscitation and removal of a football player having sudden cardiac arrest and (3) introduced and distributed the FIFA medical emergency bag which has already resulted in the successful resuscitation of a football player who had a sudden cardiac arrest on the field-of-play. Recently FIFA, in association with the Institute of Sports and Preventive Medicine in Saarbrücken, Germany, established a worldwide Sudden Death Registry with a view to documenting fatal events on the football field-of-play. These activities by F-MARC are testimony to FIFA's continued commitment to minimising sudden cardiac arrest while playing football. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Where no guideline has gone before: retrospective analysis of resuscitation in the 24th century.

Science.gov (United States)

Hörburger, David; Haslinger, Julia; Bickel, Hubert; Graf, Nikolaus; Schober, Andreas; Testori, Christoph; Weiser, Christoph; Sterz, Fritz; Haugk, Moritz

2014-12-01

Evaluation of the treatment, epidemiology and outcome of cardiac arrest in the television franchise Star Trek. Retrospective cohort study of prospective events. Screening of all episodes of Star Trek: The Next Generation, Star Trek: Deep Space Nine and Star Trek: Voyager for cardiac arrest events. Documentation was performed according to the Utstein guidelines for cardiac arrest documentation. All adult, single person cardiac arrests were included. Patients were excluded if cardiac arrest occurred during mass casualties, if the victims were annihilated by energy weapons or were murdered and nobody besides the assassin could provide first aid. Epidemiological data, treatment and outcome of cardiac arrest victims in the 24th century were studied. Ninety-six cardiac arrests were included. Twenty-three individuals were female (24%). Cardiac arrest was witnessed in 91 cases (95%), trauma was the leading cause (n = 38; 40%). Resuscitation was initiated in 17 cases (18%) and 12 patients (13%) had return of spontaneous circulation. Favorable neurological outcome and long-term survival was documented in nine patients (9%). Technically diagnosed cardiac arrest was associated with higher rates of favorable neurological outcome and long-term survival. Neurological outcome and survival did not depend on cardiac arrest location. Cardiac arrest remains a critical event in the 24th century. We observed a change of etiology from cardiac toward traumatic origin. Quick access to medical help and new prognostic tools were established to treat cardiac arrest.

Effect of dyad training on medical students' cardiopulmonary resuscitation performance.

Science.gov (United States)

Wang, Candice; Huang, Chin-Chou; Lin, Shing-Jong; Chen, Jaw-Wen

2017-03-01

We investigated the effects of dyadic training on medical students' resuscitation performance during cardiopulmonary resuscitation (CPR) training.We provided students with a 2-hour training session on CPR for simulated cardiac arrest. Student teams were split into double groups (Dyad training groups: Groups A and B) or Single Groups. All groups received 2 CPR simulation rounds. CPR simulation training began with peer demonstration for Group A, and peer observation for Group B. Then the 2 groups switched roles. Single Groups completed CPR simulation without peer observation or demonstration. Teams were then evaluated based on leadership, teamwork, and team member skills.Group B had the highest first simulation round scores overall (P = 0.004) and in teamwork (P = 0.001) and team member skills (P = 0.031). Group B also had the highest second simulation round scores overall (P training groups with those of Single Groups in overall scores, leadership scores, teamwork scores, and team member scores. In the second simulation, Dyad training groups scored higher in overall scores (P = 0.002), leadership scores (P = 0.044), teamwork scores (P = 0.005), and team member scores (P = 0.008). Dyad training groups also displayed higher improvement in overall scores (P = 0.010) and team member scores (P = 0.022).Dyad training was effective for CPR training. Both peer observation and demonstration for peers in dyad training can improve student resuscitation performance.

Effect of dyad training on medical students’ cardiopulmonary resuscitation performance

Science.gov (United States)

Wang, Candice; Huang, Chin-Chou; Lin, Shing-Jong; Chen, Jaw-Wen

2017-01-01

Abstract We investigated the effects of dyadic training on medical students’ resuscitation performance during cardiopulmonary resuscitation (CPR) training. We provided students with a 2-hour training session on CPR for simulated cardiac arrest. Student teams were split into double groups (Dyad training groups: Groups A and B) or Single Groups. All groups received 2 CPR simulation rounds. CPR simulation training began with peer demonstration for Group A, and peer observation for Group B. Then the 2 groups switched roles. Single Groups completed CPR simulation without peer observation or demonstration. Teams were then evaluated based on leadership, teamwork, and team member skills. Group B had the highest first simulation round scores overall (P = 0.004) and in teamwork (P = 0.001) and team member skills (P = 0.031). Group B also had the highest second simulation round scores overall (P training groups with those of Single Groups in overall scores, leadership scores, teamwork scores, and team member scores. In the second simulation, Dyad training groups scored higher in overall scores (P = 0.002), leadership scores (P = 0.044), teamwork scores (P = 0.005), and team member scores (P = 0.008). Dyad training groups also displayed higher improvement in overall scores (P = 0.010) and team member scores (P = 0.022). Dyad training was effective for CPR training. Both peer observation and demonstration for peers in dyad training can improve student resuscitation performance. PMID:28353555

Cardiac arrest following ventilator fire: A rare cause

Directory of Open Access Journals (Sweden)

K Nazeer Ahmed

2012-01-01

Full Text Available Operating room fires are rare events, but when occur they result in serious and sometimes fatal consequences. Anaesthesia ventilator fire leading to cardiac arrest is a rare incident and has not been reported. We report a near catastrophic ventilator fire leading to cardiac arrest in a patient undergoing subtotal thyroidectomy. In the present case sparks due to friction or electrical short circuit within the ventilator might have acted as source of ignition leading to fire and explosion in the oxygen rich environment. The patient was successfully resuscitated and revived with uneventful recovery and no adverse sequelae. The cardiac arrest was possibly due to severe hypoxia resulting from inhalation of smoke containing high concentrations of carbon monoxide and other noxious gases.

Prognostic value of electroencephalography (EEG) after out-of-hospital cardiac arrest in successfully resuscitated patients used in daily clinical practice.

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Søholm, Helle; Kjær, Troels Wesenberg; Kjaergaard, Jesper; Cronberg, Tobias; Bro-Jeppesen, John; Lippert, Freddy K; Køber, Lars; Wanscher, Michael; Hassager, Christian

2014-11-01

Out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis and predicting outcome is complex with neurophysiological testing and repeated clinical neurological examinations as key components of the assessment. In this study we examine the association between different electroencephalography (EEG) patterns and mortality in a clinical cohort of OHCA-patients. From 2002 to 2011 consecutive patients were admitted to an intensive-care-unit after resuscitation from OHCA. Utstein-criteria for pre-hospital data and review of individual patients' charts for post-resuscitation care were used. EEG reports were analysed according to the 2012 American Clinical Neurophysiology Society's guidelines. A total of 1076 patients were included, and EEG was performed in 20% (n=219) with a median of 3(IQR 2-4) days after OHCA. Rhythmic Delta Activity (RDA) was found in 71 patients (36%) and Periodic Discharges (PD) in 100 patients (45%). Background EEG frequency of Alpha+ or Theta was noted in 107 patients (49%), and change in cerebral EEG activity to stimulation (reactivity) was found in 38 patients (17%). Suppression (all activity <10 μV) was found in 26 (12%) and burst-suppression in 17 (8%) patients. A favourable EEG pattern (reactivity, favourable background frequency and RDA) was independently associated with reduced mortality with hazard ratio (HR) 0.43 (95%CI: 0.24-0.76), p=0.004 (false positive rate: 31%) and a non-favourable EEG pattern (no reactivity, unfavourable background frequency, and PD, suppressed voltage or burst-suppression) was associated with higher mortality (HR=1.62(1.09-2.41), p=0.02) after adjustment for known prognostic factors (false positive rate: 9%). EEG may be useful in work-up in prognostication of patients with OHCA. Findings such as Rhythmic Delta Activity (RDA) seem to be associated with a better prognosis, whereas suppressed voltage and burst-suppression patterns were associated with poor prognosis. Copyright © 2014 Elsevier Ireland

Advanced computer techniques for inverse modeling of electric current in cardiac tissue

Energy Technology Data Exchange (ETDEWEB)

Hutchinson, S.A.; Romero, L.A.; Diegert, C.F.

