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COSCA (Core Outcome Set for Cardiac Arrest) in Adults: An Advisory Statement From the International Liaison Committee on Resuscitation. Resuscitation 2018; 127:147-163. [DOI: 10.1016/j.resuscitation.2018.03.022] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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2
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Haywood K, Whitehead L, Nadkarni VM, Achana F, Beesems S, Böttiger BW, Brooks A, Castrén M, Ong ME, Hazinski MF, Koster RW, Lilja G, Long J, Monsieurs KG, Morley PT, Morrison L, Nichol G, Oriolo V, Saposnik G, Smyth M, Spearpoint K, Williams B, Perkins GD. COSCA (Core Outcome Set for Cardiac Arrest) in Adults: An Advisory Statement From the International Liaison Committee on Resuscitation. Circulation 2018; 137:e783-e801. [PMID: 29700122 DOI: 10.1161/cir.0000000000000562] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiac arrest effectiveness trials have traditionally reported outcomes that focus on survival. A lack of consistency in outcome reporting between trials limits the opportunities to pool results for meta-analysis. The COSCA initiative (Core Outcome Set for Cardiac Arrest), a partnership between patients, their partners, clinicians, research scientists, and the International Liaison Committee on Resuscitation, sought to develop a consensus core outcome set for cardiac arrest for effectiveness trials. Core outcome sets are primarily intended for large, randomized clinical effectiveness trials (sometimes referred to as pragmatic trials or phase III/IV trials) rather than for pilot or efficacy studies. A systematic review of the literature combined with qualitative interviews among cardiac arrest survivors was used to generate a list of potential outcome domains. This list was prioritized through a Delphi process, which involved clinicians, patients, and their relatives/partners. An international advisory panel narrowed these down to 3 core domains by debate that led to consensus. The writing group refined recommendations for when these outcomes should be measured and further characterized relevant measurement tools. Consensus emerged that a core outcome set for reporting on effectiveness studies of cardiac arrest (COSCA) in adults should include survival, neurological function, and health-related quality of life. This should be reported as survival status and modified Rankin scale score at hospital discharge, at 30 days, or both. Health-related quality of life should be measured with ≥1 tools from Health Utilities Index version 3, Short-Form 36-Item Health Survey, and EuroQol 5D-5L at 90 days and at periodic intervals up to 1 year after cardiac arrest, if resources allow.
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Sawyer KN, Callaway CW, Wagner AK. Life After Death: Surviving Cardiac Arrest—an Overview of Epidemiology, Best Acute Care Practices, and Considerations for Rehabilitation Care. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2017. [DOI: 10.1007/s40141-017-0148-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Kilgannon JH, Kirchhoff M, Pierce L, Aunchman N, Trzeciak S, Roberts BW. Association between chest compression rates and clinical outcomes following in-hospital cardiac arrest at an academic tertiary hospital. Resuscitation 2016; 110:154-161. [PMID: 27666168 DOI: 10.1016/j.resuscitation.2016.09.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 08/23/2016] [Accepted: 09/12/2016] [Indexed: 11/26/2022]
Abstract
AIMS Recent guidelines for management of cardiac arrest recommend chest compression rates of 100-120 compressions/min. However, animal studies have found cardiac output to increase with rates up to 150 compressions/min. The objective of this study was to test the association between chest compression rates during cardiopulmonary resuscitation for in-hospital cardiac arrest (IHCA) and outcome. METHODS We conducted a prospective observational study at a single academic medical center. INCLUSION CRITERIA age≥18, IHCA, cardiopulmonary resuscitation performed. We analyzed chest compression rates measured by defibrillation electrodes, which recorded changes in thoracic impedance. The primary outcome was return of spontaneous circulation (ROSC). We used multivariable logistic regression to determine odds ratios for ROSC by chest compression rate categories (100-120, 121-140, >140 compressions/min), adjusted for chest compression fraction (proportion of time chest compressions provided) and other known predictors of outcome. We set 100-120 compressions/min as the reference category for the multivariable model. RESULTS We enrolled 222 consecutive patients and found a mean chest compression rate of 139±15. Overall 53% achieved ROSC; among 100-120, 121-140, and >140 compressions/min, ROSC was 29%, 64%, and 49% respectively. A chest compression rate of 121-140 compressions/min had the greatest likelihood of ROSC, odds ratio 4.48 (95% CI 1.42-14.14). CONCLUSIONS In this sample of adult IHCA patients, a chest compression rate of 121-140 compressions/min had the highest odds ratio of ROSC. Rates above the currently recommended 100-120 compressions/min may improve the chances of ROSC among IHCA patients.
