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Berry CL, Olaf MF, Kupas DF, Berger A, Knorr AC. EMS agencies with high rates of field termination of resuscitation and longer scene times also have high rates of survival. Resuscitation 2021; 169:205-213. [PMID: 34666123 DOI: 10.1016/j.resuscitation.2021.09.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 11/30/2022]
Abstract
AIM Out-of-hospital cardiac arrest (OOHCA) management dichotomizes strategies to (1) "scoop-and-run" to a higher level of care or (2) "treat on the X" with the goal of return of spontaneous circulation (ROSC) before transport, with field termination of resuscitation (FTOR) of unsuccessful resuscitations. We hypothesized that EMS agencies with greater average time on-scene and higher rates of field termination of resuscitation would have more favorable outcomes. METHODS The Cardiac Arrest Registry to Enhance Survival (CARES) was used to identify OOHCA cases from 2013 to 2018. Agencies in the top and bottom quartiles of on-scene time were categorized as high (HiOST) and low (LoOST); in the top and bottom quartiles of field termination rate were categorized as high (HiTOR) and low (LoTOR). Generalized estimating equation models compared top and bottom quartiles. RESULTS We classified 95 agencies as HiOST (average > 25.1 min) or LoOST (average < 19.3 min). We classified 95 agencies as HiTOR (average > 46.5% FTOR) or LoTOR (average < 23.5% FTOR). Controlling for agency characteristics, HiOST had a higher survival to discharge for transported patients (28.1% vs 23.1%, OR = 2.8, 95 %CI 2.1-3.6, p < 0.001), ROSC on emergency department arrival, and favorable neurologic outcome than LoOST. HiTOR had a higher survival to discharge for transported patients (25.6% vs 19.3%, OR = 3.3, 95 %CI 2.5-4.4, p < 0.001), ROSC on emergency department arrival, and favorable neurologic outcome than LoTOR. CONCLUSION EMS agencies with higher rates of FTOR and longer on-scene times for patients with OOHCA have higher overall patient survival, ROSC, and favorable neurologic function.
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Affiliation(s)
- Christopher L Berry
- Geisinger Commonwealth School of Medicine, 1 Guthrie Square, Sayre, PA 18840, United States.
| | - Mark F Olaf
- Geisinger Commonwealth School of Medicine, 100 North Academy Ave., Danville, PA 17822-2005, United States
| | - Douglas F Kupas
- Geisinger Health System, 100 North Academy Ave., Danville, PA 17822-2005, United States
| | - Andrea Berger
- Department of Population Health Sciences, Biostatistics Core, Geisinger, 100 North Academy Ave., Danville, PA 17822-2005, United States
| | - Anne C Knorr
- Geisinger Health System, 100 North Academy Ave., Danville, PA 17822-2005, United States
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Bosson N, Tolles J, Shavelle D, Niemann JT, Thomas JL, French WJ, Gausche-Hill M. Variation in Post-Cardiac Arrest Care Within a Regional EMS System. PREHOSP EMERG CARE 2021; 26:772-781. [PMID: 34369840 DOI: 10.1080/10903127.2021.1965681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: Within Emergency Medical Systems (EMS) regional systems, there may be significant differences in the approach to patient care despite efforts to promote standardization. Identifying hospital-level factors that contribute to variations in care can provide opportunities to improve patient outcomes. The purpose of this analysis was to evaluate variation in post-cardiac arrest care within a large EMS system and explore the contribution of hospital-level factors.Methods: This was a retrospective analysis from a regional cardiac system serving over 10 million persons. Patients with out-of-hospital cardiac arrest (OHCA) with return of spontaneous circulation (ROSC) are transported to 36 cardiac arrest centers with 24/7 emergent coronary angiography (CAG) capabilities and targeted temperature management (TTM) policies based on regional guidelines. We included adult patients ≥18 years with non-traumatic OHCA from 2016-2018. Patients with a Do-Not-Resuscitate order and those who died in the emergency department (ED) were excluded. For the TTM analysis, we also excluded patients who were alert in the ED. The primary outcome was receiving CAG or TTM after cardiac arrest. The secondary outcome was neurologic recovery (dichotomized to define a "good" outcome as cerebral performance category (CPC) 1 or 2). We used generalized estimating equations including patient-level factors (age, sex, witnessed arrest, initial rhythm) and hospital-level factors (academic status, hospital size based on licensed beds, annual OHCA patient volume) to estimate the odds ratios associated with these variables.Results: There were 7831 patients with OHCA during the study period; 4694 were analyzed for CAG and 3903 for TTM. The median and range for treatment with CAG and TTM after OHCA was 23% (12-49%) and 58% (17-92%) respectively. Hospital size was associated with increased likelihood of CAG, adjusted odds ratio 1.71, 95% CI 1.05-2.86, p = 0.03. Academic status approached significance in its association with TTM, adjusted odds ratio 1.69, 95% CI 0.98-2.91, p = 0.06. Overall, 28% of patients survived with good neurologic outcome, ranging from 17 to 43% across hospitals.Conclusion: Within this regional cardiac system, there was significant variation in use of CAG and TTM after OHCA, which was not fully explained by patient-level factors. Hospital size was associated with increased CAG.