1996-08-01

For many years, ECG`s and vector cardiograms have been the tools of choice for non-invasive diagnosis of cardiac conduction problems, such as found in reentrant tachycardia or Wolff-Parkinson-White (WPW) syndrome. Through skillful analysis of these skin-surface measurements of cardiac generated electric currents, a physician can deduce the general location of heart conduction irregularities. Using a combination of high-fidelity geometry modeling, advanced mathematical algorithms and massively parallel computing, Sandia`s approach would provide much more accurate information and thus allow the physician to pinpoint the source of an arrhythmia or abnormal conduction pathway.

Do Radiologists Want/Need Training in Cardiopulmonary Resuscitation?

International Nuclear Information System (INIS)

Schellhammer, F.

2003-01-01

Purpose: Prompt and effective cardiopulmonary resuscitation (CPR) decreases morbidity and mortality following cardiopulmonary arrest. Radiologists are frequently confronted with severely ill patients, who may deteriorate at any time. Furthermore, they have to be aware of life-threatening reactions towards contrast media. This study was designed to assess experience and self-estimation of German-speaking radiologists in CPR and cardiac defibrillation (CD). Material and Methods: 650 German-speaking radiologists were audited by a specially designed questionnaire, which was sent via e-mail. The answers were expected to be re-mailed within a 2-month period. Results: The response rate was 12.6%. 72.8% of the responders had performed at least 1 CPR (range 9.5 ± 13.1) and 37% at least 1 CD. 67.9% had had opportunities to attend training courses, which had been utilized by 41.8% of them. The last training of the responders was more than 2 years ago in 69.2% and more than 5 years ago in 37%. Of all responders 75.6% expressed the need for further education. Conclusion: The small response rate indicates the small importance of CPR in the subpopulation surveyed. The vast majority of the responders, however, showed interest in basic and advanced life support and advocated regular updates. It seems reasonable that radiological Dept. themselves should organize courses in order to cope with their specific situations

Do Radiologists Want/Need Training in Cardiopulmonary Resuscitation?

Energy Technology Data Exchange (ETDEWEB)

Schellhammer, F. [St. Katharinen Hospital, Frechen (Germany). Dept. of Radiology

2003-03-01

Purpose: Prompt and effective cardiopulmonary resuscitation (CPR) decreases morbidity and mortality following cardiopulmonary arrest. Radiologists are frequently confronted with severely ill patients, who may deteriorate at any time. Furthermore, they have to be aware of life-threatening reactions towards contrast media. This study was designed to assess experience and self-estimation of German-speaking radiologists in CPR and cardiac defibrillation (CD). Material and Methods: 650 German-speaking radiologists were audited by a specially designed questionnaire, which was sent via e-mail. The answers were expected to be re-mailed within a 2-month period. Results: The response rate was 12.6%. 72.8% of the responders had performed at least 1 CPR (range 9.5 {+-} 13.1) and 37% at least 1 CD. 67.9% had had opportunities to attend training courses, which had been utilized by 41.8% of them. The last training of the responders was more than 2 years ago in 69.2% and more than 5 years ago in 37%. Of all responders 75.6% expressed the need for further education. Conclusion: The small response rate indicates the small importance of CPR in the subpopulation surveyed. The vast majority of the responders, however, showed interest in basic and advanced life support and advocated regular updates. It seems reasonable that radiological Dept. themselves should organize courses in order to cope with their specific situations.

Extracorporeal life support for cardiac arrest in a 13-year-old girl caused by Wolff-Parkinson-White syndrome.

Science.gov (United States)

Song, Kyoung Hwan; Lee, Byung Kook; Jeung, Kyung Woon; Lee, Dong Hun

2015-10-01

Generally, Wolff-Parkinson-White (WPW) syndrome presents good prognosis. However, several case reports demonstrated malignant arrhythmia or sudden cardiac death as WPW syndrome's first presentation. Cardiopulmonary resuscitation using extracorporeal life support is a therapeutic option in refractory cardiac arrest. We present a WPW syndrome patient who had sudden cardiac arrest as the first presentation of the disease and treated it using extracorporeal life support with good neurologic outcome.

Cardiac magnetic resonance imaging after ventricular tachyarrhythmias increases diagnostic precision and reduces the need for family screening for inherited cardiac disease

DEFF Research Database (Denmark)

Marstrand, Peter; Axelsson, Anna; Thune, Jens Jakob

2016-01-01

-CAG) (81%), exercise stress test (47%), late potentials (54%), electrophysiological study (44%), pharmacological provocation (44%), and/or myocardial biopsy (16%). Family screening was indicated for 53 probands (67%) prior to CMR. After full workup, only 43 cases (54%) warranted evaluation of relatives (19......AIMS: Guidelines recommend evaluation of family members of sudden cardiac death victims. However, initiation of cascade screening in families with uncertain diagnoses is not cost-effective and may cause unnecessary concern. For these reasons, we set out to assess to what extent cardiac magnetic...... resonance imaging (CMR) would increase the diagnostic precision and thereby possibly change the indication for family screening in patients with ventricular tachyarrhythmias. METHODS AND RESULTS: We retrospectively collected data from 79 patients hospitalized with aborted cardiac arrest (resuscitated from...

T-piece resuscitator versus self-inflating bag for preterm resuscitation: an institutional experience.

Science.gov (United States)

Jayaram, Archana; Sima, Adam; Barker, Gail; Thacker, Leroy R

2013-07-01

Manual ventilation in the delivery room is provided with devices such as self-inflating bags (SIBs), flow-inflating bags, and T-piece resuscitators. To compare the effect of type of manual ventilation device on overall response to resuscitation among preterm neonates born at Apgar score. Secondary outcomes were incidence of air leaks, need for chest compressions/epinephrine, need for intubation, and surfactant use. We identified 294 resuscitations requiring ventilation. SIB was used for 135 neonates, and T-piece was used for 159 neonates. There was no significant difference between the 1-min and 5-min Apgar scores between SIB and T-piece (P = .77 and P = .11, respectively), nor were there significant differences in secondary outcomes. The rate of rise of Apgar score was higher, by 0.47, with T-piece, compared to SIB (95% CI 0.08-0.87, P = .02). Although some manikin studies favor T-piece for providing reliable and consistent pressures, our experience did not indicate significant differences in effectiveness of resuscitation between the T-piece and SIB in preterm resuscitations.

Barriers and facilitators to learning and performing cardiopulmonary resuscitation in neighborhoods with low bystander cardiopulmonary resuscitation prevalence and high rates of cardiac arrest in Columbus, OH.

