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Hubble MW, Kaplan GR, Martin M. Influence of patient body weight on the probability of return of spontaneous circulation following out-of-hospital cardiac arrest: an exploratory analysis. Br Paramed J 2024; 9:11-20. [PMID: 39246831 PMCID: PMC11376325 DOI: 10.29045/14784726.2024.9.9.2.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024] Open
Abstract
Introduction In addition to key interventions, including bystander CPR and defibrillation, successful resuscitation of out-of-hospital cardiac arrest (OHCA) is also associated with several patient-level factors, including a shockable presenting rhythm, younger age, Caucasian race and female sex. An additional patient-level factor that may influence outcomes is patient weight, yet this attribute has not been extensively studied within the context of OHCA, despite globally increasing obesity rates. Objective To assess the relationship between patient weight and return of spontaneous circulation (ROSC) during OHCA. Methods This retrospective study included adult patients from a national emergency medical services (EMS) patient record, with witnessed, non-traumatic OHCA prior to EMS arrival from January to December 2020. Logistic regression was used to evaluate the relationship between patient weight and ROSC. Results Complete records were available for 9096 patients, of which 64.3% were males and 25.3% were ethnic minorities. The mean age of the participants was 65.01 years (SD = 15.8), with a mean weight of 93.52 kg (SD = 31.5). Altogether, 81.8% of arrests were of presumed cardiac aetiology and 30.3% presented with a shockable rhythm. Bystander CPR and automated external defibrillator (AED) shock were performed in 30.6% and 7.3% of cases, respectively, and 44.0% experienced ROSC. ROSC was less likely with patient weight >100 kg (OR = 0.709, p <0.001), male sex (OR = 0.782, p <0.001), and increasing age and EMS response time (OR = 0.994 per year, p <0.001 and OR = 0.970 per minute, p <0.001, respectively). Patients with shockable rhythms were more likely to achieve ROSC (OR = 1.790, p <0.001), as were patients receiving bystander CPR (OR = 1.170, p <0.001) and defibrillation prior to EMS arrival (OR = 1.658, p <0.001). Although the mean first adrenaline dose (mg/kg) followed a downward trend due to its non-weight-based dosing scheme, the mean total adrenaline dose administered to achieve ROSC demonstrated an upward linear trend of 0.05 mg for every 5 kg of body weight. Conclusions Patient weight was negatively associated with ROSC and positively associated with the total adrenaline dose required to attain ROSC.
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Affiliation(s)
- Michael W Hubble
- Wake Technical Community College, North Carolina, USA ORCID iD: https://orcid.org/0000-0002-4683-3767
| | - Ginny R Kaplan
- Methodist University, North Carolina, USA ORCID iD: https://orcid.org/0000-0002-5915-4974
| | - Melisa Martin
- Methodist University, North Carolina, USA ORCID iD: https://orcid.org/0009-0006-3648-7780
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Qi Q, Yu M, Ge J, Li C, Zhang G, Chen F. A combined impedance compensation strategy applied to external automatic defibrillators. BIOMED ENG-BIOMED TE 2023; 68:651-665. [PMID: 37350466 DOI: 10.1515/bmt-2022-0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/07/2023] [Indexed: 06/24/2023]
Abstract
Transthoracic impedance is one of the key factors affecting the success of defibrillation. Impedance compensation technique is used to adjust defibrillation parameters according to the transthoracic impedance of the defibrillator. In this paper, a combined impedance compensation strategy is proposed to address the shortcomings of existing compensation strategies. In order to evaluate the performance of the combined compensation strategy, this paper uses the prototype as the experimental machine, and uses two AED with representative impedance compensation strategies as the control machine, and the simulated defibrillation method is used for comparative testing. The results show that the combined impedance compensation has a more steadier distribution over the defibrillation energy and current: compared with the energy-based impedance compensation strategy, this strategy can significantly reduce the peak current (25 Ω: 27.8 vs. 54.7 A; 50 Ω: 20.7 vs. 32.3 A) and average current (25 Ω: 24.8 vs. 37.5 A) of defibrillation at low impedance, and compared with the current impedance compensation strategy, it can significantly reduce the defibrillation energy (150 Ω: 8.6 vs. 1.7 %, 175 Ω: 15.6 vs. 4.9 %, 200 Ω: 21.9 vs. 8.5 %) at high impedance. Impedance compensation is more precise and the current passing during defibrillation is steadier.
