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Ettl F, Magnet IAM, Warenits AM, Schober A, Testori C, Weihs W, Grassmann D, Wagner M, Teubenbacher U, Högler S, Sterz F, Janata A. Hyperoxygenation during ECLS – Pitfalls of a novel therapy for refractory cardiac arrest. Resuscitation 2015. [DOI: 10.1016/j.resuscitation.2015.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Krammel M, Winnisch M, Hamp T, Lobmeyr E, Herkner H, Schreiber W, Winnisch D, Zajicek A, van Tulder R, Datler P, Keferböck M, Weidenauer D, Poppe M, Zeiner S, Sulzgruber P, Sterz F. Survival rates significantly increases due to metropolitan police first responder defibrillation. Resuscitation 2015. [DOI: 10.1016/j.resuscitation.2015.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zeiner S, Sulzgruber P, Datler P, Keferböck M, Poppe M, Lobmeyr E, van Tulder R, Zajicek A, Buchinger A, Polz K, Schrattenbacher G, Sterz F. Mechanical chest compression does not seem to improve outcome after out-of hospital cardiac arrest. A single center observational trial. Resuscitation 2015; 96:220-5. [PMID: 26303569 DOI: 10.1016/j.resuscitation.2015.07.051] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 07/29/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
Abstract
AIM Recently three large post product placement studies, comparing mechanical chest compression (cc) devices to those who received manual cc, found equivalent outcome results for both groups. Thus the question arises whether those results could be replicated using the devices on a daily routine. METHODS We prospectively enrolled 948 patients over a 12 months period. Chi-Square test and Mann-Whitney-U test were used to assess differences between "manual" and "mechanical" cc subgroups. Uni- and multivariate Cox regression hazard analysis were used to assess the influence of cc type on survival. RESULTS A mechanical cc device was used in 30.1% (n=283) cases. Patients who received mechanical cc had a significantly worse neurological outcome - measured in cerebral performance category (CPC) - than the manual cc group (56.8% vs. 78.6%, p=0.009). Patients receiving mechanical cc were significantly younger, more were male and were more likely to have bystander CPR and an initially shock-able ECG rhythm. There was no difference in the quality of CPR that might explain the worse outcome in mechanical cc patients. CONCLUSION Even with high quality CPR in both, manual and mechanical cc groups, outcome in patients who received mechanical cc was significantly worse. The anticipated benefits of a higher compression ratio and a steadier compression depth of a mechanical cc device remain uncertain. In this study selection for mechanical cc was not standardized, and was non-random. This merits further investigation. Further research on how mechanical cc is chosen and used should be considered. CLINICAL TRIAL REGISTRATION https://ekmeduniwien.at/core/catalog/2013/ (EK-Nr:1221/2013).
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Olsen JA, Brunborg C, Steinberg M, Persse D, Sterz F, Lozano M, Westfall M, Travis DT, Lerner EB, Brouwer MA, Wik L. Pre-shock chest compression pause effects on termination of ventricular fibrillation/tachycardia and return of organized rhythm within mechanical and manual cardiopulmonary resuscitation. Resuscitation 2015; 93:158-63. [DOI: 10.1016/j.resuscitation.2015.04.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 04/01/2015] [Accepted: 04/02/2015] [Indexed: 11/28/2022]
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Uray T, Sterz F, Weiser C, Schreiber W, Spiel A, Schober A, Stratil P, Mayr FB. Quality of post arrest care does not differ by time of day at a specialized resuscitation center. Medicine (Baltimore) 2015; 94:e664. [PMID: 25860211 PMCID: PMC4554053 DOI: 10.1097/md.0000000000000664] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Previous studies suggest worse outcomes after out-of-hospital cardiac arrest (OHCA) at night. We analyzed whether patients admitted after nontraumatic OHCA to a resuscitation center received the same quality post arrest care at day and night and whether quality of care affected clinical outcomes. We analyzed data of OHCA patients with return of spontaneous circulation admitted to the Vienna general hospital emergency department between January 2006 and May 