1
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Niset A, Barrit S. Smartwatch: A wearable, readily available CPR aid. Am J Emerg Med 2024; 83:149-153. [PMID: 39003197 DOI: 10.1016/j.ajem.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 06/30/2024] [Accepted: 07/06/2024] [Indexed: 07/15/2024] Open
Affiliation(s)
- Alexandre Niset
- Médecine d'Urgence, Université Catholique de Louvain, Place de l'université 1, 1348 Louvain-la-Neuve, Belgium; Sciense, Broadway 447, New York, NY 10013, USA; Délégation des Médecins Francophones en Formation asbl, Grez-Doiceau, Belgium.
| | - Sami Barrit
- Sciense, Broadway 447, New York, NY 10013, USA; Délégation des Médecins Francophones en Formation asbl, Grez-Doiceau, Belgium; Neurochirurgie, Université Libre de Bruxelles, Avenue Franklin Roosevelt 50, 1050 Bruxelles, Belgium; Sciences Chirurgicales, Université Paris-Est Créteil, Avenue du Général de Gaulle 61, 94010 Créteil, France.
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2
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Dąbrowski S, Tomaszek L, Basiński A. Use of Analgesics and Sedatives in Nontraumatic Patients after Sudden Cardiac Arrest during the Peri-Resuscitation Period in the Emergency Department. J Clin Med 2024; 13:4563. [PMID: 39124829 PMCID: PMC11313442 DOI: 10.3390/jcm13154563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/16/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
Background: While cardiopulmonary resuscitation (CPR) may be life-saving for patients in cardiac arrest, it simultaneously puts them at risk for skeletal and soft tissue injuries. The prevalence of cardiovascular and thoracic wall injuries related to CPR varies significantly in the literature, from 21% to more than 78%. After restoration of circulation, ischemia-reperfusion brain injury ensues. Sedation is one of the interventions that can reduce its effects on brain cells. The purpose of this study was to analyse the use of analgesics and sedatives in nontraumatic patients after sudden cardiac arrest in the peri-resuscitation period in the emergency department. Methods: This was a retrospective cohort study. An analysis was performed on the electronic health records of 131 patients who underwent CPR, with ages ranging from 24 to 96 years. The study protocol was in accordance with the Declaration of Helsinki. Results: Chest wall injuries were assessed based on the results of X-ray imaging (n = 39; 31%) and computed tomography (n = 87; 69%). Of the 126 cases, 17.5% had rib fractures and 6.3% had rib and sternal fractures. Almost 78% of the patients (n = 102) received sedatives and/or analgesics during the peri-resuscitation period. Monotherapy was used in 85 cases. Among these drugs the most frequently mentioned were midazolam (45.2%), fentanyl (26.8%), and propofol (20.8%). Conclusions: As only two-thirds of the patients received sedation and half received analgesics, there is still room for a broader incorporation of analgesia and sedation into peri-resuscitation care protocols.
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Affiliation(s)
- Sebastian Dąbrowski
- Department of Medical Rescue, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | - Lucyna Tomaszek
- Department of Specialist Nursing, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, 30-705 Kraków, Poland;
- Department of Thoracic Surgery, Institute of Tuberculosis and Lung Diseases, 34-700 Rabka-Zdrój, Poland
| | - Andrzej Basiński
- Department of Medical Rescue, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
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3
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Faldaas BO, Nielsen EW, Storm BS, Lappegård KT, Nilsen BA, Kiss G, Skogvoll E, Torp H, Ingul CB. Real-time feedback on chest compression efficacy by hands-free carotid Doppler in a porcine model. Resusc Plus 2024; 18:100583. [PMID: 38404755 PMCID: PMC10885784 DOI: 10.1016/j.resplu.2024.100583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/30/2024] [Accepted: 02/08/2024] [Indexed: 02/27/2024] Open
Abstract
Aim Current guidelines for cardiopulmonary resuscitation (CPR) recommend a one-size-fits-all approach in relation to the positioning of chest compressions. We recently developed RescueDoppler, a hands-free Doppler ultrasound device for continuous monitoring of carotid blood flow velocity during CPR. The aim of the present study is to investigate whether RescueDoppler via real-time hemodynamic feedback, could identify both optimal and suboptimal compression positions. Methods In this model of animal cardiac arrest, we induced ventricular fibrillation in five domestic pigs. Manual chest compressions were performed for ten seconds at three different positions on the sternum in random order and repeated six times. We analysed Time Average Velocity (TAV) with chest compression position as a fixed effect and animal, position, and sequential time within animals as random effects. Furthermore, we compared TAV to invasive blood pressure from the contralateral carotid artery. Results We were able to detect changes in TAV when altering positions. The positions with the highest (range 19 to 48 cm/s) and lowest (6-25 cm/s) TAV were identified in all animals, with corresponding peak pressure 50-81 mmHg, and 46-64 mmHg, respectively. Blood flow velocity was, on average, highest at the middle position (TAV 33 cm/s), but with significant variability between animals (SD 2.8) and positions within the same animal (SD 9.3). Conclusion RescueDoppler detected TAV changes during CPR with alternating chest compression positions, identifying the position yielding maximal TAV. Future clinical studies should investigate if RescueDoppler can be used as a real-time hemodynamical feedback device to guide compression position.
