1
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Kiyohara K, Matsui S, Ayusawa M, Sudo T, Nitta M, Iwami T, Nakata K, Kitamura Y, Sobue T, Kitamura T. Basic life support for non-traumatic out-of-hospital cardiac arrests during school-supervised sports activities in children: A nationwide observational study in Japan. Resusc Plus 2024; 17:100531. [PMID: 38155977 PMCID: PMC10753082 DOI: 10.1016/j.resplu.2023.100531] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/16/2023] [Accepted: 12/03/2023] [Indexed: 12/30/2023] Open
Abstract
Objective To investigate the prognostic impact of bystander-initiated cardiopulmonary resuscitation (CPR) and public-access automated external defibrillator (AED) use on non-traumatic out-of-hospital cardiac arrest (OHCA) occurring during school-supervised sports activities in children. Methods From a nationwide database of pediatric OHCAs occurring under school supervision in Japan, data between April 2008 and December 2020 were obtained. We analyzed non-traumatic OHCAs that occurred during school-supervised sports activities among schoolchildren from elementary, junior high, high, and technical colleges. A multivariable logistic regression model was used to evaluate the effect of basic life support (BLS) on 1-month survival with favorable neurological outcomes after OHCA. Results In total, 318 OHCA cases were analyzed. The 1-month survival with favorable neurological outcomes was 64.8% (164/253) in cases receiving both bystander-CPR and AED application, 40.7% (11/27) in cases receiving CPR only, 38.5% (5/13) in patients receiving AED application only, and 28.0% (7/25) in cases receiving no bystander intervention. Compared with cases receiving no BLS, cases receiving both CPR and AED had a significantly higher proportion of 1-month survival with favorable neurological outcomes (adjusted odds ratio [AOR]: 3.97, 95% confidence interval [CI]: 1.32-11.90, p = 0.014). However, compared to cases receiving no BLS, there was no significant difference in the outcome in the cases receiving CPR only (AOR: 1.35, 95% CI: 0.34-5.29, p = 0.671) and the cases receiving AED application only (AOR: 1.26, 95% CI: 0.25-6.38, p = 0.778). Conclusion The combination of CPR and AED as BLS performed by bystanders for non-traumatic OHCA during school-supervised sports activities improved the outcomes.
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Affiliation(s)
- Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women’s University, Tokyo, Japan
| | - Satoshi Matsui
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Mamoru Ayusawa
- Department of Nutrition and Health Science, Faculty of Health and Medical Science, Kanagawa Institute of Technology, Atsugi, Japan
| | - Takeichiro Sudo
- Institute of Human Culture Studies, Otsuma Women’s University, Tokyo, Japan
| | - Masahiko Nitta
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Osaka, Japan
- Division of Patient Safety, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Taku Iwami
- Kyoto University Health Service, Kyoto, Japan
| | - Ken Nakata
- Medicine for Sports and Performing Arts, Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yuri Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - the SPIRITS investigators
- Department of Food Science, Faculty of Home Economics, Otsuma Women’s University, Tokyo, Japan
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
- Department of Nutrition and Health Science, Faculty of Health and Medical Science, Kanagawa Institute of Technology, Atsugi, Japan
- Institute of Human Culture Studies, Otsuma Women’s University, Tokyo, Japan
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Osaka, Japan
- Division of Patient Safety, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
- Kyoto University Health Service, Kyoto, Japan
- Medicine for Sports and Performing Arts, Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, Suita, Japan
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2
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Rahman MM, Albeverio S, Kagawa T, Kawasaki S, Okai T, Oya H, Yahagi Y, Yoshida MW. High accuracy distinction of shockable and non-shockable arrhythmias in abnormal classes through wavelet transform with pseudo differential like operators. Sci Rep 2023; 13:9513. [PMID: 37308508 DOI: 10.1038/s41598-023-36463-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 06/04/2023] [Indexed: 06/14/2023] Open
Abstract
Arrhythmia is an abnormal rhythm of the heart which leads to sudden death. Among these arrhythmias, some are shockable, and some are non-shockable arrhythmias with external defibrillation. The automated external defibrillator (AED) is used as the automated arrhythmia diagnosis system and requires an accurate and rapid decision to increase the survival rate. Therefore, a precise and quick decision by the AED has become essential in improving the survival rate. This paper presents an arrhythmia diagnosis system for the AED by engineering methods and generalized function theories. In the arrhythmia diagnosis system, the proposed wavelet transform with pseudo-differential like operators-based method effectively generates a distinguishable scalogram for the shockable and non-shockable arrhythmia in the abnormal class signals, which leads to the decision algorithm getting the best distinction. Then, a new quality parameter is introduced to get more details by quantizing the statistical features on the scalogram. Finally, design a simple AED shock and non-shock advice method by following this information to improve the precision and rapid decision. Here, an adequate topology (metric function) is adopted to the space of the scatter plot, where we can give different scales to select the best area of the scatter plot for the test sample. As a consequence, the proposed decision method gives the highest accuracy and rapid decision between shockable and non-shockable arrhythmias. The proposed arrhythmia diagnosis system increases the accuracy to 97.98%, with a gain of 11.75% compared to the conventional approach in the abnormal class signals. Therefore, the proposed method contributes an additional 11.75% possibility for increasing the survival rate. The proposed arrhythmia diagnosis system is general and could be applied to distinguish different arrhythmia-based applications. Also, each contribution could be used independently in various applications.
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Affiliation(s)
- Md Masudur Rahman
- Graduate School of Engineering, Kanagawa University, Yokohama, Japan.
| | - Sergio Albeverio
- Inst. Angewandte Mathematik, and HCM, University of Bonn, Bonn, Germany
| | - Toshinao Kagawa
- School of General Education and Management Studies, Suwa University of Science, Nagano, Japan
| | - Shuji Kawasaki
- Faculty of Science and Engineering, Iwate University, Iwate, Japan
| | - Takayuki Okai
- Faculty of Information Engineering, Tokyo City University, Tokyo, Japan
| | - Hidetoshi Oya
- Faculty of Information Engineering, Tokyo City University, Tokyo, Japan
| | - Yumi Yahagi
- Department of Information Systems, Tokyo City University, Tokyo, Japan
| | - Minoru W Yoshida
- Graduate School of Engineering, Kanagawa University, Yokohama, Japan
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3
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Pocock H, Deakin CD, Lall R, Smith CM, Perkins GD. Effectiveness of alternative shock strategies for out-of-hospital cardiac arrest: A systematic review. Resusc Plus 2022; 10:100232. [PMID: 35602465 PMCID: PMC9114679 DOI: 10.1016/j.resplu.2022.100232] [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: 02/21/2022] [Revised: 03/18/2022] [Accepted: 04/02/2022] [Indexed: 11/24/2022] Open
Abstract
Aim To determine the optimal first-shock energy level for biphasic defibrillation and whether fixed or escalating protocols for subsequent shocks are most effective. Methods We searched Medline, Embase, Cochrane CENTRAL, CINAHL, the Web of Science and national and international trial registry databases for papers published from database inception to January 2022. We reviewed reference lists of key papers to identify additional references. The population included adults sustaining non traumatic out-of-hospital cardiac arrest subject to attempted defibrillation. Studies of internal or monophasic defibrillation and studies other than randomised controlled trials or prospective cohorts were excluded. Two reviewers assessed study relevance. Data extraction and risk of bias assessment, using the ROBINS-I tool, were conducted by one reviewer and checked by a second reviewer. Data underwent intention-to-treat analysis. Results We identified no studies evaluating first shock energy. Only one study (n = 738) comparing fixed versus escalating energy met eligibility criteria: a prospective cohort analysis of a randomised controlled trial of manual versus mechanical CPR. High fixed (360 J) energy was compared with an escalating (200-200/300-360 J) strategy. Researchers found 27.5% (70/255) of patients in the escalating energy group and 27.61% (132/478) in the fixed high energy group survived to hospital discharge (unadjusted risk ratio 0.99, 95% CI 0.73, 1.23). Results were of very low certainty as the study was at serious risk of bias. Conclusion This systematic review did not identify an optimal first-shock energy for biphasic defibrillation. We identified no survival advantage at 30 days when comparing 360 J fixed with 200 J escalating strategy.
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Affiliation(s)
- Helen Pocock
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, United Kingdom
- South Central Ambulance Service NHS Foundation Trust, Southern House, Sparrowgrove, Otterbourne, Winchester SO21 2RU, United Kingdom
| | - Charles D Deakin
- South Central Ambulance Service NHS Foundation Trust, Southern House, Sparrowgrove, Otterbourne, Winchester SO21 2RU, United Kingdom
- University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, United Kingdom
| | - Ranjit Lall
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, United Kingdom
| | - Christopher M Smith
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, United Kingdom
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, United Kingdom
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4
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Liu Z, Zhang L, Yan Z, Ren Z, Han F, Tan X, Xiang Z, Dong F, Yang Z, Liu G, Wang Z, Zhang J, Que T, Tang C, Li Y, Wang S, Wu J, Li L, Huang C, Roos C, Li M. Genomic Mechanisms of Physiological and Morphological Adaptations of Limestone Langurs to Karst Habitats. Mol Biol Evol 2021; 37:952-968. [PMID: 31846031 DOI: 10.1093/molbev/msz301] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Knowledge of the physiological and morphological evolution and adaptation of nonhuman primates is critical to understand hominin origins, physiological ecology, morphological evolution, and applications in biomedicine. Particularly, limestone langurs represent a direct example of adaptations to the challenges of exploiting a high calcium and harsh environment. Here, we report a de novo genome assembly (Tfra_2.0) of a male François's langur (Trachypithecus francoisi) with contig N50 of 16.3 Mb and resequencing data of 23 individuals representing five limestone and four forest langur species. Comparative genomics reveals evidence for functional evolution in genes and gene families related to calcium signaling in the limestone langur genome, probably as an adaptation to naturally occurring high calcium levels present in water and plant resources in karst habitats. The genomic and functional analyses suggest that a single point mutation (Lys1905Arg) in the α1c subunit of the L-type voltage-gated calcium channel Cav1.2 (CACNA1C) attenuates the inward calcium current into the cells in vitro. Population genomic analyses and RNA-sequencing indicate that EDNRB is less expressed in white tail hair follicles of the white-headed langur (T. leucocephalus) compared with the black-colored François's langur and hence might be responsible for species-specific differences in body coloration. Our findings contribute to a new understanding of gene-environment interactions and physiomorphological adaptative mechanisms in ecologically specialized primate taxa.
