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Allende-Carrera R, de la Cadena-Sillas JÁ, Urzúa-González A, Gutiérrez-Vega AR, Martínez-Dunker D, Celaya-Cota M, Aguilera-Mora LF, Lainez-Zelaya JS, Lojero-Wheatley L, Asensio-Lafuente E, González-Cruz EH. Achieving successful CPR protocol training on schoolchildren: Insights from experiences in developing countries. Am J Emerg Med 2024:S0735-6757(24)00483-2. [PMID: 39317558 DOI: 10.1016/j.ajem.2024.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 09/14/2024] [Accepted: 09/15/2024] [Indexed: 09/26/2024] Open
Affiliation(s)
- Ricardo Allende-Carrera
- Grupo Intervención San Luis / Facultad de Medicina de la Universidad Autónoma de San Luis Potosí, San Luis Potosí, México.; Internal Medicine, Private practice, Monterrey, Nuevo León, México.
| | | | | | - Alan Rodrigo Gutiérrez-Vega
- Grupo Intervención San Luis / Facultad de Medicina de la Universidad Autónoma de San Luis Potosí, San Luis Potosí, México.; Internal Medicine, Private practice, Monterrey, Nuevo León, México
| | - David Martínez-Dunker
- Cardiology Department, Faculty of Medicine, Universidad Autónoma de Morelos, Morelos, México
| | | | - Luisa F Aguilera-Mora
- Heart Failure Clinic, Instituto Cardiovascular de Minima Invasion, Guadalajara, Jalisco, Mexico
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Strandqvist E, Olheden S, Bäckman A, Jörnvall H, Bäckström D. Physician-staffed prehospital units: a retrospective follow-up from an urban area in Scandinavia. Int J Emerg Med 2023; 16:43. [PMID: 37452288 PMCID: PMC10349430 DOI: 10.1186/s12245-023-00519-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND The aim of this study was to determine when and how rapid response vehicles (RRVs) make a difference in prehospital care by investigating the number and kinds of RRV assignment dispatches and the prehospital characteristics and interventions involved. METHODS This retrospective cohort study was based on data from a quality assurance system where all assignments are registered. RRV staff register every assignment directly at the site, using a smartphone, tablet, or computer. There is no mandatory information requirement or time limit for registration. The study includes data for all RRVs operating in Region Stockholm, three during daytime hours and one at night - from January 1, 2021 to December 31, 2021. RESULTS In 2021, RRVs in Stockholm were dispatched on 11,283 occasions, of which 3,571 (31.6%) resulted in stand-downs. In general, stand-downs were less common for older patients. The most common dispatch category was blunt trauma (1,584 or 14.0%), which accounted for the highest frequency of stand-downs (676 or 6.0%). The second most common category was cardiac arrest (1,086 or 9.6%), followed by shortness of breath (691 or 6.1%), medical not specified (N/S) (596 or 5.3%), and seizures (572 or 5.1%). CONCLUSION The study findings confirm that RRVs provide valuable assistance to the ambulance service in Stockholm, especially for cardiac arrest and trauma patients. In particular, RRV personnel have more advanced medical knowledge and can administer medications and perform interventions that the regular ambulance service cannot provide.
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Affiliation(s)
| | - Staffan Olheden
- Capio Akutläkarbilar, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Department of Perioperative Care, Solna Karolinska University Hospital, Stockholm, Sweden
| | - Anders Bäckman
- Capio Akutläkarbilar, Stockholm, Sweden
- Center for Resuscitation Science, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Henrik Jörnvall
- Capio Akutläkarbilar, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Department of Perioperative Care, Solna Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Section for Anesthesia and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Denise Bäckström
- Capio Akutläkarbilar, Stockholm, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden
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Horriar L, Rott N, Semeraro F, Böttiger BW. A narrative review of European public awareness initiatives for cardiac arrest. Resusc Plus 2023; 14:100390. [PMID: 37128626 PMCID: PMC10148222 DOI: 10.1016/j.resplu.2023.100390] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
A high resuscitation rate can lead to better overall survival after cardiac arrest. In Europe, various campaigns in the field of lay resuscitation are achieving up to a threefold increase in survival. As part of the new Systems Saving Lives (SSL) chapter, the European Resuscitation Council (ERC) guidelines recommend cardiac awareness campaigns to engage the broader community. It has been noted that countries with high survival rates after an out-of-hospital cardiac arrest (OHCA) start education in resuscitation techniques at school age. The ERC 2021 guidelines recommend that all schoolchildren should routinely receive CPR training each year. Since 2015, the KIDS SAVE LIVES statement recommended for two hours of instruction per year in all schools worldwide by age of 12. Cardiac awareness campaigns like World Restart a Heart Day (WRAH) are aimed to raise awareness about resuscitation and to train as many people as possible.
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Affiliation(s)
- Lina Horriar
- German Resuscitation Council, Prittwitzstraße 43, 89070 Ulm, Germany
- Corresponding author.
| | - Nadine Rott
- German Resuscitation Council, Prittwitzstraße 43, 89070 Ulm, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Straße 62, D-50937 Cologne, Germany
| | - Federico Semeraro
- European Resuscitation Council, Niel, Belgium
- Department of Anaesthesia, Intensive Care and EMS, Maggiore Hospital, Bologna, Italy
| | - Bernd W. Böttiger
- German Resuscitation Council, Prittwitzstraße 43, 89070 Ulm, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Straße 62, D-50937 Cologne, Germany
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CPR education in schools: The European "Kids-Save-Lives" initiative and our efforts in Greece. Hellenic J Cardiol 2023; 69:59-60. [PMID: 36167248 DOI: 10.1016/j.hjc.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 02/07/2023] Open
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Horriar L, Rott N, Böttiger BW. [The new 2021 resuscitation guidelines and the importance of lay resuscitation]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:972-978. [PMID: 35723698 PMCID: PMC9207856 DOI: 10.1007/s00103-022-03557-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/27/2022] [Indexed: 11/10/2022]
Abstract
Lay resuscitation is one of the most important measures to increase the survival rate of patients after out-of-hospital cardiac arrest. While European countries, and especially Scandinavian countries, achieve lay resuscitation rates of over 80%, the rate in Germany is only around 40%. The 2021 Resuscitation Guidelines updated by the European Resuscitation Council give special weight to Systems Saving Lives and focus on resuscitation by laypersons. The Systems Saving Lives emphasize the interplay between all actors involved in the chain of survival and thereby specify the link between the emergency service and the general population.Based on the BIG FIVE survival strategies after cardiac arrest, five key strategies are outlined that can achieve the greatest improvement in survival. These are (1) increasing lay resuscitation rates through campaigns and KIDS SAVE LIVES school-based resuscitation training, (2) implementing telephone resuscitation in dispatch centers, (3) first responder systems, (4) advanced life support, and (5) specialized cardiac arrest centers.
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Affiliation(s)
- Lina Horriar
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Nadine Rott
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Bernd W Böttiger
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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Influence of the Type of Physician on Survival from Emergency-Medical-Service-Witnessed Cardiac Arrest: An Observational Study. Healthcare (Basel) 2022; 10:healthcare10101841. [PMID: 36292288 PMCID: PMC9601607 DOI: 10.3390/healthcare10101841] [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: 08/06/2022] [Revised: 09/10/2022] [Accepted: 09/17/2022] [Indexed: 11/19/2022] Open
Abstract
Out-of-hospital cardiac arrest resuscitation by non-emergency dedicated physicians may not be positively associated with survival, as these physicians have less experience and exposure than specialised dedicated personnel. The aim of this study was to compare the survival results of the teams led by emergency dedicated physicians (EDPhy) with those of the teams led by non-emergency dedicated physicians (N-EDPhy) and with a team of basic life support (BLS) emergency technicians (EMTs) used as the control group. A retrospective, multicentre study of emergency-medical-service-witnessed cardiac arrest from medical causes in adults was performed. The records from 2006 to 2016 in a database of a regional emergency system were analysed and updated up to 31 December 2021. Two groups were studied: initial shockable and non-shockable rhythms. In total, 1359 resuscitation attempts were analysed, 281 of which belonged to the shockable group, and 1077 belonged to the non-shockable rhythm group. Any onsite return of spontaneous circulation, patients admitted to the hospital alive, global survival, and survival with a cerebral performance category (CPC) of 1-2 (good and moderate cerebral performance) were studied, with both of the latter categories considered at 30 days, 1 year (primary outcome), and 5 years. The shockable and non-shockable rhythm group (and CPC 1-2) survivals at 1 year were, respectively, as follows: EDPhy, 66.7 % (63.4%) and 14.0% (12.3%); N-EDPhy, 16.0% (16.0%) and 1.96 % (1.47%); and EMTs 32.0% (29.7%) and 1.3% (0.84%). The crude ORs were EDPhy vs. N-EDPhy, 10.50 (5.67) and 8.16 (4.63) (all p < 0.05); EDPhy vs. EMTs, 4.25 (2.65) and 12.86 (7.80) (p < 0.05); and N-EDPhy vs. EMTs, 0.50 (0.76) (p < 0.05) and 1.56 (1.32) (p > 0.05). The presence of an EDPhy was positively related to all the survival and CPC rates.