Science.gov (United States)

Sasson, Comilla; Haukoos, Jason S; Bond, Cindy; Rabe, Marilyn; Colbert, Susan H; King, Renee; Sayre, Michael; Heisler, Michele

2013-09-01

Residents who live in neighborhoods that are primarily black, Latino, or poor are more likely to have an out-of-hospital cardiac arrest, less likely to receive cardiopulmonary resuscitation (CPR), and less likely to survive. No prior studies have been conducted to understand the contributing factors that may decrease the likelihood of residents learning and performing CPR in these neighborhoods. The goal of this study was to identify barriers and facilitators to learning and performing CPR in 3 low-income, high-risk, and predominantly black neighborhoods in Columbus, OH. Community-Based Participatory Research approaches were used to develop and conduct 6 focus groups in conjunction with community partners in 3 target high-risk neighborhoods in Columbus, OH, in January to February 2011. Snowball and purposeful sampling, done by community liaisons, was used to recruit participants. Three reviewers analyzed the data in an iterative process to identify recurrent and unifying themes. Three major barriers to learning CPR were identified and included financial, informational, and motivational factors. Four major barriers were identified for performing CPR and included fear of legal consequences, emotional issues, knowledge, and situational concerns. Participants suggested that family/self-preservation, emotional, and economic factors may serve as potential facilitators in increasing the provision of bystander CPR. The financial cost of CPR training, lack of information, and the fear of risking one's own life must be addressed when designing a community-based CPR educational program. Using data from the community can facilitate improved design and implementation of CPR programs.

Improved survival after an out-of-hospital cardiac arrest using new guidelines

DEFF Research Database (Denmark)

Steinmetz, Jacob; Barnung, S.; Nielsen, S.L.

2008-01-01

BACKGROUND: An out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis. We hypothesized that the implementations of 2005 European Resuscitation Council resuscitation guidelines were associated with improved 30-day survival after OHCA. METHODS: We prospectively recorded data on all....... Treatment after implementation was confirmed as a significant predictor of better 30-day survival in a logistic regression analysis. CONCLUSION: The implementation of new resuscitation guidelines was associated with improved 30-day survival after OHCA Udgivelsesdato: 2008/8...... patients with OHCA treated by the Mobile Emergency Care Unit of Copenhagen in two periods: 1 June 2004 until 31 August 2005 (before implementation) and 1 January 2006 until 31 March 2007 (after implementation), separated by a 4-month period in which the above-mentioned change took place. RESULTS: We found...

"Please. Don't. Die.": A Grounded Theory Study of Bystander Cardiopulmonary Resuscitation.

Science.gov (United States)

Mausz, Justin; Snobelen, Paul; Tavares, Walter

2018-02-01

Bystander cardiopulmonary resuscitation (CPR) is an important determinant of survival from out-of-hospital cardiac arrest (OHCA), yet rates of bystander CPR are highly variable. In an effort to promote bystander CPR, the procedure has been streamlined, and ultrashort teaching modalities have been introduced. CPR has been increasingly reconceptualized as simple, safe, and easy to perform; however, current methods of CPR instruction may not adequately prepare lay rescuers for the various logistical, conceptual, and emotional challenges of resuscitating a victim of cardiac arrest. We adopted a constructivist grounded theory methodology to qualitatively explore bystander CPR and invited lay rescuers who had recently (ie, within 1 week) intervened in an OHCA to participate in semistructured interviews and focus groups. We used constant comparative analysis until theoretical saturation to derive a midrange explanatory theory of bystander CPR. We constructed a 3-stage theoretical model describing a common experiential process for lay rescuer intervention in OHCA: Being called to act is disturbing, causing panic, shock, and disbelief that must ultimately be overcome. Taking action to save the victim is complicated by several misconceptions about cardiac arrest, where victims are mistakenly believed to be choking, and agonal respirations are misinterpreted to mean the victim is alive. Making sense of the experience is challenging, at least in the short term, where lay rescuers have to contend with self-doubt, unanswered questions, and uncomfortable emotional reactions to a traumatic event. Our study suggests that current CPR training programs may not adequately prepare lay rescuers for the reality of an OHCA and identifies several key knowledge gaps that should be addressed. The long-term psychological consequences of bystander intervention in OHCA remain poorly understood and warrant further study. © 2018 American Heart Association, Inc.

Defibrillator charging before rhythm analysis significantly reduces hands-off time during resuscitation

DEFF Research Database (Denmark)

Hansen, L. K.; Folkestad, L.; Brabrand, M.

2013-01-01

BACKGROUND: Our objective was to reduce hands-off time during cardiopulmonary resuscitation as increased hands-off time leads to higher mortality. METHODS: The European Resuscitation Council (ERC) 2005 and ERC 2010 guidelines were compared with an alternative sequence (ALT). Pulseless ventricular...... physicians were included. All had prior experience in advanced life support. Chest compressions were shorter interrupted using ALT (mean, 6.7 vs 13.0 seconds). Analyzing data for ventricular tachycardia scenarios only, hands-off time was shorter using ALT (mean, 7.1 vs 18.2 seconds). In ERC 2010 vs ALT, 12...... physicians were included. Two physicians had not prior experience in advanced life support. Hands-off time was reduced using ALT (mean, 3.9 vs 5.6 seconds). Looking solely at ventricular tachycardia scenarios, hands-off time was shortened using ALT (mean, 4.5 vs 7.6 seconds). No significant reduction...

Measuring and improving cardiopulmonary resuscitation quality inside the emergency department.

Science.gov (United States)

Crowe, Christopher; Bobrow, Bentley J; Vadeboncoeur, Tyler F; Dameff, Christian; Stolz, Uwe; Silver, Annemarie; Roosa, Jason; Page, Rianne; LoVecchio, Frank; Spaite, Daniel W

2015-08-01

To evaluate CPR quality during cardiac resuscitation attempts in an urban emergency department (ED) and determine the influence of the combination of scenario-based training, real-time audiovisual feedback (RTAVF), and post-event debriefing on CPR quality. CPR quality was recorded using an R Series monitor-defibrillator (ZOLL Medical) during the treatment of adult cardiac arrest patients. Phase 1 (P1; 11/01/2010-11/15/2012) was an observation period of CPR quality. Phase 2 (P2; 11/15/2012-11/08/2013) was after a 60-min psychomotor skills CPR training and included RTAVF and post-event debriefing. A total of 52 cardiac arrest patients were treated in P1 (median age 56 yrs, 63.5% male) and 49 in P2 (age 60 yrs, 83.7% male). Chest compression (CC) depth increased from 46.7 ± 3.8mm in P1 to 61.6 ± 2.8mm in P2 (p training, real-time audiovisual CPR feedback, and post-event debriefing was associated with improved CPR quality and compliance with CPR guidelines in this urban teaching emergency department. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Acute cardiac events and deployment of emergency medical teams and automated external defibrillators in large football stadiums in the Netherlands.