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Affiliation(s)
- J Hope Kilgannon
- The Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Michael Kirchhoff
- The Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Lisa Pierce
- The Department of Medicine, Division of Critical Care Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Nicholas Aunchman
- The Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Stephen Trzeciak
- The Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, United States; The Department of Medicine, Division of Critical Care Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Brian W Roberts
- The Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, United States.
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Patel JK, Parikh PB. Association between therapeutic hypothermia and long-term quality of life in survivors of cardiac arrest: A systematic review. Resuscitation 2016; 103:54-59. [PMID: 27060536 DOI: 10.1016/j.resuscitation.2016.03.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/15/2016] [Accepted: 03/30/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Therapeutic hypothermia (TH) has increasingly become a part of the current standard of care for treating patients with cardiac arrest (CA). However, little is known regarding the association between TH and long-term quality of life (QoL) in adult survivors of CA. We conducted a systematic review to investigate the association between TH implementation and long-term QoL outcomes in adult survivors of CA following hospital discharge. METHODS We systematically searched MEDLINE and Cochrane databases to identify randomized and observational studies from January 2005 to January 2016 investigating the relationship between TH implementation immediately post-CA and long-term QoL in CA survivors post-hospital discharge. RESULTS We included 9 studies with a total of 801 patients. Six of these were prospective cohort studies, 2 were substudies of randomized controlled trials, and 1 was a retrospective cohort study. Six studies included patients only with out-of-hospital CA while 3 included patients with both in-hospital and out-of-hospital CA. There was marked between-study heterogeneity with respect to study population, TH implementation, and QoL assessment tool. TH was not associated with long-term QoL in this population. CONCLUSIONS In this systematic review, the included studies do not suggest any association between TH implementation in CA with long-term QoL in CA survivors. Further larger scale studies are needed to investigate the sustainability of TH effects long term in this patient population.
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Affiliation(s)
- Jignesh K Patel
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA.
| | - Puja B Parikh
- Division of Cardiovascular Medicine, Department of Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA
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6
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Li J, Wang H, Zhong Q, Zhu X, Chen SJ, Qian Y, Costakis J, Bunney G, Beiser DG, Leff AR, Lewandowski ED, ÓDonnell JM, Vanden Hoek TL. A novel pharmacological strategy by PTEN inhibition for improving metabolic resuscitation and survival after mouse cardiac arrest. Am J Physiol Heart Circ Physiol 2015; 308:H1414-22. [PMID: 25795713 DOI: 10.1152/ajpheart.00748.2014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 03/17/2015] [Indexed: 01/04/2023]
Abstract
Sudden cardiac arrest (SCA) is a leading cause of death in the United States. Despite return of spontaneous circulation, patients die due to post-SCA syndrome that includes myocardial dysfunction, brain injury, impaired metabolism, and inflammation. No medications improve SCA survival. Our prior work suggests that optimal Akt activation is critical for cooling protection and SCA recovery. Here, we investigate a small inhibitor of PTEN, an Akt-related phosphatase present in heart and brain, as a potential therapy in improving cardiac and neurological recovery after SCA. Anesthetized adult female wild-type C57BL/6 mice were randomized to pretreatment of VO-OHpic (VO) 30 min before SCA or vehicle control. Mice underwent 8 min of KCl-induced asystolic arrest followed by CPR. Resuscitated animals were hemodynamically monitored for 2 h and observed for 72 h. Outcomes included heart pressure-volume loops, energetics (phosphocreatine and ATP from (31)P NMR), protein phosphorylation of Akt, GSK3β, pyruvate dehydrogenase (PDH) and phospholamban, circulating inflammatory cytokines, plasma lactate, and glucose as measures of systemic metabolic recovery. VO reduced deterioration of left ventricular maximum pressure, maximum rate of change in the left ventricular pressure, and Petco2 and improved 72 h neurological intact survival (50% vs. 10%; P < 0.05). It reduced plasma lactate, glucose, IL-1β, and Pre-B cell colony enhancing factor, while increasing IL-10. VO increased phosphorylation of Akt and GSK3β in both heart and brain, and cardiac phospholamban phosphorylation while reducing p-PDH. Moreover, VO improved cardiac bioenergetic recovery. We concluded that pharmacologic PTEN inhibition enhances Akt activation, improving metabolic, cardiovascular, and neurologic recovery with increased survival after SCA. PTEN inhibitors may be a novel pharmacologic strategy for treating SCA.