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Kjaergaard J, Schmidt H, Møller JE, Hassager C. The “Blood pressure and oxygenation targets in post resuscitation care, a randomized clinical trial”: design and statistical analysis plan. Trials 2022; 23:177. [PMID: 35209951 PMCID: PMC8867659 DOI: 10.1186/s13063-022-06101-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 02/10/2022] [Indexed: 12/27/2022] Open
Abstract
Background Comatose patients admitted after resuscitation from cardiac arrest have a significant risk of poor outcome due to hypoxic brain injury. While numerous studies have investigated and challenged the target temperature as the efficacious part of the guideline endorsed Targeted Temperature Management (TTM) protocols, our knowledge and how the remaining parts of the TTM are optimized remain sparse. The present randomized trial investigated two aspects of the TTM protocol: target blood pressure during the ICU stay and oxygenation during mechanical ventilation. Furthermore, the efficacy of device-based post-TTM fever management is addressed. Methods Investigator-initiated, dual-center, randomized clinical trial in comatose OHCA patients admitted to an intensive cardiac care unit. Patients are eligible for inclusion if unconscious, older than 18 years of age, and have return of spontaneous circulation for more than 20 min. Intervention: allocation 1:1:1:1 into a group defined by (a) blood pressure targets in double-blind intervention targeting a mean arterial blood pressure of 63 or 77 mmHg and (b) restrictive (9–10 kPa) or liberal (13–14 kPa) of arterial oxygen concentration during mechanical ventilation. As a subordinate intervention, device-based active fever management is discontinued after 36 h or 72. Patients will otherwise receive protocolized standard of care according to international guidelines, including targeted temperature management at 36 °C for 24 h, sedation with fentanyl and propofol, and multimodal neuro-prognostication. Primary endpoint: Discharge from hospital in poor neurological status (Cerebral Performance category 3 or 4) or death, whichever comes first. Secondary outcomes: Time to initiation of renal replacement therapy or death, neuron-specific enolase (NSE) level at 48 h, MOCA score at day 90, Modified Ranking Scale (mRS) and CPC at 3 months, NT-pro-BNP at 90 days, eGFR and LVEF at 90 days, daily cumulated vasopressor requirement during ICU stay, and need for a combination of vasopressors and inotropic agents or mechanical circulatory support. Discussion We hypothesize that low or high target blood pressure and restrictive and liberal oxygen administration will have an impact on mortality by reducing the risk and degree of hypoxic brain injury. This will be assessment neurological outcome and biochemical and neuropsychological testing after 90 days. Trial registration ClinicalTrials.gov NCT03141099. Registered on May 2017 (retrospectively registered)
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Clinical Significance of Gray to White Matter Ratio after Cardiopulmonary Resuscitation in Children. CHILDREN 2022; 9:children9010036. [PMID: 35053661 PMCID: PMC8774629 DOI: 10.3390/children9010036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/27/2021] [Accepted: 12/04/2021] [Indexed: 11/17/2022]
Abstract
Cardiopulmonary resuscitation (CPR) successfully restores systemic circulation approximately 50% of the time; however, many successfully restored patients have severe neurologic damage. In adults, the gray matter to white matter attenuation ratio (GWR) in brain computed tomography (CT) correlates with the neurologic outcome. However, in children, the clinical significance of GWR still remains unclear. The aim of this study was to evaluate the clinical characteristics of children who underwent CPR for cardiac arrest according to the survival and to demonstrate the differentiation of grey/white matter by Hounsfield units of brain CT and to characterize the attenuations of grey and white matters. Methods: This is a retrospective single-center study. We enrolled those who underwent brain CT within 24 h after return of spontaneous circulation (ROSC) from January 2005 to June 2018. Brain CTs were taken within 24 h of ROSC. We measured the attenuation of grey and white matter in Hounsfield units and calculated GWR. They were compared with healthy controls. Patients were analyzed as follows: survivors vs. non-survivors and better neurologic outcome vs. worse neurologic outcome. Results: Among 100 pediatric patients who had CPR, 56 met inclusion criteria. There were 24 patients who survived and 32 non-survivors. Our study revealed that the incidence of seizure, duration of CPR, and instances of hypothermia were significantly different between survivors and non-survivors. In both survivors and non-survivors, the attenuation of the caudate nucleus, putamen, GWR-basal ganglia, and average GWR were significantly different from controls. In regression analyses, the medial cortex and average GWR were the significant variables to predict survival, and the receiver operating curves revealed areas under curve of 0.733 and 0.666, respectively. Also, the medial cortex 1 was the only variable that predicted the neurologic outcome. Conclusions: There was some predictive survival value of GWR and medial cortex at the centrum semiovale level in early brain CT within 24 h after cardiac arrest. Although we could not find the predictive value of GWR in the neurologic outcome of pediatric patients, we found that the absolute attenuation of the medial cortex was low in patients with worse neurologic outcomes. Further prospective, multicenter studies are needed to determine the predictive value of GWR and the medial cortex.
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Iserbyt P, Madou T. The effect of content knowledge and repeated teaching on teaching and learning basic life support: a cluster randomised controlled trial. Acta Cardiol 2021; 77:616-625. [PMID: 34448685 DOI: 10.1080/00015385.2021.1969109] [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
BACKGROUND Experimental research on the training of BLS instructors and how their performance evolves is scarce. This study investigated the role of content knowledge and repeated teaching trials for improving teaching and learning Basic Life Support (BLS). METHODS A cluster randomised controlled trial. Six secondary school teachers were assigned to either a common content knowledge (CCK) or specialised content knowledge (SCK) training. In the CCK group, teachers were taught to perform BLS technically correct. In the SCK group, teachers were additionally taught to detect and correct common errors students would make. Following the training, teachers taught two BLS lessons to two different classes of secondary school students (n = 216, age 12-14). Teachers' lesson organisation in terms of cognitive (e.g. task presentations), motor (e.g. practice time), and general (e.g. getting organised) activities was assessed. Students' BLS and CPR performance was assessed as the primary outcomes. RESULTS BLS performance was significantly higher in the second lesson for students taught by SCK versus CCK teachers (73% vs 63%). No significant difference was detected between lesson one and two across conditions and teachers. For cardiopulmonary resuscitation (CPR) variables, significant differences in favour of the SCK condition were found for chest compression depth after lesson one, and the amount and volume of ventilations after lesson two. CONCLUSION Students' BLS and CPR performance was positively impacted by the SCK training. BLS performance varied greatly by teachers with averages ranging from 53% to 83% across conditions. Results suggest teaching experience alone is not sufficient to improve teaching effectiveness.
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Affiliation(s)
- Peter Iserbyt
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Tom Madou
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
- Vives University College, Torhout, Belgium
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Mathew R, Sahu AK, Thakur N, Katyal A, Bhoi S, Aggarwal P. Hands-only cardiopulmonary resuscitation training for schoolchildren: A comparison study among different class groups. Turk J Emerg Med 2020; 20:186-192. [PMID: 33089027 PMCID: PMC7549518 DOI: 10.4103/2452-2473.297464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/07/2020] [Accepted: 07/25/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND AND AIM: Up to 70% of out-of-hospital cardiac arrests are witnessed by family members, friends, and other bystanders. These bystanders can play a vital role in delivering help, before professional help arrives. Mandatory nationwide training of schoolchildren has shown the highest impact in improving the bystander cardiopulmonary resuscitation (CPR) rate. In our study, we compared the competency of different classes of schoolchildren from middle school onward in learning hands-only CPR. MATERIALS AND METHODS: This study was conducted in four schools. Schoolchildren were divided into three groups as middle school (6th to 8th standard) (MS), secondary school (9th and 10th standard) (SC), and senior secondary school (11th and 12th standard) (SN). Training module consisted of slide presentation on “hands-only CPR” of 1 h, video demonstration of 30 min, and hands-on session of 2.5 h. Students were then individually assessed for the skills. RESULTS: A total of 810 children were enrolled and trained. Initial approach was performed correctly by 68% of MS, 79.3% of SC, and 82.4% of SN school children, whereas 49.4% of MS, 61.3% of SC, and 72.5% of SN correctly performed chest compression in terms of rate, depth, and duration. Median compression depth and maximum duration of CPR achieved were significantly different across class groups (P < 0.001) Compression depth and duration of chest compression were positively correlated with children's age, height, weight, and body mass index (P < 0.001). CONCLUSION: Theoretical training on hands-only CPR can be started at the middle school level, and practical training can be incorporated in school curricula from secondary school.
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Affiliation(s)
- Roshan Mathew
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ankit Kumar Sahu
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nirmal Thakur
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Aaditya Katyal
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Bhoi
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Aggarwal
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
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Böttiger BW, Lockey A, Georgiou M, Greif R, Monsieurs KG, Mpotos N, Nikolaou N, Nolan J, Perkins G, Semeraro F, Wingen S. KIDS SAVE LIVES: ERC Position statement on schoolteachers' education and qualification in resuscitation. Resuscitation 2020; 151:87-90. [PMID: 32339597 PMCID: PMC7194866 DOI: 10.1016/j.resuscitation.2020.04.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 12/11/2022]
Affiliation(s)
- B W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany.