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Affiliation(s)
- Bjørn Ove Faldaas
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Erik Waage Nielsen
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- Department of Surgery, Nordland Hospital Trust, Bodø, Norway
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Benjamin Stage Storm
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- Department of Surgery, Nordland Hospital Trust, Bodø, Norway
| | - Knut Tore Lappegård
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- Department of Medicine, Nordland Hospital Trust, Bodø, Norway
| | - Bent Aksel Nilsen
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Surgery, Nordland Hospital Trust, Bodø, Norway
| | - Gabriel Kiss
- Department of Computer Science (IDI), Faculty of Information Technology and Electrical Engineering, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Eirik Skogvoll
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Anesthesia and Intensive Care Medicine, St Olav University Hospital, Trondheim, Norway
| | - Hans Torp
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Charlotte Björk Ingul
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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4
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Chalkias A, Mentzelopoulos SD, Tissier R, Mongardon N. Peri-operative cardiac arrest and resuscitation: Towards an innovative, physiologically based road map. Eur J Anaesthesiol 2024; 41:393-396. [PMID: 38567683 DOI: 10.1097/eja.0000000000001944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Athanasios Chalkias
- From the Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (AC), Outcomes Research Consortium, Cleveland, Ohio, USA (AC), First Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, Athens, Greece (SDM), Ecole Nationale Vétérinaire d'Alfort, Univ Paris Est Créteil, INSERM, IMRB (RT, NM), Service d'Anesthésie-Réanimation Chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor (NM), Faculté de Santé, Univ Paris Est Créteil, Créteil, France (NM)
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5
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Coult J, Yang BY, Kwok H, Kutz JN, Boyle PM, Blackwood J, Rea TD, Kudenchuk PJ. Prediction of Shock-Refractory Ventricular Fibrillation During Resuscitation of Out-of-Hospital Cardiac Arrest. Circulation 2023; 148:327-335. [PMID: 37264936 DOI: 10.1161/circulationaha.122.063651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/08/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Out-of-hospital cardiac arrest due to shock-refractory ventricular fibrillation (VF) is associated with relatively poor survival. The ability to predict refractory VF (requiring ≥3 shocks) in advance of repeated shock failure could enable preemptive targeted interventions aimed at improving outcome, such as earlier administration of antiarrhythmics, reconsideration of epinephrine use or dosage, changes in shock delivery strategy, or expedited invasive treatments. METHODS We conducted a cohort study of VF out-of-hospital cardiac arrest to develop an ECG-based algorithm to predict patients with refractory VF. Patients with available defibrillator recordings were randomized 80%/20% into training/test groups. A random forest classifier applied to 3-s ECG segments immediately before and 1 minute after the initial shock during cardiopulmonary resuscitation was used to predict the need for ≥3 shocks based on singular value decompositions of ECG wavelet transforms. Performance was quantified by area under the receiver operating characteristic curve. RESULTS Of 1376 patients with VF out-of-hospital cardiac arrest, 311 (23%) were female, 864 (63%) experienced refractory VF, and 591 (43%) achieved functional neurological survival. Total shock count was associated with decreasing likelihood of functional neurological survival, with a relative risk of 0.95 (95% CI, 0.93-0.97) for each successive shock (P<0.001). In the 275 test patients, the area under the receiver operating characteristic curve for predicting refractory VF was 0.85 (95% CI, 0.79-0.89), with specificity of 91%, sensitivity of 63%, and a positive likelihood ratio of 6.7. CONCLUSIONS A machine learning algorithm using ECGs surrounding the initial shock predicts patients likely to experience refractory VF, and could enable rescuers to preemptively target interventions to potentially improve resuscitation outcome.
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Affiliation(s)
- Jason Coult
- Department of Medicine (J.C., T.D.R.), University of Washington, Seattle
| | - Betty Y Yang
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas (B.Y.Y.)
| | - Heemun Kwok
- Department of Applied Mathematics (J.N.K.), University of Washington, Seattle
| | - J Nathan Kutz
- Department of Applied Mathematics (J.N.K.), University of Washington, Seattle
| | - Patrick M Boyle
- Department of Bioengineering (P.M.B.), University of Washington, Seattle
- Institute for Stem Cell and Regenerative Medicine (P.M.B.), University of Washington, Seattle
- Center for Cardiovascular Biology (P.M.B.), University of Washington, Seattle
| | - Jennifer Blackwood
- Emergency Medical Services Division, Public Health - Seattle & King County, Seattle, WA (J.B., T.D.R.)
| | - Thomas D Rea
- Department of Medicine (J.C., T.D.R.), University of Washington, Seattle
- Emergency Medical Services Division, Public Health - Seattle & King County, Seattle, WA (J.B., T.D.R.)
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6
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Chalkias A, Adamos G, Mentzelopoulos SD. General Critical Care, Temperature Control, and End-of-Life Decision Making in Patients Resuscitated from Cardiac Arrest. J Clin Med 2023; 12:4118. [PMID: 37373812 DOI: 10.3390/jcm12124118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/02/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Cardiac arrest affects millions of people per year worldwide. Although advances in cardiopulmonary resuscitation and intensive care have improved outcomes over time, neurologic impairment and multiple organ dysfunction continue to be associated with a high mortality rate. The pathophysiologic mechanisms underlying the post-resuscitation disease are complex, and a coordinated, evidence-based approach to post-resuscitation care has significant potential to improve survival. Critical care management of patients resuscitated from cardiac arrest focuses on the identification and treatment of the underlying cause(s), hemodynamic and respiratory support, organ protection, and active temperature control. This review provides a state-of-the-art appraisal of critical care management of the post-cardiac arrest patient.