Science.gov (United States)

van de Sandt, Femke; Umans, Victor

2009-10-01

The incidence of acute cardiac events - including out-of-hospital cardiac arrest - may be increased in visitors of large sports stadiums when compared with the general population. This study sought to investigate the incidence of acute cardiac events inside large Dutch football stadiums, as well as the emergency response systems deployed in these stadiums and the success rate for in-stadium resuscitation. Retrospective cohort study using a questionnaire sent to the 20 Dutch stadiums that hosted professional matches during the 2006-2007 and 2007-2008 football seasons. Stadium capacity ranged from 3600 to 51 600 spectators. Nearly 13 million spectators attended 686 'Eredivisie' (Honorary Division) and European football matches. All stadiums distribute multiple emergency medical teams among the spectators. Eighty-five percent of the stadiums have an ambulance standby during matches, 95% of the stadiums were equipped with automated external defibrillators (AEDs) during the study period. On an average, one AED was available for every 7576 spectators (range 1800-29 600). Ninety-three cardiac events were reported (7.3 per 1 million spectators). An AED was used 22 times (1.7 per 1 million spectators). Resuscitation was successful in 18 cases (82%, 95% confidence interval: 61-93). The incidence of out-of-hospital cardiac arrest inside large football stadiums in the Netherlands, albeit increased when compared with the general population, is low. The success rate for in-stadium resuscitation by medical teams equipped with AEDs is high. Dutch stadiums appear vigilant in regard to acute cardiac events. This report highlights the importance of adequate emergency medical response systems (including AEDs) in large sports venues.

Outcome of cardiopulmonary resuscitation - predictors of survival

International Nuclear Information System (INIS)

Ishtiaq, O.; Iqbal, M.; Zubair, M.; Qayyum, R.; Adil, M.

2008-01-01

To assess the outcomes of patients undergoing cardiopulmonary resuscitation (CPR). Data were collected retrospectively of all adult patients who underwent CPR. Clinical outcomes of interest were survival at the end of CPR and survival at discharge from hospital. Factors associated with survival were evaluated using logistic regression analysis. Of the 159 patients included, 55 (35%) were alive at the end of CPR and 17 (11%) were discharged alive from the hospital. At the end of CPR, univariate logistic regression analysis found the following factors associated with survival: cardiac arrest within hospital as compared to outside the hospital (odds ratio = 2.8, 95% CI = 1.27-6.20, p-value = 0.01), both cardiac and pulmonary arrest as compared to either cardiac or pulmonary arrest (odds ratio = 0.37, 95% CI = 0.19- 0.73, p-value = 0.004), asystole as cardiac rhythm at presentation (odds ratio = 0.47, 95% CI = 0.24-0.93, p-value = 0.03), and total atropine dose given during CPR (odds ratio = 0.78, 95% CI = 0.62-0.97, p-value = 0.02). In multivariate logistic regression, cardiac arrest within hospital (odds ratio = 2.52, 95% CI = 1.06-5.99, p-value = 0.04) and both cardiac and pulmonary arrest as compared to cardiac or pulmonary arrest (odds ratio = 0.44, 95% CI = 0.21-0.91, p-value = 0.03) were associated with survival at the end of CPR. At the time of discharge from hospital, univariate logistic regression analysis found following factors that were associated with survival: cardiac arrest within hospital (odds ratio = 8.4, 95% CI = 1.09-65.64, p-value = 0.04), duration of CPR (odds ratio = 0.91, 95% CI = 0.85-0.96, p-value = 0.001), and total atropine dose given during CPR (odds ratio = 0.68, 95% CI = 0.47-0.99, p-value = 0.05). In multivariate logistic regression analysis cardiac arrest within hospital (odds ratio 8.69, 95% CI = 1.01-74.6, p-value = 0.05) and duration of CPR (odds ratio 0.92, 95% CI = 0.87-0.98, p-value = 0.01) were associated with survival at

Mass cardiopulmonary resuscitation 99--survey results of a multi-organisational effort in public education in cardiopulmonary resuscitation.

Science.gov (United States)

Fong, Y T; Anantharaman, V; Lim, S H; Leong, K F; Pokkan, G

2001-05-01

Mass cardiopulmonary resuscitation (CPR) 99 in Singapore was a large-scale multi-organisational effort to increase awareness and impart basic cardiac life support skills to the lay public. Mass CPR demonstrations followed by small group manikin practice with instructor guidance was conducted simultaneously in three centres, four times a day. The exercise enlisted 15 community organisations and received the support of 19 other organisations. Three hundred and ninety-eight manikins and 500 instructors ('I's) were mobilised to teach an audience of 6000 participants ('P's). Two surveys, for 'I's and 'P's were conducted with respondent rates of 65.8% and 50%, respectively. 73.6% of the P-respondents ('P-R's) indicated that they attended the event to increase their knowledge. 66.9% were willing to attend a more comprehensive CPR course. Concerns and perceptions in performing bystander CPR were assessed.

The Fibrin-Derived Peptide Bβ15-42 (FX06) Ameliorates Vascular Leakage and Improves Survival and Neurocognitive Recovery: Implications From Two Animal Models of Cardiopulmonary Resuscitation.

Science.gov (United States)

Bergt, Stefan; Gruenewald, Matthias; Beltschany, Claudia; Grub, Andrea; Neumann, Tobias; Albrecht, Martin; Vollmar, Brigitte; Zacharowski, Kai; Roesner, Jan P; Meybohm, Patrick

2016-10-01

The fibrin-derived peptide Bβ15-42 (FX06) has been proven to attenuate ischemia/reperfusion injury. We tested the hypothesis that Bβ15-42 improves survival rate and neurocognitive recovery after cardiopulmonary resuscitation. Pig and mouse model of cardiopulmonary resuscitation. Two university hospitals. Pigs and mice. Pigs (n = 16) were subjected to 8-minute cardiac arrest. Successful resuscitated pigs (n = 12) were randomized either to 3 mg/kg Bβ15-42 followed by a continuous infusion of 1 mg/kg/hr for 5 hours (pFX06; n = 6) or the control group (pCONTROL; n = 6). Cardiac damage, function, and hemodynamics were recorded up to 8 hours. Mice (n = 52) were subjected to 4-minute cardiac arrest followed by cardiopulmonary resuscitation, and randomized either to two boli of 2.4 mg/kg Bβ15-42 (mFX06; n = 26) or the control group (mCONTROL; n = 26). Fourteen-day survival rate, neurocognitive function, and endothelial integrity (additional experiment with n = 26 mice) were evaluated. Bβ15-42 reduced cumulative fluid intake (3,500 [2,600-4,200] vs 6,800 [5,700-7,400] mL; p = 0.004) within 8 hours in pigs. In mice, Bβ15-42 improved 14-day survival rate (mFX06 vs mCONTROL; 11/26 vs 6/26; p Water-Maze test (15/26 vs 9/26 mice with competence to perform test; p < 0.05). Bβ15-42-treated mice showed a significant higher length of intact pulmonary endothelium and reduced pulmonary leukocyte infiltration. This study confirms the new concept of an important role of fibrin derivatives in global ischemia/reperfusion injury, which can be attenuated by the fibrin-derived peptide Bβ15-42.

To resuscitate or not to resuscitate: a logistic regression analysis of physician-related variables influencing the decision.

Science.gov (United States)

Einav, Sharon; Alon, Gady; Kaufman, Nechama; Braunstein, Rony; Carmel, Sara; Varon, Joseph; Hersch, Moshe

2012-09-01

To determine whether variables in physicians' backgrounds influenced their decision to forego resuscitating a patient they did not previously know. Questionnaire survey of a convenience sample of 204 physicians working in the departments of internal medicine, anaesthesiology and cardiology in 11 hospitals in Israel. Twenty per cent of the participants had elected to forego resuscitating a patient they did not previously know without additional consultation. Physicians who had more frequently elected to forego resuscitation had practised medicine for more than 5 years (p=0.013), estimated the number of resuscitations they had performed as being higher (p=0.009), and perceived their experience in resuscitation as sufficient (p=0.001). The variable that predicted the outcome of always performing resuscitation in the logistic regression model was less than 5 years of experience in medicine (OR 0.227, 95% CI 0.065 to 0.793; p=0.02). Physicians' level of experience may affect the probability of a patient's receiving resuscitation, whereas the physicians' personal beliefs and values did not seem to affect this outcome.

