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Oh J, Cha KC, Lee JH, Park S, Kim DH, Lee BK, Park JS, Jung WJ, Lee DK, Roh YI, Kim TY, Chung SP, Kim YM, Park JD, Kim HS, Lee MJ, Na SH, Cho GC, Kim ARE, Hwang SO. 2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 4. Adult advanced life support. Clin Exp Emerg Med 2021; 8:S26-S40. [PMID: 34034448 PMCID: PMC8171171 DOI: 10.15441/ceem.21.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 03/19/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Jaehoon Oh
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Kyoung-Chul Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jong-Hwan Lee
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Seungmin Park
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Hyeok Kim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University College of Medicine, Gwangju, Korea
| | - Jung Soo Park
- Department of Emergency Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Woo Jin Jung
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Dong Keon Lee
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Young Il Roh
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Tae Youn Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Min Kim
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - June Dong Park
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Mi Jin Lee
- Department of Emergency Medicine, Kyungpook National University College of Medicine, Daegu, Korea
| | - Sang-Hoon Na
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Gyu Chong Cho
- Department of Emergency Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Ai-Rhan Ellen Kim
- Department of Pediatrics, Ulsan University College of Medicine, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Esmolol in the management of pre-hospital refractory ventricular fibrillation: A systematic review and meta-analysis. Am J Emerg Med 2020; 38:1921-1934. [PMID: 32777667 DOI: 10.1016/j.ajem.2020.05.083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/17/2020] [Accepted: 05/24/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Esmolol has been proposed as a viable adjunctive therapy for pre-hospital refractory ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT). OBJECTIVES We performed a systematic review and meta-analysis to assess the effectiveness of esmolol on pre-hospital refractory VF/pVT, compared with standard of care. METHODS MEDLINE, Embase, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for eligible studies. Two investigators independently extracted relevant data and assessed the methodological quality of each included study using the ROBINS-I tool. The quality of evidence for summary estimates was assessed according to GRADE guidelines. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) for each outcome of interest were calculated. RESULTS The search yielded 3253 unique records, of which two studies were found to be in accordance with the research purpose, totaling 66 patients, of whom 33.3% (n = 22) received esmolol. Additional evidence was provided in the paper but was not relevant to the analysis and was therefore not included. Esmolol was likely associated with an increased rate of survival to discharge (RR 2.82, 95% CI 1.01-7.93, p = 0.05) (GRADE: Very low) and survival with favorable neurological outcome (RR 3.44, 95% CI 1.11-10.67, p = 0.03) (GRADE: Very low). Similar results were found for return of spontaneous circulation (ROSC) (RR 2.63, 95% CI 1.37-5.07, p = 0.004) (GRADE: Very low) and survival to intensive care unit (ICU)/hospital admission (RR 2.63, 95% CI 1.37-5.07, p = 0.004) (GRADE: Very low). CONCLUSION The effectiveness of esmolol for refractory VF/pVT remains unclear. Trial sequential analysis (TSA) indicates that the evidence is inconclusive and that further trials are required in order to reach a conclusion. Therefore, it is imperative to continue to accumulate evidence in order to obtain a higher level of scientific evidence.
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Herrera-Perez D, Fox-Lee R, Bien J, Prasad V. Frequency of Medical Reversal Among Published Randomized Controlled Trials Assessing Cardiopulmonary Resuscitation (CPR). Mayo Clin Proc 2020; 95:889-910. [PMID: 32370852 DOI: 10.1016/j.mayocp.2020.01.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/31/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To characterize what proportion of all randomized controlled trials (RCTs) among patients experiencing cardiac arrest find that an established practice is ineffective or harmful, that is, a medical reversal. METHODS We reviewed a database of all published RCTs of cardiac arrest patient populations between 1995 and 2014. Articles were classified on the basis of whether they tested a new or existing therapy and whether results were positive or negative. A reversal was defined as a negative RCT of an established practice. Further review and categorization were performed to confirm that reversals were supported by subsequent systematic review, as well as to identify the type of medical practice studied in each reversal. This study was conducted from October 2017 to June 17, 2019. RESULTS We reviewed 92 original articles, 76 of which could be conclusively categorized. Of these, 18 (24%) articles examined a new medical practice, whereas 58 (76%) tested an established practice. A total of 18 (24%) studies had positive findings, whereas 58 (76%) reached a negative conclusion. Of the 58 articles testing existing standard of care, 44 (76%) reversed that practice, whereas 14 (24%) reaffirmed it. CONCLUSION Reversal of cardiopulmonary resuscitation practices is widespread. This investigation sheds new light on low-value practices and patterns of medical research and suggests that novel resuscitation practices have low pretest probability and should be empirically tested with rigorous trials before implementation.