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Affiliation(s)
- Athanasios Chalkias
- Department of Anesthesiology, Faculty of Medicine, University of Thessaly, 41500 Larisa, Greece
- Outcomes Research Consortium, Cleveland, OH 44195, USA
| | - Georgios Adamos
- First Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, 10675 Athens, Greece
| | - Spyros D Mentzelopoulos
- First Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, 10675 Athens, Greece
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7
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Cournoyer A, Cavayas YA. Central venous pressure amplitude: A novel marker of resuscitation quality. Resuscitation 2023; 185:109749. [PMID: 36842673 DOI: 10.1016/j.resuscitation.2023.109749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/26/2023]
Affiliation(s)
- Alexis Cournoyer
- Faculty of Medicine, Department of Family Medicine and Emergency Medicine, Université de Montréal, Montréal, Québec, Canada; Centre de Recherche de l'Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada; Department of Emergency Medicine, Hôpital du Sacré-Cœur de Montréal, CIUSSS-NIM, Montréal, Québec, Canada; Department of Emergency Medicine, Hôpital Maisonneuve-Rosemont, CIUSSS-EIM, Montréal, Québec, Canada; Corporation d'Urgences-santé, Montréal, Québec, Canada.
| | - Yiorgos Alexandros Cavayas
- Centre de Recherche de l'Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada; Faculty of Medicine, Department of Medicine, Université de Montréal, Montréal, Québec; Department of Medicine, Service of Intensive Care Medicine, Hôpital du Sacré-Cœur de Montréal, CIUSSS-NIM, Montréal, Québec, Canada; Department of Surgery, Service of Intensive Care Medicine, Institut de Cardiologie de Montréal, Montréal, Québec, Canada
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8
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de Roux Q, Chalkias A, Xanthos T, Mongardon N. In-hospital cardiac arrest: evidence and specificities of perioperative cardiac arrest. Crit Care 2023; 27:17. [PMID: 36639660 PMCID: PMC9840306 DOI: 10.1186/s13054-022-04300-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 12/29/2022] [Indexed: 01/15/2023] Open
Affiliation(s)
- Quentin de Roux
- grid.412116.10000 0004 1799 3934Service d’Anesthésie-Réanimation Chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 1 rue Gustave Eiffel, 94000 Créteil, France ,grid.428547.80000 0001 2169 3027U955-IMRB, Equipe 03 “Pharmacologie et Technologies pour les Maladies Cardiovasculaires (PROTECT)”, Inserm Univ Paris Est Créteil (UPEC), Ecole Nationale Vétérinaire d’Alfort (EnVA), 94700 Maisons-Alfort, France ,grid.410511.00000 0001 2149 7878Faculté de Santé, Univ Paris Est Créteil, 94010 Créteil, France
| | - Athanasios Chalkias
- grid.410558.d0000 0001 0035 6670Department of Anesthesiology, Faculty of Medicine, University of Thessaly, 41100 Larissa, Greece ,grid.512286.aOutcomes Research Consortium, 9500 Euclid Avenue, Cleveland, OH 44195 USA
| | - Theodoros Xanthos
- grid.499377.70000 0004 7222 9074School of Health Sciences, University of West Attica, 12243 Athens, Greece
| | - Nicolas Mongardon
- grid.412116.10000 0004 1799 3934Service d’Anesthésie-Réanimation Chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 1 rue Gustave Eiffel, 94000 Créteil, France ,grid.428547.80000 0001 2169 3027U955-IMRB, Equipe 03 “Pharmacologie et Technologies pour les Maladies Cardiovasculaires (PROTECT)”, Inserm Univ Paris Est Créteil (UPEC), Ecole Nationale Vétérinaire d’Alfort (EnVA), 94700 Maisons-Alfort, France ,grid.410511.00000 0001 2149 7878Faculté de Santé, Univ Paris Est Créteil, 94010 Créteil, France
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9
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Zuo F, Dai C, Wei L, Gong Y, Yin C, Li Y. Real-time amplitude spectrum area estimation during chest compression from the ECG waveform using a 1D convolutional neural network. Front Physiol 2023; 14:1113524. [PMID: 37153217 PMCID: PMC10157479 DOI: 10.3389/fphys.2023.1113524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/10/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction: Amplitude spectrum area (AMSA) is a well-established measure than can predict defibrillation outcome and guiding individualized resuscitation of ventricular fibrillation (VF) patients. However, accurate AMSA can only be calculated during cardiopulmonary resuscitation (CPR) pause due to artifacts produced by chest compression (CC). In this study, we developed a real-time AMSA estimation algorithm using a convolutional neural network (CNN). Methods: Data were collected from 698 patients, and the AMSA calculated from the uncorrupted signals served as the true value for both uncorrupted and the adjacent corrupted signals. An architecture consisting of a 6-layer 1D CNN and 3 fully connected layers was developed for AMSA estimation. A 5-fold cross-validation procedure was used to train, validate and optimize the algorithm. An independent testing set comprised of simulated data, real-life CC corrupted data, and preshock data was used to evaluate the performance. Results: The mean absolute error, root mean square error, percentage root mean square difference and correlation coefficient were 2.182/1.951 mVHz, 2.957/2.574 mVHz, 22.887/28.649% and 0.804/0.888 for simulated and real-life testing data, respectively. The area under the receiver operating characteristic curve regarding predicting defibrillation success was 0.835, which was comparable to that of 0.849 using the true value of the AMSA. Conclusions: AMSA can be accurately estimated during uninterrupted CPR using the proposed method.