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Affiliation(s)
- Nichole Bosson
- Received June 6, 2021 from Los Angeles County Emergency Medical Service Agency, Santa Fe Springs, CA, USA (NB, MGH); Department of Emergency Medicine, Harbor UCLA Medical Center, Torrance, CA, USA (NB, JT, JTN, MGH); David Geffen School of Medicine at UCLA, Los Angeles, CA, USA (NB, JT, JTN, JLT, WJF, MGH); Department of Cardiology, Long Beach Medical Center, Long Beach, CA, USA (DS); Division of Cardiology, UCLA Medical Center, Torrance, CA, USA (JLT; WJF). Revision received July 27, 2021; accepted for publication August 3, 2021
| | - Juliana Tolles
- Received June 6, 2021 from Los Angeles County Emergency Medical Service Agency, Santa Fe Springs, CA, USA (NB, MGH); Department of Emergency Medicine, Harbor UCLA Medical Center, Torrance, CA, USA (NB, JT, JTN, MGH); David Geffen School of Medicine at UCLA, Los Angeles, CA, USA (NB, JT, JTN, JLT, WJF, MGH); Department of Cardiology, Long Beach Medical Center, Long Beach, CA, USA (DS); Division of Cardiology, UCLA Medical Center, Torrance, CA, USA (JLT; WJF). Revision received July 27, 2021; accepted for publication August 3, 2021
| | - David Shavelle
- Received June 6, 2021 from Los Angeles County Emergency Medical Service Agency, Santa Fe Springs, CA, USA (NB, MGH); Department of Emergency Medicine, Harbor UCLA Medical Center, Torrance, CA, USA (NB, JT, JTN, MGH); David Geffen School of Medicine at UCLA, Los Angeles, CA, USA (NB, JT, JTN, JLT, WJF, MGH); Department of Cardiology, Long Beach Medical Center, Long Beach, CA, USA (DS); Division of Cardiology, UCLA Medical Center, Torrance, CA, USA (JLT; WJF). Revision received July 27, 2021; accepted for publication August 3, 2021
| | - James T Niemann
- Received June 6, 2021 from Los Angeles County Emergency Medical Service Agency, Santa Fe Springs, CA, USA (NB, MGH); Department of Emergency Medicine, Harbor UCLA Medical Center, Torrance, CA, USA (NB, JT, JTN, MGH); David Geffen School of Medicine at UCLA, Los Angeles, CA, USA (NB, JT, JTN, JLT, WJF, MGH); Department of Cardiology, Long Beach Medical Center, Long Beach, CA, USA (DS); Division of Cardiology, UCLA Medical Center, Torrance, CA, USA (JLT; WJF). Revision received July 27, 2021; accepted for publication August 3, 2021
| | - Joseph L Thomas
- Received June 6, 2021 from Los Angeles County Emergency Medical Service Agency, Santa Fe Springs, CA, USA (NB, MGH); Department of Emergency Medicine, Harbor UCLA Medical Center, Torrance, CA, USA (NB, JT, JTN, MGH); David Geffen School of Medicine at UCLA, Los Angeles, CA, USA (NB, JT, JTN, JLT, WJF, MGH); Department of Cardiology, Long Beach Medical Center, Long Beach, CA, USA (DS); Division of Cardiology, UCLA Medical Center, Torrance, CA, USA (JLT; WJF). Revision received July 27, 2021; accepted for publication August 3, 2021
| | - William J French