| | - A Lockey
- Emergency Department, Calderdale Royal Hospital, Halifax, United Kingdom
| | - M Georgiou
- American Medical Center, Nicosia, Cyprus
| | - R Greif
- Department of Anesthesiology and Pain Therapy, Bern University Hospital, University of Bern, Bern, Switzerland; School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - K G Monsieurs
- Emergency Department, Antwerp University Hospital, Edegem, Belgium
| | - N Mpotos
- Faculty of Medicine and Health Sciences, Ghent University and Department of Emergency Medicine, St. Lucas General Hospital, Ghent, Belgium
| | - N Nikolaou
- Department of Cardiology and Cardiac Intensive Care, Konstantopouleio General Hospital, Athens, Greece
| | - J Nolan
- Warwick Clinical Trials Unit, University of Warwick and Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, United Kingdom
| | - G Perkins
- Warwick Clinical Trials Unit and University Hospitals Birmingham NHS Foundation Trust, University of Warwick, Coventry, United Kingdom
| | - F Semeraro
- Department of Anaesthesia, Intensive Care and EMS, Maggiore Hospital, Bologna, Italy
| | - S Wingen
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
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Groß R, Böttiger BW, Thaiss HM. Laienreanimation in Deutschland: Das Nationale Aktionsbündnis Wiederbelebung (NAWIB). Notf Rett Med 2019. [DOI: 10.1007/s10049-019-0615-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sato N, Matsuyama T, Akazawa K, Nakazawa K, Hirose Y. Benefits of adding a physician-staffed ambulance to bystander-witnessed out-of-hospital cardiac arrest: a community-based, observational study in Niigata, Japan. BMJ Open 2019; 9:e032967. [PMID: 31772105 PMCID: PMC6887019 DOI: 10.1136/bmjopen-2019-032967] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE This study aimed to assess the benefits of adding a physician-staffed ambulance to bystander-witnessed out-of-hospital cardiac arrest using a community-based registry. DESIGN Population-based, retrospective cohort study. SETTING An urban city with approximately 800 000 residents. PARTICIPANTS Patients aged ≥18 years with bystander-witnessed out-of-hospital cardiac arrests of medical aetiology in Niigata City, Japan, between January 2012 and December 2016, according to the Utstein style. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was 1-month survival with a favourable neurological outcome, defined as a cerebral performance category score of 1 or 2. We used logistic regression analysis to assess the association between favourable neurological outcome and prehospital physician involvement. RESULTS During the study period, a total of 4172 cardiac arrests were registered; of these, 892 patients with out-of-hospital cardiac arrest were eligible for this analysis, among whom 135 (15.1%) had prehospital physician involvement and 757 (84.9%) did not have prehospital physician involvement. The percentage of favourable neurological outcomes was 20.7% (28 of 135) in those with physician involvement and 10.4% (79 of 757) in those without physician involvement (p=0.001). Using multivariable logistic regression, prehospital physician involvement had an OR for a favourable neurological outcome of 3.44 (95% CI 1.64 to 7.23). CONCLUSIONS Among adults with out-of-hospital cardiac arrest, adding a physician-staffed ambulance was associated with significantly greater favourable neurological outcomes than standard emergency medical services.
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Affiliation(s)
- Nobuhiro Sato
- Department of Emergency and Critical Care Medicine, Niigata City General Hospital, Niigata, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kohei Akazawa
- Department of Medical Informatics and Statistics, Niigata University Graduate School of Medicine, Niigata, Japan
| | - Kyoko Nakazawa
- Department of Medical Informatics and Statistics, Niigata University Graduate School of Medicine, Niigata, Japan
| | - Yasuo Hirose
- Department of Emergency and Critical Care Medicine, Niigata City General Hospital, Niigata, Japan
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Paglino M, Contri E, Baggiani M, Tonani M, Costantini G, Bonomo MC, Baldi E. A video-based training to effectively teach CPR with long-term retention: the ScuolaSalvaVita.it ("SchoolSavesLives.it") project. Intern Emerg Med 2019; 14:275-279. [PMID: 30209672 DOI: 10.1007/s11739-018-1946-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
Abstract
Enhancing CPR knowledge in schools is the key to improving bystander CPR rate and survival after an out-of-hospital cardiac arrest, but the best method to do so in a whole area is unknown. We wanted to assess if a province-based project, which involves the Secondary Schools of a whole Province, is effective in teaching schoolchildren CPR, and how well the skills are retained. We trained 100 teachers from the 21 Secondary Schools of the Province of Pavia with a BLS/AED course and we supplied each school with 10 low-budget manikins and four educational videos. These videos, about 2 min each, consist of a motivational part, an instructive part, a demonstrative part and a practice-while-watching part. We explained to the teachers how to use manikins and videos in a 2-h course. We carried out both a theoretical and a practical test in 21 classes, randomly selected between the classes trained by the teachers, 3 months and 6 months after the training. In the first 5 months of the project, 5146 schoolchildren aged 14-19, in the 21 Secondary Schools of our Province, were trained by their teachers. We tested 304 students 3 months after the course and 318 students 6 months after the course, with good results both in theoretical and practical skills. Our study demonstrates that the ScuolaSalvaVita project is able to effectively teach CPR through teachers using a video-based training in the Secondary Schools of a whole Province obtaining good long-term memory of CPR skills.
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Affiliation(s)
- Martina Paglino
- Pavia nel Cuore, IRC-Comunità Training Center, 27100, Pavia, Italy
- School of Anesthesia and Intensive Care, University of Pavia, 27100, Pavia, Italy
| | - Enrico Contri
- Pavia nel Cuore, IRC-Comunità Training Center, 27100, Pavia, Italy
- School of Anesthesia and Intensive Care, University of Pavia, 27100, Pavia, Italy
- AREU - Azienda Regionale Emergenza Urgenza - AAT Pavia, Department of Intensive Care Medicine, Fondazione IRCCS Policlinico San Matteo Hospital, Pavia, Italy
| | - Marta Baggiani
- Pavia nel Cuore, IRC-Comunità Training Center, 27100, Pavia, Italy
- University of Piemonte Orientale, 18100, Novara, Italy
| | - Michela Tonani
- Pavia nel Cuore, IRC-Comunità Training Center, 27100, Pavia, Italy
- Emergency Medicine Department, Ospedale Maggiore di Lodi, 26900, Lodi, Italy
| | - Giulia Costantini
- Pavia nel Cuore, IRC-Comunità Training Center, 27100, Pavia, Italy
- School of Surgery, University of Pavia, 27100, Pavia, Italy
| | - Maria Concetta Bonomo
- Pavia nel Cuore, IRC-Comunità Training Center, 27100, Pavia, Italy
- School of Anesthesia and Intensive Care, University of Pavia, 27100, Pavia, Italy
| | - Enrico Baldi
- Pavia nel Cuore, IRC-Comunità Training Center, 27100, Pavia, Italy.
- Robbio nel Cuore, IRC-Comunità Training Center, 27038, Robbio, Italy.
- School of Cardiovascular Disease, Department of Molecular Medicine, University of Pavia, 27100, Pavia, Italy.
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KIDS SAVE LIVES: School children education in resuscitation for Europe and the world. Eur J Anaesthesiol 2018; 34:792-796. [PMID: 29087993 DOI: 10.1097/eja.0000000000000713] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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16
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Weidenauer D, Hamp T, Schriefl C, Holaubek C, Gattinger M, Krammel M, Winnisch M, Weidenauer A, Mundigler G, Lang I, Schreiber W, Sterz F, Herkner H, Domanovits H. The impact of cardiopulmonary resuscitation (CPR) manikin chest stiffness on motivation and CPR performance measures in children undergoing CPR training-A prospective, randomized, single-blind, controlled trial. PLoS One 2018; 13:e0202430. [PMID: 30114240 PMCID: PMC6095555 DOI: 10.1371/journal.pone.0202430] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/02/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cardio-pulmonary-resuscitation (CPR) training starting at the age of 12 years is recommended internationally. Training younger children is not recommended because young children lack the physical ability to perform adequate CPR and discouragement to perform CPR later is apprehended. The aim of this study was to answer the following questions: Are younger children discouraged after CPR training? Is discouragement caused by their lack in physical ability to perform adequate chest compressions on a standard manikin and would the use of manikins with a reduced resistance affect their motivation or performance? METHODS We investigated the motivation and CPR performance of children aged 8-13 years after CPR training on manikins of different chest stiffness in a prospective, randomized, single-blind, controlled trial. 322 children underwent randomization and received 30 minutes CPR training in small groups at school. We used two optically identical resuscitation manikins with different compression resistances of 45kg and 30kg. Motivation was assessed with a self-administered questionnaire. Performance was measured with the Resusci®Anne SkillReporter™. FINDINGS Motivation after the training was generally high and there was no difference between the two groups in any of the questionnaire items on motivation: Children had fun (98 vs. 99%; P = 0.32), were interested in the training (99 vs. 98%; P = 0.65), and were glad to train resuscitation again in the future (89 vs. 91%; P = 0.89). CPR performance was generally poor (median compression score (8, IQR 1-45 and 29, IQR 11-54; P<0.001) and the mean compression depth was lower in the 45kg-resistance than in the 30kg-resistance group (33±10mm vs. 41±9; P<0.001). CONCLUSIONS Compression resistances of manikins, though influencing CPR performance, did not discourage 8 to 13 year old children after CPR training. The findings refute the view that young children are discouraged when receiving CPR training even though they are physically not able to perform adequate CPR.
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Affiliation(s)
- David Weidenauer
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Thomas Hamp
- Department of General Anesthesia and Intensive Care, Prehospital Emergency Medicine Research Group, Medical University of Vienna, Vienna, Austria
- * E-mail:
| | - Christoph Schriefl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Caroline Holaubek
- Department of Cardiothoracic and Vascular Anesthesia, Medical University of Vienna, Vienna, Austria
| | | | - Mario Krammel
- Municipal Ambulance Service of Vienna, Vienna, Austria
| | - Markus Winnisch
- Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Ana Weidenauer
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Gerald Mundigler
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Irene Lang
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Schreiber
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Hans Domanovits
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
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Kuvaki B, Özbilgin Ş. School Children Save Lives. Turk J Anaesthesiol Reanim 2018; 46:170-175. [PMID: 30140511 PMCID: PMC6097851 DOI: 10.5152/tjar.2018.25986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 02/06/2018] [Indexed: 11/22/2022] Open
Abstract
Sudden cardiac death is one of the most common causes of preventable death in the industrialized world. In countries with organized emergency health services, it is possible to increase the rate of resuscitation performed by the public and save more lives. Increasing the rate of correct intervention by those witnessing sudden cardiac death requires an increase in the number of adults with training in CPR in society. Resuscitation training should begin in the school years to reach the whole of society within time. As school children with training in CPR increase, the proportion of individuals in society with training and the desire to help others increases, which causes a general increase in resuscitation rates. To teach children "Basic Life Support" the training models should be applied in theory, with training kits, and accompanied by educators, with a variety of figures based on video or computer based training. One of the most important steps in increasing the resuscitation rates performed by the public globally and enhancing survival is through training school children.