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Affiliation(s)
- Feng Zuo
- Department of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing, China
| | - Chenxi Dai
- Department of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing, China
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Liang Wei
- Department of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing, China
| | - Yushun Gong
- Department of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing, China
| | - Changlin Yin
- Department of Intensive Care, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yongqin Li
- Department of Biomedical Engineering and Imaging Medicine, Army Medical University, Chongqing, China
- *Correspondence: Yongqin Li,
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10
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Coult J, Kwok H, Eftestøl T, Bhandari S, Blackwood J, Sotoodehnia N, Kudenchuk PJ, Rea TD. Continuous Assessment of Ventricular Fibrillation Prognostic Status during CPR: Implications for Resuscitation. Resuscitation 2022; 179:152-162. [PMID: 36031076 DOI: 10.1016/j.resuscitation.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/19/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Ventricular fibrillation (VF) waveform measures reflect myocardial physiologic status. Continuous assessment of VF prognosis using such measures could guide resuscitation, but has not been possible due to CPR artifact in the ECG. A recently-validated VF measure (termed VitalityScore), which estimates the probability (0-100%) of return-of-rhythm (ROR) after shock, can assess VF during CPR, suggesting potential for continuous application during resuscitation. OBJECTIVE We evaluated VF using VitalityScore to characterize VF prognostic status continuously during resuscitation. METHODS We characterized VF using VitalityScore during 60 seconds of CPR and 10 seconds of subsequent pre-shock CPR interruption in patients with out-of-hospital VF arrest. VitalityScore utility was quantified using area under the receiver operating characteristic curve (AUC). VitalityScore trends over time were estimated using mixed-effects models, and associations between trends and ROR were evaluated using logistic models. A sensitivity analysis characterized VF during protracted (100-second) periods of CPR. RESULTS We evaluated 724 VF episodes among 434 patients. After an initial decline from 0-8 seconds following VF onset, VitalityScore increased slightly during CPR from 8-60 seconds (slope: 0.18 %/min). During the first 10 seconds of subsequent pre-shock CPR interruption, VitalityScore declined (slope: -14 %/min). VitalityScore predicted ROR throughout CPR with AUCs 0.73-0.75. Individual VitalityScore trends during 8-60 seconds of CPR were marginally associated with subsequent ROR (adjusted odds ratio for interquartile slope change (OR)=1.10, p=0.21), and became significant with protracted (≥100 seconds) CPR duration (OR=1.28, p=0.006). CONCLUSION VF prognostic status can be continuously evaluated during resuscitation, a development that could translate to patient-specific resuscitation strategies.
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Affiliation(s)
- Jason Coult
- Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Heemun Kwok
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA
| | - Trygve Eftestøl
- Department of Electrical and Computer Science, University of Stavanger, Stavanger, Norway
| | - Shiv Bhandari
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jennifer Blackwood
- Seattle-King County Department of Public Health, King County Emergency Medical Services, Seattle, WA, USA
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
| | - Peter J Kudenchuk
- Seattle-King County Department of Public Health, King County Emergency Medical Services, Seattle, WA, USA; Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Thomas D Rea
- Department of Medicine, University of Washington, Seattle, WA, USA; Seattle-King County Department of Public Health, King County Emergency Medical Services, Seattle, WA, USA
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11
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Dunning J, Archbold A, de Bono JP, Butterfield L, Curzen N, Deakin CD, Gudde E, Keeble TR, Keys A, Lewis M, O'Keeffe N, Sarma J, Stout M, Swindell P, Ray S. Joint British Societies' guideline on management of cardiac arrest in the cardiac catheter laboratory. BRITISH HEART JOURNAL 2022; 108:e3. [PMID: 35470236 DOI: 10.1136/heartjnl-2021-320588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
More than 300 000 procedures are performed in cardiac catheter laboratories in the UK each year. The variety and complexity of percutaneous cardiovascular procedures have both increased substantially since the early days of invasive cardiology, when it was largely focused on elective coronary angiography and single chamber (right ventricular) permanent pacemaker implantation. Modern-day invasive cardiology encompasses primary percutaneous coronary intervention, cardiac resynchronisation therapy, complex arrhythmia ablation and structural heart interventions. These procedures all carry the risk of cardiac arrest.We have developed evidence-based guidelines for the management of cardiac arrest in adult patients in the catheter laboratory. The guidelines include recommendations which were developed by collaboration between nine professional and patient societies that are involved in promoting high-quality care for patients with cardiovascular conditions. We present a set of protocols which use the skills of the whole catheter laboratory team and which are aimed at achieving the best possible outcomes for patients who suffer a cardiac arrest in this setting. We identified six roles and developed a treatment algorithm which should be adopted during cardiac arrest in the catheter laboratory. We recommend that all catheter laboratory staff undergo regular training for these emergency situations which they will inevitably face.