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Affiliation(s)
- Jing Li
- Program in Advanced Resuscitation Medicine, Center for Cardiovascular Research, and Department of Emergency Medicine, University of Illinois Hospital & Health Sciences System, Chicago, Illinois
| | - Huashan Wang
- Program in Advanced Resuscitation Medicine, Center for Cardiovascular Research, and Department of Emergency Medicine, University of Illinois Hospital & Health Sciences System, Chicago, Illinois
| | - Qiang Zhong
- Program in Advanced Resuscitation Medicine, Center for Cardiovascular Research, and Department of Emergency Medicine, University of Illinois Hospital & Health Sciences System, Chicago, Illinois; Department of Emergency Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science & Technology, China
| | - Xiangdong Zhu
- Program in Advanced Resuscitation Medicine, Center for Cardiovascular Research, and Department of Emergency Medicine, University of Illinois Hospital & Health Sciences System, Chicago, Illinois
| | - Sy-Jou Chen
- Program in Advanced Resuscitation Medicine, Center for Cardiovascular Research, and Department of Emergency Medicine, University of Illinois Hospital & Health Sciences System, Chicago, Illinois; Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Yuanyu Qian
- Program in Advanced Resuscitation Medicine, Center for Cardiovascular Research, and Department of Emergency Medicine, University of Illinois Hospital & Health Sciences System, Chicago, Illinois; Emergency Department, Chinese PLA General Hospital, Beijing, China
| | - Jim Costakis
- Program in Advanced Resuscitation Medicine, Center for Cardiovascular Research, and Department of Emergency Medicine, University of Illinois Hospital & Health Sciences System, Chicago, Illinois
| | - Gabrielle Bunney
- Program in Advanced Resuscitation Medicine, Center for Cardiovascular Research, and Department of Emergency Medicine, University of Illinois Hospital & Health Sciences System, Chicago, Illinois
| | - David G Beiser
- Section of Emergency Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Alan R Leff
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois; and
| | - E Douglas Lewandowski
- Program in Integrative Cardiac Metabolism, Center for Cardiovascular Research, and Department of Physiology and Biophysics, University of Illinois Hospital & Health Sciences System, Chicago, Illinois
| | - J Michael ÓDonnell
- Program in Integrative Cardiac Metabolism, Center for Cardiovascular Research, and Department of Physiology and Biophysics, University of Illinois Hospital & Health Sciences System, Chicago, Illinois
| | - Terry L Vanden Hoek
- Program in Advanced Resuscitation Medicine, Center for Cardiovascular Research, and Department of Emergency Medicine, University of Illinois Hospital & Health Sciences System, Chicago, Illinois;
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Whitehead L, Perkins G, Clarey A, Haywood K. A systematic review of the outcomes reported in cardiac arrest clinical trials: The need for a core outcome set. Resuscitation 2015; 88:150-7. [DOI: 10.1016/j.resuscitation.2014.11.013] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 11/10/2014] [Accepted: 11/12/2014] [Indexed: 10/24/2022]
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Tweddell JS, Ghanayem NS, Hoffman GM. All this monitoring…what's necessary, what's not? Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2014; 17:81-90. [PMID: 24725722 DOI: 10.1053/j.pcsu.2014.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The goal of perioperative monitoring is to aid the clinician in optimizing care to achieve the best possible survival with the lowest possible morbidity. Ideally, we would like to have monitoring that can rapidly and accurately identify perturbations in circulatory well-being that would permit timely intervention and allow for restoration before the patient is damaged. The evidence to support the use of our standard monitoring strategies (continuous electrocardiography, blood pressure, central venous pressure, oxygen saturation and capnography) is based on expert opinion, case series, or at best observational studies. While these monitoring parameters will identify life-threatening events, they provide no direct information concerning the oxygen economy of the patient. Nevertheless, they are mandated by professional societies representing specialists in cardiac disease, critical care, and anesthesiology. Additional non-routine monitoring strategies that provide data concerning the body's oxygen economy, such as venous saturation monitoring and near infrared spectroscopy, have shown promise in prospective observational studies in managing these complex groups of patients. Ideally, high-level evidence would be required before adopting these newer strategies, but in the absence of new funding sources and the challenges of the wide variation in practice patterns between centers, this seems unlikely. The evidence supporting the current standard perioperative monitoring strategies will be reviewed. In addition, evidence supporting non-routine monitoring strategies will be reviewed and their potential for added benefit assessed.