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Affiliation(s)
- Bahar Kuvaki
- Department of Anaesthesiology and Reanimation, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Şule Özbilgin
- Department of Anaesthesiology and Reanimation, Dokuz Eylül University School of Medicine, İzmir, Turkey
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Luc G, Baert V, Escutnaire J, Genin M, Vilhelm C, Di Pompéo C, Khoury CE, Segal N, Wiel E, Adnet F, Tazarourte K, Gueugniaud PY, Hubert H. Epidemiology of out-of-hospital cardiac arrest: A French national incidence and mid-term survival rate study. Anaesth Crit Care Pain Med 2018; 38:131-135. [PMID: 29684654 DOI: 10.1016/j.accpm.2018.04.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/03/2018] [Accepted: 04/05/2018] [Indexed: 11/25/2022]
Abstract
Out-of-hospital cardiac arrest (OHCA) is considered an important public health issue but its incidence has not been examined in France. The aim of this study is to define the incidence of OHCA in France and to compare this to other neighbouring countries. Data were extracted from the French OHCA registry. Only exhaustive centres during the period from January 1, 2013, to September 30, 2014 were included. All patients were included, regardless of their age and cause of OHCA. The participating centres covered about 10% of the French population. The study involved 6918 OHCA. The median age was 68 years, with 63% of males. Paediatric population (<15years) represented 1.8%. The global incidence of OHCA was 61.5 per 100,000 inhabitants per year in the total population corresponding to approximately 46,000 OHCA per year. In the adult population, we found an incidence of 75.3 cases per 100,000 inhabitants per year. In adults, the incidences were 100.3 and 52.7 in males and females, respectively. Most (75%) OHCA occurred at home and were due to medical causes (88%). Half of medical OHCA had cardiovascular causes. Survival rates at 30 days was 4.9% [4.4; 5.4] and increased to 10.4% [9.1; 11.7] when resuscitation was immediately performed by bystander at patient's collapse. The incidence and survival at 30 days of OHCA in France appeared similar to that reported in other European countries. Compared to other causes of deaths in France, OHCA is one of the most frequent causes, regardless of the initial pathology.
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Affiliation(s)
- Gérald Luc
- Department of Public Health EA2694, University of Lille, 42, rue Ambroise-Paré, 59120 Loos, France
| | - Valentine Baert
- French national out-of-hospital cardiac arrest registry, RéAC, 59000 Lille, France
| | - Joséphine Escutnaire
- Department of Public Health EA2694, University of Lille, 42, rue Ambroise-Paré, 59120 Loos, France
| | - Michael Genin
- Department of Public Health EA2694, University of Lille, 42, rue Ambroise-Paré, 59120 Loos, France
| | - Christian Vilhelm
- Department of Public Health EA2694, University of Lille, 42, rue Ambroise-Paré, 59120 Loos, France
| | - Christophe Di Pompéo
- Department of Public Health EA2694, University of Lille, 42, rue Ambroise-Paré, 59120 Loos, France
| | - Carlos El Khoury
- RESCUE (Réseau Cardiologie Medecine d'Urgence) Network, Hussel Hospital, 38200 Vienne, France
| | - Nicolas Segal
- Department of Emergency Medicine, Assistance publique-Hôpitaux de Paris (AP-HP), Lariboisière Hospital, 75010 Paris, France
| | - Eric Wiel
- Department of Public Health EA2694, University of Lille, 42, rue Ambroise-Paré, 59120 Loos, France; Department of Emergency Medicine, SAMU 59, Lille University hospital, 59000 Lille, France
| | - Frédéric Adnet
- Inserm U942, Department of emergency medicine, hôpital Avicenne, AP-HP, Paris 13 University, 93000 Bobigny, France
| | - Karim Tazarourte
- SAMU 69, Lyon University Hospital, Claude Bernard University, 69003 Lyon, France
| | | | - Hervé Hubert
- Department of Public Health EA2694, University of Lille, 42, rue Ambroise-Paré, 59120 Loos, France.
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- Research Group on the French national out-of-hospital cardiac arrest registry, RéAC, 59000 Lille, France
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Böttiger BW, Lockey A, Aickin R, Castren M, de Caen A, Escalante R, Kern KB, Lim SH, Nadkarni V, Neumar RW, Nolan JP, Stanton D, Wang TL, Perkins GD. "All citizens of the world can save a life" - The World Restart a Heart (WRAH) initiative starts in 2018. Resuscitation 2018; 128:188-190. [PMID: 29679697 DOI: 10.1016/j.resuscitation.2018.04.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 04/14/2018] [Indexed: 01/14/2023]
Abstract
"All citizens of the world can save a life". With these words, the International Liaison Committee on Resuscitation (ILCOR) is launching the first global initiative - World Restart a Heart (WRAH) - to increase public awareness and therefore the rates of bystander cardiopulmonary resuscitation (CPR) for victims of cardiac arrest. In most of the cases, it takes too long for the emergency services to arrive on scene after the victim's collapse. Thus, the most effective way to increase survival and favourable outcome in cardiac arrest by two- to fourfold is early CPR by lay bystanders and by "first responders". Lay bystander resuscitation rates, however, differ significantly across the world, ranging from 5 to 80%. If all countries could have high lay bystander resuscitation rates, this would help to save hundreds of thousands of lives every year. In order to achieve this goal, all seven ILCOR councils have agreed to participate in WRAH 2018. Besides schoolchildren education in CPR ("KIDS SAVE LIVES"), many other initiatives have already been developed in different parts of the world. ILCOR is keen for the WRAH initiative to be as inclusive as possible, and that it should happen every year on 16 October or as close to that day as possible. Besides recommending CPR training for children and adults, it is hoped that a unified global message will enable our policy makers to take action to address the inequalities in patient survival around the world.
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Affiliation(s)
- B W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937 Köln, Cologne, Germany.
| | - A Lockey
- Emergency Department, Calderdale Royal Hospital, Halifax, United Kingdom
| | - R Aickin
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
| | - M Castren
- Department of Emergency Medicine and Services, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - A de Caen
- Pediatric Critical Care Medicine, Stollery Children's Hospital, Edmonton, Canada
| | - R Escalante
- Unidad de Cuidados Intensivos, Instituto Nacional de Salud del Niño, Universidad Peruana de Ciencias Aplicadas - Centro de Simulación Clínica, Chair InterAmerican Heart Foundation/Emergency Cardiovascular Care, Lima, Peru
| | - K B Kern
- Department of Medicine, Division of Cardiology, University of Arizona, Tucson, AZ, USA
| | - S H Lim
- Department of Emergency Medicine and Education, Singapore General Hospital, Adjunct Associate Professor, Yong Loo Lin School of Medicine and Duke-NUS Medical School, National University of Singapore, Singapore
| | - V Nadkarni
- Department of Anesthesia, Critical Care and Pediatrics, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19063, USA
| | - R W Neumar
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - J P Nolan
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, United Kingdom
| | - D Stanton
- Chair, Resuscitation Council of Southern Africa, Clinical Leadership, Netcare 911, South Africa
| | - T-L Wang
- Chairman, Resuscitation Council of Asia, CEO, National Resuscitation Council of Taiwan, Chang Bing Show Chwang Memorial Hospital, Taiwan, Medical and Law School, Fu-Jen Catholic University, Taiwan
| | - G D Perkins
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, United Kingdom
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Zhu BF, Chen HL, Shen JH, Xing JL, Chen JR. The Relationship between Emergency Response Time and Out-Of-Hospital Cardiac Arrest Prognosis: A Meta-Analysis. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791502200602] [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] Open
Abstract
Objective To assess the relationship between emergency response time and prognosis of patients with out-of-hospital cardiac arrest. Design Systematic review. Methods Relevant observational studies were identified by a search of PubMed and ISI databases to 30 January 2014. Primary outcome was survival to discharge. The weighted mean differences (WMD) for response time were calculated for those survivals to discharge and death in hospital. We also carried out a dose response meta-analysis for assessing summary odds ratio (OR) of survival by response time. Results A total of 13 studies with 804,998 patients included in the meta-analysis. The WMD of response time between survivals to discharge group and death in hospital group was 1.976 (95% confidence interval [CI] = 1.161-2.792; p<0.001). Sensitivity analyses by only included prospective cohorts showed the WMD of response time between two groups was 1.115 (95% CI=0.508-1.723; p<0.001). Dose-response relationship between response time and survival to discharge risk was observed statistically significant (χ2=39.86, p<0.001). In linear model, the summary OR was 0.914 (95% CI=0.889-0.940) for every 1 minutes delay in response time. In spline model, the survival OR decreased along with the response time, especially when response time less than 7 minutes. Conclusions Emergency response time is an important risk factor for prognosis after OHCA in adults. The EMS team must arrive as soon as possible to the site of the event. (Hong Kong j.emerg.med. 2015;22:345-351)
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21
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Wai AKC, Cameron P, Cheung CK, Mak P, Rainer TH. Out-of-Hospital Cardiac Arrest in a Teaching Hospital in Hong Kong: Descriptive Study Using the Utstein Style. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790501200304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To describe, using the Utstein template, the characteristics of patients presenting with out-of-hospital cardiac arrest to a university teaching hospital in the New Territories of Hong Kong, and to evaluate survival. Design Prospective study. Setting The emergency department of a teaching hospital in the New Territories, Hong Kong. Participants Patients older than 12 years with non-traumatic out-of-hospital cardiac arrest who were transported to the hospital between 1 July 2002 and 31 December 2002. Main outcome measures Demographic data, characteristics of cardiac arrest and response time intervals of the emergency medical service presented according to the Utstein style, and also survival to hospital discharge rate. Results A total of 124 patients were included (49.2% male; mean age 71.9 years). The majority of cardiac arrests occurred in patients' home. The overall bystander cardiopulmonary resuscitation (CPR) rate was 15.3% (19/124). The most common electrocardiographic rhythm at scene was asystole, whilst pulseless ventricular tachycardia (VT)/ventricular fibrillation (VF) was found in 18.0%. The overall survival was 0.8% (1/124), and survival to hospital discharge was significantly higher for patients with VF or pulseless VT than those patients with other rhythms of cardiac arrest (11.1% versus 0%). The median witnessed/recognised collapse to defibrillation time was 14 minutes. The median prehospital time interval from collapse/recognition to arrival at hospital was 33 minutes. Conclusion The prognosis of out-of-hospital cardiac arrest in Hong Kong was poor. Major improvements in every component of the chain of survival are necessary.