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Affiliation(s)
- Zhijin Liu
- CAS Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Beijing 100101, China.,Institute of Physical Science and Information Technology, Anhui University, Hefei 230601, China
| | - Liye Zhang
- CAS Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Beijing 100101, China.,University of Chinese Academy of Sciences, Beijing 100049, China
| | - Zhongze Yan
- CAS Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Beijing 100101, China.,Institute of Physical Science and Information Technology, Anhui University, Hefei 230601, China
| | - Zhijie Ren
- College of Life Sciences, Capital Normal University, Beijing 100048, China
| | - Fengming Han
- Biomarker Technologies Corporation, Beijing 101300, China
| | - Xinxin Tan
- CAS Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Beijing 100101, China.,University of Chinese Academy of Sciences, Beijing 100049, China
| | - Zhiyuan Xiang
- CAS Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Beijing 100101, China.,University of Chinese Academy of Sciences, Beijing 100049, China
| | - Fang Dong
- CAS Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Beijing 100101, China.,Institute of Physical Science and Information Technology, Anhui University, Hefei 230601, China
| | - Zuomin Yang
- CAS Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Beijing 100101, China.,School of Life Sciences, Qufu Normal University, Qufu 273165, Shandong, China
| | - Guangjian Liu
- CAS Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Beijing 100101, China
| | - Ziming Wang
- CAS Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Beijing 100101, China.,University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jiali Zhang
- CAS Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Beijing 100101, China
| | - Tengcheng Que
- Guangxi Zhuang Autonomous Region Terrestrial Wildlife Medical-Aid Monitoring Epidemic Diseases Research Center, Nanning 530001, Guangxi Province, China
| | - Chaohui Tang
- Wuzhou Langur Breeding and Research Center, Wuzhou 543002, Guangxi Province, China
| | - Yifeng Li
- Wuzhou Langur Breeding and Research Center, Wuzhou 543002, Guangxi Province, China
| | - Song Wang
- Nanning Zoo, Nanning 530000, Guangxi Province, China
| | - Junyi Wu
- Nanning Zoo, Nanning 530000, Guangxi Province, China
| | - Legong Li
- College of Life Sciences, Capital Normal University, Beijing 100048, China
| | - Chengming Huang
- CAS Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Beijing 100101, China
| | - Christian Roos
- Gene Bank of Primates and Primate Genetics Laboratory, German Primate Center, Leibniz Institute for Primate Research, Göttingen 37077, Germany
| | - Ming Li
- CAS Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Beijing 100101, China.,Center for Excellence in Animal Evolution and Genetics, Chinese Academy of Sciences, Kunming 650223, China
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5
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Thompson PD, Baggish AL, Franklin B, Jaworski C, Riebe D. American College of Sports Medicine Expert Consensus Statement to Update Recommendations for Screening, Staffing, and Emergency Policies to Prevent Cardiovascular Events at Health Fitness Facilities. Curr Sports Med Rep 2020; 19:223-231. [PMID: 32516193 DOI: 10.1249/jsr.0000000000000721] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | - Aaron L Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, MA
| | - Barry Franklin
- Division of Cardiology, William Beaumont Hospital, Royal Oak, MI
| | - Carrie Jaworski
- Division of Primary Care Sports Medicine, NorthShore University HealthSystem, Glenview, IL
| | - Deborah Riebe
- Department of Kinesiology, University of Rhode Island, Kingston, RI
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6
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Defibrillator charging before rhythm analysis causes peri-shock pauses exceeding guideline recommended maximum 5 s : A randomized simulation trial. Anaesthesist 2020; 68:546-554. [PMID: 31332449 DOI: 10.1007/s00101-019-0623-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Charging defibrillators prior to analyzing heart rhythms may decrease the no-flow time during rhythm check pauses while resuscitating in cardiac arrest. Although this anticipatory method is already used in some centers little is known about its safety. This study was carried out to confirm the safety and feasibility of the anticipatory method. It was hypothesized that this anticipatory method results in shorter total no-flow times, while other parameters of defibrillation efficacy including defibrillator safety and minimization of peri-shock pauses are unchanged. METHODS This manikin study assigned 243 medical students randomly to study groups, 121 to the anticipatory method and 122 to the recommended European Resuscitation Council (ERC) algorithm. Of these 237 students ultimately underwent training (112 anticipatory method vs. 125 ERC algorithm). Participants were assessed and video recorded during a simulated cardiac arrest scenario which included three different heart rhythms (ventricular fibrillation [VF], pulseless ventricular tachycardia [pVT], asystole) in randomized order. Video and software analyses were performed. Defibrillation safety was assessed using a 17-item checklist defined beforehand. RESULTS A total of 203 simulated cardiac arrests (75 anticipatory method and 128 ERC 2010 algorithm) were analyzed. The anticipatory method did not significantly reduce no-flow time (25.8 s, standard deviation, SD 7.4 s vs. 27.4 s SD 8.4 s, p = 0.19); however, peri-shock pauses were significantly longer in the anticipatory group compared to the ERC 2010 group (9.5 s SD 2.8 s vs. 3.3 s SD 1.9 s, p < 0.001). No significant difference concerning defibrillation safety between the groups was observed according to the 17-item checklist (14.6 SD 1.6 vs. 15.0 SD 1.4, p = 0.07). CONCLUSION Charging defibrillators before rhythm analysis did not decrease total no-flow time in simulated cardiac arrests but resulted in significantly longer peri-shock pauses exceeding 5 s. No significant differences in defibrillation safety were observed between the groups.
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7
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Olsen JA, Brunborg C, Steinberg M, Persse D, Sterz F, Lozano M, Westfall M, van Grunsven PM, Lerner EB, Wik L. Survival to hospital discharge with biphasic fixed 360 joules versus 200 escalating to 360 joules defibrillation strategies in out-of-hospital cardiac arrest of presumed cardiac etiology. Resuscitation 2019; 136:112-118. [PMID: 30708074 DOI: 10.1016/j.resuscitation.2019.01.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/02/2019] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Guidelines recommend constant or escalating energy levels for shocks after the initial defibrillation attempt. Studies comparing survival to hospital discharge with escalating vs fixed high energy level shocks are lacking. We compared survival to hospital discharge for 200 J escalating to 360 J vs fixed 360 J in patients with initial ventricular fibrillation/pulseless ventricular tachycardia in a post-hoc analysis of the Circulation Improving Resuscitation Care trial database. METHODS AND RESULTS Pre-shock rhythm, rhythm 5 s after shock, shock energy levels, termination of ventricular fibrillation/pulseless ventricular tachycardia (TOF), and survival to hospital discharge were recorded. Association between defibrillation strategy and survival to hospital discharge was investigated with multivariable logistic regression. The escalating energy group included 260 patients and 883 shocks vs 478 patients and 1736 shocks in the fixed-high energy group. There was no difference in survival to hospital discharge between escalating (70/255 patients, 28%) and fixed energy group (132/478 patients, 28%) (unadjusted OR 1.00, 95% CI 0.72-1.42 and adjusted OR 0.81, 95% CI 0.54-1.22, p = 0.32). First shock TOF was 86% in the escalating group compared to 83% in the fixed-high group, p = 0.27. CONCLUSION There was no difference in survival to hospital discharge or the frequency of TOF between escalating energy and fixed-high energy group. ClinicalTrials.gov Identifier: NCT00597207.
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Affiliation(s)
- Jan-Aage Olsen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway; Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Cathrine Brunborg
- Department of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Mikkel Steinberg
- Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - David Persse
- Houston Fire Department and the Baylor College of Medicine, Houston, TX, United States
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Lozano
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Mark Westfall
- Gold Cross Ambulance Service, Appleton Neenah-Menasha and Grand Chute Fire Departments, WI, United States; Theda Clark Regional Medical Center, Neenah, WI, United States
| | | | - E Brooke Lerner
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Lars Wik
- Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway.
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8
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Vasconcellos AP, Huntley CT, Schell AE, Soose RJ, Boon MS. Dysfunctional hypoglossal nerve stimulator after electrical cardioversion: A case series. Laryngoscope 2018; 129:1949-1953. [PMID: 30444012 DOI: 10.1002/lary.27488] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Upper airway stimulation has demonstrated marked improvements in apnea-hypopnea index, oxygen desaturation index, and quality-of-life measures in patients with moderate to severe obstructive sleep apnea (OSA) who cannot tolerate continuous positive airway pressure. Cardiac arrhythmias are common in patients with OSA and can require electrical cardioversion. We describe the first four reported cases of hypoglossal nerve stimulator (HGNS) dysfunction after electrical cardioversion and illustrate our operative approach to device troubleshooting and repair. STUDY DESIGN Retrospective case series. METHODS A retrospective review of 201 HGNS implantations performed at two academic institutions revealed four cases of HGNS device dysfunction after electrical cardioversion requiring surgical revision. Preoperative and postoperative device performance metrics and electrical cardioversion specifications were retrospectively assessed and compiled for this case series. The senior authors (R.J.S., M.S.B.) detail operative planning and approach for HGNS implantable pulse generator (IPG) replacement. RESULTS At least two patients with HGNS device dysfunction had received cardioversion via anterolateral electrode pad placement. Three patients had received multiple shocks. All four patients experienced a change in device functionality or complete cessation of functionality after electrocardioversion. Operatively, each patient required replacement of the IPG, with subsequent intraoperative interrogation revealing proper device functionality. CONCLUSION Counseling for patients with HGNS undergoing external electrical cardioversion should include possible device damage and need for operative replacement. Anteroposterior electrode pad placement should be considered for patients with HGNS who require electrocardioversion. Operative replacement of an HGNS system damaged by electrocardioversion begins with IPG replacement and intraoperative device interrogation. LEVEL OF EVIDENCE 4 Laryngoscope, 129:1949-1953, 2019.