Dynamic prediction of patient outcomes during ongoing cardiopulmonary resuscitation.

Science.gov (United States)

Kim, Joonghee; Kim, Kyuseok; Callaway, Clifton W; Doh, Kibbeum; Choi, Jungho; Park, Jongdae; Jo, You Hwan; Lee, Jae Hyuk

2017-02-01

The probability of the return of spontaneous circulation (ROSC) and subsequent favourable outcomes changes dynamically during advanced cardiac life support (ACLS). We sought to model these changes using time-to-event analysis in out-of-hospital cardiac arrest (OHCA) patients. Adult (≥18 years old), non-traumatic OHCA patients without prehospital ROSC were included. Utstein variables and initial arterial blood gas measurements were used as predictors. The incidence rate of ROSC during the first 30min of ACLS in the emergency department (ED) was modelled using spline-based parametric survival analysis. Conditional probabilities of subsequent outcomes after ROSC (1-week and 1-month survival and 6-month neurologic recovery) were modelled using multivariable logistic regression. The ROSC and conditional probability models were then combined to estimate the likelihood of achieving ROSC and subsequent outcomes by providing k additional minutes of effort. A total of 727 patients were analyzed. The incidence rate of ROSC increased rapidly until the 10th minute of ED ACLS, and it subsequently decreased. The conditional probabilities of subsequent outcomes after ROSC were also dependent on the duration of resuscitation with odds ratios for 1-week and 1-month survival and neurologic recovery of 0.93 (95% CI: 0.90-0.96, p<0.001), 0.93 (0.88-0.97, p=0.001) and 0.93 (0.87-0.99, p=0.031) per 1-min increase, respectively. Calibration testing of the combined models showed good correlation between mean predicted probability and actual prevalence. The probability of ROSC and favourable subsequent outcomes changed according to a multiphasic pattern over the first 30min of ACLS, and modelling of the dynamic changes was feasible. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Comparative Effectiveness of Emergency Resuscitative Thoracotomy versus Closed Chest Compressions among Patients with Critical Blunt Trauma: A Nationwide Cohort Study in Japan.

Science.gov (United States)

Suzuki, Kodai; Inoue, Shigeaki; Morita, Seiji; Watanabe, Nobuo; Shintani, Ayumi; Inokuchi, Sadaki; Ogura, Shinji

2016-01-01

Although emergency resuscitative thoracotomy is performed as a salvage maneuver for critical blunt trauma patients, evidence supporting superior effectiveness of emergency resuscitative thoracotomy compared to conventional closed-chest compressions remains insufficient. The objective of this study was to investigate whether emergency resuscitative thoracotomy at the emergency department or in the operating room was associated with favourable outcomes after blunt trauma and to compare its effectiveness with that of closed-chest compressions. This was a retrospective nationwide cohort study. Data were obtained from the Japan Trauma Data Bank for the period between 2004 and 2012. The primary and secondary outcomes were patient survival rates 24 h and 28 d after emergency department arrival. Statistical analyses were performed using multivariable generalized mixed-effects regression analysis. We adjusted for the effects of different hospitals by introducing random intercepts in regression analysis to account for the differential quality of emergency resuscitative thoracotomy at hospitals where patients in cardiac arrest were treated. Sensitivity analyses were performed using propensity score matching. In total, 1,377 consecutive, critical blunt trauma patients who received cardiopulmonary resuscitation in the emergency department or operating room were included in the study. Of these patients, 484 (35.1%) underwent emergency resuscitative thoracotomy and 893 (64.9%) received closed-chest compressions. Compared to closed-chest compressions, emergency resuscitative thoracotomy was associated with lower survival rate 24 h after emergency department arrival (4.5% vs. 17.5%, respectively, P chest compressions (P chest compressions.

e-Learning in Advanced Life Support-What factors influence assessment outcome?

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Thorne, C J; Lockey, A S; Kimani, P K; Bullock, I; Hampshire, S; Begum-Ali, S; Perkins, G D

2017-05-01

To establish variables which are associated with favourable Advanced Life Support (ALS) course assessment outcomes, maximising learning effect. Between 1 January 2013 and 30 June 2014, 8218 individuals participated in a Resuscitation Council (UK) e-learning Advanced Life Support (e-ALS) course. Participants completed 5-8h of online e-learning prior to attending a one day face-to-face course. e-Learning access data were collected through the Learning Management System (LMS). All participants were assessed by a multiple choice questionnaire (MCQ) before and after the face-to-face aspect alongside a practical cardiac arrest simulation (CAS-Test). Participant demographics and assessment outcomes were analysed. The mean post e-learning MCQ score was 83.7 (SD 7.3) and the mean post-course MCQ score was 87.7 (SD 7.9). The first attempt CAS-Test pass rate was 84.6% and overall pass rate 96.6%. Participants with previous ALS experience, ILS experience, or who were a core member of the resuscitation team performed better in the post-course MCQ, CAS-Test and overall assessment. Median time spent on the e-learning was 5.2h (IQR 3.7-7.1). There was a large range in the degree of access to e-learning content. Increased time spent accessing e-learning had no effect on the overall result (OR 0.98, P=0.367) on simulated learning outcome. Clinical experience through membership of cardiac arrest teams and previous ILS or ALS training were independent predictors of performance on the ALS course whilst time spent accessing e-learning materials did not affect course outcomes. This supports the blended approach to e-ALS which allows participants to tailor their e-learning experience to their specific needs. Copyright © 2017 Elsevier B.V. All rights reserved.

Resuscitating the Baby after Shoulder Dystocia

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Savas Menticoglou

2016-01-01

Full Text Available Background. To propose hypovolemic shock as a possible explanation for the failure to resuscitate some babies after shoulder dystocia and to suggest a change in clinical practice. Case Presentation. Two cases are presented in which severe shoulder dystocia was resolved within five minutes. Both babies were born without a heartbeat. Despite standard resuscitation by expert neonatologists, no heartbeat was obtained until volume resuscitation was started, at 25 minutes in the first case and 11 minutes in the second. After volume resuscitation circulation was restored, there was profound brain damage and the babies died. Conclusion. Unsuspected hypovolemic shock may explain some cases of failed resuscitation after shoulder dystocia. This may require a change in clinical practice. Rather than immediately clamping the cord after the baby is delivered, it is proposed that (1 the obstetrician delay cord clamping to allow autotransfusion of the baby from the placenta and (2 the neonatal resuscitators give volume much sooner.

