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Zhang L, Liu M, Xie L, Tian X. Cardiac Arrest Due to Capecitabine Toxicosis Treated With ECMO and CRRT: A Case Report. Crit Care Nurse 2024; 44:57-62. [PMID: 39084667 DOI: 10.4037/ccn2024858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
INTRODUCTION This is the first report of a patient who developed cardiogenic shock after receiving oral chemotherapy with capecitabine and was treated with venoarterial extracorporeal membrane oxygenation combined with continuous renal replacement therapy. CLINICAL FINDINGS A 58-year-old man developed an arrhythmia that rapidly progressed to cardiogenic shock and cardiac arrest after receiving oral capecitabine tablets to treat a rectal malignancy. INTERVENTIONS The patient was treated with venoarterial extracorporeal membrane oxygenation in combination with continuous renal replacement therapy. OUTCOME The patient made a full recovery and was discharged from the hospital. CONCLUSION The use of comprehensive supportive treatments such as extracorporeal membrane oxygenation combined with continuous renal replacement therapy in patients with capecitabine-induced cardiac arrest can rapidly reduce drug concentrations, eliminate harmful substances, and improve the prognosis.
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Affiliation(s)
- Liqin Zhang
- Liqin Zhang is a resident physician in the Department of Intensive Care Medicine, Lishui Municipal Central Hospital, Lishui City, Zhejiang Province, China
| | - Mingjun Liu
- Mingjun Liu is a chief physician in the Department of Emergency Medicine, Lishui Municipal Central Hospital
| | - Lutao Xie
- Lutao Xie is an associate chief physician in the Department of Emergency Medicine, Lishui Municipal Central Hospital
| | - Xin Tian
- Xin Tian is a chief physician in the Department of Intensive Care Medicine, Lishui Municipal Central Hospital
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2
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Current situation, efficacy, and safety of extracorporeal cardiopulmonary resuscitation in China. Chin Med J (Engl) 2022; 135:2878-2879. [PMID: 36745768 PMCID: PMC9945289 DOI: 10.1097/cm9.0000000000002455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Extracorporeal cardiopulmonary resuscitation in-hospital cardiac arrest due to acute coronary syndrome. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:311-319. [PMID: 34589249 PMCID: PMC8462106 DOI: 10.5606/tgkdc.dergisi.2021.21238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/21/2021] [Indexed: 11/26/2022]
Abstract
Background
The aim of this study was to analyze the effect of extracorporeal cardiopulmonary resuscitation on survival and neurological outcomes in in-hospital cardiac arrest patients.
Methods
Between January 2018 and December 2020, a total of 22 patients (17 males, 5 females; mean age: 52.8±9.0 years; range, 32 to 70 years) treated with extracorporeal cardiopulmonary resuscitation using veno-arterial extracorporeal membrane oxygenation support for in-hospital cardiac arrest after acute coronary syndrome were retrospectively analyzed. The patients were divided into two groups as those weaned (n=13) and non-weaned (n=9) from the veno-arterial extracorporeal membrane oxygenation. Demographic data of the patients, heart rhythms at the beginning of conventional cardiopulmonary resuscitation, the angiographic and interventional results, survival and neurological outcomes of the patients before and after extracorporeal cardiopulmonary resuscitation were recorded.
Results
There was no significant difference between the groups in terms of comorbidity and baseline laboratory test values. The underlying rhythm was ventricular fibrillation in 92% of the patients in the weaned group and there was no cardiac rhythm in 67% of the patients in the non-weaned group (p=0.125). The recovery in the mean left ventricular ejection fraction was significantly evident in the weaned group (36.5±12.7% vs. 21.1±7.4%, respectively; p=0.004). The overall wean rate from veno-arterial extracorporeal membrane oxygenation was 59.1%; however, the discharge rate from hospital of survivors without any neurological sequelae was 36.4%.
Conclusion
In-hospital cardiac arrest is a critical emergency situation requiring instantly life-saving interventions through conventional cardiopulmonary resuscitation. If it fails, extracorporeal cardiopulmonary resuscitation should be initiated, regardless the underlying etiology or rhythm disturbances. An effective conventional cardiopulmonary resuscitation is mandatory to prevent brain and body hypoperfusion.
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Dalton HJ, Berg RA, Nadkarni VM, Kochanek PM, Tisherman SA, Thiagarajan R, Alexander P, Bartlett RH. Cardiopulmonary Resuscitation and Rescue Therapies. Crit Care Med 2021; 49:1375-1388. [PMID: 34259654 DOI: 10.1097/ccm.0000000000005106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The history of cardiopulmonary resuscitation and the Society of Critical Care Medicine have much in common, as many of the founders of the Society of Critical Care Medicine focused on understanding and improving outcomes from cardiac arrest. We review the history, the current, and future state of cardiopulmonary resuscitation.