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Affiliation(s)
- Qi Qi
- Unit for Drug and Instrument Supervision and Inspection of Wuxi Joint Logistic Support Center, PLA, Nanjing, China
| | - Ming Yu
- Medical Support Technology Research Department,Systems Engineering Institute, Academy of Military Sciences, PLA, Tianjin, China
| | - Jianhui Ge
- Unit for Drug and Instrument Supervision and Inspection of Wuxi Joint Logistic Support Center, PLA, Nanjing, China
| | - Chuanjun Li
- Unit for Drug and Instrument Supervision and Inspection of Wuxi Joint Logistic Support Center, PLA, Nanjing, China
| | - Guang Zhang
- Medical Support Technology Research Department,Systems Engineering Institute, Academy of Military Sciences, PLA, Tianjin, China
| | - Feng Chen
- Medical Support Technology Research Department,Systems Engineering Institute, Academy of Military Sciences, PLA, Tianjin, China
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Kosmopoulos M, Kalra R, Alexy T, Gaisendrees C, Jaeger D, Chahine J, Voicu S, Tsangaris A, Gutierrez AB, Elliott A, Bartos JA, Yannopoulos D. The Impact Of BMI On Arrest Characteristics and Survival of Patients with Out-Of-Hospital Cardiac Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation. Resuscitation 2023:109842. [PMID: 37196806 DOI: 10.1016/j.resuscitation.2023.109842] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/02/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023]
Abstract
AIM To assess the impact of body mass index (BMI) on survival to hospital discharge of patients presenting with refractory ventricular fibrillation treated with extracorporeal cardiopulmonary resuscitation. We hypothesize that due to limitations in pre-hospital care delivery, people with high BMI have worse survival after prolonged resuscitation and ECPR. METHODS This study is a retrospective single-centre study that included patients suffering refractory VT/VF OHCA from December 2015 to October 2021 and had a BMI calculated at hospital admission. We compared the baseline characteristics and survival between patients with obesity (>30 kg/m2) and those without (≤30kg/m2). RESULTS Two-hundred eighty-three patients were included in this study, and two-hundred twenty-four required mechanical support with veno-arterial extracorporeal cardiopulmonary membrane oxygenation (VA ECMO). Patients with BMI >30 (n = 133) had significantly prolonged CPR duration compared to their peers with BMI ≤30kg/m2 (n = 150) and were significantly more likely to require support with VA ECMO (85.7% vs 73.3%, p = 0.015). Survival to hospital discharge was significantly higher in patients with BMI≤30 kg/m2 (48% vs. 29.3%, p <0.001). BMI was an independent predictor of mortality in a multivariable logistic regression analysis. The four-year mortality rate was low and not significantly different between the two groups (p=0.32). CONCLUSION ECPR yields clinically meaningful long-term survival in patients with BMI>30kg/m2. However, the resuscitation time is significantly prolonged, and the overall survival significantly lower compared to patients with BMI≤30 kg/m2. ECPR should, therefore, not be withheld for this population, but faster transport to an ECMO capable centre is mandated to improve survival to hospital discharge.
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Affiliation(s)
- Marinos Kosmopoulos
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Rajat Kalra
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Tamas Alexy
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Christopher Gaisendrees
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States; Department of Cardiothoracic Surgery, University Hospital of Cologne, Germany
| | - Deborah Jaeger
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States; INSERM U 1116, University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Johnny Chahine
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Sebastian Voicu
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States; INSERM UMRS-1144, Lariboisière Hospital, Paris-Diderot University, Paris, France
| | - Adamantios Tsangaris
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Alejandra B Gutierrez
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Andrea Elliott
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Jason A Bartos
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Demetris Yannopoulos
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States.