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Affiliation(s)
- Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, Middlesbrough, UK
| | - Andrew Archbold
- Department of General & Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Joseph Paul de Bono
- Department of Cardiology, Queen Elizabeth Hospital, University of Birmingham, Birmingham, West Midlands, UK
| | - Liz Butterfield
- School of Nursing, Midwifery and Social Work, Faculty of Health and Wellbeing, Canterbury Christ Church University, Canterbury, UK
| | - Nick Curzen
- Faculty of Medicine, University of Southampton and Department of Cardiology, Southampton, UK
| | - Charles D Deakin
- Anaesthesia and Intensive Care, Southampton University Hospitals NHS Trust, Southampton, Southampton, UK
| | - Ellie Gudde
- Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Basildon, Essex, UK.,Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, UK
| | - Thomas R Keeble
- Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Basildon, Essex, UK.,Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, UK
| | - Alan Keys
- Cardiovascular Care Partnership (UK), British Cardiovascular Society, London, London, UK
| | - Mike Lewis
- Department of Cardiac Surgery, Royal Sussex County Hospital, Brighton, UK
| | - Niall O'Keeffe
- Department of Cardiothoracic Anaesthesia and Critical Care, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Jaydeep Sarma
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Martin Stout
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | | | - Simon Ray
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
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12
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Chalkias A, Laou E, Papagiannakis N, Varvarousi G, Ragias D, Koutsovasilis A, Makris D, Varvarousis D, Iacovidou N, Pantazopoulos I, Xanthos T. Determinants of venous return in steady-state physiology and asphyxia-induced circulatory shock and arrest: an experimental study. Intensive Care Med Exp 2022; 10:13. [PMID: 35412084 PMCID: PMC9005574 DOI: 10.1186/s40635-022-00440-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/05/2022] [Indexed: 01/02/2023] Open
Abstract
Background Mean circulatory filling pressure (Pmcf) provides information on stressed volume and is crucial for maintaining venous return. This study investigated the Pmcf and other determinants of venous return in dysrhythmic and asphyxial circulatory shock and arrest. Methods Twenty Landrace/Large-White piglets were allocated into two groups of 10 animals each. In the dysrhythmic group, ventricular fibrillation was induced with a 9 V cadmium battery, while in the asphyxia group, cardiac arrest was induced by stopping and disconnecting the ventilator and clamping the tracheal tube at the end of exhalation. Mean circulatory filling pressure was calculated using the equilibrium mean right atrial pressure at 5–7.5 s after the onset of cardiac arrest and then every 10 s until 1 min post-arrest. Successful resuscitation was defined as return of spontaneous circulation (ROSC) with a MAP of at least 60 mmHg for a minimum of 5 min. Results After the onset of asphyxia, a ΔPmca increase of 0.004 mmHg, 0.01 mmHg, and 1.26 mmHg was observed for each mmHg decrease in PaO2, each mmHg increase in PaCO2, and each unit decrease in pH, respectively. Mean Pmcf value in the ventricular fibrillation and asphyxia group was 14.81 ± 0.5 mmHg and 16.04 ± 0.6 mmHg (p < 0.001) and decreased by 0.031 mmHg and 0.013 mmHg (p < 0.001), respectively, for every additional second passing after the onset of cardiac arrest. With the exception of the 5–7.5 s time interval, post-cardiac arrest right atrial pressure was significantly higher in the asphyxia group. Mean circulatory filling pressure at 5 to 7.5 s after cardiac arrest predicted ROSC in both groups, with a cut-off value of 16 mmHg (AUC = 0.905, p < 0.001). Conclusion Mean circulatory filling pressure was higher in hypoxic hypercapnic conditions and decreased at a lower rate after cardiac arrest compared to normoxemic and normocapnic state. A Pmcf cut-off point of 16 mmHg at 5–7.5 s after cardiac arrest can highly predict ROSC. Supplementary Information The online version contains supplementary material available at 10.1186/s40635-022-00440-z.
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13
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Suazo M, Herrero J, Fortuny G, Puigjaner D, López JM. Biomechanical response of human rib cage to cardiopulmonary resuscitation maneuvers: Effects of the compression location. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3585. [PMID: 35188706 PMCID: PMC9285513 DOI: 10.1002/cnm.3585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/01/2022] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
The biomechanical response of a human rib cage to cardiopulmonary resuscitation maneuvers was investigated by means of finite element simulations. We analyzed the effect of the location where the force was applied on the achieved compression depths and stress levels experienced by the breastbone and ribs. For compression locations on the breastbone, a caudal shift of the application area toward the breastbone tip resulted in a 17% reduction of the force required to achieve a target 5 cm compression depth. We found that the use of compression regions located on the costal cartilages would involve higher risk of rib fractures.
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Affiliation(s)
- Mario Suazo
- Departament d’ Enginyeria Informàtica i MatemàtiquesUniversitat Rovira i VirgiliTarragonaCatalunyaSpain
- Departamento de Matemática AplicadaEscuela de Matemática y Ciencias de la Computación, UNAH–VSTegucigalpaHonduras
| | - Joan Herrero
- Departament d’ Enginyeria QuímicaUniversitat Rovira i VirgiliTarragonaCatalunyaSpain
| | - Gerard Fortuny
- Departament d’ Enginyeria Informàtica i MatemàtiquesUniversitat Rovira i VirgiliTarragonaCatalunyaSpain
| | - Dolors Puigjaner
- Departament d’ Enginyeria Informàtica i MatemàtiquesUniversitat Rovira i VirgiliTarragonaCatalunyaSpain
| | - Josep M. López
- Departament d’ Enginyeria Informàtica i MatemàtiquesUniversitat Rovira i VirgiliTarragonaCatalunyaSpain
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14
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Koyama Y, Matsuyama T, Inoue Y. Association between haemodynamics during cardiopulmonary resuscitation and patient outcomes. Resuscitation 2021; 170:295-302. [PMID: 34673153 DOI: 10.1016/j.resuscitation.2021.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 10/01/2021] [Accepted: 10/09/2021] [Indexed: 11/15/2022]
Abstract
AIM There is no defined target for blood flow during chest compressions (CC). We previously reported various haemodynamic patterns in which dominant arterial and venous pressures were observed during CC. This study aimed to evaluate arterial and venous perfusion pressures during CC and determine their association with patient outcomes. METHODS In this prospective observational single-centre study, arterial and venous pressures were recorded continuously on arrival at the emergency department for patients with non-traumatic out-of-hospital cardiac arrest. Parameters included multiple pressure measurements: the arterial systolic (A sys), mean (A mean), and diastolic (A dias); the venous systolic (V sys), mean (V mean), and diastolic (V dias); and the differences between arterial and venous systolic (ΔSys A-V), mean (ΔMean A-V), and diastolic (ΔDias A-V). We compared patients with and without return of spontaneous circulation (ROSC). RESULTS Among 50 patients, 16 (32%) had ROSC. Of the total measurement time, average A sys, A dias, ΔSys A-V, ΔDias A-V, A mean, and ΔMean A-V were significantly higher in patients with ROSC. When the average ΔMean A-V was stratified, there were 19 (38%) patients with negative average ΔMean A-V values, none of whom had ROSC. As the average ΔMean A-V increased, the ROSC rate also increased (p = 0.00002). CONCLUSIONS ROSC did not occur in patients with negative average ΔMean A-V values. ROSC may be achieved through individualised resuscitation that places a greater emphasis on differences between mean arterial and venous pressure, rather than through uniform resuscitation.