- Received June 6, 2021 from Los Angeles County Emergency Medical Service Agency, Santa Fe Springs, CA, USA (NB, MGH); Department of Emergency Medicine, Harbor UCLA Medical Center, Torrance, CA, USA (NB, JT, JTN, MGH); David Geffen School of Medicine at UCLA, Los Angeles, CA, USA (NB, JT, JTN, JLT, WJF, MGH); Department of Cardiology, Long Beach Medical Center, Long Beach, CA, USA (DS); Division of Cardiology, UCLA Medical Center, Torrance, CA, USA (JLT; WJF). Revision received July 27, 2021; accepted for publication August 3, 2021
| | - Marianne Gausche-Hill
- Received June 6, 2021 from Los Angeles County Emergency Medical Service Agency, Santa Fe Springs, CA, USA (NB, MGH); Department of Emergency Medicine, Harbor UCLA Medical Center, Torrance, CA, USA (NB, JT, JTN, MGH); David Geffen School of Medicine at UCLA, Los Angeles, CA, USA (NB, JT, JTN, JLT, WJF, MGH); Department of Cardiology, Long Beach Medical Center, Long Beach, CA, USA (DS); Division of Cardiology, UCLA Medical Center, Torrance, CA, USA (JLT; WJF). Revision received July 27, 2021; accepted for publication August 3, 2021
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Onoe A, Kajino K, Daya MR, Ong MEH, Nakamura F, Nakajima M, Takahashi H, Kishimoto M, Sakuramoto K, Muroya T, Ikegawa H, Kuwagata Y. Outcomes of patients with OHCA of presumed cardiac etiology that did not achieve prehospital restoration of spontaneous circulation: The All-Japan Utstein Registry experience. Resuscitation 2021; 162:245-250. [PMID: 33766662 DOI: 10.1016/j.resuscitation.2021.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/18/2020] [Accepted: 03/08/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Correct identification of futile prehospital resuscitation for out-of-hospital cardiac arrest (OHCA) may reduce unnecessary transports. Prehospital return of spontaneous circulation (ROSC) is considered by many to be an important predictor of outcome. The purpose of this study was to evaluate OHCA victims without prehospital ROSC characteristics and their outcomes in relation to the universal Termination of Resuscitation (TOR) rule. METHODS A retrospective, population-based review of OHCA victims without prehospital ROSC from January 1, 2010 to December 31, 2017 in the All-Japan Utstein Registry. We compared those that met the universal TOR rule and those that did not for the primary outcome: one-month survival with neurologically favorable Cerebral Performance Category (CPC) 1 or 2. RESULTS 989,929 OHCA cases, 18 years of age or older, were registered in the All-Japan Utstein Registry and 525,801 cases were of presumed cardiac origin and had no prehospital ROSC. Of these, the one-month CPC was 1 or 2 for 3957 cases (0.8%). In the 'no ROSC' group who also met the TOR rule, the number of cases was 433,571 with a one-month survival of 0.9% (3799 cases), and the proportion with a CPC 1or 2 was 0.2% (699 cases). CONCLUSIONS Continued resuscitation and transport of cases with no field ROSC who fulfill the TOR rule is futile and could be considered for adoption in Japan.
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Affiliation(s)
- Atsunori Onoe
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan.