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Affiliation(s)
- Adam P Vasconcellos
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Colin T Huntley
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Amy E Schell
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Ryan J Soose
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Maurits S Boon
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
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9
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Lee CYF, Anantharaman V, Lim SH, Ng YY, Chee TS, Seet CM, Ong MEH. Singapore Defibrillation Guidelines 2016. Singapore Med J 2018; 58:354-359. [PMID: 28741000 DOI: 10.11622/smedj.2017068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The most common initial rhythm in a sudden cardiac arrest is ventricular fibrillation or pulseless ventricular tachycardia. This is potentially treatable with defibrillation, especially if provided early. However, any delay in defibrillation will result in a decline in survival. Defibrillation requires coordination with the cardiopulmonary resuscitation component for effective resuscitation. These two components, which form the key links in the chain of survival, have to be brought to the cardiac victim in a timely fashion. An effective chain of survival is needed in both the institution and community settings.
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Affiliation(s)
| | | | - Swee Han Lim
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Yih Yng Ng
- Medical Department, Singapore Civil Defence Force, Singapore
| | - Tek Siong Chee
- Chee Heart Specialist Clinic, Parkway East Hospital, Singapore
| | - Chong Meng Seet
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore.,Health Services and Systems Research, Duke-NUS Medical School, Singapore
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10
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Nehme Z, Andrew E, Nair R, Bernard S, Smith K. Manual Versus Semiautomatic Rhythm Analysis and Defibrillation for Out-of-Hospital Cardiac Arrest. Circ Cardiovasc Qual Outcomes 2018; 10:CIRCOUTCOMES.116.003577. [PMID: 28698191 DOI: 10.1161/circoutcomes.116.003577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 05/15/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although manual and semiautomatic external defibrillation (SAED) are commonly used in the management of out-of-hospital cardiac arrest, the optimal strategy is not known. We hypothesized that SAED would reduce the time to first shock and lead to higher rates of cardioversion and survival compared with a manual strategy. METHODS AND RESULTS Between July 2005 and June 2015, we included adult out-of-hospital cardiac arrest of presumed cardiac pathogenesis. On October 2012, a treatment protocol using SAED was introduced after years of manual defibrillation. The effect of the SAED implementation on the time to first shock, successful cardioversion, and patient outcomes was assessed using interrupted time series regression adjusting for arrest factors and temporal trend. Of the 14 776 cases, 10 224 (69.2%) and 4552 (30.8%) occurred during the manual and SAED protocols, respectively. Although the proportion of patients shocked within 2 minutes of arrival increased during the SAED protocol for initial shockable rhythms (from 58.9% to 69.2%; P<0.001), there was no difference in unadjusted rate of successful cardioversion after first shock (from 12.3% to 13.8%; P=0.13). After adjustment, the odds of delivering the first shock within 2 minutes of arrival increased under the SAED protocol (adjusted odds ratio [AOR], 1.72; 95% confidence interval [CI], 1.32-2.26; P<0.001). Despite this, the SAED protocol was associated with a reduction in survival to hospital discharge (AOR, 0.71; 95% CI, 0.55-0.92; P=0.009), event survival (AOR, 0.74; 95% CI, 0.62-0.88; P=0.001), and prehospital return of spontaneous circulation (AOR, 0.81; 95% CI, 0.68-0.96; P=0.01) when compared with the manual protocol. There was also no improvement in the rate of successful cardioversion after first shock (AOR, 0.73; 95% CI, 0.51-1.06; P=0.10). CONCLUSIONS Although SAED improved the time to first shock, this did not translate into higher rates of successful cardioversion or survival after out-of-hospital cardiac arrest. Advanced life support providers should be trained to use a manual defibrillation protocol.
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Affiliation(s)
- Ziad Nehme
- From the Department of Research and Evaluation, Ambulance Victoria, Doncaster, Australia (Z.N., E.A., R.N., S.B., K.S.); Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia (Z.N., E.A., S.B., K.S.); Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia (Z.N., K.S.); Intensive Care Unit, Alfred Hospital, Prahran, Victoria, Australia (S.B.); and Discipline of Emergency Medicine, University of Western Australia, Crawley, Australia (K.S.).
| | - Emily Andrew
- From the Department of Research and Evaluation, Ambulance Victoria, Doncaster, Australia (Z.N., E.A., R.N., S.B., K.S.); Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia (Z.N., E.A., S.B., K.S.); Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia (Z.N., K.S.); Intensive Care Unit, Alfred Hospital, Prahran, Victoria, Australia (S.B.); and Discipline of Emergency Medicine, University of Western Australia, Crawley, Australia (K.S.)
| | - Resmi Nair
- From the Department of Research and Evaluation, Ambulance Victoria, Doncaster, Australia (Z.N., E.A., R.N., S.B., K.S.); Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia (Z.N., E.A., S.B., K.S.); Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia (Z.N., K.S.); Intensive Care Unit, Alfred Hospital, Prahran, Victoria, Australia (S.B.); and Discipline of Emergency Medicine, University of Western Australia, Crawley, Australia (K.S.)
| | - Stephen Bernard
- From the Department of Research and Evaluation, Ambulance Victoria, Doncaster, Australia (Z.N., E.A., R.N., S.B., K.S.); Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia (Z.N., E.A., S.B., K.S.); Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia (Z.N., K.S.); Intensive Care Unit, Alfred Hospital, Prahran, Victoria, Australia (S.B.); and Discipline of Emergency Medicine, University of Western Australia, Crawley, Australia (K.S.)
| | - Karen Smith
- From the Department of Research and Evaluation, Ambulance Victoria, Doncaster, Australia (Z.N., E.A., R.N., S.B., K.S.); Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia (Z.N., E.A., S.B., K.S.); Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia (Z.N., K.S.); Intensive Care Unit, Alfred Hospital, Prahran, Victoria, Australia (S.B.); and Discipline of Emergency Medicine, University of Western Australia, Crawley, Australia (K.S.)
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Factors of importance to 30-day survival after in-hospital cardiac arrest in Sweden – A population-based register study of more than 18,000 cases. Int J Cardiol 2018; 255:237-242. [DOI: 10.1016/j.ijcard.2017.12.068] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/12/2017] [Accepted: 12/19/2017] [Indexed: 11/21/2022]
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Chang HC, Lin JF, Yeh KH. Paddle Position and Contact Force: An Important Step to Check When Troubleshooting for Refractory Ventricular Fibrillation. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791602300506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Ventricular fibrillation (VF) is a lethal medical emergency that requires immediate defibrillation. VF is resistant when it persists after three or more defibrillator shocks. Successful defibrillation requires depolarisation of a critical mass of myocardium. Several variables, such as the length of time in VF, body type, total energy used, and energy waveform have been reported to be associated with the success rate of defibrillation. Correct paddle position and good contact force to create an adequate current flow through the heart is essential for defibrillation. We report a patient who developed VF because of acute myocardial infarction that was resistant to a total of 13 shocks. The cause of shock-resistant VF was diagnosed by noticing the skin marks caused by the defibrillator paddle that indicated incorrect paddle position and inadequate paddle force. By checking the skin marks, an emergency physician could make a correct diagnosis within a few seconds and save a patient.
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OH SHULIH, HAGIWARA YUKI, ADAM MUHAMMAD, SUDARSHAN VIDYAK, KOH JOELEW, TAN JENHONG, CHUA CHUAK, TAN RUSAN, NG EDDIEYK. SHOCKABLE VERSUS NONSHOCKABLE LIFE-THREATENING VENTRICULAR ARRHYTHMIAS USING DWT AND NONLINEAR FEATURES OF ECG SIGNALS. J MECH MED BIOL 2017. [DOI: 10.1142/s0219519417400048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Shockable ventricular arrhythmias (VAs) such as ventricular tachycardia (VT) and ventricular fibrillation (VFib) are the life-threatening conditions requiring immediate attention. Cardiopulmonary resuscitation (CPR) and defibrillation are the significant immediate recommended treatments for these shockable arrhythmias to obtain the return of spontaneous circulation. However, accurate classification of these shockable VAs from nonshockable ones is the key step during defibrillation by automated external defibrillator (AED). Therefore, in this work, we have proposed a novel algorithm for an automated differentiation of shockable and nonshockable VAs from electrocardiogram (ECG) signal. The ECG signals are segmented into 5, 8 and 10[Formula: see text]s. These segmented ECGs are subjected to four levels of discrete wavelet transformation (DWT). Various nonlinear features such as approximate entropy ([Formula: see text], signal energy ([Formula: see text]), Fuzzy entropy ([Formula: see text]), Kolmogorov Sinai entropy ([Formula: see text], permutation entropy ([Formula: see text]), Renyi entropy ([Formula: see text]), sample entropy ([Formula: see text]), Shannon entropy ([Formula: see text]), Tsallis entropy ([Formula: see text]), wavelet entropy ([Formula: see text]), fractal dimension ([Formula: see text]), Kolmogorov complexity ([Formula: see text]), largest Lyapunov exponent ([Formula: see text]), recurrence quantification analysis (RQA) parameters ([Formula: see text]), Hurst exponent ([Formula: see text]), activity entropy ([Formula: see text]), Hjorth complexity ([Formula: see text]), Hjorth mobility ([Formula: see text]), modified multi scale entropy ([Formula: see text]) and higher order statistics (HOS) bispectrum ([Formula: see text]) are obtained from the DWT coefficients. Later, these features are subjected to sequential forward feature selection (SFS) method and selected features are then ranked using seven ranking methods namely, Bhattacharyya distance, entropy, Fuzzy maximum relevancy and minimum redundancy (mRMR), receiver operating characteristic (ROC), Student’s [Formula: see text]-test, Wilcoxon and ReliefF. These ranked features are supplied independently into the [Formula: see text]-Nearest Neighbor (kNN) classifier. Our proposed system achieved maximum accuracy, sensitivity and specificity of (i) 97.72%, 94.79% and 98.74% for 5[Formula: see text]s, (ii) 98.34%, 95.49% and 99.14% for 8[Formula: see text]s and (iii) 98.32%, 95.16% and 99.20% for 10[Formula: see text]s of ECG segments using only ten features. The integration of the proposed algorithm with ECG acquisition systems in the intensive care units (ICUs) can help the clinicians to decipher the shockable and nonshockable life-threatening arrhythmias accurately. Hence, doctors can use the CPR or AED immediately and increase the chance of survival during shockable life-threatening arrhythmia intervals.