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Affiliation(s)
- Yasuaki Koyama
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, Tsukuba City, Ibaraki, Japan.
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto City, Kyoto, Japan
| | - Yoshiaki Inoue
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, Tsukuba City, Ibaraki, Japan
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15
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Azeli Y, Bardají A, Barbería E, Lopez-Madrid V, Bladé-Creixenti J, Fernández-Sender L, Bonet G, Rica E, Álvarez S, Fernández A, Axelsson C, Jiménez-Herrera MF. Clinical outcomes and safety of passive leg raising in out-of-hospital cardiac arrest: a randomized controlled trial. Crit Care 2021; 25:176. [PMID: 34034775 PMCID: PMC8152146 DOI: 10.1186/s13054-021-03593-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/30/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There are data suggesting that passive leg raising (PLR) improves hemodynamics during cardiopulmonary resuscitation (CPR). This trial aimed to determine the effectiveness and safety of PLR during CPR in out-of-hospital cardiac arrest (OHCA). METHODS We conducted a randomized controlled trial with blinded assessment of the outcomes that assigned adults OHCA to be treated with PLR or in the flat position. The trial was conducted in the Camp de Tarragona region. The main end point was survival to hospital discharge with good neurological outcome defined as cerebral performance category (CPC 1-2). To study possible adverse effects, we assessed the presence of pulmonary complications on the first chest X-rays, brain edema on the computerized tomography (CT) in survivors and brain and lungs weights from autopsies in non-survivors. RESULTS In total, 588 randomized cases were included, 301 were treated with PLR and 287 were controls. Overall, 67.8% were men and the median age was 72 (IQR 60-82) years. At hospital discharge, 3.3% in the PLR group and 3.5% in the control group were alive with CPC 1-2 (OR 0.9; 95% CI 0.4-2.3, p = 0.91). No significant differences in survival at hospital admission were found in all patients (OR 1.0; 95% CI 0.7-1.6, p = 0.95) and among patients with an initial shockable rhythm (OR 1.7; 95% CI 0.8-3.4, p = 0.15). There were no differences in pulmonary complication rates in chest X-rays [7 (25.9%) vs 5 (17.9%), p = 0.47] and brain edema on CT [5 (29.4%) vs 10 (32.6%), p = 0.84]. There were no differences in lung weight [1223 mg (IQR 909-1500) vs 1239 mg (IQR 900-1507), p = 0.82] or brain weight [1352 mg (IQR 1227-1457) vs 1380 mg (IQR 1255-1470), p = 0.43] among the 106 autopsies performed. CONCLUSION In this trial, PLR during CPR did not improve survival to hospital discharge with CPC 1-2. No evidence of adverse effects has been found. Clinical trial registration ClinicalTrials.gov: NCT01952197, registration date: September 27, 2013, https://clinicaltrials.gov/ct2/show/NCT01952197 .
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Affiliation(s)
- Youcef Azeli
- Sistema d'Emergències Mèdiques de Catalunya, Carrer de Pablo Iglesias 101-115, L'Hospitalet de Llobregat, Barcelona, Spain.
- Emergency Department, Sant Joan University Hospital, Reus, Spain.
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain.