2013. Data reported include admission time (day defined from 8 AM to 4 PM based on staffing), time to initiation of hypothermia, and door-to-balloon time in patients with ST-elevation myocardial infarction. Survival and cognitive performance at 12 months were assessed. In this retrospective observational study, 1059 patients (74% males, n = 784) with a mean age of 58 ± 16 years were analyzed. The vast majority was treated with induced hypothermia (77% of day vs. 79% of night admissions, P = 0.32) within 1 hour of admission (median time admission to cooling 27 (confidence interval [CI]: 10-60) vs. 23 (CI: 11-59) minutes day vs. night, P = 0.99). In 298 patients with ST-elevation myocardial infarction, median door-to-balloon time did not differ between day and night admissions (82 minutes, CI: 60 to 142 for day vs. 86 minutes, CI: 50 to 135 for night, P = 0.36). At 12 months, survival was recorded in 238 of 490 day and 275 of 569 night admissions (49% vs. 48%, P = 0.94%), and a good neurologic outcome was recorded in 210 of 490 day and 231 of 569 night admissions (43% vs. 41%, P = 0.46). Patients admitted to our department after OHCA were equally likely to receive timely high-quality postresuscitation care irrespective of time of day. Survival and good neurologic outcome at 12 months did not differ between day and night admissions. Our results may support the concept of specialized post arrest care centers.
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van Tulder R, Laggner R, Kienbacher C, Schmid B, Zajicek A, Haidvogel J, Sebald D, Laggner AN, Herkner H, Sterz F, Eisenburger P. The capability of professional- and lay-rescuers to estimate the chest compression-depth target: A short, randomized experiment. Resuscitation 2015; 89:137-41. [DOI: 10.1016/j.resuscitation.2015.01.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 01/13/2015] [Accepted: 01/23/2015] [Indexed: 11/29/2022]
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Holzinger U, Brunner R, Losert H, Fuhrmann V, Herkner H, Madl C, Sterz F, Schneeweiß B. Resting energy expenditure and substrate oxidation rates correlate to temperature and outcome after cardiac arrest - a prospective observational cohort study. Crit Care 2015; 19:128. [PMID: 25888299 PMCID: PMC4404232 DOI: 10.1186/s13054-015-0856-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/04/2015] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Targeted temperature management improves outcome after cardiopulmonary resuscitation. Reduction of resting energy expenditure might be one mode of action. The aim of this study was to correlate resting energy expenditure and substrate oxidation rates with targeted temperature management at 33°C and outcome in patients after cardiac arrest. METHODS This prospective, observational cohort study was performed at the department of emergency medicine and a medical intensive care unit of a university hospital. Patients after successful cardiopulmonary resuscitation undergoing targeted temperature management at 33°C for 24 hours with subsequent rewarming to 36°C and standardized sedation, analgesic and paralytic medication were included. Indirect calorimetry was performed five times within 48 h after cardiac arrest. Measurements were correlated to outcome with repeated measures ANOVA, linear and logistic regression analysis. RESULTS In 25 patients resting energy expenditure decreased 20 (18 to 27) % at 33°C compared to 36°C without differences between outcome groups (favourable vs. unfavourable: 25 (21 to 26) vs. 21 (16 to 26); P = 0.5). In contrast to protein oxidation rate (favourable vs. unfavourable: 35 (11 to 68) g/day vs. 39 (7 to 75) g/day, P = 0.8) patients with favourable outcome had a significantly higher fat oxidation rate (139 (104 to 171) g/day vs. 117 (70 to 139) g/day, P <0.05) and a significantly lower glucose oxidation rate (30 (-34 to 88) g/day vs. 77 (19 to 138) g/day; P < 0.05) as compared to patients with unfavourable neurological outcome. CONCLUSIONS Targeted temperature management at 33°C after cardiac arrest reduces resting energy expenditure by 20% compared to 36°C. Glucose and fat oxidation rates differ significantly between patients with favourable and unfavourable neurological outcome. TRIAL REGISTRATION Clinicaltrials.gov NCT00500825. Registered 11 July 2007.