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Affiliation(s)
- James S Tweddell
- Herma Heart Center, Milwaukee, WI; Children's Hospital of Wisconsin, Milwaukee, WI; Department of Surgery, Division of Cardiothoracic Surgery, Milwaukee, WI.
| | - Nancy S Ghanayem
- Herma Heart Center, Milwaukee, WI; Children's Hospital of Wisconsin, Milwaukee, WI; Department of Pediatrics, Section of Critical Care, Milwaukee, WI
| | - George M Hoffman
- Herma Heart Center, Milwaukee, WI; Children's Hospital of Wisconsin, Milwaukee, WI; Department of Anesthesiology, The Medical College of Wisconsin, Milwaukee, WI
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Arterial Blood Pressure and Neurologic Outcome After Resuscitation From Cardiac Arrest*. Crit Care Med 2014; 42:2083-91. [DOI: 10.1097/ccm.0000000000000406] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Roberts BW, Kilgannon JH, Chansky ME, Trzeciak S. Association between initial prescribed minute ventilation and post-resuscitation partial pressure of arterial carbon dioxide in patients with post-cardiac arrest syndrome. Ann Intensive Care 2014; 4:9. [PMID: 24602367 PMCID: PMC3973966 DOI: 10.1186/2110-5820-4-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 02/25/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Post-cardiac arrest hypocapnia/hypercapnia have been associated with poor neurological outcome. However, the impact of arterial carbon dioxide (CO2) derangements during the immediate post-resuscitation period following cardiac arrest remains uncertain. We sought to test the correlation between prescribed minute ventilation and post-resuscitation partial pressure of CO2 (PaCO2), and to test the association between early PaCO2 and neurological outcome. METHODS We retrospectively analyzed a prospectively compiled single-center cardiac arrest registry. We included adult (age ≥ 18 years) patients who experienced a non-traumatic cardiac arrest and required mechanical ventilation. We analyzed initial post-resuscitation ventilator settings and initial arterial blood gas analysis (ABG) after initiation of post-resuscitation ventilator settings. We calculated prescribed minute ventilation:MVmL/kg/min=tidalvolumeTV/idealbodyweightIBWxrespiratoryrateRRfor each patient. We then used Pearson's correlation to test the correlations between prescribed MV and PaCO2. We also determined whether patients had normocapnia (PaCO2 between 30 and 50 mmHg) on initial ABG and tested the association between normocapnia and good neurological function (Cerebral Performance Category 1 or 2) at hospital discharge using logistic regression analyses. RESULTS Seventy-five patients were included. The majority of patients were in-hospital arrests (85%). Pulseless electrical activity/asystole was the initial rhythm in 75% of patients. The median (IQR) TV, RR, and MV were 7 (7 to 8) mL/kg, 14 (14 to 16) breaths/minute, and 106 (91 to 125) mL/kg/min, respectively. Hypocapnia, normocapnia, and hypercapnia were found in 15%, 62%, and 23% of patients, respectively. Good neurological function occurred in 32% of all patients, and 18%, 43%, and 12% of patients with hypocapnia, normocapnia, and hypercapnia respectively. We found prescribed MV had only a weak correlation with initial PaCO2, R = -0.40 (P < 0.001). Normocapnia was associated with good neurological function, odds ratio 4.44 (95% CI 1.33 to 14.85). CONCLUSIONS We found initial prescribed MV had only a weak correlation with subsequent PaCO2 and that early Normocapnia was associated with good neurological outcome. These data provide rationale for future research to determine the impact of PaCO2 management during mechanical ventilation in post-cardiac arrest patients.