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Fujii T, Nagamatsu H, Nakano M, Ohno Y, Nakazawa G, Shinozaki N, Yoshimachi F, Ikari Y. Clinical outcomes in patients with acute hemodynamic collapse supported by extracorporeal life support. Intern Emerg Med 2017; 12:1207-1214. [PMID: 27665579 DOI: 10.1007/s11739-016-1542-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 09/15/2016] [Indexed: 10/21/2022]
Abstract
Although extracorporeal life support (ECLS) is utilized for acute hemodynamic collapse, clinical outcomes for such patients are uncertain. The present study examined 30-day clinical outcomes in patients treated with ECLS for acute hemodynamic collapse, and determined the factors associated with 30-day mortality in patients who required ECLS for cardiopulmonary arrest (CPA). A total of 200 patients, in whom emergency ECLS was utilized for acute hemodynamic collapse from 2006 to 2015, were analyzed retrospectively. The impact of CPA on all-cause 30-day death in the overall population was examined by multivariable logistic regression analysis; comparisons were made between 30-day survivors (n = 78) and non-survivors (n = 122). In addition, clinical factors associated with 30-day survival for patients in whom ECLS was utilized for CPA (n = 139) were examined. All-cause 30-day mortality in the overall study population was 61 % (122/200). CPA was the most common cause of ECLS requirement (70 %), and the factor associated strongest with death at 30-days (OR 3.31, 95 % CI 1.75-6.36, P < 0.01). Witnessed CPA with bystander cardiopulmonary resuscitation (CPR) (OR 4.33, 95 % CI 1.08-29.1, P = 0.04) and a less than 40 min interval between CPA and ECLS (OR 3.49, 95 % CI 1.39-9.02, P < 0.01) were suggested as factors associated with 30-day survival in CPA patients. CPA as a trigger of ECLS was a strong contributor to 30-day death in patients in whom emergency ECLS was utilized. However, witnessed CPA with bystander CPR and a less than 40 min interval from CPA to start of ECLS were suggested as factors associated with survival in these CPA patients.
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Affiliation(s)
- Toshiharu Fujii
- Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Hirofumi Nagamatsu
- Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Masataka Nakano
- Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Yohei Ohno
- Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Gaku Nakazawa
- Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Norihiko Shinozaki
- Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Fuminobu Yoshimachi
- Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Yuji Ikari
- Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan.
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Sato R, Kuriyama A, Nasu M, Gima S, Iwanaga W, Takada T, Kitahara Y, Fukui H, Yonemori T, Yagi M. Impact of rapid response car system on ECMO in out-of-hospital cardiac arrest: A retrospective cohort study. Am J Emerg Med 2017; 36:442-445. [PMID: 28863949 DOI: 10.1016/j.ajem.2017.08.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 08/25/2017] [Accepted: 08/26/2017] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Extracorporeal life support (ECLS) has been reported to be more effective than conventional cardiopulmonary resuscitation (CPR). In ECLS, a shorter time from arrival to implantation of extracorporeal membrane oxygenation (ECMO; door-to-ECMO) time was predicted to be associated with better survival rates. This study aimed to examine the impact of the physician-based emergency medical services (P-EMS) using a rapid response car (RRC) on door-to-ECMO time in patients with out-of-hospital cardiac arrest (OHCA). METHODS In this retrospective cohort study, adult patients with OHCA who were admitted to a Japanese tertiary care hospital from April 2012 to December 2016 and underwent venoarterial ECMO were included. Patients were either transferred by emergency medical service (EMS only group) or RRC (RRC group). Primary outcome was door-to-ECMO time. Wilcoxon rank-sum test was used to compare the outcome between the two groups. RESULTS A total of 34 patients were included in this study, and outcome data were available for all patients. The door-to-ECMO time was significantly shorter in the RRC group than in the EMS only group (median, 23min vs. 36min; P=0.006). Additionally, the RRC was also associated with earlier successful intubation and intravenous adrenaline administration. CONCLUSION The physician-based RRC system was associated with a shorter door-to-ECMO time and successful advanced procedures in prehospital settings. Combination of the RRC system with ECLS may lead to better outcomes in patients with OHCA.
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Affiliation(s)
- Ryota Sato
- Department of Emergency and Critical Care Medicine, Urasoe General Hospital, Okinawa, Japan; Department of Internal Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA.
| | - Akira Kuriyama
- Emergency and Critical Care Center, Kurashiki Central Hospital, Okayama, Japan
| | - Michitaka Nasu
- Department of Emergency and Critical Care Medicine, Urasoe General Hospital, Okinawa, Japan
| | - Shinnji Gima
- Department of Emergency and Critical Care Medicine, Urasoe General Hospital, Okinawa, Japan
| | - Wataru Iwanaga
- Department of Emergency and Critical Care Medicine, Urasoe General Hospital, Okinawa, Japan
| | - Tadaaki Takada
- Department of Emergency Medicine, Tokushima Red Cross Hospital, Tokushima, Japan
| | - Yusuke Kitahara
- Department of Emergency and Critical Care Medicine, Urasoe General Hospital, Okinawa, Japan
| | - Hideto Fukui
- Department of Emergency and Critical Care Medicine, Urasoe General Hospital, Okinawa, Japan
| | - Terutake Yonemori
- Department of Emergency and Critical Care Medicine, Urasoe General Hospital, Okinawa, Japan
| | - Masaharu Yagi
- Department of Emergency and Critical Care Medicine, Urasoe General Hospital, Okinawa, Japan
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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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Effect of Adipose-Derived Mesenchymal Stem Cell Administration and Mild Hypothermia Induction on Delayed Neuronal Death After Transient Global Cerebral Ischemia. Crit Care Med 2017; 45:e508-e515. [PMID: 28252535 DOI: 10.1097/ccm.0000000000002289] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Global cerebral ischemia is a cause of poor prognosis after resuscitation from cardiac arrest. Various attempts have been made to minimize global cerebral ischemia but none been more effective than mild hypothermia induction. A few studies have shown the effect of mesenchymal stem cells on global cerebral ischemia, but no studies have compared this effect with mild hypothermia or assessed any possible interaction. We aimed to show the effect of mesenchymal stem cells on delayed neuronal death after global cerebral ischemia and to compare this effect with mild hypothermia. DESIGN Experimental study. SETTING Animal research laboratory. SUBJECTS Adult male Sprague-Dawley rats weighing 250-300 g. INTERVENTIONS Rats were subjected to 7 minutes of transient global cerebral ischemia and randomized into four groups: control, mild hypothermia, injection of human adipose-derived mesenchymal stem cells, and combined application of mild hypothermia and mesenchymal stem cells, along with four sham groups treated identically. Rats were euthanized 7 days after global cerebral ischemia. MEASUREMENTS AND MAIN RESULTS Degree of neuronal death in hippocampus was significantly higher in control than in other groups. The number of activated microglia was higher in control group than in other groups and was higher in mild hypothermia than shams, mesenchymal stem cells, mild hypothermia/mesenchymal stem cells. Degree of blood-brain barrier disruption and the count of infiltrated neutrophils were significantly higher in control than in other groups. Degree of oxidative injury was significantly higher in control than other groups. It was higher in mild hypothermia than sham groups, mesenchymal stem cells, mild hypothermia/mesenchymal stem cells and was higher in mesenchymal stem cells group than sham groups. Significantly, worse functional results were found in control than in other groups. CONCLUSIONS Administration of mesenchymal stem cells after transient global cerebral ischemia has a prominent protective effect on delayed neuron death, even compared with mild hypothermia.