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Sulzgruber P, Kliegel A, Wandaller C, Uray T, Losert H, Laggner AN, Sterz F, Kliegel M. Survivors of cardiac arrest with good neurological outcome show considerable impairments of memory functioning. Resuscitation 2015; 88:120-5. [DOI: 10.1016/j.resuscitation.2014.11.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 10/14/2014] [Accepted: 11/04/2014] [Indexed: 11/30/2022]
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Steinberg MT, Olsen JA, Brunborg C, Persse D, Sterz F, Lozano Jr M, Brouwer MA, Westfall M, Souders CM, van Grunsven PM, Travis DT, Lerner EB, Wik L. Minimizing pre-shock chest compression pauses in a cardiopulmonary resuscitation cycle by performing an earlier rhythm analysis. Resuscitation 2015; 87:33-7. [DOI: 10.1016/j.resuscitation.2014.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 10/03/2014] [Accepted: 11/15/2014] [Indexed: 11/24/2022]
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Parnia S, Spearpoint K, de Vos G, Fenwick P, Goldberg D, Yang J, Zhu J, Baker K, Killingback H, McLean P, Wood M, Zafari AM, Dickert N, Beisteiner R, Sterz F, Berger M, Warlow C, Bullock S, Lovett S, McPara RMS, Marti-Navarette S, Cushing P, Wills P, Harris K, Sutton J, Walmsley A, Deakin CD, Little P, Farber M, Greyson B, Schoenfeld ER. AWARE—AWAreness during REsuscitation—A prospective study. Resuscitation 2014; 85:1799-805. [DOI: 10.1016/j.resuscitation.2014.09.004] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 09/02/2014] [Accepted: 09/07/2014] [Indexed: 11/25/2022]
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Uray T, Mayr FB, Stratil P, Aschauer S, Testori C, Sterz F, Haugk M. Prehospital surface cooling is safe and can reduce time to target temperature after cardiac arrest. Resuscitation 2014; 87:51-6. [PMID: 25447355 DOI: 10.1016/j.resuscitation.2014.10.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/25/2014] [Accepted: 10/30/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Mild therapeutic hypothermia proved to be beneficial when induced after cardiac arrest in humans. Prehospital cooling with i.v. fluids was associated with adverse side effects. Our primary objective was to compare time to target temperature of out-of hospital cardiac arrest patients cooled non-invasively either in the prehospital setting vs. the in-hospital (IH) setting, to assess surface-cooling safety profile and long term outcome. METHODS In this retrospective, single center cohort study, a group of adult patients with restoration of spontaneous circulation (ROSC) after out-of hospital cardiac arrest were cooled with a surface cooling pad beginning either in the prehospital or IH setting for 24h. Time to target temperature (33.9°C), temperature on admission, time to admission after ROSC and outcome were compared. Also, rearrests and pulmonary edema were assessed. Neurologic outcome at 12 months was evaluated (Cerebral Performance Category, CPC 1-2, favorable outcome). RESULTS Between September 2005 and February 2010, 56 prehospital cooled patients and 54 IH-cooled patients were treated. Target temperature was reached in 85 (66-117)min (prehospital) and in 135 (102-192)min (IH) after ROSC (p<0.001). After prehospital cooling, hospital admission temperature was 35.2 (34.2-35.8)°C, and in the IH-cooling patients initial temperature was 35.8 (35.2-36.3)°C (p=0.001). No difference in numbers of rearrests and pulmonary edema between groups was observed. In both groups, no skin lesions were observed. Favorable outcome was reached in 26.8% (prehospital) and in 37.0% (IH) of the patients (p=0.17). CONCLUSIONS Using a non-invasive prehospital surface cooling method after cardiac arrest, target temperature can be reached faster without any major complications than starting cooling IH. The effect of early non-invasive cooling on long-term outcome remains to be determined in larger studies.