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Chen CT, Lin MC, Lee YJ, Li LH, Chen YJ, Chuanyi Hou P, How CK. Association between body mass index and clinical outcomes in out-of-hospital cardiac arrest survivors treated with targeted temperature management. J Chin Med Assoc 2021; 84:504-509. [PMID: 33742993 DOI: 10.1097/jcma.0000000000000513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND To determine the impact of body mass index (BMI) on clinical outcomes in out-of-hospital cardiac arrest (OHCA) survivors treated with targeted temperature management (TTM). METHODS We conducted a retrospective cohort study of 261 adult OHCA survivors who received complete TTM between January 2011 and December 2018 using data from the Research Patient Database Registry of Partners HealthCare system in Boston. Patients were categorized as underweight (BMI < 18.5 kg/m2), normal weight (BMI = 18.5-24.9 kg/m2), overweight (BMI = 25-29.9 kg/m2), and obese (BMI ≥ 30 kg/m2), according to the World Health Organization classification. RESULTS The average BMI was 28.9 ± 7.1 kg/m2. Patients with a higher BMI had higher rates of hypertension and diabetes mellitus, and were more likely to be witnessed on collapse. Patients with lower BMI levels had higher sequential organ failure assessment (SOFA) scores, blood urea nitrogen values, and mild thrombocytopenia rates (platelet count <150 K/μL) after the TTM treatment. The survival to discharge and favorable neurological outcome at discharge were reported in 117 (44.8%) and 76 (29.1%) patients, respectively. The survival at discharge, favorable neurologic outcomes at discharge, length of hospital admission, and the occurrence of acute kidney injury did not significantly differ between the BMI subgroups. In logistic regression model, BMI was not an independent predictor for survival at discharge (adjusted odds ratio 0.945, 95% CI 0.883-1.012, p = 0.108) nor for the favorable neurologic outcome at discharge (adjusted odds ratio 1.022, 95% CI 0.955-1.093, p = 0.528). CONCLUSION In OHCA patients treated with TTM, there was no significant difference across BMI subgroups for survival or favorable neurologic outcome at discharge.
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Affiliation(s)
- Chung-Ting Chen
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Meng-Chen Lin
- Nursing Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Jing Lee
- Nursing Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Li-Hua Li
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Pathology and Laboratory Medicine Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ying-Ju Chen
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Environmental and Occupational Health Science, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Peter Chuanyi Hou
- Division of Emergency Critical Care Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Chorng-Kuang How
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Kinmen Hospital, Ministry of Health and Welfare, Kinmen, Taiwan, ROC
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Neumann T, Finke SR, Henninger M, Lemke S, Hoepfner B, Steven D, Maul AC, Schroeder DC, Annecke T. First-time evaluation of ascending compared to rectangular transthoracic defibrillation waveforms in modelled out-of-hospital cardiac arrest. Resusc Plus 2020; 1-2:100006. [PMID: 34223293 PMCID: PMC8244241 DOI: 10.1016/j.resplu.2020.100006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 11/04/2022] Open
Abstract
Aim of the study Prognosis in out-of-hospital cardiac arrest (OHCA) depends on cardiopulmonary resuscitation (CPR) duration. Therefore, the optimal biphasic defibrillation waveform shows high conversion rates besides low energy. Matthew Fishler theoretically predicted it to be truncated ascending exponential. We realised a prototypic defibrillator and compared ascending with conventional rectangular waveforms in modelled OHCA and CPR. Methods Approved by the authorities, 57 healthy swine (Landrace × Piétrain) were randomised to ASCDefib (n 26) or CONVDefib (n 26). Five swine served as sham control. We induced ventricular fibrillation (VF) electrically in anaesthetised swine randomised to ASCDefib or CONVDefib and discontinued mechanical ventilation. After 5 min of untreated cardiac arrest, we started CPR with mechanical chest compressions and ventilation. We performed transthoracic biphasic defibrillations after 2, 4, 6 and 8 min CPR targeting 4 J/kg in either group. Depending on the randomised group, the defibrillation protocol was either three ascending followed by one rectangular waveform (ASCDefib) or three rectangular followed by one ascending waveform (CONVDefib). Results Under our model-specific conditions, VF was initially terminated by 13/80 ascending waveforms and 13/79 rectangular waveforms and persistent return of spontaneous circulation was achieved in 8/26 (ASCDefib) vs. 10/26 (CONVDefib) animals. Mean current rather than waveform design was predictive for defibrillation success in a generalised linear model. Conclusion Contrary to theoretical assumptions, transthoracic biphasic defibrillation with ascending waveforms is not superior to rectangular waveforms in modelled OHCA. We advocate defibrillation dosage to be guided by current, that has proven its predictive value again. Institutional protocol number 84–02.04.2017.A176.