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Affiliation(s)
- Heidi J Dalton
- Heart and Vascular Institute and Department of Pediatrics, INOVA Fairfax Medical Center, Falls Church, VA. Department of Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA. Department of Anesthesiology/Critical Care Medicine, Peter Safer Resuscitation Center, Pittsburgh, PA. Department of Surgery, R Adams Cowley Shock Trauma Center, Baltimore, MD. Department of Cardiology, Division of Cardiovascular Critical Care, Boston Children's Hospital, Boston, MA. Department of Surgery, University of Michigan, Ann Arbor, MI
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Outcomes of Veno-Arterial Extracorporeal Membrane Oxygenation for In-Hospital Cardiac Arrest. Cardiol Rev 2020; 30:75-79. [PMID: 33165089 DOI: 10.1097/crd.0000000000000371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is increasingly used in cardiac arrest. Currently, public registries report the outcomes of cardiac arrest regardless of the setting (out-of-hospital versus in-hospital). Meanwhile, in-hospital cardiac arrest represents a more favorable setting for ECMO-assisted cardiopulmonary resuscitation than out-of-hospital cardiac arrest. Survival to discharge varies, but looks promising overall, ranging from 18.9 to 65%, with the bulk of the studies reporting survival to discharge between 30% and 50%, with about one-third to half of the patients discharged with no or minimal neurologic deficit. Based on the reported outcomes, in-hospital cardiac arrests can become a next focus for studies on successful implementation of VA ECMO.
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Verm RA, Weston JA, Kiankhooy A. State of the Art: Extracorporeal Cardiopulmonary Resuscitation for In-Hospital Arrest. Semin Thorac Cardiovasc Surg 2020; 33:1-9. [PMID: 32891789 DOI: 10.1053/j.semtcvs.2020.09.001] [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: 03/12/2020] [Revised: 07/28/2020] [Accepted: 09/02/2020] [Indexed: 11/11/2022]
Abstract
Extracorporeal membrane oxygenation has been used since the 1970s and recently has seen increased use for in-hospital arrest requiring extracorporeal cardiopulmonary resuscitation (ECPR). This paper provides an updated review of the ECPR literature and practical recommendations for implementation of an ECPR program.
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Affiliation(s)
- Raymond A Verm
- University of Southern California, Los Angeles, California.
| | - Jaye A Weston
- University of Southern California, Los Angeles, California
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7
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When NOT to use short-term mechanical circulatory support. JTCVS OPEN 2020; 3:106-110. [PMID: 36003880 PMCID: PMC9390503 DOI: 10.1016/j.xjon.2020.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/08/2020] [Accepted: 06/02/2020] [Indexed: 11/24/2022]
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Outcomes After Extracorporeal Cardiopulmonary Resuscitation of Pediatric In-Hospital Cardiac Arrest: A Report From the Get With the Guidelines-Resuscitation and the Extracorporeal Life Support Organization Registries. Crit Care Med 2020; 47:e278-e285. [PMID: 30747771 DOI: 10.1097/ccm.0000000000003622] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to determine cardiac arrest- and extracorporeal membrane oxygenation-related risk factors associated with unfavorable outcomes after extracorporeal cardiopulmonary resuscitation. DESIGN We performed an analysis of merged data from the Extracorporeal Life Support Organization and the American Heart Association Get With the Guidelines-Resuscitation registries. SETTING A total of 32 hospitals reporting to both registries between 2000 and 2014. PATIENTS Children younger than 18 years old who suffered in-hospital cardiac arrest and underwent extracorporeal cardiopulmonary resuscitation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of the 593 children included in the final cohort, 240 (40.5%) died prior to decannulation from extracorporeal membrane oxygenation and 352 (59.4%) died prior to hospital discharge. A noncardiac diagnosis and preexisting renal insufficiency were associated with increased odds of death (adjusted odds ratio, 1.85 [95% CI, 1.19-2.89] and 4.74 [95% CI, 2.06-10.9], respectively). The median time from onset of the cardiopulmonary resuscitation event to extracorporeal membrane oxygenation initiation was 48 minutes (interquartile range, 28-70 min). Longer time from onset of the cardiopulmonary resuscitation event to extracorporeal membrane oxygenation initiation was associated with higher odds of death prior to hospital discharge (adjusted odds ratio for each 5 additional minutes of cardiopulmonary resuscitation prior to extracorporeal membrane oxygenation initiation, 1.04 [95% CI, 1.01-1.07]). Each individual adverse event documented during the extracorporeal membrane oxygenation course, including neurologic, pulmonary, renal, metabolic, cardiovascular and hemorrhagic, was associated with higher odds of death, with higher odds as the cumulative number of documented adverse events during the extracorporeal membrane oxygenation course increased. CONCLUSIONS Outcomes after extracorporeal cardiopulmonary resuscitation reported by linking two national registries are encouraging. Noncardiac diagnoses, preexisting renal insufficiency, longer time from onset of the cardiopulmonary resuscitation event to extracorporeal membrane oxygenation initiation, and adverse events during the extracorporeal membrane oxygenation course are associated with worse outcomes.