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Affiliation(s)
- SHU LIH OH
- Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore
| | - YUKI HAGIWARA
- Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore
| | - MUHAMMAD ADAM
- Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore
| | - VIDYA K. SUDARSHAN
- Department of Biomedical Engineering, School of Science and Technology, Singapore University of Social Sciences, Singapore
- School of Electrical and Computer Engineering, University of Newcastle, Singapore
| | - JOEL EW KOH
- Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore
| | - JEN HONG TAN
- Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore
| | - CHUA K. CHUA
- Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore
| | - RU SAN TAN
- Department of Cardiology, National Heart Centre, Singapore
| | - EDDIE Y. K. NG
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
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14
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Stærk M, Bødtker H, Lauridsen KG, Løfgren B. Automated external defibrillation training on the left or the right side - a randomized simulation study. Open Access Emerg Med 2017; 9:73-79. [PMID: 29066936 PMCID: PMC5605125 DOI: 10.2147/oaem.s140220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Correct placement of the left automated external defibrillator (AED) electrode is rarely achieved. AED electrode placement is predominantly illustrated and trained with the rescuer sitting on the right side of the patient. Placement of the AED electrodes from the left side of the patient may result in a better overview of and access to the left lateral side of the thorax. This study aimed to investigate if training in automated external defibrillation on the left side compared to the right side of a manikin improves left AED electrode placement. Methods Laypeople attending basic life support training were randomized to learn automated external defibrillation from the left or right side of a manikin. After course completion, participants used an AED and placed AED electrodes in a simulated cardiac arrest scenario. Results In total, 40 laypersons were randomized to AED training on the left (n=19 [missing data =1], 63% female, mean age: 47.3 years) and right (n=20, 75% female, mean age: 48.7 years) sides of a manikin. There was no difference in left AED electrode placement when trained on the left or right side: the mean (SD) distances to the recommended left AED electrode position were 5.9 (2.1) cm vs 6.9 (2.2) cm (p=0.15) and to the recommended right AED electrode position were 2.6 (1.5) cm vs 1.8 (0.8) cm (p=0.06), respectively. Conclusion Training in automated external defibrillation on the left side of a manikin does not improve left AED electrode placement compared to training on the right side.
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Affiliation(s)
- Mathilde Stærk
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus
| | - Henrik Bødtker
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus
| | - Kasper G Lauridsen
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus.,Clinical Research Unit.,Department of Internal Medicine, Randers Regional Hospital, Randers
| | - Bo Løfgren
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus.,Department of Internal Medicine, Randers Regional Hospital, Randers.,Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
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15
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Soar J, Nolan J, Böttiger B, Perkins G, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars M, Smith G, Sunde K, Deakin C. Erweiterte Reanimationsmaßnahmen für Erwachsene („adult advanced life support“). Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0330-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Update on in hospital resuscitation. Med Clin (Barc) 2016; 147:558-563. [PMID: 27855945 DOI: 10.1016/j.medcli.2016.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 10/06/2016] [Indexed: 11/21/2022]
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17
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Rajagopal S, Kaye C, Lall R, Deakin C, Gates S, Pocock H, Quinn T, Rees N, Smyth M, Perkins G. Characteristics of patients who are not resuscitated in out of hospital cardiac arrests and opportunities to improve community response to cardiac arrest. Resuscitation 2016; 109:110-115. [DOI: 10.1016/j.resuscitation.2016.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/14/2016] [Accepted: 09/14/2016] [Indexed: 01/25/2023]
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18
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RAMIREZ FDANIEL, FISET SANDRAL, CLELAND MARKJ, ZAKUTNEY TIMOTHYJ, NERY PABLOB, NAIR GIRISHM, REDPATH CALUMJ, SADEK MOUHANNADM, BIRNIE DAVIDH. Effect of Applying Force to Self-Adhesive Electrodes on Transthoracic Impedance: Implications for Electrical Cardioversion. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:1141-1147. [DOI: 10.1111/pace.12937] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 07/20/2016] [Accepted: 08/18/2016] [Indexed: 11/28/2022]
Affiliation(s)
- F. DANIEL RAMIREZ
- Arrhythmia Service; University of Ottawa Heart Institute; Ottawa Ontario Canada
| | - SANDRA L. FISET
- Biomedical Engineering; University of Ottawa Heart Institute; Ottawa Ontario Canada
| | - MARK J. CLELAND
- Biomedical Engineering; University of Ottawa Heart Institute; Ottawa Ontario Canada
| | - TIMOTHY J. ZAKUTNEY
- Biomedical Engineering; University of Ottawa Heart Institute; Ottawa Ontario Canada
| | - PABLO B. NERY
- Arrhythmia Service; University of Ottawa Heart Institute; Ottawa Ontario Canada
| | - GIRISH M. NAIR
- Arrhythmia Service; University of Ottawa Heart Institute; Ottawa Ontario Canada
| | - CALUM J. REDPATH
- Arrhythmia Service; University of Ottawa Heart Institute; Ottawa Ontario Canada
| | - MOUHANNAD M. SADEK
- Arrhythmia Service; University of Ottawa Heart Institute; Ottawa Ontario Canada
| | - DAVID H. BIRNIE
- Arrhythmia Service; University of Ottawa Heart Institute; Ottawa Ontario Canada
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19
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Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars MB, Smith GB, Sunde K, Deakin CD. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation 2016; 95:100-47. [PMID: 26477701 DOI: 10.1016/j.resuscitation.2015.07.016] [Citation(s) in RCA: 923] [Impact Index Per Article: 115.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK.
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Pierre Carli
- SAMU de Paris, Department of Anaesthesiology and Intensive Care, Necker University Hospital, Paris, France
| | - Tommaso Pellis
- Anaesthesia, Intensive Care and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
| | - Markus B Skrifvars
- Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Gary B Smith
- Centre of Postgraduate Medical Research & Education, Bournemouth University, Bournemouth, UK
| | - Kjetil Sunde
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care, NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK
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The Effect of the Duration of Basic Life Support Training on the Learners' Cardiopulmonary and Automated External Defibrillator Skills. BIOMED RESEARCH INTERNATIONAL 2016; 2016:2420568. [PMID: 27529066 PMCID: PMC4978818 DOI: 10.1155/2016/2420568] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/17/2016] [Accepted: 06/23/2016] [Indexed: 11/17/2022]
Abstract
Background. Basic life support (BLS) training with hands-on practice can improve performance during simulated cardiac arrest, although the optimal duration for BLS training is unknown. This study aimed to assess the effectiveness of various BLS training durations for acquiring cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) skills. Methods. We randomised 485 South Korean nonmedical college students into four levels of BLS training: level 1 (40 min), level 2 (80 min), level 3 (120 min), and level 4 (180 min). Before and after each level, the participants completed questionnaires regarding their willingness to perform CPR and use AEDs, and their psychomotor skills for CPR and AED use were assessed using a manikin with Skill-Reporter™ software. Results. There were no significant differences between levels 1 and 2, although levels 3 and 4 exhibited significant differences in the proportion of overall adequate chest compressions (p < 0.001) and average chest compression depth (p = 0.003). All levels exhibited a greater posttest willingness to perform CPR and use AEDs (all, p < 0.001). Conclusions. Brief BLS training provided a moderate level of skill for performing CPR and using AEDs. However, high-quality skills for CPR required longer and hands-on training, particularly hands-on training with AEDs.
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21
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Hulleman M, Mes H, Blom MT, Koster RW. Conduction disorders in bradyasystolic out-of-hospital cardiac arrest. Resuscitation 2016; 106:113-9. [PMID: 27422306 DOI: 10.1016/j.resuscitation.2016.06.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/17/2016] [Accepted: 06/22/2016] [Indexed: 10/21/2022]
Abstract
AIMS Bradyasystolic heart rhythms are often recorded in out-of-hospital cardiac arrest (OHCA). Atrioventricular (AV) conduction disorders might lead to OHCA, but the prevalence of AV-conduction disorders and other bradyasystolic rhythms in OHCA is unknown. These patients might benefit from pre-hospital pacing. We aimed to determine the prevalence of different types of bradyasystolic heart rhythms in OHCA, including third degree AV-block, and document survival rates. METHODS We used data from the ARREST-registry of OHCA in the Netherlands. Patients with bradyasystolic OHCA in 2006-2012 were included. ECGs were classified according to the presence of P-waves and QRS complexes in five rhythm groups. Differences in survival to discharge in relation to resuscitation characteristics, rhythm and pacing were tested using Chi-Square test and multivariate regression analysis. RESULTS We included 2333 patients with a bradyasystolic rhythm; 371 patients (16%) presented with a third degree AV-block. In total 45 patients (1.9%, 95%-CI 1.4-2.5%) survived. A third degree AV-block (adjusted OR 0.86, 95%-CI 0.38-1.96) or pacing (adjusted OR 0.89, 95%-CI 0.21-3.78) was not associated with survival. Pacing was initiated in 110 patients (4.7%), after a long delay (median 18.7min). The strongest association with survival was found for the presence of a bradycardia (vs. asystole) (adjusted OR 4.20, 95%-CI 1.79-9.83), bystander witnessed (OR 4.13, 95%-CI 1.45-11.8) and EMS witnessed collapse (OR 5.18, 95%-CI 2.77-9.67). CONCLUSION In bradyasystolic OHCA, 16% of all patients present with third degree AV-block, but survival for these and other bradyasystolic patients remains poor. Pacing is seldom initiated, often delayed, and rarely beneficial.