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Affiliation(s)
- Tobias Neumann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Research Group "Clinical Research and Teaching", Kerpener Str. 62, 50937 Cologne, Germany
| | - Simon-Richard Finke
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Research Group "Clinical Research and Teaching", Kerpener Str. 62, 50937 Cologne, Germany
| | - Maja Henninger
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Research Group "Clinical Research and Teaching", Kerpener Str. 62, 50937 Cologne, Germany
| | - Sebastian Lemke
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Research Group "Clinical Research and Teaching", Kerpener Str. 62, 50937 Cologne, Germany
| | - Ben Hoepfner
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Research Group "Clinical Research and Teaching", Kerpener Str. 62, 50937 Cologne, Germany
| | - Daniel Steven
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Electrophysiology, Kerpener Str. 62, 50937 Cologne, Germany
| | - Alexandra C Maul
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Experimental Medicine, Kerpener Str. 62, 50937 Cologne, Germany
| | - Daniel C Schroeder
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Research Group "Clinical Research and Teaching", Kerpener Str. 62, 50937 Cologne, Germany
| | - Thorsten Annecke
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Research Group "Clinical Research and Teaching", Kerpener Str. 62, 50937 Cologne, Germany
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Defibrillation for Ventricular Fibrillation: A Shocking Update. J Am Coll Cardiol 2017; 70:1496-1509. [PMID: 28911514 DOI: 10.1016/j.jacc.2017.07.778] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/24/2017] [Indexed: 01/09/2023]
Abstract
Cardiac arrest is defined as the termination of cardiac activity associated with loss of consciousness, of spontaneous breathing, and of circulation. Sudden cardiac arrest and sudden cardiac death (SCD) are terms often used interchangeably. Most patients with out-of-hospital cardiac arrest have shown coronary artery disease or symptoms during the hour before the event. Cardiac arrest is potentially reversible by cardiopulmonary resuscitation, defibrillation, cardioversion, cardiac pacing, or treatments targeted at the underlying disease (e.g., acute coronary occlusion). We restrict SCD hereafter to cardiac arrest due to ventricular fibrillation, including rhythms shockable by an automatic external defibrillator (AED), implantable cardioverter-defibrillator (ICD), or wearable cardioverter-defibrillator (WCD). We summarize the state of the art related to defibrillation in treating SCD, including a brief history of the evolution of defibrillation, technical characteristics of modern AEDs, strategies to improve AED access and increase survival, ancillary treatments, and use of ICDs or WCDs.