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Scholz KH, Böttiger BW. Cardiac-Arrest-Zentren. Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0307-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Böttiger BW, Semeraro F, Wingen S. "Kids Save Lives": Educating Schoolchildren in Cardiopulmonary Resuscitation Is a Civic Duty That Needs Support for Implementation. J Am Heart Assoc 2017; 6:JAHA.117.005738. [PMID: 28292747 PMCID: PMC5524048 DOI: 10.1161/jaha.117.005738] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bernd W Böttiger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany
| | - Federico Semeraro
- Department of Anesthesia and Intensive Care Medicine, Maggiore Hospital, Bologna, Italy
| | - Sabine Wingen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany
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Böttiger BW, Semeraro F, Altemeyer KH, Breckwold J, Kreimeier U, Rücker G, Wingen S. KIDS SAVE LIVES – Schülerausbildung in Wiederbelebung. Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0286-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Niforopoulou P, Iacovidou N, Lelovas P, Karlis G, Papalois Α, Siakavellas S, Spapis V, Kaparos G, Siafaka I, Xanthos T. Correlation of Impedance Threshold Device use during cardiopulmonary resuscitation with post-cardiac arrest Acute Kidney Injury. Am J Emerg Med 2017; 35:846-854. [PMID: 28131602 DOI: 10.1016/j.ajem.2017.01.040] [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: 12/11/2016] [Revised: 01/16/2017] [Accepted: 01/21/2017] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To assess whether use of Impedance Threshold Device (ITD) during cardiopulmonary resuscitation (CPR) reduces the degree of post-cardiac arrest Acute Kidney Injury (AKI), as a result of improved hemodynamics, in a porcine model of ventricular fibrillation (VF) cardiac arrest. METHODS After 8 min of untreated cardiac arrest, the animals were resuscitated either with active compression-decompression (ACD) CPR plus a sham ITD (control group, n=8) or with ACD-CPR plus an active ITD (ITD group, n=8). Adrenaline was administered every 4 min and electrical defibrillation was attempted every 2 min until return of spontaneous circulation (ROSC) or asystole. After ROSC the animals were monitored for 6 h under general anesthesia and then returned to their cages for a 48 h observation, before euthanasia. Two novel biomarkers, Neutrophil Gelatinase-Associated Lipocalin (NGAL) in plasma and Interleukin-18 (IL-18) in urine, were measured at 2 h, 4 h, 6 h, 24 h and 48 h post-ROSC, in order to assess the degree of AKI. RESULTS ROSC was observed in 7 (87.5%) animals treated with the sham valve and 8 (100%) animals treated with the active valve (P=NS). However, more than twice as many animals survived at 48 h in the ITD group (n=8, 100%) compared to the control group (n=3, 37.5%). Urine IL-18 and plasma NGAL levels were augmented post-ROSC in both groups, but they were significantly higher in the control group compared with the ITD group, at all measured time points. CONCLUSION Use of ITD during ACD-CPR improved hemodynamic parameters, increased 48 h survival and decreased the degree of post-cardiac arrest AKI in the resuscitated animals.
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Affiliation(s)
- Panagiota Niforopoulou
- National and Kapodistrian University of Athens, Medical School, 3A Parou st, Melissia, Athens 15127, Greece.
| | - Nicoletta Iacovidou
- National and Kapodistrian University of Athens, Medical School, 3 Pavlou Mela st, Athens 16233, Greece.
| | - Pavlos Lelovas
- National and Kapodistrian University of Athens, Medical School, Laboratory of Research of the Musculoskeletal System, 10 Athinas st, Kifissia, Athens 14561, Greece.
| | - George Karlis
- National and Kapodistrian University of Athens, Medical School, 45-47 Ypsilantou st, Athens 10676, Greece.
| | - Αpostolos Papalois
- Experimental-Research Centre, ELPEN Pharmaceutical Co. Inc., 95 Marathonos Ave, Pikermi, Athens 19009, Greece.
| | - Spyros Siakavellas
- National and Kapodistrian University of Athens, Medical School, Academic Department of Gastroenterology, Laikon General Hospital, 17 Aghiou Thoma st, Athens 11527, Greece.
| | - Vasileios Spapis
- Hippokrateion General Hospital of Athens, 114 Vassilissis Sofias Ave, Athens, 11527, Greece.
| | - George Kaparos
- Aretaieion University Hospital, Biopathology Department, 76 Vassilissis Sofias Ave, Athens 11528, Greece.
| | - Ioanna Siafaka
- National and Kapodistrian University of Athens, Medical School, Aretaieion University Hospital, 76 Vassilissis Sofias Ave, Athens 11528, Greece.
| | - Theodoros Xanthos
- European University of Cyprus, School of Medicine, 6 Diogenis str, Engomi, Nicosia 1516, Cyprus.
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Krishna CK, Showkat HI, Taktani M, Khatri V. Out of hospital cardiac arrest resuscitation outcome in North India - CARO study. World J Emerg Med 2017; 8:200-205. [PMID: 28680517 DOI: 10.5847/wjem.j.1920-8642.2017.03.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To evaluate the outcome of cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrests (OHCA) in India and factors influencing the outcome. METHODS The outcome and related factors like demographics, aspects of the OHCA event, return of spontaneous circulation (ROSC) and survival to discharge, among the 80 adult patients presenting to emergency department experiencing OHCA considered for resuscitation between January 2014 to April 2015, were analyzed, according to the guidelines of the Utstein consensus conference. RESULTS The survival rate to hospital admission was 32.5%, the survival rate to hospital discharge was 8.8% and with good cerebral performance category (CPC1) neurological status was 3.8%. Majority of OHCA was seen in elderly individuals between 51 to 60 years, predominately in males. Majority of OHCA were witnessed arrests (56.5%) with 1.3% bystander CPR rate, 92.5% arrests occurred at home, 96% presented with initial non-shockable rhythm and 92.5% with presumed cardiac etiology but survival was better in those who experienced OHCA at public place, in witnessed arrests, in patients who had shockable presenting rhythm and in those where CPR duration was ≤20 minutes. CONCLUSION Witnessed arrests, early initiation of CPR by bystanders, CPR duration ≤20 minutes, initial presenting shockable rhythm, OHCA with non-cardiac etiology are associated with a good outcome. To improve the outcome of CPR and the low survival rates after an OHCA event in India, focused strategies should be designed to set up an emergency medical system (EMS), to boost the rates of bystander CPR and education of the lay public in basic CPR.
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Affiliation(s)
| | | | | | - Vikram Khatri
- Department of Cardiology, Moolchand Medcity, New Delhi, India
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Hamilton A, Steinmetz J, Wissenberg M, Torp-Pedersen C, Lippert FK, Hove L, Lohse N. Association between prehospital physician involvement and survival after out-of-hospital cardiac arrest: A Danish nationwide observational study. Resuscitation 2016; 108:95-101. [DOI: 10.1016/j.resuscitation.2016.08.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 07/18/2016] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
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The new European Resuscitation Council guidelines on cardiopulmonary resuscitation and post-resuscitation care. Eur J Anaesthesiol 2016; 33:701-4. [DOI: 10.1097/eja.0000000000000492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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"A Time to Act"--Anaesthesiologists in resuscitation help save 200,000 lives per year worldwide: School children, lay resuscitation, telephone-CPR, IOM and more. Eur J Anaesthesiol 2016; 32:825-7. [PMID: 26509241 DOI: 10.1097/eja.0000000000000374] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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: 926] [Impact Index Per Article: 115.8] [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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Dispatcher-assisted compression-only cardiopulmonary resuscitation provides best quality cardiopulmonary resuscitation by laypersons. Eur J Anaesthesiol 2016; 33:575-80. [DOI: 10.1097/eja.0000000000000432] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Böttiger BW, Bossaert LL, Castrén M, Cimpoesu D, Georgiou M, Greif R, Grünfeld M, Lockey A, Lott C, Maconochie I, Melieste R, Monsieurs KG, Nolan JP, Perkins GD, Raffay V, Schlieber J, Semeraro F, Soar J, Truhlář A, Van de Voorde P, Wyllie J, Wingen S. Kids Save Lives - ERC position statement on school children education in CPR.: "Hands that help - Training children is training for life". Resuscitation 2016; 105:A1-3. [PMID: 27339096 DOI: 10.1016/j.resuscitation.2016.06.005] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
Affiliation(s)
- B W Böttiger
- European Resuscitation Council (ERC), Niel, Belgium; Department of Anaesthesiology and Intensive Care Medicine, University Hospital and University of Cologne, Germany.
| | - L L Bossaert
- European Resuscitation Council (ERC), Niel, Belgium; University of Antwerp, Antwerp, Belgium
| | - M Castrén
- European Resuscitation Council (ERC), Niel, Belgium; Department of Emergency Medicine and Services, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - D Cimpoesu
- European Resuscitation Council (ERC), Niel, Belgium; University of Medicine and Pharmacy Gr.T. Popa Iasi, Emergency Department - Emergency County Hospital Sf. Spiridon, Iasi, Romania
| | - M Georgiou
- European Resuscitation Council (ERC), Niel, Belgium; American Medical Center Cyprus, Nicosia University Medical School, Nicosia, Cyprus
| | - R Greif
- European Resuscitation Council (ERC), Niel, Belgium; Department of Anaesthesiology and Pain Therapy, University Hospital Bern and University of Bern, Switzerland
| | - M Grünfeld
- European Resuscitation Council (ERC), Niel, Belgium; Department of Emergency Medicine, Prehospital Unit, Community Health Centre Kranj, Kranj, Slovenia
| | - A Lockey
- European Resuscitation Council (ERC), Niel, Belgium; Department of Emergency Medicine, Calderdale and Huddersfield NHS Foundation Trust, Halifax, UK
| | - C Lott
- European Resuscitation Council (ERC), Niel, Belgium; Department of Anesthesiology, University of Mainz, Germany
| | - I Maconochie
- European Resuscitation Council (ERC), Niel, Belgium; Department of Paediatric Emergency Medicine, Imperial College NHS Healthcare Trust, Imperial College, London, UK
| | - R Melieste
- European Resuscitation Council (ERC), Niel, Belgium
| | - K G Monsieurs
- European Resuscitation Council (ERC), Niel, Belgium; Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Belgium
| | - J P Nolan
- European Resuscitation Council (ERC), Niel, Belgium; Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
| | - G D Perkins
- European Resuscitation Council (ERC), Niel, Belgium; Warwick Medical School and Heart of England NHS Foundation, Warwick, UK
| | - V Raffay
- European Resuscitation Council (ERC), Niel, Belgium
| | - J Schlieber
- European Resuscitation Council (ERC), Niel, Belgium; AUVA Trauma Center Salzburg, Department of Anaesthesiology, Salzburg, Austria
| | - F Semeraro
- European Resuscitation Council (ERC), Niel, Belgium; Department of Anaesthesia and Intensive Care Medicine, Maggiore Hospital, Bologna Italy
| | - J Soar
- European Resuscitation Council (ERC), Niel, Belgium; Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol UK
| | - A Truhlář
- European Resuscitation Council (ERC), Niel, Belgium; Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University of Hradec Králové, Czech Republic
| | - P Van de Voorde
- European Resuscitation Council (ERC), Niel, Belgium; Department of Emergency Medicine, University of Ghent, Belgium
| | - J Wyllie
- European Resuscitation Council (ERC), Niel, Belgium; Department of Neonatology, James Cook University Hospital, Middlesbrough, UK
| | - S Wingen
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital and University of Cologne, Germany.