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Affiliation(s)
- Michiel Hulleman
- Academic Medical Center - Department of Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Hanne Mes
- Academic Medical Center - Department of Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Marieke T Blom
- Academic Medical Center - Department of Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Rudolph W Koster
- Academic Medical Center - Department of Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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22
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Huschak G, Dünnebier A, Kaisers UX, Bercker S. Automated External Defibrillator Use for In-Hospital Emergency Management. Anaesth Intensive Care 2016; 44:353-8. [DOI: 10.1177/0310057x1604400304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The in-hospital spread of automated external defibrillators (AEDs) is aimed to allow for a shock-delivery within three minutes. However, it has to be questioned if the implementation of AED alone really contributes to a ‘heart-safe hospital’. We performed a cohort study of 1008 in-hospital emergency calls in a university tertiary care hospital, analysing cardiopulmonary resuscitation (CPR) cases with and without AED use. In total, 484 patients (48%) had cardiac arrest and received CPR. Response time of the emergency team was 4.3 ± 4.0 minutes. Only 8% percent of the CPR cases had a shockable rhythm. In three of 43 placements a shock was delivered by the AED. There were no differences in survival between patients with CPR only and CPR with AED use. Our data do not support the use of an AED for in-hospital CPR if a professional response team is rapidly available.
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Affiliation(s)
- G. Huschak
- MD, Anaesthetist, Intensivist, Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Medical Faculty, Leipzig, Germany
| | - A. Dünnebier
- MD, Anaesthetist, Intensivist, Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Medical Faculty, Leipzig, Germany
| | - U. X. Kaisers
- MD, Anaesthetist, Intensivist, Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Medical Faculty, Leipzig, Germany
| | - S. Bercker
- MD, Anaesthetist, Intensivist, Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Medical Faculty, Leipzig, Germany
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Krawczyk P, Kononowicz AA, Andres J. Barriers in the implementation of the Resuscitation Guidelines: European survey of defibrillation techniques. Scand J Trauma Resusc Emerg Med 2016; 24:28. [PMID: 26969512 PMCID: PMC4788833 DOI: 10.1186/s13049-016-0219-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 03/02/2016] [Indexed: 11/12/2022] Open
Abstract
Background The European Resuscitation Council (ERC) Guidelines recommend providing chest compressions during defibrillator charging and using adhesive pads for defibrillation to increase the effectiveness of resuscitation. However, the most common defibrillation technique in each European country is unknown, as are the potential barriers in implementation of the guidelines. The aim of this study was to assess the techniques of defibrillation procedures performed by professional European healthcare providers and to estimate how frequently adhesive pads are used. Methods We sent an online questionnaire to the ERC National Representatives that contained 12 questions regarding the techniques of defibrillation and monitoring heart rhythm during cardiac arrest. We also evaluated the frequency and indications of manual paddles use. Results We collected questionnaires from 27 out of 33 invited ERC member countries. The response rate was 82 %. Seventeen (17/27; 63 %) declared the use of adhesive pads. The leading cause for not using adhesive pads was economic reason (9/17; 53 %). Some respondents declared resistance to using adhesive pads by healthcare providers or tradition connected with manual paddles use. We found three leading techniques of defibrillation with manual paddles: Charging paddles keeping them on the defibrillator during chest compressions being delivered (9/21; 43 %), Charging paddles keeping them on the patient chest during chest compressions being delivered (6/21; 29 %), Charging paddles on the patient chest without chest compressions (5/21; 24 %). Respondents from 11 countries declared the use of gel or electrode pastes during defibrillation with manual paddles. Discussion This study collected preliminary data showing how defibrillation is performed in Europe. It revealed the recommeded techniques underuse and identyfied barriers in the Resuscitation Guidelines implementation. The survey should be open to a wider group of respondents. in each country in future. Conclusions There are limitations and barriers in the implementation of the defibrillation technique guidelines. There are still countries where the use of adhesive pads is low due to economic and traditional reasons. There is a need for further efforts focused on guidelines implementation.
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Affiliation(s)
- Paweł Krawczyk
- Department of Anaesthesiology and Intensive Care, Jagiellonian University Medical College, Kopernika 17, 31-501, Krakow, Poland.
| | - Andrzej A Kononowicz
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Lazarza 16, 31-530, Krakow, Poland
| | - Janusz Andres
- Department of Anaesthesiology and Intensive Care, Jagiellonian University Medical College, Kopernika 17, 31-501, Krakow, Poland
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Kill C, Rupp D, Hartmann H, Wranze E, Müller M, Plöger B. Strukturiertes Team-Feedback bei der Reanimation. Notf Rett Med 2016. [DOI: 10.1007/s10049-015-0115-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Huschak G, Dünnebier A, Kaisers UX, Bercker S. Automated external defibrillator use for in-hospital emergency management. Anaesth Intensive Care 2016. [DOI: 10.1177/0310057x1604400202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary The in-hospital spread of automated external defibrillators (AEDs) is aimed to allow for a shock-delivery within three minutes. However, it has to be questioned if the implementation of AED alone really contributes to a ‘heart-safe hospital’. Methods Cohort study of 1008 in-hospital emergency calls in a university tertiary care hospital. Analysis of cardio-pulmonary resuscitation (CPR) cases with and without AED use. Results A number of 484 patients (48%) had cardiac arrest and received CPR. Response time of the emergency team was 4.3 ± 4.0 minutes. 8% percent of the CPR cases had a shockable rhythm. In only three cases of 43 placements a shock was delivered by the AED. There were no differences in survival between patients with CPR only and CPR with AED use. Conclusion Our data do not support the use of an AED for in-hospital CPR if a professional response team is rapidly available.
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Affiliation(s)
- G. Huschak
- Intensivist, Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Medical Faculty, Leipzig, Germany
| | - A. Dünnebier
- Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Medical Faculty, Leipzig, Germany
| | - U. X. Kaisers
- Anaesthetist, Intensivist, Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Medical Faculty, Leipzig, Germany
| | - S. Bercker
- Intensivist, Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Medical Faculty, Leipzig, Germany
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Yu M, Zhang G, Wu T, Li C, Wan Z, Li L, Wang C, Wang Y, Lu H, Chen F. A new method without reference channels used for ventricular fibrillation detection during cardiopulmonary resuscitation. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2016; 39:391-401. [PMID: 26831488 DOI: 10.1007/s13246-016-0425-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 01/22/2016] [Indexed: 10/22/2022]
Abstract
Ventricular fibrillation (VF) is observed as the initial rhythm in the majority of patients suffering from sudden cardiac arrest. It is vitally important to accurately recognize the initial VF rhythm and then implement electrical defibrillation. However, artifacts produced by chest compression during cardiopulmonary resuscitation (CPR) make the VF detection algorithms utilized by current automated external defibrillators (AEDs) unreliable. CPR must be traditionally interrupted for a reliable diagnosis. However, interruptions in chest compression have a deleterious effect on the success of defibrillation. The elimination of the CPR artifacts would enable compressions to continue during AED VF detection and thereby increase the likelihood of resuscitation success. We have estimated a model of this artifact by adaptively incorporating noise-assisted multivariate empirical mode decomposition (NA-MEMD) and least mean squares (LMS) and then removing the artifact from the corrupted ECGs. The simulation experiment indicated that the CPR artifact could be accurately modeled without any reference channels. We constructed a BP neural network to evaluate the results. A total of 372 VF and 645 normal sinus rhythm (SR) ECG samples were included in the analysis, and 24 CPR artifact signals were used to construct corrupted ECGs. The results indicated that at different SNR levels ranging from 0 to -12 dB, the sensitivity and specificity were always above 95 and 80 %, respectively.
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Affiliation(s)
- Ming Yu
- Institute of Medical Equipment, Academy of Military Medical Science, Tianjin, China
| | - Guang Zhang
- Institute of Medical Equipment, Academy of Military Medical Science, Tianjin, China
| | - Taihu Wu
- Institute of Medical Equipment, Academy of Military Medical Science, Tianjin, China
| | - Chao Li
- Institute of Medical Equipment, Academy of Military Medical Science, Tianjin, China
| | - Zongming Wan
- Department of Pharmacology, Logistics University of Chinese People's Armed Police Forces, Tianjin, China
| | - Liangzhe Li
- Institute of Medical Equipment, Academy of Military Medical Science, Tianjin, China
| | - Chunfei Wang
- Institute of Medical Equipment, Academy of Military Medical Science, Tianjin, China.,Instrument Department, The PLA 174 Hospital, Xiamen, China
| | - Yalin Wang
- Institute of Medical Equipment, Academy of Military Medical Science, Tianjin, China.,Medical Engineering Department, Navy General Hospital of the PLA, Beijing, China
| | - Hengzhi Lu
- Institute of Medical Equipment, Academy of Military Medical Science, Tianjin, China
| | - Feng Chen
- Institute of Medical Equipment, Academy of Military Medical Science, Tianjin, China.
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Monsieurs K, Nolan J, Bossaert L, Greif R, Maconochie I, Nikolaou N, Perkins G, Soar J, Truhlář A, Wyllie J, Zideman D. Kurzdarstellung. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0097-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Soar J, Nolan J, Böttiger B, Perkins G, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars M, Smith G, Sunde K, Deakin C. Erweiterte Reanimationsmaßnahmen für Erwachsene („adult advanced life support“). Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0085-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Glick J, Lehman E, Terndrup T. The effect of compressor-administered defibrillation on peri-shock pauses in a simulated cardiac arrest scenario. West J Emerg Med 2015; 15:246-50. [PMID: 24672620 PMCID: PMC3966454 DOI: 10.5811/westjem.2013.9.18007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 07/04/2013] [Accepted: 09/16/2013] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Coordination of the tasks of performing chest compressions and defibrillation can lead to communication challenges that may prolong time spent off the chest. The purpose of this study was to determine whether defibrillation provided by the provider performing chest compressions led to a decrease in peri-shock pauses as compared to defibrillation administered by a second provider, in a simulated cardiac arrest scenario. METHODS This was a randomized, controlled study measuring pauses in chest compressions for defibrillation in a simulated cardiac arrest model. We approached hospital providers with current CPR certification for participation between July, 2011 and October, 2011. Volunteers were randomized to control (facilitator-administered defibrillation) or experimental (compressor-administered defibrillation) groups. All participants completed one minute of chest compressions on a mannequin in a shockable rhythm prior to administration of defibrillation. We measured and compared pauses for defibrillation in both groups. RESULTS Out of 200 total participants, we analyzed data from 197 defibrillations. Compressor-initiated defibrillation resulted in a significantly lower pre-shock hands-off time (0.57 s; 95% CI: 0.47-0.67) compared to facilitator-initiated defibrillation (1.49 s; 95% CI: 1.35-1.64). Furthermore, compressor-initiated defibrillation resulted in a significantly lower peri-shock hands-off time (2.77 s; 95% CI: 2.58-2.95) compared to facilitator-initiated defibrillation (4.25 s; 95% CI: 4.08-4.43). CONCLUSION Assigning the responsibility for shock delivery to the provider performing compressions encourages continuous compressions throughout the charging period and decreases total time spent off the chest. However, as this was a simulation-based study, clinical implementation is necessary to further evaluate these potential benefits.