| | - Alfredo Bardají
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
- Cardiology Department, Joan XXIII, University Hospital, Tarragona, Spain
- Universitat Rovira i Virgili, Tarragona, Spain
| | - Eneko Barbería
- Universitat Rovira i Virgili, Tarragona, Spain
- Pathology Service, Institute of Legal Medicine and Forensic Sciences of Catalonia, Tarragona, Spain
| | | | | | | | - Gil Bonet
- Cardiology Department, Joan XXIII, University Hospital, Tarragona, Spain
| | - Elena Rica
- Department de Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, Spain
| | - Susana Álvarez
- Department de Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, Spain
| | - Alberto Fernández
- Departament d'Enginyeria Química, Universitat Rovira i Virgili, Tarragona, Spain
| | - Christer Axelsson
- Center of Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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16
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Yoshimura S, Hirayama A, Kiguchi T, Irisawa T, Yamada T, Yoshiya K, Park C, Nishimura T, Ishibe T, Yagi Y, Kishimoto M, Inoue T, Hayashi Y, Sogabe T, Morooka T, Sakamoto H, Suzuki K, Nakamura F, Matsuyama T, Okada Y, Nishioka N, Kobayashi D, Matsui S, Kimata S, Shimazu T, Kitamura T, Iwami T. Trends in In-Hospital Advanced Management and Survival of Out-of-Hospital Cardiac Arrest Among Adults From 2013 to 2017 - A Multicenter, Prospective Registry in Osaka, Japan. Circ J 2021; 85:1851-1859. [PMID: 33536400 DOI: 10.1253/circj.cj-20-1022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of our study was to investigate in detail the temporal trends in in-hospital characteristics, actual management, and survival, including neurological status, among adult out-of-hospital cardiac arrest (OHCA) patients in recent years.Methods and Results:From the prospective database of the Comprehensive Registry of Intensive Care for OHCA Survival (CRITICAL) study in Osaka, Japan, we enrolled all OHCA patients aged ≥18 years for whom resuscitation was attempted, and who were transported to participating hospitals between the years 2013 and 2017. The primary outcome measure was 1-month survival with favorable neurological outcome after OHCA. Temporal trends in in-hospital management and favorable neurological outcome among adult OHCA patients were assessed. Of the 11,924 patients in the database, we included a total of 10,228 adult patients from 16 hospitals. As for in-hospital advanced treatments, extracorporeal cardiopulmonary resuscitation (ECPR) use increased from 2.4% in 2013 to 4.3% in 2017 (P for trend <0.001). However, the proportion of adult OHCA patients with favorable neurological outcome did not change during the study period (from 5.7% in 2013 to 4.4% in 2017, adjusted odds ratio (OR) for 1-year increment: 0.98 (95% confidence interval: 0.94-1.23)). CONCLUSIONS In this target population, in-hospital management such as ECPR increased slightly between 2013 and 2017, but 1-month survival with favorable neurological outcome after adult OHCA did not improve significantly.
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Affiliation(s)
- Satoshi Yoshimura
- Department of Preventive Services, Kyoto University School of Public Health
| | - Atsushi Hirayama
- Public Health, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine
| | - Takeyuki Kiguchi
- Department of Preventive Services, Kyoto University School of Public Health.,Critical Care and Trauma Center, Osaka General Medical Center
| | - Taro Irisawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine
| | - Tomoki Yamada
- Emergency and Critical Care Medical Center, Osaka Police Hospital
| | - Kazuhisa Yoshiya
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Takii Hospital
| | - Changhwi Park
- Department of Emergency Medicine, Tane General Hospital
| | | | - Takuya Ishibe
- Department of Emergency and Critical Care Medicine, Kindai University School of Medicine
| | | | | | | | | | - Taku Sogabe
- Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital
| | - Takaya Morooka
- Emergency and Critical Care Medical Center, Osaka City General Hospital
| | | | - Keitaro Suzuki
- Emergency and Critical Care Medical Center, Kishiwada Tokushukai Hospital
| | - Fumiko Nakamura
- Department of Emergency and Critical Care Medicine, Kansai Medical University
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine
| | - Yohei Okada
- Department of Preventive Services, Kyoto University School of Public Health
| | - Norihiro Nishioka
- Department of Preventive Services, Kyoto University School of Public Health
| | | | - Satoshi Matsui
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine
| | - Shunsuke Kimata
- Department of Preventive Services, Kyoto University School of Public Health
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine
| | - Taku Iwami
- Department of Preventive Services, Kyoto University School of Public Health
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17
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Coult J, Rea TD, Blackwood J, Kudenchuk PJ, Liu C, Kwok H. A method to predict ventricular fibrillation shock outcome during chest compressions. Comput Biol Med 2020; 129:104136. [PMID: 33278632 DOI: 10.1016/j.compbiomed.2020.104136] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 11/11/2020] [Accepted: 11/18/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Out-of-hospital ventricular fibrillation (VF) cardiac arrest is a leading cause of death. Quantitative analysis of the VF electrocardiogram (ECG) can predict patient outcomes and could potentially enable a patient-specific, guided approach to resuscitation. However, VF analysis during resuscitation is confounded by cardiopulmonary resuscitation (CPR) artifact in the ECG, challenging continuous application to guide therapy throughout resuscitation. We therefore sought to design a method to predict VF shock outcomes during CPR. METHODS Study data included 4577 5-s VF segments collected during and without CPR prior to defibrillation attempts in N = 1151 arrest patients. Using training data (460 patients), an algorithm was designed to predict the VF shock outcomes of defibrillation success (return of organized ventricular rhythm) and functional survival (Cerebral Performance Category 1-2). The algorithm was designed with variable-frequency notch filters to reduce CPR artifact in the ECG based on real-time chest compression rate. Ten ECG features and three dichotomous patient characteristics were developed to predict outcomes. These variables were combined using support vector machines and logistic regression. Algorithm performance was evaluated by area under the receiver operating characteristic curve (AUC) to predict outcomes in validation data (691 patients). RESULTS AUC (95% Confidence Interval) for predicting defibrillation success was 0.74 (0.71-0.77) during CPR and 0.77 (0.74-0.79) without CPR. AUC for predicting functional survival was 0.75 (0.72-0.78) during CPR and 0.76 (0.74-0.79) without CPR. CONCLUSION A novel algorithm predicted defibrillation success and functional survival during ongoing CPR following VF arrest, providing a potential proof-of-concept towards real-time guidance of resuscitation therapy.