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Affiliation(s)
- Brian W Roberts
- The Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, One Cooper Plaza, K152, Camden, NJ 08103, USA.
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Multiple organ dysfunction after return of spontaneous circulation in postcardiac arrest syndrome. Crit Care Med 2013; 41:1492-501. [PMID: 23507719 DOI: 10.1097/ccm.0b013e31828a39e9] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Recent guidelines for the treatment of postcardiac arrest syndrome recommend optimization of vital organ perfusion after return of spontaneous circulation to reduce the risk of postresuscitation multiple organ injury. However, the prevalence of extracerebral multiple organ dysfunction in postcardiac arrest patients and its association with in-hospital mortality remain unclear. DESIGN Single-center, prospective observational study. SETTING Urban academic medical center. PATIENTS Postcardiac arrest patients. Inclusion criteria were as follows: age older than 17 years, nontrauma cardiac arrest, and comatose after return of spontaneous circulation. INTERVENTIONS We prospectively captured all extracerebral components of the Sequential Organ Failure Assessment score over the first 72 hours after return of spontaneous circulation. The primary outcome measure was in-hospital mortality. We used multivariate logistic regression to determine if multiple organ dysfunction (defined as the highest extracerebral Sequential Organ Failure Assessment score) was an independent predictor of death, after adjustment for the presence of cerebral injury (defined as not following commands at any point over 0-72 hr). MEASUREMENTS AND MAIN RESULTS We enrolled 203 postcardiac arrest patients; 96% had some degree of extracerebral organ dysfunction and 66% had severe dysfunction in two or more extracerebral organ systems. The most common extracerebral organ failures were cardiovascular (i.e., vasopressor dependence) and respiratory (i.e., oxygenation impairment). The highest extracerebral Sequential Organ Failure Assessment score over 72 hours had an independent association with in-hospital mortality (odds ratio 1.95 [95% CI, 1.15-3.29]). Of the individual organ systems, only the cardiovascular and respiratory Sequential Organ Failure Assessment scores had an independent association with in-hospital mortality. CONCLUSIONS The results of this study support the hypothesis that extracerebral organ dysfunction is common and associated with mortality in postcardiac arrest syndrome. This association appears to be driven by postresuscitation hemodynamic dysfunction and oxygenation impairment. Further research is needed to determine the value of hemodynamic and oxygenation optimization as a part of treatment strategies for patients with postcardiac arrest syndrome.
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Roberts BW, Kilgannon JH, Chansky ME, Mittal N, Wooden J, Trzeciak S. Association Between Postresuscitation Partial Pressure of Arterial Carbon Dioxide and Neurological Outcome in Patients With Post–Cardiac Arrest Syndrome. Circulation 2013; 127:2107-13. [DOI: 10.1161/circulationaha.112.000168] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Partial pressure of arterial CO
2
(Pa
co
2
) is a regulator of cerebral blood flow after brain injury. Recent guidelines for the management of cardiac arrest recommend maintaining Pa
co
2
at 40 to 45 mm Hg after successful resuscitation; however, there is a paucity of data on the prevalence of Pa
co
2
derangements during the post–cardiac arrest period and its association with outcome.