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Affiliation(s)
- Joshua Glick
- Penn State Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | - Erik Lehman
- Penn State Hershey College of Medicine, Department of Public Health Sciences, Hershey, Pennsylvania
| | - Thomas Terndrup
- The Ohio State University, College of Medicine, Department of Emergency Medicine, Columbus, Ohio
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Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, Perkins GD, Soar J, Truhlář A, Wyllie J, Zideman DA, Alfonzo A, Arntz HR, Askitopoulou H, Bellou A, Beygui F, Biarent D, Bingham R, Bierens JJ, Böttiger BW, Bossaert LL, Brattebø G, Brugger H, Bruinenberg J, Cariou A, Carli P, Cassan P, Castrén M, Chalkias AF, Conaghan P, Deakin CD, De Buck ED, Dunning J, De Vries W, Evans TR, Eich C, Gräsner JT, Greif R, Hafner CM, Handley AJ, Haywood KL, Hunyadi-Antičević S, Koster RW, Lippert A, Lockey DJ, Lockey AS, López-Herce J, Lott C, Maconochie IK, Mentzelopoulos SD, Meyran D, Monsieurs KG, Nikolaou NI, Nolan JP, Olasveengen T, Paal P, Pellis T, Perkins GD, Rajka T, Raffay VI, Ristagno G, Rodríguez-Núñez A, Roehr CC, Rüdiger M, Sandroni C, Schunder-Tatzber S, Singletary EM, Skrifvars MB, Smith GB, Smyth MA, Soar J, Thies KC, Trevisanuto D, Truhlář A, Vandekerckhove PG, de Voorde PV, Sunde K, Urlesberger B, Wenzel V, Wyllie J, Xanthos TT, Zideman DA. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation 2015; 95:1-80. [PMID: 26477410 DOI: 10.1016/j.resuscitation.2015.07.038] [Citation(s) in RCA: 568] [Impact Index Per Article: 63.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Koenraad G Monsieurs
- Emergency Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, Bristol, UK
| | | | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, University Hospital Bern, Bern, Switzerland; University of Bern, Bern, Switzerland
| | - Ian K Maconochie
- Paediatric Emergency Medicine Department, Imperial College Healthcare NHS Trust and BRC Imperial NIHR, Imperial College, London, UK
| | | | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| | - Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Jonathan Wyllie
- Department of Neonatology, The James Cook University Hospital, Middlesbrough, UK
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Howe A, O'Hare P, Crawford P, Delafont B, McAlister O, Di Maio R, Clutton E, Adgey J, McEneaney D. An investigation of thrust, depth and the impedance cardiogram as measures of cardiopulmonary resuscitation efficacy in a porcine model of cardiac arrest. Resuscitation 2015; 96:114-20. [PMID: 26234892 DOI: 10.1016/j.resuscitation.2015.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 07/20/2015] [Accepted: 07/22/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Optimising the depth and rate of applied chest compressions following out of hospital cardiac arrest is crucial in maintaining end organ perfusion and improving survival. The impedance cardiogram (ICG) measured via defibrillator pads produces a characteristic waveform during chest compressions with the potential to provide feedback on cardiopulmonary resuscitation (CPR) and enhance performance. The objective of this pre-clinical study was to investigate the relationship between mechanical and physiological markers of CPR efficacy in a porcine model and examine the strength of correlation between the ICG amplitude, compression depth and end-tidal CO2 (ETCO2). METHODS Two experiments were performed using 24 swine (12 per experiment). For experiment 1, ventricular fibrillation (VF) was induced and mechanical CPR commenced at varying thrusts (0-60 kg) for 2 min intervals. Chest compression depth was recorded using a Philips QCPR device with additional recording of invasive physiological parameters: systolic blood pressure, ETCO2, cardiac output and carotid flow. For experiment 2, VF was induced and mechanical CPR commenced at varying depths (0-5 cm) for 2 min intervals. The ICG was recorded via defibrillator pads attached to the animal's sternum and connected to a Heartsine 500 P defibrillator. ICG amplitude, chest compression depth, systolic blood pressure and ETCO2 were recorded during each cycle. In both experiments the within-animal correlation between the measured parameters was assessed using a mixed effect model. RESULTS In experiment 1 moderate within-animal correlations were observed between physiological parameters and compression depth (r=0.69-0.77) and thrust (r=0.66-0.82). A moderate correlation was observed between compression depth and thrust (r=0.75). In experiment 2 a strong within-animal correlation and moderate overall correlations were observed between ICG amplitude and compression depth (r=0.89, r=0.79) and ETCO2 (r=0.85, r=0.64). CONCLUSION In this porcine model of induced cardiac arrest moderate within animal correlations were observed between mechanical and physiological markers of chest compression efficacy demonstrating the challenge in utilising a single mechanical metric to quantify chest compression efficacy. ICG amplitude demonstrated strong within animal correlations with compression depth and ETCO2 suggesting its potential utility to provide CPR feedback in the out of hospital setting to improve performance.
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Affiliation(s)
- Andrew Howe
- Cardiovascular Research Unit, Craigavon Area Hospital, Portadown, UK.
| | | | - Paul Crawford
- Veterinary Anaesthesia Consultancy, Larne, Co Antrim, UK
| | | | | | | | - Eddie Clutton
- Royal (Dick) School of Veterinary Studies, Dept. of Anaesthesia, University of Edinburgh, Edinburgh, UK
| | - Jennifer Adgey
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, UK
| | - David McEneaney
- Cardiovascular Research Unit, Craigavon Area Hospital, Portadown, UK
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Olsen JA, Brunborg C, Steinberg M, Persse D, Sterz F, Lozano M, Westfall M, Travis DT, Lerner EB, Brouwer MA, Wik L. Pre-shock chest compression pause effects on termination of ventricular fibrillation/tachycardia and return of organized rhythm within mechanical and manual cardiopulmonary resuscitation. Resuscitation 2015; 93:158-63. [DOI: 10.1016/j.resuscitation.2015.04.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 04/01/2015] [Accepted: 04/02/2015] [Indexed: 11/28/2022]
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Liu JJ, Gui L, Chen ZM, Xu KY, Li Y, Zhang J, Zhou LJ. Effectiveness of combining manual external defibrillator and automated external defibrillator training for third-year nurse students. Int J Nurs Sci 2015. [DOI: 10.1016/j.ijnss.2015.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Achieving safe hands-on defibrillation using electrical safety gloves--a clinical evaluation. Resuscitation 2015; 90:163-7. [PMID: 25725295 DOI: 10.1016/j.resuscitation.2014.12.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 12/15/2014] [Accepted: 12/21/2014] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Safe hands-on defibrillation (HOD) will allow uninterrupted chest compression during defibrillation and may improve resuscitation success. We tested the ability of electrical insulating gloves to protect the rescuer during HOD using a 'worst case' electrical scenario. MATERIALS AND METHOD Leakage current flowing from the patient to the 'rescuer' during antero-lateral defibrillation of patients undergoing elective cardioversion was measured. The 'rescuer' maintained firm (20 kgf) contact with the patient during defibrillation, wearing Class 1 electrical insulating gloves while simulating an inadvertent contact with the patient, through an additional wired contact between 'rescuer' and patient. RESULTS Data from 61 shocks from 43 different patients were recorded. The median leakage current from all defibrillations was 20.0 μA, (range: 2.0-38.5). In total, 18 of the shocks were delivered at 360 J and had a median leakage current of 27.0 μA (range: 14.3-38.5). CONCLUSION When using Class 1 electrical insulating gloves for hands-on defibrillation, rescuer leakage current is significantly below the 1 mA safe threshold, allowing safe hands-on defibrillation if the rescuer makes only one other point of contact with the patient.
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Smith G, McD Taylor D, Morgans A, Cameron P. Measuring the effectiveness of a revised clinical practice guideline for the pre-hospital management of supraventricular tachycardia. Emerg Med Australas 2015; 27:22-8. [DOI: 10.1111/1742-6723.12340] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Gavin Smith
- Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | | | - Amee Morgans
- Innovation, Policy and Research; Benetas; Melbourne Victoria Australia
- DCEHPP; Monash University; Melbourne Victoria Australia
| | - Peter Cameron
- Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
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Abstract
BACKGROUND We reviewed Greek mythology to accumulate tales of resuscitation and we explored whether these tales could be viewed as indirect evidence that ancient Greeks considered resuscitation strategies similar to those currently used. METHODS Three compendia of Greek mythology: The Routledge Handbook of Greek Mythology, The Greek Myths by Robert Graves, and Greek Mythology by Ioannis Kakridis were used to find potentially relevant narratives. RESULTS Thirteen myths that may suggest resuscitation (including 1 case of autoresuscitation) were identified. Methods to attempt mythological resuscitation included use of hands (which may correlate with basic life support procedures), a kiss on the mouth (similar to mouth-to-mouth resuscitation), application of burning torches (which might recall contemporary use of external defibrillators), and administration of drugs (a possible analogy to advanced life support procedures). A careful assessment of relevant myths demonstrated that interpretations other than medical might be more credible. CONCLUSIONS Although several narratives of Greek mythology might suggest modern resuscitation techniques, they do not clearly indicate that ancient Greeks presaged scientific methods of resuscitation. Nevertheless, these elegant tales reflect humankind's optimism that a dying human might be restored to life if the appropriate procedures were implemented. Without this optimism, scientific improvement in the field of resuscitation might not have been achieved.