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Nishiyama C, Brown SP, May S, Iwami T, Koster RW, Beesems SG, Kuisma M, Salo A, Jacobs I, Finn J, Sterz F, Nürnberger A, Smith K, Morrison L, Olasveengen TM, Callaway CW, Shin SD, Gräsner JT, Daya M, Ma MHM, Herlitz J, Strömsöe A, Aufderheide TP, Masterson S, Wang H, Christenson J, Stiell I, Davis D, Huszti E, Nichol G. Apples to apples or apples to oranges? International variation in reporting of process and outcome of care for out-of-hospital cardiac arrest. Resuscitation 2014; 85:1599-609. [PMID: 25010784 PMCID: PMC4253685 DOI: 10.1016/j.resuscitation.2014.06.031] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 06/09/2014] [Accepted: 06/22/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Survival after out-of-hospital cardiac arrest (OHCA) varies between communities, due in part to variation in the methods of measurement. The Utstein template was disseminated to standardize comparisons of risk factors, quality of care, and outcomes in patients with OHCA. We sought to assess whether OHCA registries are able to collate common data using the Utstein template. A subsequent study will assess whether the Utstein factors explain differences in survival between emergency medical services (EMS) systems. STUDY DESIGN Retrospective study. SETTING This retrospective analysis of prospective cohorts included adults treated for OHCA, regardless of the etiology of arrest. Data describing the baseline characteristics of patients, and the process and outcome of their care were grouped by EMS system, de-identified, and then collated. Included were core Utstein variables and timed event data from each participating registry. This study was classified as exempt from human subjects' research by a research ethics committee. MEASUREMENTS AND MAIN RESULTS Thirteen registries with 265 first-responding EMS agencies in 13 countries contributed data describing 125,840 cases of OHCA. Variation in inclusion criteria, definition, coding, and process of care variables were observed. Contributing registries collected 61.9% of recommended core variables and 42.9% of timed event variables. Among core variables, the proportion of missingness was mean 1.9±2.2%. The proportion of unknown was mean 4.8±6.4%. Among time variables, missingness was mean 9.0±6.3%. CONCLUSIONS International differences in measurement of care after OHCA persist. Greater consistency would facilitate improved resuscitation care and comparison within and between communities.
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Wik L, Olsen JA, Persse D, Sterz F, Lozano M, Brouwer MA, Westfall M, Souders CM, Malzer R, van Grunsven PM, Travis DT, Whitehead A, Herken UR, Brooke Lerner E. Corrigendum to ‘Manual vs. integrated automatic load-distributing band CPR with equal survival after out of hospital cardiac arrest. The randomized CIRC trial’ [Resuscitation 85 (2014) 741–8]. Resuscitation 2014. [DOI: 10.1016/j.resuscitation.2014.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wik L, Olsen JA, Persse D, Sterz F, Lozano M, Brouwer MA, Westfall M, Souders CM, Malzer R, van Grunsven PM, Travis DT, Whitehead A, Herken UR, Lerner EB. Manual vs. integrated automatic load-distributing band CPR with equal survival after out of hospital cardiac arrest. The randomized CIRC trial. Resuscitation 2014; 85:741-8. [DOI: 10.1016/j.resuscitation.2014.03.005] [Citation(s) in RCA: 211] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/07/2014] [Accepted: 03/07/2014] [Indexed: 11/28/2022]
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Abstract
Full cerebral recovery after cardiopulmonary resuscitation is still a rare event. Unfortunately, up to now, no specific and outcome-improving therapy was available after such events. From several cases it is known that low body and brain temperature during a cardiocirculatory arrest improves the neurological outcome following these events. As it is not possible in acute events to induce hypothermia beforehand, whether cooling after the insult could also be protective was evaluated. After animal studies in the 1990s and first clinical pilot trials of mild therapeutic and induced hypothermia, two randomized trials of hypothermic therapy after successful resuscitation after cardiac arrest were conducted. These studies demonstrated that hypothermia after cardiac arrest could improve neurological outcome as well as overall mortality.