| | - Kentaro Kajino
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Mohamud R Daya
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Fumiko Nakamura
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Mari Nakajima
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Hiroki Takahashi
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Masanobu Kishimoto
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Kazuhito Sakuramoto
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Takashi Muroya
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Hitoshi Ikegawa
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
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Qin S, Chen MH, Fang W, Tan XF, Xie L, Yang YG, Qin T, Li N. Cerebral protection of epigallocatechin gallate (EGCG) via preservation of mitochondrial function and ERK inhibition in a rat resuscitation model. DRUG DESIGN DEVELOPMENT AND THERAPY 2019; 13:2759-2768. [PMID: 31496652 PMCID: PMC6689542 DOI: 10.2147/dddt.s215358] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 07/19/2019] [Indexed: 12/16/2022]
Abstract
Background Various and opposite roles of epigallocatechin gallate (EGCG) have been reported in different studies. We aimed to investigate how EGCG affects the cerebral injury in a cardiac arrest/cardiopulmonary resuscitation (CA/CPR) model of rat. Methods The rats which were subjected to CA/CPR randomly received low dose of EGCG (3 mg/kg, Low-EGCG group, n=16), high dose of EGCG (9 mg/kg, High-EGCG group, n=16) and equal volume of 0.9% saline solution (NS group, n=16) at the first minute after return of spontaneous circulation (ROSC). The rats underwent anesthesia and intubation were defined as Sham group (n=16). Twenty-four hours after ROSC, neural defect score (NDS), ROS fluorescence intensity, degree of mitochondrial permeability transition pore (mPTP) opening, ATP contents and mitochondrial ATP synthase expression were evaluated in the four groups. The expression of extracellular signal-regulated kinase (ERK) activity and cleaved-caspase 3 were also detected by Western blot. Results CA/CPR induced severe ischemia-reperfusion injury (IRI), resulted in mitochondrial dysfunction and upregulated phosphorylation of ERK. EGCG dose-dependently alleviated the IRI after CA/CPR, inhibited ERK activity and restored mitochondrial function and, as indicated by improved NDS, reduced ROS level, decreased mPTP opening, elevated ATP content, increased ATPase expression and downregulated cleaved-caspase 3 level. Conclusion EGCG alleviated global cerebral IRI by restoring mitochondrial dysfunction and ERK modulation in a rat CA/CPR model, which might make it a potential candidate agent against IRI after CA/CPR in the future. Further study is needed to determine whether higher dosage of EGCG might aggravate cerebral IRI post-CA/CPR.
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Affiliation(s)
- Sina Qin
- Intensive Care Unit, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Meng-Hua Chen
- Intensive Care Unit, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Wei Fang
- Intensive Care Unit, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Xiao-Feng Tan
- Intensive Care Unit, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Lu Xie
- Intensive Care Unit, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Ye-Gui Yang
- Intensive Care Unit, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Tao Qin
- Intensive Care Unit, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Nuo Li
- Intensive Care Unit, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
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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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Xiong Y, Zhan H, Lu Y, Guan K, Okoro N, Mitchell D, Dwyer M, Leatham A, Salazar G, Liao X, Idris A. Out-of-hospital cardiac arrest without return of spontaneous circulation in the field: Who are the survivors? Resuscitation 2017; 112:28-33. [DOI: 10.1016/j.resuscitation.2016.12.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/06/2016] [Accepted: 12/09/2016] [Indexed: 10/20/2022]
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Factors associated with the outcome of out-of-hospital cardiopulmonary arrest among people over 80 years old in Japan. Resuscitation 2017; 113:63-69. [PMID: 28185923 DOI: 10.1016/j.resuscitation.2017.01.014] [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: 08/11/2016] [Revised: 12/27/2016] [Accepted: 01/14/2017] [Indexed: 11/23/2022]
Abstract
AIM To determine if termination of resuscitation should be considered for older individuals, we sought to identify factors associated with clinical outcome following out-of-hospital cardiac arrest (OHCA) in people ≥80 years old and over. METHODS A prospective, population-based, observational study was conducted for ≥80-year-old individuals who experienced out-of-hospital cardiac arrest and to whom resuscitation was provided by emergency responders between January 1, 2005 and December 31, 2012 (n=377,577). The primary endpoint was 1-month survival. Signal detection analysis was applied to estimate predictive factors among 17 variables. RESULTS Among all out-of-hospital cardiac arrest cases, 59.4% were of cardiac origin, and 1-month survival rate was 3.3%. Following signal detection analysis, cases of both cardiac and non-cardiac origin were categorized into three subgroups defined by return of spontaneous circulation (ROSC) and epinephrine use. One-month survival ranged between 1.2 and 41.0% for the three subgroups of cardiac origin and between 2.0 and 41.1% for the three subgroups of non-cardiac origin. CONCLUSIONS ROSC was the most significant predictor of 1-month survival among patients with cardiac and non-cardiac OHCA who were ≥80 years old. Absence of ROSC might be an important factor to the termination of resuscitation rule for OHCA in individuals who are ≥80years old.
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Aelen P, Noordergraaf GJ. Dynamic prediction of ROSC: Is the art of prognostication in Resuscitation becoming science? Resuscitation 2016; 111:A3-A4. [PMID: 27855274 DOI: 10.1016/j.resuscitation.2016.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 11/06/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Paul Aelen
- Patient Care & Measurements, Philips Research, High Tech Campus, Eindhoven, The Netherlands; CPRLab, Elisabeth-Tweesteden Ziekenhuis, Tilburg, The Netherlands
| | - Gerrit J Noordergraaf
- Departments of Anesthesiology, Resuscitation & Pain management/CPRLab, Elisabeth-Tweesteden Ziekenhuis, Tilburg, The Netherlands.