Methods and Results—
We analyzed a prospectively compiled and maintained cardiac arrest registry at a single academic medical center. Inclusion criteria are as follows: age ≥18, nontrauma arrest, and comatose after return of spontaneous circulation. We analyzed arterial blood gas data during 0 to 24 hours after the return of spontaneous circulation and determined whether patients had exposure to hypocapnia and hypercapnia (defined as Pa
co
2
≤30 mm Hg and Pa
co
2
≥50 mm Hg, respectively, based on previous literature). The primary outcome was poor neurological function at hospital discharge, defined as Cerebral Performance Category ≥3. We used multivariable logistic regression, with multiple sensitivity analyses, adjusted for factors known to predict poor outcome, to determine whether post–return of spontaneous circulation hypocapnia and hypercapnia were independent predictors of poor neurological function. Of 193 patients, 52 (27%) had hypocapnia only, 63 (33%) had hypercapnia only, 18 (9%) had both hypocapnia and hypercapnia exposure, and 60 (31%) had no exposure; 74% of patients had poor neurological outcome. Hypocapnia and hypercapnia were independently associated with poor neurological function, odds ratio 2.43 (95% confidence interval, 1.04–5.65) and 2.20 (95% confidence interval, 1.03–4.71), respectively.
Conclusions—
Hypocapnia and hypercapnia were common after cardiac arrest and were independently associated with poor neurological outcome. These data suggest that Pa
co
2
derangements could be potentially harmful for patients after resuscitation from cardiac arrest.
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Affiliation(s)
- Brian W. Roberts
- From the Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ (B.W.R., J.H.K., M.E.C, N.M., J.W., S.T.); and the Department of Medicine, Division of Critical Care Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ (S.T.)
| | - J. Hope Kilgannon
- From the Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ (B.W.R., J.H.K., M.E.C, N.M., J.W., S.T.); and the Department of Medicine, Division of Critical Care Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ (S.T.)
| | - Michael E. Chansky
- From the Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ (B.W.R., J.H.K., M.E.C, N.M., J.W., S.T.); and the Department of Medicine, Division of Critical Care Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ (S.T.)
| | - Neil Mittal
- From the Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ (B.W.R., J.H.K., M.E.C, N.M., J.W., S.T.); and the Department of Medicine, Division of Critical Care Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ (S.T.)
| | - Jonathan Wooden
- From the Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ (B.W.R., J.H.K., M.E.C, N.M., J.W., S.T.); and the Department of Medicine, Division of Critical Care Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ (S.T.)
| | - Stephen Trzeciak
- From the Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ (B.W.R., J.H.K., M.E.C, N.M., J.W., S.T.); and the Department of Medicine, Division of Critical Care Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ (S.T.)
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Expósito JA, Caballero A, López AM, Vallejo J, Aguilera A, Praena JM, Echevarría C. Outcomes and safety of a cardiac rehabilitation programme in cardiac arrest victims. Resuscitation 2012. [DOI: 10.1016/j.resuscitation.2012.08.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Monitoring of standard hemodynamic parameters: heart rate, systemic blood pressure, atrial pressure, pulse oximetry, and end-tidal CO2. Pediatr Crit Care Med 2011; 12:S2-S11. [PMID: 22129545 DOI: 10.1097/pcc.0b013e318220e7ea] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Continuous monitoring of various clinical parameters of hemodynamic and respiratory status in pediatric critical care medicine has become routine. The evidence supporting these practices is examined in this review. METHODOLOGY A search of MEDLINE, EMBASE, PubMed, and the Cochrane Database was conducted to find controlled trials of heart rate, electrocardiography, noninvasive and invasive blood pressure, atrial pressure, end-tidal carbon dioxide, and pulse oximetry monitoring. Adult and pediatric data were considered. Guidelines published by the Society for Critical Care Medicine, the American Heart Association, the American Academy of Pediatrics, and the International Liaison Committee on Resuscitation were reviewed, including further review of references cited. RESULTS AND CONCLUSIONS Use of heart rate, electrocardiography, noninvasive and arterial blood pressure, atrial pressure, pulse oximetry, and end-tidal carbon dioxide monitoring in the pediatric critical care unit is commonplace; this practice, however, is not supported by well-controlled clinical trials. Despite the majority of literature being case series, expert opinion would suggest that use of routine pulse oximetry and end-tidal carbon dioxide is the current standard of care. In addition, literature would suggest that invasive arterial monitoring is the current standard for monitoring in the setting of shock. The use of heart rate, electrocardiography. and atrial pressure monitoring is advantageous in specific clinical scenarios (postoperative cardiac surgery); however, the evidence for this is based on numerous case series only.
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