Acute management of sudden cardiac death in adults based upon the new CPR guidelines

Cardiac Muscle Membrane Stabilization in Myocardial Reperfusion Injury

The phospholipid bilayer membrane that surrounds each cell in the body represents the first and last line of defense for preserving overall cell viability. In several forms of cardiac and skeletal muscle disease, deficits in the integrity of the muscle membrane play a central role in disease pathogenesis. In Duchenne muscular dystrophy, an inherited and uniformly fatal disease of progressive muscle deterioration, muscle membrane instability is the primary cause of disease, including significant heart disease, for which there is no cure or highly effective treatment. Further, in multiple clinical forms of myocardial ischemia-reperfusion injury, the cardiac sarcolemma is damaged and this plays a key role in disease etiology. In this review, cardiac muscle membrane stability is addressed, with a focus on synthetic block copolymers as a unique chemical-based approach to stabilize damaged muscle membranes. Recent advances using clinically relevant small and large animal models of heart disease are discussed. In addition, mechanistic insights into the copolymer-muscle membrane interface, featuring atomistic, molecular, and physiological structure-function approaches are highlighted. Collectively, muscle membrane instability contributes significantly to morbidity and mortality in prominent acquired and inherited heart diseases. In this context, chemical-based muscle membrane stabilizers provide a novel therapeutic approach for a myriad of heart diseases wherein the integrity of the cardiac muscle membrane is at risk.

Use of a Load Distributing Band Device (with Ventilation Prompts) during Cardiopulmonary Resuscitation

Introduction

Over-ventilation can compromise coronary perfusion pressures during cardiopulmonary resuscitation (CPR) and should be minimised. We compared ventilations during manual and mechanical (load-distributing band - LDB) CPR, which gives ventilation prompts. Our primary objective was to compare the ventilation rate between manual CPR and LDB-CPR.

Method

This was a phased, non-randomised study at a tertiary hospital emergency department. All out-of-hospital, non-traumatic cardiac arrest adult patients during the study period from February 2007 till July 2008 were eligible. Pregnant females and patients aged less than 18 years of age were excluded. Ventilation rates in the first and second 5 minutes segments were recorded. Over-ventilation was defined as ventilation rate above 12 breaths per minute. All data analyses were performed with SPSS, version 17.0. Mean differences with 95% confidence interval (CI) were compared between the 2 treatment groups.

Results

From February 2007 till August 2007, there were 29 patients with manual CPR; and from September 2007 till July 2008, there were 62 with LDB-CPR. In the first 5 minutes of CPR, the proportion of patients that were over-ventilated, was 27.6% (manual) and 4.8% (LDB) (difference = 22.7%; 95% CI: 3.5-46.4%). In the next 5 minutes, the proportion of patients that were over-ventilated was 37.9% and 1.6% for manual and mechanical CPR respectively (difference = 36.3%; 95% CI: 16.5-58.9%).

Conclusion

Over-ventilation is reduced significantly in LDB-CPR compared to manual CPR during the first and second 5 minutes of resuscitation.

Advances in cardiopulmonary resuscitation

This article focuses on important advances in the science of cardiopulmonary resuscitation in the last decade that have led to a significant improvement in understanding the complex physiology of cardiac arrest and critical interventions for the initial management of cardiac arrest and postresuscitation treatment. Special emphasis is given to the basic simple ways to improve circulation, vital organ perfusion pressures, and the grave prognosis of sudden cardiac death.

Comparison of chest compression to ventilation outcome ratio during basic life support and CPR in 2009

The aim of this study was to compare the effect of a 40:2, 15:2 versus 30:2 Compression: Ventilation (C:V) ratio on rate of Chest Compression (CC), rescuer fatigue and satisfaction. We measured the BP and pulse. Fifty three persons performed BLS and CPR using C:V of 15:2, 30:2 and 40:2 on an adult resuscitation lardal manikin for 2 min. Two researchers measured the above mentioned variables. Data were analyzed by ANOVA, student's t-test or Mann-Whitney U test between groups. The value of p < 0.05 was considered as significant. The results revealed fatigue after 2 min and satisfaction from the performed technique in the groups differed (p< 0.05). Number of breathing in two minutes was 8.8 +/- 4.7(1-24). Total cardiac massage in 2 min. in the study groups was 131.7 +/- 40.6 (20-265), of this number in 130.6 +/- 40.5 was done correctly. The number of compression per 2 min increased with C:V ratio of 40:2 than to other C:V ratio. Most of participants (71.7%) prefer using 30:2 ratios to achieve the primary goal of Cardiopulmonary Resuscitation (CPR). The PR and systolic, diastolic BP of rescuers before and 2 min after resuscitation had insignificant difference (p < 0.001) and SBP differed between groups (p < 0.04). Although the rescuers prefer to perform the C:V ratio 30:2, but number of CC is less than standard recommended by AHA. Alternative C:V ratio of 40:2 methods, is equal to the AHA recommended 80 compressions/minute and also highest number of CC is done in 2 min, while, in the other methods is less than the recommended number.

Advances in Cardiopulmonary Resuscitation

This article focuses on important advances in the science of cardiopulmonary resuscitation (CPR) in the last decade that have led to a significant improvement in understanding the complex physiology of cardiac arrest and critical interventions for the initial management of cardiac arrest and postresuscitation treatment. Special emphasis is given to the basic simple ways to improve circulation, vital organ perfusion pressures, and the grave prognosis of sudden cardiac death.

Resuscitation Outcomes Consortium (ROC) PRIMED cardiac arrest trial methods part 1: rationale and methodology for the impedance threshold device (ITD) protocol

AIM

The primary aim of this study is to compare survival to hospital discharge with a modified Rankin score (MRS)< or =3 between standard cardiopulmonary resuscitation (CPR) plus an active impedance threshold device (ITD) versus standard CPR plus a sham ITD in patients with out-of-hospital cardiac arrest. Secondary aims are to compare functional status and depression at discharge and at 3 and 6 months post-discharge in survivors.

MATERIALS AND METHODS

DESIGN

Prospective, double-blind, randomized, controlled, clinical trial.

POPULATION

Patients with non-traumatic out-of-hospital cardiac arrest treated by emergency medical services (EMS) providers.

SETTING

EMS systems participating in the Resuscitation Outcomes Consortium.

SAMPLE SIZE

Based on a one-sided significance level of 0.025, power=0.90, a survival with MRS< or =3 to discharge rate of 5.33% with standard CPR and sham ITD, and two interim analyses, a maximum of 14,742 evaluable patients are needed to detect a 6.69% survival with MRS< or =3 to discharge with standard CPR and active ITD (1.36% absolute survival difference).

CONCLUSION

If the ITD demonstrates the hypothesized improvement in survival, it is estimated that 2700 deaths from cardiac arrest per year would be averted in North America alone.

Sudden cardiac death: prevalence, pathogenesis, and prevention

Sudden cardiac death (SCD), also known as sudden arrest, is a major health problem worldwide. It is usually defined as an unexpected death from a cardiac cause occurring within a short time in a person with or without preexisting heart disease. The pathogenesis of SCD is complex and multifaceted. A dynamic triggering factor usually interacts with an underlying heart disease, either genetically determined or acquired, and the final outcome is the development of lethal tachyarrhythmias or, less frequently, bradycardia. It has increasingly been highlighted that a reliable clinical and diagnostic approach might be effective to unmask the most important genetic and environmental factors, allowing the construction of a rational personalized medicine framework that can be applied in both the preclinical and clinical settings of SCD. The aim of the present article is to provide a concise overview of prevalence, pathogenesis, clinical presentation, and diagnostic approach to this challenging disorder.