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Shahreyar M, Dang G, Waqas Bashir M, Kumar G, Hussain J, Ahmad S, Pandey B, Thakur A, Bhandari S, Thandra K, Sra J, Tajik AJ, Jahangir A. Outcomes of In-Hospital Cardiopulmonary Resuscitation in Morbidly Obese Patients. JACC Clin Electrophysiol 2016; 3:174-183. [PMID: 29759391 DOI: 10.1016/j.jacep.2016.08.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 07/15/2016] [Accepted: 08/15/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study sought to assess the impact of morbid obesity on outcomes in patients with in-hospital cardiac arrest (IHCA). BACKGROUND Obesity is associated with increased risk of out-of-hospital cardiac arrest; however, little is known about survival of morbidly obese patients with IHCA. METHODS Using the Nationwide Inpatient Sample database from 2001 to 2008, we identified adult patients undergoing resuscitation for IHCA, including those with morbid obesity (body mass index ≥40 kg/m2) by using International Classification of Diseases 9th edition codes and clinical outcomes. Outcomes including in-hospital mortality, length of stay, and discharge dispositions were identified. Logistic regression model was used to examine the independent association of morbid obesity with mortality. RESULTS Of 1,293,071 IHCA cases, 27,469 cases (2.1%) were morbidly obese. The overall mortality was significantly higher for the morbidly obese group than for the nonobese group experiencing in-hospital non-ventricular fibrillation (non-VF) (77% vs. 73%, respectively; p = 0.006) or VF (65% vs. 58%, respectively; p = 0.01) arrest particularly if cardiac arrest happened late (>7 days) after hospitalization. Discharge to home was significantly lower in the morbidly obese group (21% vs. 31%, respectively; p = 0.04). After we adjusted for baseline variables, morbid obesity remained an independent predictor of increased mortality. Other independent predictors of mortality were age and severe sepsis for non-VF and VF group and venous thromboembolism, cirrhosis, stroke, malignancy, and rheumatologic conditions for non-VF group. CONCLUSIONS The overall mortality of morbidly obese patients after IHCA is worse than that for nonobese patients, especially if IHCA occurs after 7 days of hospitalization and survivors are more likely to be transferred to a skilled nursing facility.
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Affiliation(s)
- Muhammad Shahreyar
- Division of Hospital Medicine, Department of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Geetanjali Dang
- Division of Hospital Medicine, Department of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mohammad Waqas Bashir
- Division of Hospital Medicine, Department of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Gagan Kumar
- Phoebe Putney Memorial Hospital, Albany, Georgia
| | - Jawad Hussain
- Division of Hospital Medicine, Department of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Shahryar Ahmad
- Division of Hospital Medicine, Department of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Beneet Pandey
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Atul Thakur
- Saint Mary's Hospital, Department of General Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Sanjay Bhandari
- Division of Hospital Medicine, Department of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Krishna Thandra
- Division of Hospital Medicine, Department of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jasbir Sra
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Abdul J Tajik
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Arshad Jahangir
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin; Center for Integrative Research on Cardiovascular Aging, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Health Care, Milwaukee, Wisconsin.
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Ogunnaike BO, Whitten CW, Minhajuddin A, Melikman E, Joshi GP, Moon TS, Schneider PM, Bradley SM. Body mass index and outcomes of in-hospital ventricular tachycardia and ventricular fibrillation arrest. Resuscitation 2016; 105:156-60. [DOI: 10.1016/j.resuscitation.2016.05.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/19/2016] [Accepted: 05/27/2016] [Indexed: 11/27/2022]
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Semiautomated external defibrillators for in-hospital early defibrillation: a comparative study. Int J Technol Assess Health Care 2014; 30:78-89. [PMID: 24507242 DOI: 10.1017/s0266462313000652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Semiautomated external defibrillators (AEDs) should be considered as a means to facilitate in-hospital early defibrillation (IHED) in areas where advanced life support rescuers are not readily available. In this study, we aimed to develop a checklist and a measurement protocol to evaluate and compare AEDs by assessing factors that may affect IHED. METHODS A clinical and technical comparison of six AEDs was performed. Technical specifications were analyzed, while an emergency team evaluated ergonomics and appropriateness for IHED at Bambino Gesù Children's Hospital. A measurement protocol was implemented, which aimed to assess the ability of defibrillators to recognize shockable and nonshockable rhythms, accuracy of delivered energy, and charging time. RESULTS Designs of AEDs differed in several features which influence their appropriateness for IHED. Some units showed poor ergonomics and instructions/feedback for cardiopulmonary resuscitation. Differences between defibrillators in recognizing shockable and nonshockable rhythms emerged for polymorphic ventricular tachycardia waveforms and when the frequency and amplitude of input signals varied. Tests for accuracy revealed poor performances at low and high impedance levels for most AEDs. Notably, differences greater than 20 seconds were found in the time from power-on to "ready for discharge." CONCLUSIONS The approach we used to assess AEDs allowed us to evaluate their appropriateness with respect to the organizational context, to measure their parameters, and to compare models. Results showed that ergonomics and/or performances (timing and accuracy) could be improved in each device.