Better outcome after pediatric resuscitation is still a dilemma

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Sahu Sandeep

2010-01-01

Full Text Available Pediatric cardiac arrest is not a single problem. Although most episodes of pediatric cardiac arrest occur as complications and progression of respiratory failure and shock. Sudden cardiac arrest may result from abrupt and unexpected arrhythmias. With a better-tailored therapy, we can optimize the outcome. In the hospital, cardiac arrest often develops as a progression of respiratory failure and shock. Typically half or more of pediatric victims of in-hospital arrest have pre-existing respiratory failure and one-third or more have shock, although these figures vary somewhat among reporting hospitals. When in-hospital respiratory arrest or failure is treated before the development of cardiac arrest, survival ranges from 60% to 97%. Bradyarrthmia, asystole or pulseless electric activity (PEA were recorded as an initial rhythm in half or more of the recent reports of in-hospital cardiac arrest, with survival to hospital discharge ranging from 22% to 40%. Data allowing characterization of out of hospital pediatric arrest are limited, although existing data support the long-held belief that as with hospitalized children, cardiac arrest most often occurs as a progression of respiratory failure or shock to cardiac arrest with bradyasystole rhythm. Although VF (Ventricular fibrillation, is a very rapid, uncoordinated, ineffective series of contractions throughout the lower chambers of the heart. Unless stopped, these chaotic impulses are fatal and VT (Ventricular tachycardia is a rapid heartbeat that originates in one of the ventricles of the heart. To be classified as tachycardia, the heart rate is usually at least 100 beats per minute are not common out-of-cardiac arrest in children, they are more likely to be present with sudden, witnessed collapse, particularly among adolescents. Pre-hospital care till the late 1980s was mainly concerned with adult care, and the initial focus for pediatric resuscitation was provision of oxygen and ventilation, with

Is there a difference in survival between men and women suffering in-hospital cardiac arrest?

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Israelsson, Johan; Persson, Carina; Strömberg, Anna; Arestedt, Kristofer

2014-01-01

To describe in-hospital cardiac arrest (CA) events with regard to sex and to investigate if sex is associated with survival. Previous studies exploring differences between sexes are incongruent with regard to clinical outcomes. In order to provide equality and improve care, further investigations into these aspects are warranted. This registry study included 286 CAs. To investigate if sex was associated with survival, logistic regression analyses were performed. The proportion of CA with a resuscitation attempt compared to CA without resuscitation was higher among men. There were no associations between sex and survival when controlling for previously known predictors and interaction effects. Sex does not appear to be a predictor for survival among patients suffering CA where resuscitation is attempted. The difference regarding proportion of resuscitation attempts requires more attention. It is important to consider possible interaction effects when studying the sex perspective. Copyright © 2014 Elsevier Inc. All rights reserved.

In-hospital resuscitation: opioids and other factors influencing survival

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Karamarie Fecho

2009-12-01

Full Text Available Karamarie Fecho1, Freeman Jackson1, Frances Smith1, Frank J Overdyk21Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina, USA; 2Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USAPurpose: “Code Blue” is a standard term used to alertt hospital staff that a patient requires resuscitation. This study determined rates of survival from Code Blue events and the role of opioids and other factors on survival.Methods: Data derived from medical records and the Code Blue and Pharmacy databases were analyzed for factors affecting survival.Results: During 2006, rates of survival from the code only and to discharge were 25.9% and 26.4%, respectively, for Code Blue events involving cardiopulmonary resuscitation (CPR; N = 216. Survival rates for events not ultimately requiring CPR (N = 77 were higher, with 32.5% surviving the code only and 62.3% surviving to discharge. For CPR events, rates of survival to discharge correlated inversely with time to chest compressions and defibrillation, precipitating event, need for airway management, location and age. Time of week, witnessing, postoperative status, gender and opioid use did not influence survival rates. For non-CPR events, opioid use was associated with decreased survival. Survival rates were lowest for patients receiving continuous infusions (P < 0.01 or iv boluses of opioids (P < 0.05.Conclusions: One-quarter of patients survive to discharge after a CPR Code Blue event and two-thirds survive to discharge after a non-CPR event. Opioids may influence survival from non-CPR events.Keywords: code blue, survival, opioids, cardiopulmonary resuscitation, cardiac arrest, patient safety

Education Strategies Through Simulation For Training In Cardiopulmonary Resuscitation Treatment

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Regimar Carla Machado

2017-01-01

Full Text Available Theoretical and reflective study based on scientific literature and critical analysis of authors related to teaching strategies through simulation for training in cardiopulmonary resuscitation (CPR. Current teaching methodologies CPR involve realistic simulation strategies and simulations in virtual environments, but the first method provides the best results, allowing proactivity of individuals in their teaching-learning process and bringing them the experience of a life threatening situation. It is noteworthy that health professionals need to be able to assist a victim in cardiac arrest, but even  existing effective teaching methodologies to enable them in this subject, is not fully applicable in the Brazilian context of health education.

Mitigating hyperventilation during cardiopulmonary resuscitation.

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Nikolla, Dhimitri; Lewandowski, Tyler; Carlson, Jestin

2016-03-01

Although multiple airway management and ventilation strategies have been proposed during cardiac arrest, the ideal strategy is unknown. Current strategies call for advanced airways, such as endotracheal intubation and supraglottic airways. These may facilitate hyperventilation which is known to adversely affect cardiopulmonary physiology. We provide a summary of conceptual models linking hyperventilation to patient outcomes and identify methods for mitigating hyperventilation during cardiac arrest. Copyright © 2015 Elsevier Inc. All rights reserved.

Cardiac Arrest after Local Anaesthetic Toxicity in a Paediatric Patient

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Liana Maria Torres de Araújo Azi

2016-01-01

Full Text Available We report a case of a paediatric patient undergoing urological procedure in which a possible inadvertent intravascular or intraosseous injection of bupivacaine with adrenaline in usual doses caused subsequent cardiac arrest, completely reversed after administration of 20% intravenous lipid emulsion. Early diagnosis of local anaesthetics toxicity and adequate cardiovascular resuscitation manoeuvres contribute to the favourable outcome.

Incidence and management of life-threatening adverse events during cardiac catheterization for congenital heart disease.

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Lin, C Huie; Hegde, Sanjeet; Marshall, Audrey C; Porras, Diego; Gauvreau, Kimberlee; Balzer, David T; Beekman, Robert H; Torres, Alejandro; Vincent, Julie A; Moore, John W; Holzer, Ralf; Armsby, Laurie; Bergersen, Lisa

2014-01-01

Continued advancements in congenital cardiac catheterization and interventions have resulted in increased patient and procedural complexity. Anticipation of life-threatening events and required rescue measures is a critical component to preprocedural preparation. We sought to determine the incidence and nature of life-threatening adverse events in congenital and pediatric cardiac catheterization, risk factors, and resources necessary to anticipate and manage events. Data from 8905 cases performed at the 8 participating institutions of the Congenital Cardiac Catheterization Project on Outcomes were captured between 2007 and 2010 [median 1,095/site (range 133-3,802)]. The incidence of all life-threatening events was 2.1 % [95 % confidence interval (CI) 1.8-2.4 %], whereas mortality was 0.28 % (95 % CI 0.18-0.41 %). Fifty-seven life-threatening events required cardiopulmonary resuscitation, whereas 9 % required extracorporeal membrane oxygenation. Use of a risk adjustment model showed that age events. Using this model, standardized life-threatening event ratios were calculated, thus showing that one institution had a life-threatening event rate greater than expected. Congenital cardiac catheterization and intervention can be performed safely with a low rate of life-threatening events and mortality; preprocedural evaluation of risk may optimize preparation of emergency rescue and bailout procedures. Risk predictors (age < 1, hemodynamic vulnerability, and procedure risk category) can enhance preprocedural patient risk stratification and planning.

Basic life support training into cardiac rehabilitation programs: A chance to give back. A community intervention controlled manikin study.