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L’emergenza medica nello studio odontoiatrico: riconoscimento e primo intervento. DENTAL CADMOS 2015. [DOI: 10.1016/s0011-8524(15)70258-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Muschart X. Burns to be alive: a complication of transcutaneous cardiac stimulation. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:622. [PMID: 25672246 PMCID: PMC4236425 DOI: 10.1186/s13054-014-0622-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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A South Australian registry of biphasic cardioversions of atrial arrhythmias: efficacy and predictors of success. Heart Lung Circ 2014; 24:342-7. [PMID: 25465515 DOI: 10.1016/j.hlc.2014.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 10/08/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Restoration of sinus rhythm by biphasic cardioversion is an established strategy for patients in atrial arrhythmias. This study aimed to investigate the real-life practice of cardioversions throughout a local hospital to determine frequency and predictors of success and use of high energy (> 200 joules). METHODS Prospective analysis of consecutive biphasic cardioversions from 2009-2013. Patient demographics, medical history and cardioversion data were collected. RESULTS 484 cardioversions from 379 patients were included in the final analysis. The majority (73%) of cardioversions were immediately successful after a single shock; overall success was 88% (1-5 shocks). Exploratory analyses revealed that single-shock success was significantly associated with lighter weight (OR 1.19, 95% CI 1.0-1.4, p<0.05). If a second shock was required, energy escalation was significantly associated with success (OR 3.11, 95% CI 1.43-6.77, p<0.05). Increasing weight was the strongest predictor of receiving high energy (10kg increase OR 1.43, 95% CI 1.13-1.81, p<0.05). CONCLUSIONS This prospective analysis reflects the real-life heterogeneous practice of biphasic cardioversions of atrial arrhythmias throughout a local hospital. These findings highlight the importance of first shock energy selection with careful consideration of patient weight. We emphasise the recommendation to escalate energy, highlighting the need for high-energy defibrillators in 'hard-to-cardiovert' patients.
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Ströhle M, Paal P, Strapazzon G, Avancini G, Procter E, Brugger H. Defibrillation in rural areas. Am J Emerg Med 2014; 32:1408-12. [PMID: 25224021 DOI: 10.1016/j.ajem.2014.08.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 07/18/2014] [Accepted: 08/19/2014] [Indexed: 02/03/2023] Open
Abstract
AIM OF THE STUDY Automated external defibrillation (AED) and public access defibrillation (PAD) have become cornerstones in the chain of survival in modern cardiopulmonary resuscitation. Most studies of AED and PAD have been performed in urban areas, and evidence is scarce for sparsely populated rural areas. The aim of this review was to review the literature and discuss treatment strategies for out-of-hospital cardiac arrest in rural areas. METHODS A Medline search was performed with the keywords automated external defibrillation (617 hits), public access defibrillation (256), and automated external defibrillator public (542). Of these 1415 abstracts and additional articles found by manually searching references, 92 articles were included in this nonsystematic review. RESULTS Early defibrillation is crucial for survival with good neurological outcome after cardiac arrest. Rapid defibrillation can be a challenge in sparsely populated and remote areas, where the incidence of cardiac arrest is low and rescuer response times can be long. The few studies performed in rural areas showed that the introduction of AED programs based on a 2-tier emergency medical system, consisting of Basic Life Support and Advanced Life Support teams, resulted in a decrease in collapse-to-defibrillation times and better survival of patients with out-of-hospital cardiac arrest. CONCLUSIONS In rural areas, introducing AED programs and a 2-tier emergency medical system may increase survival of out-of-hospital cardiac arrest patients. More studies on AED and PAD in rural areas are required.
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Affiliation(s)
- Mathias Ströhle
- Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.
| | - Peter Paal
- Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria; International Commission for Mountain Emergency Medicine, ICAR MEDCOM.
| | - Giacomo Strapazzon
- International Commission for Mountain Emergency Medicine, ICAR MEDCOM; EURAC Institute of Mountain Emergency Medicine, Viale Druso 1, I-39100 Bozen/Bolzano, Italy.
| | - Giovanni Avancini
- EURAC Institute of Mountain Emergency Medicine, Viale Druso 1, I-39100 Bozen/Bolzano, Italy.
| | - Emily Procter
- EURAC Institute of Mountain Emergency Medicine, Viale Druso 1, I-39100 Bozen/Bolzano, Italy.
| | - Hermann Brugger
- International Commission for Mountain Emergency Medicine, ICAR MEDCOM; EURAC Institute of Mountain Emergency Medicine, Viale Druso 1, I-39100 Bozen/Bolzano, Italy.
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Chen B, Yu T, Ristagno G, Quan W, Li Y. Average current is better than peak current as therapeutic dosage for biphasic waveforms in a ventricular fibrillation pig model of cardiac arrest. Resuscitation 2014; 85:1399-404. [PMID: 25010783 DOI: 10.1016/j.resuscitation.2014.06.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 05/17/2014] [Accepted: 06/11/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Defibrillation current has been shown to be a clinically more relevant dosing unit than energy. However, the effects of average and peak current in determining shock outcome are still undetermined. The aim of this study was to investigate the relationship between average current, peak current and defibrillation success when different biphasic waveforms were employed. METHODS Ventricular fibrillation (VF) was electrically induced in 22 domestic male pigs. Animals were then randomized to receive defibrillation using one of two different biphasic waveforms. A grouped up-and-down defibrillation threshold-testing protocol was used to maintain the average success rate of 50% in the neighborhood. In 14 animals (Study A), defibrillations were accomplished with either biphasic truncated exponential (BTE) or rectilinear biphasic waveforms. In eight animals (Study B), shocks were delivered using two BTE waveforms that had identical peak current but different waveform durations. RESULTS Both average and peak currents were associated with defibrillation success when BTE and rectilinear waveforms were investigated. However, when pathway impedance was less than 90Ω for the BTE waveform, bivariate correlation coefficient was 0.36 (p=0.001) for the average current, but only 0.21 (p=0.06) for the peak current in Study A. In Study B, a high defibrillation success (67.9% vs. 38.8%, p<0.001) was observed when the waveform delivered more average current (14.9±2.1A vs. 13.5±1.7A, p<0.001) while keeping the peak current unchanged. CONCLUSION In this porcine model of VF, average current was better than peak current to be an adequate parameter to describe the therapeutic dosage when biphasic defibrillation waveforms were used. The institutional protocol number: P0805.
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Affiliation(s)
- Bihua Chen
- School of Biomedical Engineering, Third Military Medical University and Chongqing University, Chongqing, China
| | - Tao Yu
- Emergency Department, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Giuseppe Ristagno
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Weilun Quan
- ZOLL Medical Corporation, Chelmsford, MA, USA
| | - Yongqin Li
- School of Biomedical Engineering, Third Military Medical University and Chongqing University, Chongqing, China.
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Cardiopulmonary resuscitation guidance improves medical students' adherence to guidelines in simulated cardiac arrest: a randomised cross-over study. Eur J Anaesthesiol 2014; 30:752-7. [PMID: 23702601 DOI: 10.1097/eja.0b013e328362147f] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The 2010 Resuscitation Guidelines require high-quality chest compression and rapid defibrillation for patients with ventricular fibrillation with rhythm analysis and defibrillation repeated every 2 min. A lack of adherence to the guidelines by medical students was observed during simulated resuscitation training. OBJECTIVES To assess whether real-time cardiopulmonary resuscitation guidance, including an audiovisual countdown timer, a metronome, a display of the chest compression quality and voice prompts, might improve adherence to the guidelines by medical students. DESIGN Randomised cross-over simulation study. SETTING Studienhospital Münster, Faculty of Medicine University Münster, Germany PARTICIPANTS One hundred and forty-one medical students (fifth year) in 47 teams. INTERVENTION Simulated resuscitation with and without real-time cardiopulmonary resuscitation guidance. MAIN OUTCOME MEASURES The preshock pause, postshock pause, fraction of time without chest compression and defibrillation intervals. Observed quality parameters were chest compression depth and chest compression rate. RESULTS With real-time cardiopulmonary resuscitation guidance, there were improved mean (SD) chest compression rates (105 ± 8 vs. 121 ± 12 bpm; P < 0.005), fewer inappropriate shock intervals [median (interquartile range) 0 (1 to 5) vs. 4 (1 to 7); P < 0.005], a smaller fraction of time without chest compression (18.9 ± 4.4 vs. 22.5 ± 7.0%; P < 0.005) and shorter postshock pauses (2.3 ± 0.9 vs. 3.4 ± 1.2 s; P < 0.005). CONCLUSION Real-time cardiopulmonary resuscitation guidance significantly increased adherence to the guidelines by medical students treating simulated out-of-hospital cardiac arrest. Using a simple tool such as a countdown timer makes it possible to reduce the number of inappropriate shock intervals and time without chest compression.
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Diószeghy C, Molnár N. Current practice and perspective of hands-free defibrillation in Hungary - Investigating the obstacles of implementation. Interv Med Appl Sci 2014; 6:69-74. [PMID: 24936308 DOI: 10.1556/imas.6.2014.2.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 02/19/2014] [Accepted: 02/19/2014] [Indexed: 11/19/2022] Open
Abstract
Defibrillation with self-adhesive pads is the gold standard method during resuscitation as it allows minimal interruptions of chest compressions. Unfortunately, the implementation of the new recommendations often requires the purchase of new equipment. We have conducted a nationwide survey by telephone interviews with senior clinicians in order to investigate the current position of the implementation and to identify possible obstacles. We have audited 56 hospitals and 92 departments across the country and interviewed the senior consultants of the intensive care units (ICUs) and emergency departments (EDs). Only 6.5% of all responders were using hands-free defibrillation routinely at the time of the survey. According to 67.4% of respondents, purchasing of new equipment was not likely within 2 years. The major obstacle was the perceived higher costs (59.8%); however, the majority of clinicians (92.4%) were aware of the potential benefits of hands-free defibrillation. Our results suggest that the implementation of the new guidelines is slower than expected due to the unavailability of hands-free defibrillators. The major obstacle is the perceived cost-efficiency concerns. The need for an interim recommendation for safe delivery of defibrillation using hard paddles might be considered to enhance the chance of survival for a large number of patients.