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Electrical features of eighteen automated external defibrillators: a systematic evaluation. Resuscitation 2013; 84:1596-603. [PMID: 23735652 DOI: 10.1016/j.resuscitation.2013.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 05/17/2013] [Accepted: 05/17/2013] [Indexed: 11/21/2022]
Abstract
AIM Assessment and comparison of the electrical parameters (energy, current, first and second phase waveform duration) among eighteen AEDs. METHOD Engineering bench tests for a descriptive systematic evaluation in commercially available AEDs. AEDs were tested through an ECG simulator, an impedance simulator, an oscilloscope and a measuring device detecting energy delivered, peak and average current, and duration of first and second phase of the biphasic waveforms. All tests were performed at the engineering facility of the Lombardia Regional Emergency Service (AREU). RESULTS Large variations in the energy delivered at the first shock were observed. The trend of current highlighted a progressive decline concurrent with the increases of impedance. First and second phase duration varied substantially among the AEDs using the exponential biphasic waveform, unlike rectilinear waveform AEDs in which phase duration remained relatively constant. CONCLUSIONS There is a large variability in the electrical features of the AEDs tested. Energy is likely not to be the best indicator for strength dose selection. Current and shock duration should be both considered when approaching the technical features of AEDs. These findings may prompt further investigations to define the optimal current and duration of the shock waves to increase the success rate in the clinical setting.
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Ristagno G, Yu T, Quan W, Freeman G, Li Y. Current is better than energy as predictor of success for biphasic defibrillatory shocks in a porcine model of ventricular fibrillation. Resuscitation 2012; 84:678-83. [PMID: 23032689 DOI: 10.1016/j.resuscitation.2012.09.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 09/13/2012] [Accepted: 09/24/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The evidence that monophasic defibrillation success is mainly determined by current is secure. However, modern defibrillators use biphasic waveforms. The aim of this study was to compare energy, peak voltage and peak current in predicting biphasic shock success in a porcine model of ventricular fibrillation (VF) where the impedance varies within a wide of ranges. METHODS In 14 domestic male pigs weighing between 27 and 38 kg, VF was electrically induced and untreated for 15 s. Animals were randomized to receive defibrillation attempts from one of two defibrillators with different impedance compensation methods. A grouped up-and-down defibrillation threshold testing protocol was used to maintain the average success rate in the neighborhood of 50%. After a recovery interval of 5 min, the testing sequence was repeated for a total of 60 test shocks for each animal. RESULTS A high defibrillation success was observed when high peak current was delivered. The area under ROC curve for predicting shock success was 0.681 for peak current, 0.585 for peak voltage and 0.562 for energy. The odds ratio revealed that peak current was a better predictor (OR=1.321, p<0.001) for defibrillation outcome compared with energy (OR=0.979, p<0.001) and peak voltage (OR=1.000, p=0.69) when multivariable logistic regression was conducted. CONCLUSION In this porcine model of VF within a wide range of transthoracic impedance, peak current was a better indicator for shock success than the currently used energy for biphasic defibrillatory shocks. This finding may encourage design of new current-based biphasic defibrillators.