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Singh G, Hudson D, Shaw A. Medical Optimization and Liberation of Adult Patients From VA-ECMO. Can J Cardiol 2019; 36:280-290. [PMID: 32036869 DOI: 10.1016/j.cjca.2019.10.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/31/2019] [Accepted: 10/31/2019] [Indexed: 12/30/2022] Open
Abstract
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) can be an efficacious cardiopulmonary support for adults as rescue from refractory cardiogenic shock. It is best employed as a bridging strategy to recovery or alternative support rather than sustained, long-term mechanical circulatory support. The purpose of this paper is to discuss strategies to optimize patient management on VA-ECMO and approaches to promote successful separation from support. Rapid medical optimization will assist in reducing the time on VA-ECMO, thereby improving the likelihood of patient salvage. Suitably trained physicians and personnel, guided by structured protocols, can promote excellence in team care and provision of consistent management. Focusing on anticoagulation, careful neurologic monitoring, prevention of leg ischemia, awareness of differential hypoxemia, optimizing mechanical ventilation, identifying and timely intervention for left-ventricular distension (LVD), along with a strategic weaning algorithm, can prevent significant morbidity and mortality. LVD physiology, diagnosis, and risk factors are reviewed. Indications for LV decompression, along with medical and mechanical management options, are elucidated.
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Affiliation(s)
- Gurmeet Singh
- Critical Care Medicine, Edmonton, Alberta, Canada; Cardiac Surgery, Edmonton, Alberta, Canada; Adult ECMO Program, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada; University of Alberta, Edmonton, Alberta, Canada.
| | - Darren Hudson
- Critical Care Medicine, Edmonton, Alberta, Canada; University of Alberta, Edmonton, Alberta, Canada
| | - Andrew Shaw
- Department of Anesthesiology and Pain Medicine, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada; University of Alberta, Edmonton, Alberta, Canada
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11
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Mehaffey JH, Money D, Charles EJ, Schubert S, Piñeros AF, Wu D, Bontha SV, Hawkins R, Teman NR, Laubach VE, Mas VR, Tribble CG, Maluf DG, Sharma AK, Yang Z, Kron IL, Roeser ME. Adenosine 2A Receptor Activation Attenuates Ischemia Reperfusion Injury During Extracorporeal Cardiopulmonary Resuscitation. Ann Surg 2019; 269:1176-1183. [PMID: 31082918 PMCID: PMC6757347 DOI: 10.1097/sla.0000000000002685] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE We tested the hypothesis that systemic administration of an A2AR agonist will reduce multiorgan IRI in a porcine model of ECPR. SUMMARY BACKGROUND DATA Advances in ECPR have decreased mortality after cardiac arrest; however, subsequent IRI contributes to late multisystem organ failure. Attenuation of IRI has been reported with the use of an A2AR agonist. METHODS Adult swine underwent 20 minutes of circulatory arrest, induced by ventricular fibrillation, followed by 6 hours of reperfusion with ECPR. Animals were randomized to vehicle control, low-dose A2AR agonist, or high-dose A2AR agonist. A perfusion specialist using a goal-directed resuscitation protocol managed all the animals during the reperfusion period. Hourly blood, urine, and tissue samples were collected. Biochemical and microarray analyses were performed to identify differential inflammatory markers and gene expression between groups. RESULTS Both the treatment groups demonstrated significantly higher percent reduction from peak lactate after reperfusion compared with vehicle controls. Control animals required significantly more fluid, epinephrine, and higher final pump flow while having lower urine output than both the treatment groups. The treatment groups had lower urine NGAL, an early marker of kidney injury (P = 0.01), lower plasma aspartate aminotransferase, and reduced rate of troponin rise (P = 0.01). Pro-inflammatory cytokines were lower while anti-inflammatory cytokines were significantly higher in the treatment groups. CONCLUSIONS Using a novel and clinically relevant porcine model of circulatory arrest and ECPR, we demonstrated that a selective A2AR agonist significantly attenuated systemic IRI and warrants clinical investigation.