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Affiliation(s)
- Diana Herrera-Perez
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland
| | - Ryan Fox-Lee
- School of Medicine, Oregon Health and Science University, Portland
| | - Jeffrey Bien
- School of Medicine, Oregon Health and Science University, Portland
| | - Vinay Prasad
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland; Center for Health Care Ethics, Oregon Health and Science University, Portland.
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Miraglia D, Miguel LA, Alonso W, Ayala JE. Double sequential defibrillation for out-of-hospital refractory ventricular fibrillation: A scoping review. Am J Emerg Med 2020; 38:1211-1217. [PMID: 31937443 DOI: 10.1016/j.ajem.2019.12.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/12/2019] [Accepted: 12/21/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Double sequential defibrillation (DSD) has been proposed as a viable treatment option for patients in refractory ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) out-of-hospital cardiac arrests (OHCA). However, currently there is insufficient evidence to support a widespread implementation of this therapy. STUDY OBJECTIVES The aim of this scoping review was to summarize the current available evidence of DSD for patients with refractory VF/pVT OHCA as well as to identify gaps in the literature that may require further research. METHODS We conducted a comprehensive literature search of MEDLINE via PubMed, Embase via Ovid, and Scopus on August 19, 2019. We also checked reference lists of relevant papers to identify additional studies. Any controlled clinical study design (randomized controlled trials and non-randomized controlled trials), and observational studies (cohort studies and case-control studies) providing information on resuscitative parameters, survival rates and neurological outcomes in adults (≥ 18 years old) treated with DSD for refractory VF/pVT OHCA were included. Two investigators independently conducted the literature search, study selection, and data extraction. RESULTS The search yielded 1612 unique records, of which 4 peer-reviewed articles were found relating to the research purpose, totaling 1061 patients of who 20.5% (n = 217) received DSD. Most studies evaluated if pre-hospital DSD was associated with improved survival to discharge after refractory VF/pVT. No randomized controlled trials were identified. CONCLUSION To date, it is difficult to conclude the real benefit of DSD for patients in refractory VF based on the available evidence. The findings of this scoping review suggest there is limited evidence to support at large-scale the use of DSD for refractory VF/pVT OHCA. Further research is needed to better characterize and understand the use of DSD for refractory VF/pVT, in order to implement best practices to maximize the effectiveness and efficiency of care.
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Affiliation(s)
- Dennis Miraglia
- Department of Internal Medicine, Good Samaritan Hospital, Aguadilla, Puerto Rico.