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Evaluation of cyclosporine a as a cardio- and neuroprotective agent after cardiopulmonary resuscitation in a rat model. Shock 2016; 43:576-81. [PMID: 25705861 DOI: 10.1097/shk.0000000000000357] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The immunosuppressant drug cyclosporine A (CsA) is a direct inhibitor of the mitochondrial permeability transition pore, which is the common end point of many pathways of ischemic preconditioning and postconditioning. We studied the neuroprotective and cardioprotective effect of CsA after cardiac arrest (CA) in a rat model of cardiopulmonary resuscitation. After institutional approval by the Governmental Animal Care Committee, 83 rats were subjected to 6 min of CA and were randomly and investigator-blinded allocated either to placebo (n = 15) or interventional group (n = 15; 10-mg/kg body weight CsA intravenously) after restoration of spontaneous circulation (ROSC). Before CA (baseline) as well as 1 h and 3 h after ROSC, continuous measurement of stroke volume, left ventricular ejection fraction, preload adjusted maximum power, and end diastolic volume was performed using a conductance catheter. One day, 3 days, and 7 days after ROSC, neurological outcome was evaluated by a tape removal test. After 7 days of reperfusion, coronal brain sections were analyzed by counting Nissl-positive (i.e., viable) neurons and terminal deoxynucleotidyl transferase dUTP nick end labeling positive (i.e., apoptotic) cells. Animals treated with CsA had a higher stroke volume (96 [93; 107] μL vs. 78 [73; 94] μL; P = 0.02), higher ejection fraction (58% [51%; 63%] vs. 42% [35%; 51%]; P = 0.002), and higher preload adjusted maximum power (4.8 [3.9; 6.1] vs. 2.3 [2.0; 2.6] mW/μL; P < 0.001). End diastolic volume remained stable in the CsA group 3 h after ROSC in comparison to baseline (160 [143; 181] μL vs. 157 [148; 192] μL; P = 0.56), whereas it increased in the placebo group (169 [153; 221] μL vs. 156 [138; 166] μL, P = 0.05). More neurons survived after administration of CsA (2.5 [1.6; 4.9] vs. 0.7 [0.4; 1.4]; P = 0.005). Compared to placebo-treated animals, the time in the tape removal test 7 days after ROSC was reduced by half in the CsA group without reaching statistical significance (26 [22; 51] vs. placebo 53 [38; 56] s; P = 0.13). Cyclosporine A treatment neither affected the number of terminal deoxynucleotidyl transferase dUTP nick end labeling-positive cells nor the survival rate. Pharmacological postconditioning with CsA after successful cardiopulmonary resuscitation attenuates myocardial dysfunction and reduces neuronal damage.
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Arrich J, Holzer M, Havel C, Müllner M, Herkner H. Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation. Cochrane Database Syst Rev 2016; 2:CD004128. [PMID: 26878327 PMCID: PMC6516972 DOI: 10.1002/14651858.cd004128.pub4] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Good neurological outcome after cardiac arrest is difficult to achieve. Interventions during the resuscitation phase and treatment within the first hours after the event are critical. Experimental evidence suggests that therapeutic hypothermia is beneficial, and several clinical studies on this topic have been published. This review was originally published in 2009; updated versions were published in 2012 and 2016. OBJECTIVES We aimed to perform a systematic review and meta-analysis to assess the influence of therapeutic hypothermia after cardiac arrest on neurological outcome, survival and adverse events. SEARCH METHODS We searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 10); MEDLINE (1971 to May 2015); EMBASE (1987 to May 2015); the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1988 to May 2015); and BIOSIS (1989 to May 2015). We contacted experts in the field to ask for information on ongoing, unpublished or published trials on this topic.The original search was performed in January 2007. SELECTION CRITERIA We included all randomized controlled trials (RCTs) conducted to assess the effectiveness of therapeutic hypothermia in participants after cardiac arrest, without language restrictions. We restricted studies to adult populations cooled by any cooling method, applied within six hours of cardiac arrest. DATA COLLECTION AND ANALYSIS We entered validity measures, interventions, outcomes and additional baseline variables into a database. Meta-analysis was performed only for a subset of comparable studies with negligible heterogeneity. We assessed the quality of the evidence by using standard methodological procedures as expected by Cochrane and incorporated the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach. MAIN RESULTS We found six RCTs (1412 participants overall) conducted to evaluate the effects of therapeutic hypothermia - five on neurological outcome and survival, one on only neurological outcome. The quality of the included studies was generally moderate, and risk of bias was low in three out of six studies. When we compared conventional cooling methods versus no cooling (four trials; 437 participants), we found that participants in the conventional cooling group were more likely to reach a favourable neurological outcome (risk ratio (RR) 1.94, 95% confidence interval (CI) 1.18 to 3.21). The quality of the evidence was moderate.Across all studies that used conventional cooling methods rather than no cooling (three studies; 383 participants), we found a 30% survival benefit (RR 1.32, 95% CI 1.10 to 1.65). The quality of the evidence was moderate.Across all studies, the incidence of pneumonia (RR 1.15, 95% CI 1.02 to 1.30; two trials; 1205 participants) and hypokalaemia (RR 1.38, 95% CI 1.03 to 1.84; two trials; 975 participants) was slightly increased among participants receiving therapeutic hypothermia, and we observed no significant differences in reported adverse events between hypothermia and control groups. Overall the quality of the evidence was moderate (pneumonia) to low (hypokalaemia). AUTHORS' CONCLUSIONS Evidence of moderate quality suggests that conventional cooling methods provided to induce mild therapeutic hypothermia improve neurological outcome after cardiac arrest, specifically with better outcomes than occur with no temperature management. We obtained available evidence from studies in which the target temperature was 34°C or lower. This is consistent with current best medical practice as recommended by international resuscitation guidelines for hypothermia/targeted temperature management among survivors of cardiac arrest. We found insufficient evidence to show the effects of therapeutic hypothermia on participants with in-hospital cardiac arrest, asystole or non-cardiac causes of arrest.
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Affiliation(s)
- Jasmin Arrich
- Medical University of ViennaDepartment of Emergency MedicineWähringer Gürtel 18‐20 / 6DViennaAustria1090
| | - Michael Holzer
- Medical University of ViennaDepartment of Emergency MedicineWähringer Gürtel 18‐20 / 6DViennaAustria1090
| | - Christof Havel
- Medical University of ViennaDepartment of Emergency MedicineWähringer Gürtel 18‐20 / 6DViennaAustria1090
| | - Marcus Müllner
- Internistisches Zentrum BrigittenauTreustrasse 43ViennaAustria1200
| | - Harald Herkner
- Medical University of ViennaDepartment of Emergency MedicineWähringer Gürtel 18‐20 / 6DViennaAustria1090
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Influence of EMS-physician presence on survival after out-of-hospital cardiopulmonary resuscitation: systematic review and meta-analysis. Crit Care 2016; 20:4. [PMID: 26747085 PMCID: PMC4706668 DOI: 10.1186/s13054-015-1156-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 12/06/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence suggests that EMS-physician-guided cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OOHCA) may be associated with improved outcomes, yet randomized controlled trials are not available. The goal of this meta-analysis was to determine the association between EMS-physician- versus paramedic-guided CPR and survival after OOHCA. METHODS AND RESULTS Studies that compared EMS-physician- versus paramedic-guided CPR in OOHCA published until June 2014 were systematically searched in MEDLINE, EMBASE and Cochrane databases. All studies were required to contain survival data. Data on study characteristics, methods, and as well as survival outcomes were extracted. A random-effects model was used for the meta-analysis due to a high degree of heterogeneity among the studies (I(2) = 44%). Return of spontaneous circulation [ROSC], survival to hospital admission, and survival to hospital discharge were the outcome measures. Out of 3,385 potentially eligible studies, 14 met the inclusion criteria. In the pooled analysis (n = 126,829), EMS-physician-guided CPR was associated with significantly improved outcomes compared to paramedic-guided CPR: ROSC 36.2% (95% confidence interval [CI] 31.0 - 41.7%) vs. 23.4% (95% CI 18.5 - 29.2%) (pooled odds ratio [OR] 1.89, 95% CI 1.36 - 2.63, p < 0.001); survival to hospital admission 30.1 % (95% CI 24.2 - 36.7%) vs. 19.2% (95% CI 12.7 - 28.1%) (pooled OR 1.78, 95% CI 0.97 - 3.28, p = 0.06); and survival to discharge 15.1% (95% CI 14.6 - 15.7%) vs. 8.4% (95% CI 8.2 - 8.5%) (pooled OR 2.03, 95% CI 1.48 - 2.79, p < 0.001). CONCLUSIONS This systematic review suggests that EMS-physician-guided CPR in out-of-hospital cardiac arrest is associated with improved survival outcomes.