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Abstract
BACKGROUND The quality and effectiveness of resuscitation processes may be influenced by the patient's body mass index (BMI); however, the relationship between BMI and survival after in-hospital cardiac arrest has not been previously studied. METHODS AND RESULTS We evaluated 21 237 adult patients with an in-hospital cardiac arrest within the National Registry for Cardiopulmonary Resuscitation (NRCPR). We examined the association between BMI (classified as underweight [<18.5 kg/m(2)], normal [18.5 to 24.9 kg/m(2)], overweight [25.0 to 29.9 kg/m(2)], obese [30.0 to 34.9 kg/m(2)], and very obese [≥35.0 kg/m(2)]) and survival to hospital discharge using multivariable logistic regression, after stratifying arrests by rhythm type and adjusting for patient characteristics. Of 4499 patients with ventricular fibrillation or pulseless ventricular tachycardia as initial rhythm, 1825 (40.6%) survived to discharge. After multivariable adjustment, compared with overweight patients, underweight (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.41 to 0.84; P=0.003), normal weight (OR, 0.75; 95% CI, 0.63 to 0.89; P<0.001), and very obese (OR, 0.78; 95% CI, 0.63 to 0.96; P=0.02) had lower rates of survival, whereas obese patients had similar rates of survival (OR, 0.87; 95% CI, 0.72 to 1.06; P=0.17). In contrast, of 16 738 patients with arrests caused by asystole or pulseless electric activity, only 2501 (14.9%) survived. After multivariable adjustment, all BMI groups had similar rates of survival except underweight patients (OR, 0.67; 95% CI, 0.54 to 0.82; P<0.001). CONCLUSIONS For cardiac arrest caused by shockable rhythms, underweight, normal weight, and very obese patients had lower rates of survival to discharge. In contrast, for cardiac arrest caused by nonshockable rhythms, survival to discharge was similar across BMI groups except for underweight patients. Future studies are needed to clarify the extent to which BMI affects the quality and effectiveness of resuscitation measures.
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Affiliation(s)
- Renuka Jain
- University of Michigan Division of Cardiovascular Medicine, Ann Arbor, MI
| | - Brahmajee K. Nallamothu
- University of Michigan Division of Cardiovascular Medicine, Ann Arbor, MI
- The VA Ann Arbor Health Services Research & Development Center of Excellence
| | | | - American Heart Association National Registry of Cardiopulmonary Resuscitation (NRCPR)Investigators
- The American Heart Association National Registry of CPR investigators include the authors P. Chan, G. Nichol, E. Allen, R. Berg, S. Braithwaite, B. Eigel, R. Geocadin, E. Hunt, K. Kern, T. Mader, D. Magid, M. Mancini, V. Nadkarni, T. Noel, J. Ornato, M. Peberdy, J. Potts, T. Truitt, S. Warren
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Abstract
PURPOSE OF REVIEW To explore recent findings on the treatment and outcome of cardiac arrhythmias and how they affect ICU activities. RECENT FINDINGS The rate vs. rhythm control debate for the treatment of chronic atrial fibrillation continues. It is still unclear whether the postcardiac surgery inflammatory response contributes to the development of atrial fibrillation. In noncardiothoracic surgery/trauma patients hospitalized in an ICU, new-onset supraventricular arrhythmias are associated with markedly elevated mortality when compared with patients with a prior history of such arrhythmias and patients who do not develop arrhythmias. The onset of new supraventricular arrhythmias in such patients appears to be a manifestation of multiple system organ failure as it is closely associated with sepsis. Cardioversion of supraventricular arrhythmias with biphasic waveforms is being studied to determine whether it is more effective than cardioversion with monophasic waveforms. SUMMARY Supraventricular arrhythmias, especially atrial fibrillation, occur frequently in ICU patients. Intensivists not only treat atrial fibrillation itself but also its complications and the complications of the therapies used to prevent these complications. In ICU patients, ventricular arrhythmias have ominous implications because they usually portend either a major cardiac or a systemic dysfunction or both.
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In this issue. Resuscitation 2007. [DOI: 10.1016/j.resuscitation.2007.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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