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González-Salvado, Violeta; Abelairas-Gómez, Cristian; Peña-Gil, Carlos; Neiro-Rey, Carmen; Barcala-Furelos, Roberto; González-Juanatey, José Ramón; Rodríguez-Núñez, Antonio

2018-03-12

Early basic life support is crucial to enhance survival from out-of-hospital cardiac arrest but rates remain low, especially in households. High-risk groups' training has been advocated, but the optimal method is unclear. The CArdiac REhabilitation and BAsic life Support (CAREBAS) project aims to compare the effectiveness of two basic life support educational strategies implemented in a cardiac rehabilitation program. A community intervention study including consecutive patients enrolled on an exercise-based cardiac rehabilitation program after acute coronary syndrome or revascularization was conducted. A standard basic life support training (G-Stan) and a novel approach integrating cardiopulmonary resuscitation hands-on rolling refreshers (G-CPR) were randomly assigned to each group and compared. Basic life support performance was assessed by means of simulation at baseline, following brief instruction and after the 2-month program. 114 participants were included and 108 completed the final evaluation (G-Stan:58, G-CPR:50). Basic life support performance was equally poor at baseline and significantly improved following a brief instruction. A better skill retention was found after the 2-month program in G-CPR, significantly superior for safety and sending for an automated external defibrillator. Confidence and self-perceived preparation were also significantly greater in G-CPR after the program. Integrating cardiopulmonary resuscitation hands-on rolling refreshers in the training of an exercise-based cardiac rehabilitation program is feasible and improves patients' skill retention and confidence to perform a basic life support sequence, compared to conventional training. Exporting this formula to other programs may result in increased numbers of trained citizens, enhanced social awareness and bystander resuscitation. Copyright © 2018 Elsevier B.V. All rights reserved.

Post-hypothermia fever is associated with increased mortality after out-of-hospital cardiac arres

DEFF Research Database (Denmark)

Bro-Jeppesen, John; Hassager, Christian; Wanscher, Michael

2013-01-01

Post-cardiac arrest fever has been associated with adverse outcome before implementation of therapeutic hypothermia (TH), however the prognostic implications of post-hypothermia fever (PHF) in the era of modern post-resuscitation care including TH has not been thoroughly investigated. The aim...

Takayasu's arteritis: A rare cause of cardiac death in a Caucasian teenage female patient

NARCIS (Netherlands)

S.A.M. Saïd (Salah); J.C. Koetsveld-Baart (J.); J.C. den Hollander (Jan)

1997-01-01

textabstractA Caucasian teenage Dutch schoolgirl with known chronic low visual acuity and albinism, presented with frank acute pulmonary oedema, died after 1 h of cardio-pulmonary resuscitation for bradyarrhythmia and cardiac arrest. Two weeks prior to presentation, during sport training, she

The presence of resuscitation equipment and influencing factors at General Practitioners' offices in Denmark: a cross-sectional study.

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Niegsch, Mark L; Krarup, Nikolaj T; Clausen, Niels Erikstrup

2014-01-01

Automated external defibrillators (AEDs) have proven effective when used by GPs. Despite this and the latest guidelines from the European Resuscitation Council, there are no recommendations for Danish GPs regarding proper equipment to treat cardiac arrest. Currently, there are no published data on the distribution of AEDs among GPs in Denmark. To assess the prevalence of resuscitation equipment and educated staff among Danish GPs and the parameters influencing the absence of AEDs at GP offices. A cross-sectional questionnaire-based survey among the 2030 GPs registered in Denmark. Questions concerned demographics, occurrence of resuscitation equipment and attitude towards acquisition of an AED. With a response rate >70%, we found that the prevalence of AEDs in GP offices is low (31.7%). Limited financial possibilities and relevant treatment by ambulance personnel were stated as the primary causes for not having an AED. In general, Danish primary care physicians believe that AEDs should be governmentally sponsored. Positive influential factors on the acquisition of an AED were education, number of physicians in the GP office and previous experience of cardiac arrest. Danish primary care physicians are generally not equipped with AEDs despite the proven effect of AEDs in GP offices. The main reasons for not acquiring an AED are financial considerations and believing that response time by ambulance services and nearby health facilities are the optimal treatment. We recommend better education and information in order to facilitate future acquisition of AEDs among GPs. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Improved Clinical Performance and Teamwork of Pediatric Interprofessional Resuscitation Teams With a Simulation-Based Educational Intervention.

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Gilfoyle, Elaine; Koot, Deanna A; Annear, John C; Bhanji, Farhan; Cheng, Adam; Duff, Jonathan P; Grant, Vincent J; St George-Hyslop, Cecilia E; Delaloye, Nicole J; Kotsakis, Afrothite; McCoy, Carolyn D; Ramsay, Christa E; Weiss, Matthew J; Gottesman, Ronald D

2017-02-01

To measure the effect of a 1-day team training course for pediatric interprofessional resuscitation team members on adherence to Pediatric Advanced Life Support guidelines, team efficiency, and teamwork in a simulated clinical environment. Multicenter prospective interventional study. Four tertiary-care children's hospitals in Canada from June 2011 to January 2015. Interprofessional pediatric resuscitation teams including resident physicians, ICU nurse practitioners, registered nurses, and registered respiratory therapists (n = 300; 51 teams). A 1-day simulation-based team training course was delivered, involving an interactive lecture, group discussions, and four simulated resuscitation scenarios, each followed by a debriefing. The first scenario of the day (PRE) was conducted prior to any team training. The final scenario of the day (POST) was the same scenario, with a slightly modified patient history. All scenarios included standardized distractors designed to elicit and challenge specific teamwork behaviors. Primary outcome measure was change (before and after training) in adherence to Pediatric Advanced Life Support guidelines, as measured by the Clinical Performance Tool. Secondary outcome measures were as follows: 1) change in times to initiation of chest compressions and defibrillation and 2) teamwork performance, as measured by the Clinical Teamwork Scale. Correlation between Clinical Performance Tool and Clinical Teamwork Scale scores was also analyzed. Teams significantly improved Clinical Performance Tool scores (67.3-79.6%; p Teamwork Scale scores (56.0-71.8%; p Teamwork Scale (R = 0.281; p teamwork during simulated pediatric resuscitation. A positive correlation between clinical and teamwork performance suggests that effective teamwork improves clinical performance of resuscitation teams.

Implementation and execution of military forward resuscitation programs.

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Hooper, Timothy J; Nadler, Roy; Badloe, John; Butler, Frank K; Glassberg, Elon

2014-05-01

Through necessity, military medicine has been the driver of medical innovation throughout history. The battlefield presents challenges, such as the requirement to provide care while under threat, resource limitation, and prolonged evacuation times, which must be overcome to improve casualty survival. Focus must also be placed on identifying the causes, and timing, of death within the battlefield. By doing so, military medical doctrine can be shaped, appropriate goals set, new concepts adopted, and relevant technologies investigated and implemented. The majority of battlefield casualties still die in the prehospital environment, before reaching a medical treatment facility, and hemorrhage remains the leading cause of potentially survivable death. Many countries have adopted policies that push damage control resuscitation forward into the prehospital setting, while understanding the need for timely medical evacuation. Although these policies vary according to country, the majority share many common principles. These include the need for early catastrophic hemorrhage control at point-of-wounding, judicious use of fluid resuscitation, use of blood products as far forward as possible, and early evacuation to a surgical facility. Some countries place medical providers with the ability, and resources, for advanced resuscitation with the forward fighting units (perhaps at company level), whereas others have established en route resuscitation capabilities. If we are to continue to improve battlefield casualty survival, we must continue to work together and learn from each other. We must also carry on working alongside our civilian colleagues so that the benefits of translational experience are not lost. This review describes several countries current military approaches to prehospital trauma care. These approaches, refined through a decade of experience, merit consideration for integration into civilian prehospital care practice.