| | - Lourdes A Miguel
- Department of Internal Medicine, Good Samaritan Hospital, Aguadilla, Puerto Rico
| | - Wilfredo Alonso
- Department of Internal Medicine, Good Samaritan Hospital, Aguadilla, Puerto Rico
| | - Jonathan E Ayala
- Department of Internal Medicine, Good Samaritan Hospital, Aguadilla, Puerto Rico
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More systematic reviews were registered in PROSPERO each year, but few records' status was up-to-date. J Clin Epidemiol 2020; 117:60-67. [DOI: 10.1016/j.jclinepi.2019.09.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 12/19/2022]
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Pourmand A, Galvis J, Yamane D. The controversial role of dual sequential defibrillation in shockable cardiac arrest. Am J Emerg Med 2018; 36:1674-1679. [DOI: 10.1016/j.ajem.2018.05.078] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 05/24/2018] [Accepted: 05/31/2018] [Indexed: 12/21/2022] Open
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Semenov I, Grigoryev S, Neuber JU, Zemlin CW, Pakhomova ON, Casciola M, Pakhomov AG. Excitation and injury of adult ventricular cardiomyocytes by nano- to millisecond electric shocks. Sci Rep 2018; 8:8233. [PMID: 29844431 PMCID: PMC5974370 DOI: 10.1038/s41598-018-26521-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 05/08/2018] [Indexed: 12/13/2022] Open
Abstract
Intense electric shocks of nanosecond (ns) duration can become a new modality for more efficient but safer defibrillation. We extended strength-duration curves for excitation of cardiomyocytes down to 200 ns, and compared electroporative damage by proportionally more intense shocks of different duration. Enzymatically isolated murine, rabbit, and swine adult ventricular cardiomyocytes (VCM) were loaded with a Ca2+ indicator Fluo-4 or Fluo-5N and subjected to shocks of increasing amplitude until a Ca2+ transient was optically detected. Then, the voltage was increased 5-fold, and the electric cell injury was quantified by the uptake of a membrane permeability marker dye, propidium iodide. We established that: (1) Stimuli down to 200-ns duration can elicit Ca2+ transients, although repeated ns shocks often evoke abnormal responses, (2) Stimulation thresholds expectedly increase as the shock duration decreases, similarly for VCMs from different species, (3) Stimulation threshold energy is minimal for the shortest shocks, (4) VCM orientation with respect to the electric field does not affect the threshold for ns shocks, and (5) The shortest shocks cause the least electroporation injury. These findings support further exploration of ns defibrillation, although abnormal response patterns to repetitive ns stimuli are of a concern and require mechanistic analysis.
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Affiliation(s)
- Iurii Semenov
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, 23508, USA
| | - Sergey Grigoryev
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, 23508, USA
| | - Johanna U Neuber
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, 23508, USA.,Department of Electrical and Computer Engineering, Old Dominion University, Norfolk, VA, 23508, USA
| | - Christian W Zemlin
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, 23508, USA.,Department of Electrical and Computer Engineering, Old Dominion University, Norfolk, VA, 23508, USA
| | - Olga N Pakhomova
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, 23508, USA
| | - Maura Casciola
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, 23508, USA
| | - Andrei G Pakhomov
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, 23508, USA.
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Hagihara A, Onozuka D, Ono J, Nagata T, Hasegawa M. Interaction of defibrillation waveform with the time to defibrillation or the number of defibrillation attempts on survival from out-of-hospital cardiac arrest. Resuscitation 2017; 122:54-60. [PMID: 29175354 DOI: 10.1016/j.resuscitation.2017.11.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 11/17/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
Abstract
AIM Early biphasic defibrillation is effective in out-of-hospital cardiac arrest (OHCA) cases. In the resuscitation of patients with OHCA, it is not clear how the defibrillation waveform interacts with the time to defibrillation to influence patient survival. The second, and any subsequent, shocks need to be administered by an on-line physician in Japan. Thus, we investigated the interaction between the defibrillation waveform and time to or the number of defibrillation on resuscitation outcomes. METHODS This prospective observational study used data for all OHCAs that occurred between 2005 and 2014 in Japan. To investigate the interaction effect between the defibrillation waveform and the time to defibrillation or the number of defibrillations on the return to spontaneous circulation (ROSC), 1-month survival, and cerebral performance category (CPC) (1, 2), we assessed the modifying effects of the defibrillation waveform and the time to or the number of defibrillation on additive scale (i.e., the relative excessive risk due to interaction, RERI) and multiplicative scale (i.e., ratio of odds ratios (ORs)). RESULTS In total, 71,566 cases met the inclusion criteria. For the measure of interaction between the defibrillation waveform and the time to defibrillation, ratio of ORs for ROSC was 0.84 (0.75-0.94), implying that the effect of time to first defibrillation on ROSC was negatively modified by defibrillation waveform. For the interaction between the defibrillation waveform and the number of defibrillations, RERI and ratio of ORs for CPC (1, 2) was -0.25 (-0.47 to -0.06) and 0.79 (0.67-0.93), respectively. It is implied that the effect of number of defibrillation on CPC (1, 2) was negatively modified by defibrillation waveform. CONCLUSIONS An increased number of defibrillations was associated with a decreased ROSC in the case of biphasic and monophasic defibrillation, while an increased number of defibrillations was related to an increased 1-month survival rate and CPC (1, 2) only in the case of biphasic defibrillation. When two or more defibrillations were performed, a biphasic waveform was more effective in terms of long-term survival than a monophasic waveform.