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Högler S, Teubenbacher U, Janata A, Weihs W, Magnet I, Ettl F, Sterz F, Schmidt P. Establishing a Rat Model for Prolonged Cardiac Arrest: Influence of Arrest Duration on Hippocampal Lesions. J Comp Pathol 2014. [DOI: 10.1016/j.jcpa.2013.11.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hörburger D, Kurkciyan I, Sterz F, Schober A, Stöckl M, Stratil P, Uray T, Testori C, Weiser C, Haugk M. Cardiac arrest caused by acute intoxication—insight from a registry. Am J Emerg Med 2013; 31:1443-7. [DOI: 10.1016/j.ajem.2013.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/05/2013] [Accepted: 07/06/2013] [Indexed: 11/28/2022] Open
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Testori C, Sterz F, Delle-Karth G, Malzer R, Holzer M, Stratil P, Stöckl M, Weiser C, van Tulder R, Gangl C, Sebald D, Zajicek A, Buchinger A, Lang I. Strategic target temperature management in myocardial infarction--a feasibility trial. Heart 2013; 99:1663-7. [PMID: 24064228 PMCID: PMC3812852 DOI: 10.1136/heartjnl-2013-304624] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The purpose of this study was to demonstrate the feasibility of a combined cooling strategy started out of hospital as an adjunctive to percutaneous coronary intervention (PCI) in the treatment of ST-elevation acute coronary syndrome (STE-ACS). DESIGN Non-randomised, single-centre feasibility trial. SETTING Department of emergency medicine of a tertiary-care facility, Medical University of Vienna, Vienna, Austria. In cooperation with the Municipal ambulance service of the city of Vienna. PATIENTS Consecutive patients with STE-ACS presenting to the emergency medical service within 6 h after symptom onset. INTERVENTIONS Cooling was initiated with surface cooling pads in the out-of-hospital setting, followed by the administration of 1000-2000 mL of cold saline at hospital arrival and completed by endovascular cooling in the catheterisation laboratory. MAIN OUTCOME MEASURES Feasibility of lowering core temperature below 35.0°C prior to immediately performed revascularisation. Safety and tolerability of the cooling procedure. RESULTS In enrolled 19 patients (one woman, median age 51 years (IQR 45-59)), symptom onset to first medical contact (FMC) was 45 min (IQR 31-85). A core temperature below 35.0°C at reperfusion of the culprit lesion was achieved in 11 patients (78%) within 100 min (IQR 90-111) after FMC without any cooling-related serious adverse event. Temperature could be lowered from baseline 36.4°C (IQR 36.2-36.5°C) to 34.4°C (IQR 34.1-35.0°C) at the time of reperfusion. CONCLUSIONS With limitations an immediate out-of-hospital therapeutic hypothermia strategy was feasible and safe in patients with STE-ACS undergoing primary PCI. CLINICAL TRIAL REGISTRATION http://www.clinicaltrials.gov/ct2/show/NCT01864343; clinical trials unique identifier: NCT01864343.
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van Tulder R, Roth D, Krammel M, Laggner R, Heidinger B, Kienbacher C, Novosad H, Chwojka C, Havel C, Sterz F, Schreiber W, Herkner H. Effects of repetitive or intensified instructions in telephone assisted, bystander cardiopulmonary resuscitation: an investigator-blinded, 4-armed, randomized, factorial simulation trial. Resuscitation 2013; 85:112-8. [PMID: 24012684 DOI: 10.1016/j.resuscitation.2013.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 08/08/2013] [Accepted: 08/14/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Compression depth is frequently suboptimal in cardiopulmonary resuscitation (CPR). We investigated effects of intensified wording and/or repetitive target depth instructions on compression depth in telephone-assisted, protocol driven, bystander CPR on a simulation manikin. METHODS Thirty-two volunteers performed 10 min of compression only-CPR in a prospective, investigator-blinded, 4-armed, factorial setting. Participants were randomized either to standard wording ("push down firmly 5 cm"), intensified wording ("it is very important to push down 5 cm every time") or standard or intensified wording repeated every 20s. Three dispatchers were randomized to give these instructions. Primary outcome was relative compression depth (absolute compression depth minus leaning depth). Secondary outcomes were absolute distance, hands-off times as well as BORG-scale and nine-hole peg test (NHPT), pulse rate and blood pressure to reflect physical exertion. We applied a random effects linear regression model. RESULTS Relative compression depth was 35 ± 10 mm (standard) versus 31 ± 11 mm (intensified wording) versus 25 ± 8 mm (repeated standard) and 31 ± 14 mm (repeated intensified wording). Adjusted for design, body mass index and female sex, intensified wording and repetition led to decreased compression depth of 13 (95%CI -25 to -1) mm (p=0.04) and 9 (95%CI -21 to 3) mm (p=0.13), respectively. Secondary outcomes regarding intensified wording showed significant differences for absolute distance (43 ± 2 versus 20 (95%CI 3-37) mm; p=0.01) and hands-off times (60 ± 40 versus 157 (95%CI 63-251) s; p=0.04). CONCLUSION In protocol driven, telephone-assisted, bystander CPR, intensified wording and/or repetitive target depth instruction will not improve compression depth compared to the standard instruction.