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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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Kudenchuk PJ, Stuart R, Husain S, Fahrenbruch C, Eisenberg M. Treatment and outcome of out-of-hospital cardiac arrest in outpatient health care facilities. Resuscitation 2015; 97:97-102. [PMID: 26476198 DOI: 10.1016/j.resuscitation.2015.08.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/25/2015] [Accepted: 08/31/2015] [Indexed: 11/15/2022]
Abstract
AIM We evaluated the frequency and effectiveness of basic and advanced life support (ALS) interventions by medical professionals when out-of-hospital cardiac arrest (OHCA) occurred in ambulatory healthcare clinics before emergency medical services (EMS) arrival. METHODS Non-traumatic OHCAs in adults were systematically characterized over a 15 year period by their occurrence in clinics, at home, or in non-medical public locations, and outcomes compared between matched cohorts from each group. RESULTS Among 7784 patients, 6098 OHCA occurred at home, 1612 in non-medical public locations and 74 in clinics. Compared to non-medical public locations, clinic patients with OHCA were older, more often women and more frequently shocked; clinic arrests were more often witnessed, less likely to be of cardiac cause and to occur before EMS arrival. Compared to home, more clinic arrests were witnessed, occurred after EMS arrival, had bystander CPR, shockable rhythms and were defibrillated. When OHCA occurred before EMS arrival, 51 of 56 clinic patients (91%) received CPR, a defibrillator applied to 23 (41%), 17 (30%) were shocked, 4 (7%) intubated, and 7 (13%) received intravenous medications from facility personnel. Of these, only pre-EMS defibrillator use was associated with improved outcome. Among matched patients, OHCA survival was higher in clinics than at home (42% vs 26%, p=0.029), but comparable to other public locations. CONCLUSIONS Survival from OHCA in clinics was comparable to non-medical public locations, and higher than at home. Alongside CPR, use of defibrillators was associated with improved survival and worth prioritizing over other interventions before EMS arrival regardless of OHCA location.
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Affiliation(s)
- Peter J Kudenchuk
- University of Washington Department of Medicine, Seattle, WA, United States; King County Emergency Medical Services, Seattle-King County Department of Public Health, Seattle, WA, United States.
| | - Russell Stuart
- University of Virginia Health System, Department of Anesthesiology, Charlottesville, VA 22903, United States
| | - Sofia Husain
- King County Emergency Medical Services, Seattle-King County Department of Public Health, Seattle, WA, United States
| | - Carol Fahrenbruch
- King County Emergency Medical Services, Seattle-King County Department of Public Health, Seattle, WA, United States
| | - Mickey Eisenberg
- University of Washington Department of Medicine, Seattle, WA, United States; King County Emergency Medical Services, Seattle-King County Department of Public Health, Seattle, WA, United States
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von Vopelius-Feldt J, Coulter A, Benger J. The impact of a pre-hospital critical care team on survival from out-of-hospital cardiac arrest. Resuscitation 2015; 96:290-5. [PMID: 26375661 DOI: 10.1016/j.resuscitation.2015.08.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/26/2015] [Accepted: 08/25/2015] [Indexed: 11/25/2022]
Abstract
AIM To assess the impact of a pre-hospital critical care team (CCT) on survival from out-of-hospital cardiac arrest (OHCA). METHODS We undertook a retrospective observational study, comparing OHCA patients attended by advanced life support (ALS) paramedics with OHCA patients attended by ALS paramedics and a CCT between April 2011 and April 2013 in a single ambulance service in Southwest England. We used multiple logistic regression to control for an anticipated imbalance of prognostic factors between the groups. The primary outcome was survival to hospital discharge. All data were collected independently of the research. RESULTS 1851 cases of OHCA were included in the analysis, of which 1686 received ALS paramedic treatment and 165 were attended by both ALS paramedics and a CCT. Unadjusted rates of survival to hospital discharge were significantly higher in the CCT group, compared to the ALS paramedic group (15.8% and 6.5%, respectively, p<0.001). After adjustment using multiple logistic regression, the effect of CCT treatment was no longer statistically significant (OR 1.54, 95% CI 0.89-2.67, p=0.13). Subgroup analysis of OHCA with first monitored rhythm of ventricular fibrillation or pulseless ventricular tachycardia showed similar results. CONCLUSION Pre-hospital critical care for OHCA was not associated with significantly improved rates of survival to hospital discharge. These results are in keeping with previously published studies. Further research with a larger sample size is required to determine whether CCTs can improve outcome in OHCA.
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Affiliation(s)
- Johannes von Vopelius-Feldt
- Academic Emergency Department, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Way, BS2 8HW Bristol, United Kingdom.
| | - Archibald Coulter
- North Bristol NHS Trust, Southmead Road, BS10 5NB Bristol, United Kingdom
| | - Jonathan Benger
- Academic Emergency Department, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Way, BS2 8HW Bristol, United Kingdom; University of the West of England, Bristol, United Kingdom
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Böttiger BW, Van Aken H. Kids save lives--Training school children in cardiopulmonary resuscitation worldwide is now endorsed by the World Health Organization (WHO). Resuscitation 2015. [PMID: 26209417 DOI: 10.1016/j.resuscitation.2015.07.005] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany.
| | - Hugo Van Aken
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital of Münster, Münster, Germany
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Chesters A, Harris T, Hodgetts TJ, Keefe N. Survival to Discharge After Cardiac Arrest Attended by a Doctor-Paramedic Helicopter Emergency Medical Service: An Utstein-style Multiservice Review of 1085 Activations. J Emerg Med 2015; 49:439-47. [PMID: 26168871 DOI: 10.1016/j.jemermed.2015.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 04/19/2015] [Accepted: 05/14/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND The presentation of outcomes after cardiac arrest presented by emergency medical service and in-hospital teams in the Utstein style allows for comparative analysis of populations and systems. Essex and Herts Air Ambulance Trust (EHAAT) and the East Anglian Air Ambulance (EAAA) are doctor-plus-paramedic prehospital care teams that respond to a large number of medical cardiac arrests. OBJECTIVE To report the outcomes of medical cardiac arrests according to the Utstein style. METHODS Retrospective database analysis and hospital follow-up of all cardiac arrests attended by either service over a 31-month period. Traumatic cardiac arrests were excluded. PRIMARY OUTCOME survival and cerebral performance category at discharge from the hospital. RESULTS There were 429 patients attended by the two services; 193 patients achieved return of spontaneous circulation, which was sustained at the time of handover to the hospital team. Of 140 patients for whom complete follow-up was available, the overall survival rate was 50.7%, 86% of whom had a Cerebral Performance Category of 1 or 2. The overall survival-to-discharge rate for all patients attended was 11.7%. CONCLUSION Benchmarking of performance is essential to understand reasons for variability, and to allow individual systems to reflect on their own practices. We have described 31 months of data that pertain to medical cardiac arrest cases attended by our services and demonstrated a comparable survival rate to discharge with good neurological outcome.
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Affiliation(s)
| | - Tim Harris
- Department of Emergency Medicine, Queen Mary, University of London and Bart's Health NHS Trust, London, UK; East Anglian Air Ambulance, Norwich, UK
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Reanimation. Med Klin Intensivmed Notfmed 2015; 110:81-93; quiz 94-5. [DOI: 10.1007/s00063-014-0460-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/12/2014] [Accepted: 12/16/2014] [Indexed: 10/24/2022]
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Savastano S, Klersy C, Raimondi M, Langord K, Vanni V, Rordorf R, Vicentini A, Petracci B, Landolina M, Visconti LO. Positive trend in survival to hospital discharge after out-of-hospital cardiac arrest. J Cardiovasc Med (Hagerstown) 2014; 17:227. [DOI: 10.2459/jcm.0000000000000040] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Knapp J, Teschendorf P, Scholz E, Roewer J, Russ N, Böttiger BW, Popp E. Conductance catheter measurement and effect of different anesthetics in a rat model of postresuscitation myocardial dysfunction. JOURNAL OF THE AMERICAN ASSOCIATION FOR LABORATORY ANIMAL SCIENCE : JAALAS 2014; 53:392-8. [PMID: 25199096 PMCID: PMC4113240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 07/25/2013] [Accepted: 01/03/2014] [Indexed: 06/03/2023]
Abstract
We demonstrate the usefulness of left ventricular pressure-volume (PV) loops generated by the use of conductance catheter measurements and investigate the influence of the type of general anesthesia on postresuscitation myocardial dysfunction in a rat model of cardiac arrest (CA) and subsequent cardiopulmonary resuscitation. A total of 42 Wistar-Han rats were randomized to receive general anesthesia with sevoflurane and resuscitation after CA, general anesthesia with pentobarbital intraperitoneally and resuscitation after CA, or general anesthesia with pentobarbital without CA (sham group). Myocardial function, assessed by analysis of PV loops, was measured continuously and in real-time by using a PV-conductance catheter. Rats were monitored for 3 h after restoration of spontaneous circulation (ROSC). The use of PV-conductance catheters supported objective and reliable evaluation of myocardial function and proved feasible in this rat model of CA. End-diastolic volume increased in rats anesthetized with pentobarbital after ROSC (before CA, 237 ± 45 μL; after ROSC, 402 ± 64 μL). Preloadadjusted maximal power before CA was the same in all groups but decreased in both resuscitated groups. The decrease was less pronounced in rats anesthetized with sevoflurane compared with pentobarbital (11.8 ± 4.9 mW/μL(2) compared with 4.8 ± 1.9 mW/μL(2) at 3 h after ROSC). This finding indicates that the type of general anesthesia influences postresuscitation myocardial dysfunction in this rat model of experimentally induced CA and cardiopulmonary resuscitation. Rats that were anesthetized with sevoflurane exhibited less postresuscitation myocardial dysfunction than did those anesthetized with pentobarbital.
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Affiliation(s)
| | - Peter Teschendorf
- Department of Anaesthesiology and Postoperative Intensive Care Medicine, Clinical Center of Osnabrück, Osnabrück, Germany
| | - Eberhard Scholz
- Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
| | | | | | - Bernd W Böttiger
- Department of Anaesthesiology and Postoperative Intensive Care Medicine, University of Cologne, Köln, Germany
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