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Affiliation(s)
- Akihito Hagihara
- Department of Health Services Management and Policy, Kyushu University Graduate School of Medicine, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Daisuke Onozuka
- Department of Health Services Management and Policy, Kyushu University Graduate School of Medicine, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Junko Ono
- Department of Health Services Management and Policy, Kyushu University Graduate School of Medicine, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takashi Nagata
- Department of Emergency and Critical Care Center, Kyushu University Hospital, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Manabu Hasegawa
- Shimonoseki-City Welfare Department, 1-1 Nanbu-cho, Shimonoseki-city, Yamaguchi 750-8521, Japan
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Ross EM, Redman TT, Harper SA, Mapp JG, Wampler DA, Miramontes DA. Dual defibrillation in out-of-hospital cardiac arrest: A retrospective cohort analysis. Resuscitation 2016; 106:14-7. [PMID: 27344928 DOI: 10.1016/j.resuscitation.2016.06.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/31/2016] [Accepted: 06/08/2016] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVES The goal of our study is to determine if prehospital dual defibrillation (DD) is associated with better neurologically intact survival in out-of-hospital cardiac arrest. METHODS This study is a retrospective cohort analysis of prospectively collected Quality Assurance/Quality Improvement data from a large urban fire based EMS system out-of-hospital cardiac arrest (OHCA) database between Jan 2013 and Dec 2015. Our inclusion criteria were administration of DD or at least four conventional 200J defibrillations for cases of recurrent and refractory ventricular fibrillation (VF). We excluded any case with incomplete data. The primary outcome for our study was neurologically intact survival (defined as Cerebral Performance Category 1 and 2). RESULTS A total of 3470 cases of OHCA were treated during the time period of Jan 2013 to Dec 2015. There were 302 cases of recurrent and refractory VF identified. Twenty-three cases had incomplete data. Of the remaining 279 cases, 50 were treated with DD and 229 received standard single shock 200J defibrillations. There was no statistically significant difference in the primary outcome of neurologically intact survival between the DD group (6%) and the standard defibrillation group (11.4%) (p=0.317) (OR 0.50, 95% CI 0.15-1.72). CONCLUSION Our retrospective cohort analysis on the prehospital use of DD in OHCA found no association with neurologically intact survival. Case-control studies are needed to further evaluate the efficacy of DD in the prehospital setting.
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Affiliation(s)
- Elliot M Ross
- Department of Emergency Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA; San Antonio Fire Department, San Antonio, TX 78205, USA; San Antonio Uniformed Services Health Education Consortium, JBSA Fort Sam, Houston, TX 78234, USA.
| | - Theodore T Redman
- Department of Emergency Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA; San Antonio Fire Department, San Antonio, TX 78205, USA; San Antonio Uniformed Services Health Education Consortium, JBSA Fort Sam, Houston, TX 78234, USA
| | - Stephen A Harper
- Department of Emergency Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA; San Antonio Fire Department, San Antonio, TX 78205, USA; San Antonio Uniformed Services Health Education Consortium, JBSA Fort Sam, Houston, TX 78234, USA
| | - Julian G Mapp
- Department of Emergency Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA; San Antonio Fire Department, San Antonio, TX 78205, USA; San Antonio Uniformed Services Health Education Consortium, JBSA Fort Sam, Houston, TX 78234, USA
| | - David A Wampler
- Department of Emergency Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA; San Antonio Fire Department, San Antonio, TX 78205, USA
| | - David A Miramontes
- Department of Emergency Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA; San Antonio Fire Department, San Antonio, TX 78205, USA
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Zhu A, Zhang J. Meta-analysis of outcomes of the 2005 and 2010 cardiopulmonary resuscitation guidelines for adults with in-hospital cardiac arrest. Am J Emerg Med 2016; 34:1133-9. [DOI: 10.1016/j.ajem.2016.03.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/02/2016] [Accepted: 03/02/2016] [Indexed: 10/22/2022] Open
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