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Wallmüller C, Sterz F, Testori C, Schober A, Stratil P, Hörburger D, Stöckl M, Weiser C, Kricanac D, Zimpfer D, Deckert Z, Holzer M. Emergency cardio-pulmonary bypass in cardiac arrest: Seventeen years of experience. Resuscitation 2013; 84:326-30. [DOI: 10.1016/j.resuscitation.2012.05.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 04/08/2012] [Accepted: 05/11/2012] [Indexed: 11/16/2022]
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Weiser C, van Tulder R, Stöckl M, Schober A, Herkner H, Chwojka CC, Hopfgartner A, Novosad H, Schreiber W, Sterz F. Dispatchers impression plus Medical Priority Dispatch System reduced dispatch centre times in cases of out of hospital cardiac arrest. Pre-alert--a prospective, cluster randomized trial. Resuscitation 2013; 84:883-8. [PMID: 23295777 DOI: 10.1016/j.resuscitation.2012.12.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 12/04/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
Abstract
AIM OF THE STUDY Dispatch centre processing times for out-of-hospital cardiac arrest or critically ill patients should be as short as possible. A modified 'pre-alert' dispatch workflow might be able to improve the processing time. METHODS Between October 2010 and May 2011 dispatch events, suspicious for cardiac arrest, were prospectively randomized in 24h clusters. The emergency medical service of the intervention group got, based on the dispatchers impression, a 'pre-alert' alarm-message followed by the standard Medical Priority Dispatch System query whereas the control group did not. RESULTS In 225 clusters 1500 events were eligible for analysis. Data are presented as median and 25-75 interquartile ranges. Per-protocol analysis demonstrated for the intervention group on 'pre-alert' days a median processing time of 143 s (109-187; n=256) versus 198 s (167-255; n=502) in the control group on non 'pre-alert' days, with a difference of 0.23 log-seconds (p<0.001; 95% CI 0.74-0.28). In critical ill patients, intention-to-treat analysis showed for the intervention group a median of 168 s (131-264; n=153) versus 239 s (176-309; n=164) in the control group, with a difference of 1.4 log-seconds (p<0.001; 95% CI 1.25-1.55). CONCLUSION Dispatch times can effectively be reduced in cases of out-of-hospital cardiac arrest or critical ill patients with a 'pre-alert' dispatch workflow in combination with the Medical Priority Dispatch System protocol. This might play an important role in improving patient care.