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Affiliation(s)
- Jason Coult
- Department of Medicine, University of Washington, Seattle, WA, USA; Center for Progress in Resuscitation, University of Washington, Seattle, WA, USA.
| | - Thomas D Rea
- Department of Medicine, University of Washington, Seattle, WA, USA; Center for Progress in Resuscitation, University of Washington, Seattle, WA, USA; King County Emergency Medical Services, Public Health, Seattle & King County, Seattle, WA, USA
| | - Jennifer Blackwood
- Center for Progress in Resuscitation, University of Washington, Seattle, WA, USA; King County Emergency Medical Services, Public Health, Seattle & King County, Seattle, WA, USA
| | - Peter J Kudenchuk
- Department of Medicine, University of Washington, Seattle, WA, USA; Center for Progress in Resuscitation, University of Washington, Seattle, WA, USA; King County Emergency Medical Services, Public Health, Seattle & King County, Seattle, WA, USA
| | - Chenguang Liu
- Philips Emergency Care & Resuscitation, Bothell, WA, USA
| | - Heemun Kwok
- Center for Progress in Resuscitation, University of Washington, Seattle, WA, USA; Department of Emergency Medicine, University of Washington, Seattle, WA, USA
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18
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Chalkias A, Koutsovasilis A, Laou E, Papalois A, Xanthos T. Measurement of mean systemic filling pressure after severe hemorrhagic shock in swine anesthetized with propofol-based total intravenous anesthesia: implications for vasopressor-free resuscitation. Acute Crit Care 2020; 35:93-101. [PMID: 32506874 PMCID: PMC7280792 DOI: 10.4266/acc.2019.00773] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/12/2020] [Indexed: 01/27/2023] Open
Abstract
Background Mean systemic filling pressure (Pmsf) is a quantitative measurement of a patient’s volume status and represents the tone of the venous reservoir. The aim of this study was to estimate Pmsf after severe hemorrhagic shock and cardiac arrest in swine anesthetized with propofol-based total intravenous anesthesia, as well as to evaluate Pmsf’s association with vasopressor-free resuscitation. Methods Ten healthy Landrace/Large-White piglets aged 10–12 weeks with average weight 20±1 kg were used in this study. The protocol was divided into four distinct phases: stabilization, hemorrhagic, cardiac arrest, and resuscitation phases. We measured Pmsf at 5–7.5 seconds after the onset of cardiac arrest and then every 10 seconds until 1 minute postcardiac arrest. During resuscitation, lactated Ringers was infused at a rate that aimed for a mean right atrial pressure of ≤4 mm Hg. No vasopressors were used. Results The mean volume of blood removed was 860±20 ml (blood loss, ~61%) and the bleeding time was 43.2±2 minutes while all animals developed pulseless electrical activity. Mean Pmsf was 4.09±1.22 mm Hg, and no significant differences in Pmsf were found until 1 minute postcardiac arrest (4.20±0.22 mm Hg at 5–7.5 seconds and 3.72±0.23 mm Hg at 55– 57.5 seconds; P=0.102). All animals achieved return of spontaneous circulation (ROSC), with mean time to ROSC being 6.1±1.7 minutes and mean administered volume being 394±20 ml. Conclusions For the first time, Pmsf was estimated after severe hemorrhagic shock. In this study, Pmsf remained stable during the first minute post-arrest. All animals achieved ROSC with goal-directed fluid resuscitation and no vasopressors.
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Affiliation(s)
- Athanasios Chalkias
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.,Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | | | - Eleni Laou
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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19
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Azeli Y, Lorente Olazabal JV, Monge García MI, Bardají A. Understanding the Adverse Hemodynamic Effects of Serious Thoracic Injuries During Cardiopulmonary Resuscitation: A Review and Approach Based on the Campbell Diagram. Front Physiol 2019; 10:1475. [PMID: 31849717 PMCID: PMC6901598 DOI: 10.3389/fphys.2019.01475] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 11/15/2019] [Indexed: 01/29/2023] Open
Abstract
Chest compressions during cardiopulmonary resuscitation (CPR) generate cardiac output during cardiac arrest. Their quality performance is key to achieving the return of spontaneous circulation. Serious thoracic injuries (STIs) are common during CPR, and they can change the shape and mechanics of the thorax. Little is known about their hemodynamic effects, so a review of this emerging concept is necessary. The Campbell diagram (CD) is a theoretical framework that integrates the lung and chest wall pressure-volume curves, allowing us to assess the consequences of STIs on respiratory mechanics and hemodynamics. STIs produce a decrease in the compliance of the chest wall and lung. The representation of STIs on the CD shows a decrease in the intrathoracic negative pressure and a functional residual capacity decrease during the thoracic decompression, leading to a venous return impairment. The thorax with STIs is more vulnerable to the adverse hemodynamic effects of leaning, hyperventilation, and left ventricular outflow tract obstruction during CPR. A better understanding of the effects of STIs during CPR, and the study of avoidable injuries, can help to improve the effectiveness of chest compressions and the survival in cardiac arrest.
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Affiliation(s)
- Youcef Azeli
- Sistema d’Emergències Mèdiques de Catalunya, Barcelona, Spain
- Emergency Department, Sant Joan University Hospital, Reus, Spain
- Institut d’Investigació Sanitari Pere Virgili, Tarragona, Spain
| | - Juan Víctor Lorente Olazabal
- Clinical Management Anaesthesiology Unit, Resuscitation and Pain Therapy, Juan Ramón Jiménez Hospital, Huelva, Spain
- School of Medicine and Health Sciences, International University of Catalonia (IUC), Barcelona, Spain
| | | | - Alfredo Bardají
- Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain
- School of Medicine, Rovira i Virgili University, Tarragona, Spain
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