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Removal of cardiopulmonary resuscitation artifacts with an enhanced adaptive filtering method: an experimental trial. BIOMED RESEARCH INTERNATIONAL 2014; 2014:140438. [PMID: 24795878 PMCID: PMC3985144 DOI: 10.1155/2014/140438] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 02/25/2014] [Accepted: 02/26/2014] [Indexed: 11/18/2022]
Abstract
Current automated external defibrillators mandate interruptions of chest compression to avoid the effect of artifacts produced by CPR for reliable rhythm analyses. But even seconds of interruption of chest compression during CPR adversely affects the rate of restoration of spontaneous circulation and survival. Numerous digital signal processing techniques have been developed to remove the artifacts or interpret the corrupted ECG with promising result, but the performance is still inadequate, especially for nonshockable rhythms. In the present study, we suppressed the CPR artifacts with an enhanced adaptive filtering method. The performance of the method was evaluated by comparing the sensitivity and specificity for shockable rhythm detection before and after filtering the CPR corrupted ECG signals. The dataset comprised 283 segments of shockable and 280 segments of nonshockable ECG signals during CPR recorded from 22 adult pigs that experienced prolonged cardiac arrest. For the unfiltered signals, the sensitivity and specificity were 99.3% and 46.8%, respectively. After filtering, a sensitivity of 93.3% and a specificity of 96.0% were achieved. This animal trial demonstrated that the enhanced adaptive filtering method could significantly improve the detection of nonshockable rhythms without compromising the ability to detect a shockable rhythm during uninterrupted CPR.
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Coute RA, Mader TJ, Sherman LD. Outcomes by rescue shock number during the metabolic phase of porcine ventricular fibrillation resuscitation. Am J Emerg Med 2014; 32:586-91. [PMID: 24698471 DOI: 10.1016/j.ajem.2014.02.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 02/21/2014] [Accepted: 02/24/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Optimal resuscitation duration before the first rescue shock (RS) to maximize the probability of success after prolonged ventricular fibrillation (VF) cardiac arrest remains unknown. The purpose of this study was to determine the occurrence of return of spontaneous circulation (ROSC) and survival by RS attempt after 12 minutes of untreated VF. METHODS This was a secondary analysis of prospectively collected data from an institutional animal care and use committee-approved protocol. Fifty-three swine (30-35 kg) were instrumented under anesthesia. Ventricular fibrillation was electrically induced. After 12 minutes of untreated VF, cardiopulmonary resuscitation (CPR) was initiated (and continued as necessary (prn)) and a standard dose of epinephrine (0.01 mg/kg) was given (and repeated every 3 (q3) minutes prn). The first RS was delivered after 3 minutes of CPR (and q3 minutes thereafter prn). Each failed RS was followed (in series) by vasopressin (0.57 mg/kg), amiodarone (4.3 mg/kg), and sodium bicarbonate (1 mEq/kg) prn. Resuscitation continued until ROSC or 20-minute elapsed time. The primary outcomes were ROSC and 20-minute survival. Data were analyzed using descriptive statistics. RESULTS After 3 minutes of resuscitation, 1 animal (1.9% [95% confidence interval {CI, 0.3-10.0]) achieved ROSC on RS1 and survived. After 6 minutes of resuscitation, 17 animals (32.1% [95% CI, 21.1-45.5]) achieved ROSC on RS2 and 15 (28.3% [95% CI, 18.0-41.6]) survived. Twelve additional animals had ROSC and survival with continued resuscitation. In 23 animals, ROSC was never achieved and efforts were terminated per protocol. CONCLUSION Our data suggest that during the metabolic phase of VF, 3 minutes of CPR and 1 standard dose of epinephrine may be insufficient to achieve ROSC on the first RS attempt. A longer duration of CPR and/or additional vasopressors may increase the likelihood of successful defibrillation.
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Affiliation(s)
- Ryan A Coute
- Kansas City University of Medicine and Biosciences, Kansas City, MO
| | - Timothy J Mader
- Department of Emergency Medicine, Baystate Medical Center/Tufts University School of Medicine, Springfield, MA.
| | - Lawrence D Sherman
- Departments of Medicine and Bioengineering, University of Washington School of Medicine, Seattle, WA; Department of Emergency Medicine at St Francis Hospital, Federal Way, WA
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Melissopoulou T, Stroumpoulis K, Sampanis MA, Vrachnis N, Papadopoulos G, Chalkias A, Xanthos T. Comparison of blind intubation through the I-gel and ILMA Fastrach by nurses during cardiopulmonary resuscitation: A manikin study. Heart Lung 2014; 43:112-6. [DOI: 10.1016/j.hrtlng.2013.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 12/30/2013] [Accepted: 12/31/2013] [Indexed: 10/25/2022]
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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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KARLIS G, IACOVIDOU N, LELOVAS P, NIFOROPOULOU P, ZACHARIOUDAKI A, PAPALOIS A, SUNDE K, STEEN PA, XANTHOS T. Effects of early amiodarone administration during and immediately after cardiopulmonary resuscitation in a swine model. Acta Anaesthesiol Scand 2014; 58:114-22. [PMID: 24341695 DOI: 10.1111/aas.12226] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Aim of this experimental study was to compare haemodynamic effects and outcome with early administration of amiodarone and adrenaline vs. adrenaline alone in pigs with prolonged ventricular fibrillation (VF). METHODS After 8 min of untreated VF arrest, bolus doses were administered of adrenaline (0.02 mg/kg) and either amiodarone (5 mg/kg) or saline (n = 8 per group) after randomisation. Cardiopulmonary resuscitation (CPR) was commenced immediately after drug administration, and defibrillation was attempted 2 min later. CPR was resumed for another 2 min after each defibrillation attempt, and the same dose of adrenaline was given every 4th minute during CPR. Haemodynamic monitoring and mechanical ventilation continued for 6 h after return of spontaneous circulation (ROSC), and the pigs were euthanised at 48 h. Researchers were blinded for drug groups throughout the study. RESULTS There was no difference in rates of ROSC and 48-h survival with amiodarone vs. saline (5/8 vs. 7/8 and 0/8 vs. 3/8, respectively). Diastolic aortic pressure and coronary perfusion pressure were significantly lower with amiodarone during CPR and 1 min after ROSC (P < 0.05). The number of electric shocks required for terminating VF, time to ROSC and adrenaline dose were significantly higher with amiodarone (P < 0.01). The incidence of post-resuscitation tachyarrhythmias tended to be higher in the saline group (P = 0.081). CONCLUSION Early administration of amiodarone did not improve ROSC or 48-h survival rates, and was associated with worse haemodynamics in this swine model of cardiac arrest.
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Affiliation(s)
- G. KARLIS
- 2nd Department of Internal Medicine; Sismanoglio General Hospital; Athens Greece
| | - N. IACOVIDOU
- Medical School; University of Athens; Athens Greece
| | - P. LELOVAS
- Medical School; University of Athens; Athens Greece
| | | | - A. ZACHARIOUDAKI
- Experimental-Research Center; ELPEN Pharmaceutical; Athens Greece
| | - A. PAPALOIS
- Experimental-Research Center; ELPEN Pharmaceutical; Athens Greece
| | - K. SUNDE
- Department of Anaesthesiology; Division of Emergencies and Critical Care; Oslo University Hospital; University of Oslo; Oslo Norway
| | - P. A. STEEN
- Department of Anaesthesiology; Division of Emergencies and Critical Care; Oslo University Hospital; University of Oslo; Oslo Norway
| | - T. XANTHOS
- Medical School; University of Athens; Athens Greece
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[Unexpected atrial fibrillation when monitoring in operating room. Case of the trimester]. ACTA ACUST UNITED AC 2013; 61:e23-6. [PMID: 24287084 DOI: 10.1016/j.redar.2013.10.002] [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: 10/12/2013] [Accepted: 10/21/2013] [Indexed: 11/20/2022]
Abstract
A real case reported to the SENSAR database of incidents is presented. In a patient scheduled for nose fracture repair surgery an unexpected atrial fibrillation was found when monitored in the operating room. The operation was not delayed. After induction of general anaesthesia heart rate suddenly increased and hemodinamic situation was impaired. Cardioversion was required. Two electric countershocks were given but sinus rhythm was not restored. Heart rate was controlled with amiodarone infusion. Optimal defibrillation characteristics are described in these cases. Increased risk of thromboembolism (1-2%) following cardioversion is present even if atrial thrombi are ruled out. The mainstay therapies of are rhythm and rate control and prevention of thromboembolic complications. We describe recommendations on the management of these critical situations with emphasis in learning through the creation of protocols and training practice in simulation.
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Goldberg SA, Leatham A, Pepe PE. Year in review 2012: Critical Care--Out-of-hospital cardiac arrest and trauma. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:248. [PMID: 24267483 PMCID: PMC4059384 DOI: 10.1186/cc13128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
In 2012 Critical Care published many articles pertaining to the resuscitation of out-of-hospital cardiac arrest and trauma. In this review, we summarize several of these articles, including those regarding advances in resuscitation techniques and methods. We examine articles pertaining to prehospital endotracheal intubation, the use of specialized devices for cardiopulmonary resuscitation and policies regarding transport destinations for both cardiac arrest and trauma patients. Articles on the predictors of outcome in both pediatric and adult populations are evaluated, including articles on the effects of obesity on survival from hemorrhage and pediatric outcomes from traumatic cardiac arrest. The effects of the type and volume of resuscitation fluids for both adult and pediatric patients are discussed, as are the factors contributing to hypothermia in trauma patients.
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