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Affiliation(s)
- James H Mehaffey
- Department of Surgery, University of Virginia, Charlottesville, VA
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Perioperative Extracorporeal Cardiopulmonary Resuscitation: The Defibrillator of the 21st Century?: A Case Report. A A Pract 2018; 11:87-89. [PMID: 29634540 DOI: 10.1213/xaa.0000000000000742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Veno-arterial-extracorporeal membrane oxygenation (ECMO) for cardiopulmonary resuscitation (ECMO-CPR) has been recommended by new resuscitation guidelines in the United Kingdom. Our recently established yet unfunded ECMO-CPR service has thus far treated 6 patients, with 3 making a good recovery. One patient suffered a catastrophic perioperative complication through glycine absorption and we are in no doubt that she would not have survived without ECMO. We argue for a pragmatic approach to funding of ECMO-CPR because observational evidence suggests superiority over traditional resuscitation and there exists major methodological and ethical barriers to randomized controlled studies. We also call for high-quality observational evidence in the perioperative setting.
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13
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Timek TA. Go with the flow, but do not get mixed up. J Thorac Cardiovasc Surg 2018; 155:1640-1641. [PMID: 29395202 DOI: 10.1016/j.jtcvs.2017.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 12/02/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Tomasz A Timek
- Division of Cardiothoracic Surgery, Spectrum Health, Michigan State University College of Human Medicine, Grand Rapids, Mich.
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Stewart JA. Automated external defibrillators in the hospital: A case of medical reversal. Am J Emerg Med 2017; 36:871-874. [PMID: 29162440 DOI: 10.1016/j.ajem.2017.11.035] [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: 10/23/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022] Open
Abstract
Automated external defibrillators (AEDs) emerged in the 1980s as an important innovation in pre-hospital emergency cardiac care (ECC). In the years since, the American Heart Association (AHA) and the International Liaison Committee for Resuscitation (ILCOR) have promoted AED technology for use in hospitals as well, resulting in the widespread purchase and use of AED-capable defibrillators. In-hospital use of AEDs now appears to have decreased survival from cardiac arrests. This article will look at the use of AEDs in hospitals as a case of "medical reversal." Medical reversal occurs when an accepted, widely used treatment is found to be ineffective or even harmful. This article will discuss the issue of AEDs in the hospital using a conceptual framework provided by recent work on medical reversal. It will go on to consider the implications of the reversal for in-hospital resuscitation programs and emergency medicine more generally.
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Grunau B, Hornby L, Singal RK, Christenson J, Ortega-Deballon I, Shemie SD, Bashir J, Brooks SC, Callaway CW, Guadagno E, Nagpal D. Extracorporeal Cardiopulmonary Resuscitation for Refractory Out-of-Hospital Cardiac Arrest: The State of the Evidence and Framework for Application. Can J Cardiol 2017; 34:146-155. [PMID: 29249614 DOI: 10.1016/j.cjca.2017.08.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/01/2017] [Accepted: 08/16/2017] [Indexed: 01/08/2023] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) affects 134 per 100,000 citizens annually. Extracorporeal cardiopulmonary resuscitation (ECPR), providing mechanical circulatory support, may improve the likelihood of survival among those with refractory OHCA. Compared with in-hospital ECPR candidates, those in the out-of-hospital setting tend to be sudden unexpected arrests in younger and healthier patients. The aims of this review were to summarize, and identify the limitations of, the evidence evaluating ECPR for OHCA, and to provide an approach for ECPR program application. Although there are many descriptions of ECPR-treated cohorts, we identified a paucity of robust data showing ECPR effectiveness compared with conventional resuscitation. However, it is highly likely that ECPR, provided after a prolonged attempt with conventional resuscitation, does benefit select patient populations compared with conventional resuscitation alone. Although reliable data showing the optimal patient selection criteria for ECPR are lacking, most implementations sought young previously healthy patients with rapid high-quality cardiopulmonary resuscitation. Carefully planned development of ECPR programs, in high-performing emergency medical systems at experienced extracorporeal membrane oxygenation centres, may be reasonable as part of systematic efforts to determine ECPR effectiveness and globally improve care. Protocol evaluation requires regional-level assessment, examining the incremental benefit of survival compared with standard care, while accounting for resource utilization.
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Affiliation(s)
- Brian Grunau
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; St Paul's Hospital, Vancouver, British Columbia, Canada.
| | - Laura Hornby
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Rohit K Singal
- Section of Cardiovascular Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; St Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Jim Christenson
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Ivan Ortega-Deballon
- Faculty of Medicine and Health Sciences, Universidad de Alcalá, Madrid, Spain; Helicopter Emergency Medical Service, Servicio de Urgencias Medicas de Madrid, Madrid, Spain
| | - Sam D Shemie
- Division of Critical Care Medicine, McGill University, Montreal, Quebec, Canada
| | - Jamil Bashir
- St Paul's Hospital, Vancouver, British Columbia, Canada; Division of Cardiovascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Steve C Brooks
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elena Guadagno
- McConnell Resource Centre, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dave Nagpal
- Divisions of Cardiac Surgery and Critical Care Medicine, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
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