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De Robertis E, Cirillo F. To stop or not to stop. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2016. [DOI: 10.1016/j.tacc.2016.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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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: 920] [Impact Index Per Article: 115.0] [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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Zhuo X, Xie L, Shi FR, Li N, Chen X, Chen M. The benefits of respective and combined use of green tea polyphenols and ERK inhibitor on the survival and neurologic outcomes in cardiac arrest rats induced by ventricular fibrillation. Am J Emerg Med 2015; 34:570-5. [PMID: 26783148 DOI: 10.1016/j.ajem.2015.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 11/25/2015] [Accepted: 12/08/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Cerebral injury is a main factor contributing to a high mortality after cardiac arrest (CA)/cardiopulmonary resuscitation (CPR). OBJECTIVE We sought to evaluate the effect of green tea polyphenols (GTPs) and ERK1/2 inhibitor PD98059 (PD) on the survival and neurologic outcomes after CA/CPR in rats. METHODS First, rats were subjected to CA after CPR. The rats that restored spontaneous circulation were blindly allocated to the saline group (saline, IV, n = 12), the GTP group (GTPs, 10 mg/kg, IV, n = 12), the PD group (PD, 0.3 mg/kg, IV, n = 12), and the GTPs + PD group (GTPs, 10 mg/kg; PD, 0.3 mg/kg, IV, n = 12). Another 12 rats without experiencing CA and CPR were served as a sham group. Survival and the neurologic deficit score were observed for 72 hours after restoration of spontaneous circulation. Second, same experimental procedures were performed, and in 1 of 5 groups, animals were divided into 4 subgroups further according to the different time points (12, 24, 48, and 72 hours after restoration of spontaneous circulation [ROSC], n = 6/group). Brain tissues were harvested at relative time points for the morphologic evaluation as well as reactive oxygen species (ROS), malonylaldehyde, and superoxide dismutase (SOD) measurement. RESULTS Green tea polyphenols, PD, and a combination of GTPs and PD used after ROSC alleviated the morphologic changes of the cerebrum. These 3 treatments also decreased the productions of ROS and malonylaldehyde, increased SOD activities in cerebral tissues, and improved the neurologic deficit and survival rates at 12, 24, 48, and 72 hours after ROSC. CONCLUSIONS Administration of GTPs and PD after ROSC can alleviate cerebral injury, improve the survival and neurologic outcomes via reduction of ROS, and increase of SOD activity in a rat CA/CPR model.
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Affiliation(s)
- Xiaojun Zhuo
- Institute of Cardiovascular Diseases, The First Hospital Affiliated to Guangxi Medical University, Nanning, Guangxi, China
| | - Lu Xie
- Department of Physiology, School of Pre-Clinical Sciences, Guangxi Medical University, Nanning, Guangxi, China
| | - Fangying Ruan Shi
- Department of Physiology, School of Pre-Clinical Sciences, Guangxi Medical University, Nanning, Guangxi, China
| | - Nuo Li
- Institute of Cardiovascular Diseases, The First Hospital Affiliated to Guangxi Medical University, Nanning, Guangxi, China
| | - Xiaoyang Chen
- Institute of Cardiovascular Diseases, The First Hospital Affiliated to Guangxi Medical University, Nanning, Guangxi, China
| | - Menghua Chen
- Institute of Cardiovascular Diseases, The First Hospital Affiliated to Guangxi Medical University, Nanning, Guangxi, China.
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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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Abstract
Since their introduction over 40 years ago, paramedics have been trained to deliver select advanced life support interventions in the community with the goal of reducing morbidity and mortality from cardiovascular disease and trauma. The ensuing decades witnessed a great deal of interest in paramedic care, with an exponential growth in prehospital resuscitation research. As part of the CJEM series on emergency medical services (EMS), we review recent prehospital research in out-of-hospital cardiac arrest and discuss how, in a novel departure from the origins of EMS, prehospital research is beginning to influence in-hospital care. We discuss emerging areas of study related to cardiopulmonary resuscitation (CPR) quality, therapeutic hypothermia, termination of resuscitation, and the use of end-tidal carbon dioxide measurement, as well as the subtle ripple effects that prehospital research is having on the broader understanding of the management of these critically ill patients.
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