A model of survival following pre-hospital cardiac arrest based on the Victorian Ambulance Cardiac Arrest Register.

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Fridman, Masha; Barnes, Vanessa; Whyman, Andrew; Currell, Alex; Bernard, Stephen; Walker, Tony; Smith, Karen L

2007-11-01

This study describes the epidemiology of sudden cardiac arrest patients in Victoria, Australia, as captured via the Victorian Ambulance Cardiac Arrest Register (VACAR). We used the VACAR data to construct a new model of out-of-hospital cardiac arrest (OHCA), which was specified in accordance with observed trends. All cases of cardiac arrest in Victoria that were attended by Victorian ambulance services during the period of 2002-2005. Overall survival to hospital discharge was 3.8% among 18,827 cases of OHCA. Survival was 15.7% among 1726 bystander witnessed, adult cardiac arrests of presumed cardiac aetiology, presenting in ventricular fibrillation or ventricular tachycardia (VF/VT), where resuscitation was attempted. In multivariate logistic regression analysis, bystander CPR, cardiac arrest (CA) location, response time, age and sex were predictors of VF/VT, which, in turn, was a strong predictor of survival. The same factors that affected VF/VT made an additional contribution to survival. However, for bystander CPR, CA location and response time this additional contribution was limited to VF/VT patients only. There was no detectable association between survival and age younger than 60 years or response time over 15min. The new model accounts for relationships among predictors of survival. These relationships indicate that interventions such as reduced response times and bystander CPR act in multiple ways to improve survival.

Hypertrophic Cardiomyopathy Mimicking Acute Anterior Myocardial Infarction Associated with Sudden Cardiac Death

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Y. Daralammouri

2012-01-01

Full Text Available Hypertrophic cardiomyopathy is the most common genetic disease of the heart. We report a rare case of hypertrophic obstructive cardiomyopathy mimicking an acute anterior myocardial infarction associated with sudden cardiac death. The patient presented with acute ST elevation myocardial infarction and significant elevation of cardiac enzymes. Cardiac catheterization showed some atherosclerotic coronary artery disease, without significant stenosis. Echocardiography showed left ventricular hypertrophy with a left ventricular outflow tract obstruction; the pressure gradient at rest was 20 mmHg and became severe with the Valsalva maneuver (100 mmHg. There was no family history of sudden cardiac death. Six days later, the patient suffered a syncope on his way to magnetic resonance imaging. He was successfully resuscitated by ventricular fibrillation.

The clinical nurse specialist as resuscitation process manager.

Science.gov (United States)

Schneiderhahn, Mary Elizabeth; Fish, Anne Folta

2014-01-01

The purpose of this article was to describe the history and leadership dimensions of the role of resuscitation process manager and provide specific examples of how this role is implemented at a Midwest medical center. In 1992, a medical center in the Midwest needed a nurse to manage resuscitation care. This role designation meant that this nurse became central to all quality improvement efforts in resuscitation care. The role expanded as clinical resuscitation guidelines were updated and as the medical center grew. The role became known as the critical care clinical nurse specialist as resuscitation process manager. This clinical care nurse specialist was called a manager, but she had no direct line authority, so she accomplished her objectives by forming a multitude of collaborative networks. Based on a framework by Finkelman, the manager role incorporated specific leadership abilities in quality improvement: (1) coordination of medical center-wide resuscitation, (2) use of interprofessional teams, (3) integration of evidence into practice, and (4) staff coaching to develop leadership. The manager coordinates resuscitation care with the goals of prevention of arrests if possible, efficient and effective implementation of resuscitation protocols, high quality of patient and family support during and after the resuscitation event, and creation or revision of resuscitation policies for in-hospital and for ambulatory care areas. The manager designs a comprehensive set of meaningful and measurable process and outcome indicators with input from interprofessional teams. The manager engages staff in learning, reflecting on care given, and using the evidence base for resuscitation care. Finally, the manager role is a balance between leading quality improvement efforts and coaching staff to implement and sustain these quality improvement initiatives. Revisions to clinical guidelines for resuscitation care since the 1990s have resulted in medical centers developing improved

Possibly preventable cardiac arrest in a morbidly obese patient - a comment on the 2015 ERC guidelines.

Science.gov (United States)

Hans, Felix Patricius; Hoeren, Claudia Johanna Maria; Kellmeyer, Phillipp; Hohloch, Lisa; Busch, Hans-Jörg; Bayer, Jörg

2016-10-04

The incidence of overweight and obesity has been steadily on the rise and has reached epidemic proportions in various countries and this represents a well-known major health problem. Nevertheless, current guidelines for resuscitation do not include special sequences of action in this subset of patients. The aim of this letter is to bring this controversy into focus and to suggest alterations of the known standard cardiopulmonary resuscitation in the obese. An obese patient weighing 272 kg fell to the floor, afterwards being unable to get up again. Thus, emergency services were called for assistance. There were no signs or symptoms signifying that the person had been harmed in consequence of the fall. Only when brought into a supine position the patient suffered an immediate cardiac arrest. Cardiopulmonary resuscitation was performed but there was no return of a stable spontaneous circulation until the patient was brought into a full lateral position. In spite of immediate emergency care the patient ultimately suffered a lethal hypoxic brain damage. A full lateral position should be considered in obese patients having a cardiac arrest as it might help to re-establish stable circulatory conditions.

Haemostatic resuscitation in trauma

DEFF Research Database (Denmark)

Stensballe, Jakob; Ostrowski, Sisse Rye; Johansson, Par I.

2016-01-01

of a ratio driven strategy aiming at 1 : 1 : 1, using tranexamic acid according to CRASH-2, and applying haemostatic monitoring enabling a switch to a goal-directed approach when bleeding slows. Haemostatic resuscitation is the mainstay of trauma resuscitation and is associated with improved survival...

Increasing arterial oxygen partial pressure during cardiopulmonary resuscitation is associated with improved rates of hospital admission.

Science.gov (United States)

Spindelboeck, Walter; Schindler, Otmar; Moser, Adrian; Hausler, Florian; Wallner, Simon; Strasser, Christa; Haas, Josef; Gemes, Geza; Prause, Gerhard

2013-06-01

As recent clinical data suggest a harmful effect of arterial hyperoxia on patients after resuscitation from cardiac arrest (CA), we aimed to investigate this association during cardiopulmonary resuscitation (CPR), the earliest and one of the most crucial phases of recirculation. We analysed 1015 patients who from 2003 to 2010 underwent out-of-hospital CPR administered by emergency medical services serving 300,000 inhabitants. Inclusion criteria for further analysis were nontraumatic background of CA and patients >18 years of age. One hundred and forty-five arterial blood gas analyses including oxygen partial pressure (paO2) measurement were obtained during CPR. We observed a highly significant increase in hospital admission rates associated with increases in paO2 in steps of 100 mmHg (13.3 kPa). Subsequently, data were clustered according to previously described cutoffs (≤ 60 mmHg [8 kPa

Acceptability of Bedside Resuscitation With Intact Umbilical Cord to Clinicians and Patients’ Families in the United States

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