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Krizanac D, Stratil P, Hoerburger D, Testori C, Wallmueller C, Schober A, Haugk M, Haller M, Behringer W, Herkner H, Sterz F, Holzer M. Femoro-iliacal artery versus pulmonary artery core temperature measurement during therapeutic hypothermia: an observational study. Resuscitation 2012. [PMID: 23200998 DOI: 10.1016/j.resuscitation.2012.11.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM OF THE STUDY Therapeutic hypothermia after cardiac arrest improves neurologic outcome. The temperature measured in the pulmonary artery is considered to best reflect core temperature, yet is limited by invasiveness. Recently a femoro-arterial thermodilution catheter (PiCCO-Pulse Contour Cardiac Output) has been introduced in clinical practice as a safe and accurate haemodynamic monitoring system, which is also able to measure blood temperature. The aim of the study was to investigate, if the temperature measured with the PiCCO catheter reflects pulmonary artery temperature better than other sites during therapeutic hypothermia. METHODS In this observational study twenty patients after cardiac arrest and successful resuscitation were cooled with various cooling methods to 33 ± 1°C for 24h, followed by rewarming. Temperatures were recorded continuously in the pulmonary artery (Tpa), femoro-iliacal artery (Tpicco), ear canal (Tear), oesophagus (Toeso) and urinary bladder (Tbla). We assessed agreement of methods using the Bland Altman approach including bias and limits of agreement (LA). RESULTS All other sites differed significantly from Tpa with the bias varying from 0.4°C (Tbla) to -0.6°C (Tear). Standard deviations varied from 0.1°C (Tpicco, Toeso) to 0.5°C (Tear). For all sites bias was closer to zero with increasing average temperatures. Bias tended to be larger in the cooling phase compared to overall measurements. CONCLUSIONS Temperature measurement in the femoro-iliacal artery (Tpicco) reflects the gold standard of pulmonary artery temperature most accurately, especially during the cooling phase. Tpicco is easily accessible and might be used for monitoring core temperature without the need for additional temperature probes.
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Weiser C, Testori C, Sterz F, Schober A, Stöckl M, Stratil P, Wallmüller C, Hörburger D, Spiel A, Kürkciyan I, Gangl C, Herkner H, Holzer M. The effect of percutaneous coronary intervention in patients suffering from ST-segment elevation myocardial infarction complicated by out-of-hospital cardiac arrest on 30 days survival. Resuscitation 2012; 84:602-8. [PMID: 23089158 DOI: 10.1016/j.resuscitation.2012.10.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 10/05/2012] [Accepted: 10/11/2012] [Indexed: 12/26/2022]
Abstract
AIM OF THE STUDY To question the beneficial effects of the recommended early percutaneous coronary intervention (PCI) after out-of-hospital cardiac arrest on 30-day survival with favourable neurological outcome. METHODS Prospectively collected data of 1277 out of hospital cardiac arrest patients between 2005 and 2010 from a registry at a tertiary care university hospital were used for a cohort study. RESULTS In 494 (39%) arrest patients ST-segment elevation was identified in 249 (19%). Within 12h after restoration of spontaneous circulation catheter laboratory investigations were initiated in 197 (79%) and PCI in 183 (93%) (78% got PCI in less than 180 min). Adjustment for a cumulative time without chest compressions <2 min, initial shockable rhythm, cardiac arrest witnessed by healthcare professionals, and a higher core temperature at time of hospitalization reduced the effect of PCI on favourable neurological outcome at 30 days (OR 1.40; 95% CI, 0.53-3.7) compared to the univariate analysis (OR 2.52; 95% CI, 1.42-4.48). CONCLUSION This cohort study failed to demonstrate the beneficial effects of PCI as part of post-resuscitation care on 30-day survival with a favourable neurological outcome.
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van Tulder R, Roth D, Havel C, Eisenburger P, Heidinger B, Chwojka CC, Novosad H, Sterz F, Herkner H, Schreiber W. Compression-only-cardiopulmonary resuscitation in telephone assisted bystanders: Is the instruction “push as hard as you can” superior to achieve 5–6cm chest compression depth than the current guideline recommendation? A double blind-randomized-parallel group-simulation-study. Resuscitation 2012. [DOI: 10.1016/j.resuscitation.2012.08.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Spiel A, Wallmüller C, Stratil P, Schober A, Stöckl M, Weiser C, Testori C, Hörburger D, Aschauer S, Sterz F. Outcome before and after implementation of therapeutic hypothermia in patients with not witnessed out of hospital cardiac arrest and sustained return of spontaneous circulation. Resuscitation 2012. [DOI: 10.1016/j.resuscitation.2012.08.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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