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Matsuzaki M, Matsumoto N, Nagao K, Sawano H, Yokoyama H, Tahara Y, Hase M, Shirai S, Hazui H, Arimoto H, Kashiwase K, Kasaoka S, Motomura T, Kuroda Y, Yasuga Y, Yonemoto N, Nonogi H. Impact of Induced Therapeutic Hypothermia by Intravenous Infusion of Ice-Cold Fluids After Hospital Arrival in Comatose Survivors of Out-of-Hospital Cardiac Arrest With Initial Shockable Rhythm. Circ J 2021; 85:1842-1848. [PMID: 34261843 DOI: 10.1253/circj.cj-20-0793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The effect of in-hospital rapid cooling by intravenous ice-cold fluids for comatose survivors of out-of-hospital cardiac arrest (OHCA) is unclear.Methods and Results:From the J-PULSE-HYPO study registry, data for 248 comatose survivors with return of spontaneous circulation (ROSC) who were treated with therapeutic hypothermia (34℃ for 12-72 h) after witnessed shockable OHCA were extracted. Patients were divided into 2 groups by the median collapse-to-ROSC interval (18 min), and then into 2 groups by cooling method (rapid cooling by intravenous ice-cold fluids vs. standard cooling). The primary endpoint was favorable neurological outcome (Cerebral Performance Category of 1 or 2) at 30 days after OHCA. In the whole cohort, the shorter collapse-to-ROSC interval group had significantly higher favorable neurological outcome than the longer collapse-to-ROSC interval group (78.2% vs. 46.8%, P<0.001). In the shorter collapse-to-ROSC interval group, no significant difference was observed in favorable neurological outcome between the 2 cooling groups (rapid cooling group: 79.4% vs. standard cooling group: 77.0%, P=0.75). In the longer collapse-to-ROSC interval group, however, favorable neurological outcome was significant higher in the rapid cooling group than in the standard cooling group (60.7% vs. 33.3%, P<0.01) and the adjusted odds ratio after rapid cooling was 3.069 (95% confidence interval 1.423-6.616, P=0.004). CONCLUSIONS In-hospital rapid cooling by intravenous ice-cold fluids improved neurologically intact survival in comatose survivors whose collapse-to-ROSC interval was delayed over 18 min after shockable OHCA.
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Affiliation(s)
| | | | - Ken Nagao
- Department of Cardiology, Nihon University Hospital
| | - Hirotaka Sawano
- Senri Critical Care Medical Center, Saiseikai Senri Hospital
| | | | | | - Mamoru Hase
- Emergency and Critical Care Center, Sapporo City University Hospital
| | | | - Hiroshi Hazui
- Emergency Medicine, Osaka Mishima Emergency and Critical Care Center
| | - Hideki Arimoto
- Emergency and Critical Care Medical Center, Osaka City General Hospital
| | | | - Shunji Kasaoka
- Disaster Medical Education and Research Center, Kumamoto University Hospital
| | | | - Yasuhiro Kuroda
- Emergency and Critical Care Center, Kagawa University Hospital
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Jeejeebhoy F, Windrim R. Management of cardiac arrest in pregnancy. Best Pract Res Clin Obstet Gynaecol 2014; 28:607-18. [DOI: 10.1016/j.bpobgyn.2014.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 03/14/2014] [Indexed: 10/25/2022]
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Rajapakse BN, Neeman T, Dawson AH. The effectiveness of a 'train the trainer' model of resuscitation education for rural peripheral hospital doctors in Sri Lanka. PLoS One 2013; 8:e79491. [PMID: 24255702 PMCID: PMC3821851 DOI: 10.1371/journal.pone.0079491] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 09/22/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Sri Lankan rural doctors based in isolated peripheral hospitals routinely resuscitate critically ill patients but have difficulty accessing training. We tested a train-the-trainer model that could be utilised in isolated rural hospitals. METHODS Eight selected rural hospital non-specialist doctors attended a 2-day instructor course. These "trained trainers" educated their colleagues in advanced cardiac life support at peripheral hospital workshops and we tested their students in resuscitation knowledge and skills pre and post training, and at 6- and 12-weeks. Knowledge was assessed through 30 multiple choice questions (MCQ), and resuscitation skills were assessed by performance in a video recorded simulated scenario of a cardiac arrest using a Resuci Anne Skill Trainer mannequin. RESULTS/DISCUSSION/CONCLUSION Fifty seven doctors were trained. Pre and post training assessment was possible in 51 participants, and 6-week and 12-week follow up was possible for 43, and 38 participants respectively. Mean MCQ scores significantly improved over time (p<0.001), and a significant improvement was noted in "average ventilation volume", "compression count", and "compressions with no error", "adequate depth", "average depth", and "compression rate" (p<0.01). The proportion of participants with compression depth ≥40mm increased post intervention (p<0.05) and at 12-week follow up (p<0.05), and proportion of ventilation volumes between 400-1000mls increased post intervention (p<0.001). A significant increase in the proportion of participants who "checked for responsiveness", "opened the airway", "performed a breathing check", who used the "correct compression ratio", and who used an "appropriate facemask technique" was also noted (p<0.001). A train-the-trainer model of resuscitation education was effective in improving resuscitation knowledge and skills in Sri Lankan rural peripheral hospital doctors. Improvement was sustained to 12 weeks for most components of resuscitation knowledge and skills. Further research is needed to identify which components of training are most effective in leading to sustained improvement in resuscitation.
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Affiliation(s)
- Bishan N. Rajapakse
- Australian National University, Canberra, Australia
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Teresa Neeman
- Statistical Consulting Unit, Australian National University, Canberra, Australia
| | - Andrew H. Dawson
- Australian National University, Canberra, Australia
- Central Clinical School, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
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Maternal cardiac arrest: a practical and comprehensive review. Emerg Med Int 2013; 2013:274814. [PMID: 23956861 PMCID: PMC3730371 DOI: 10.1155/2013/274814] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 06/09/2013] [Indexed: 12/02/2022] Open
Abstract
Cardiac arrest during pregnancy is a dedicated chapter in the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care; however, a robust maternal cardiac arrest knowledge translation strategy and emergency response plan is not usually the focus of institutional emergency preparedness programs. Although maternal cardiac arrest is rare, the emergency department is a high-risk area for receiving pregnant women in either prearrest or full cardiac arrest. It is imperative that institutions review and update emergency response plans for a maternal arrest. This review highlights the most recent science, guidelines, and recommended implementation strategies related to a maternal arrest. The aim of this paper is to increase the understanding of the important physiological differences of, and management strategies for, a maternal cardiac arrest, as well as provide institutions with the most up-to-date literature on which they can build emergency preparedness programs for a maternal arrest.
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Increasing arterial oxygen partial pressure during cardiopulmonary resuscitation is associated with improved rates of hospital admission. Resuscitation 2013; 84:770-5. [PMID: 23333452 DOI: 10.1016/j.resuscitation.2013.01.012] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Revised: 12/14/2012] [Accepted: 01/06/2013] [Indexed: 11/24/2022]
Abstract
AIM As recent clinical data suggest a harmful effect of arterial hyperoxia on patients after resuscitation from cardiac arrest (CA), we aimed to investigate this association during cardiopulmonary resuscitation (CPR), the earliest and one of the most crucial phases of recirculation. METHODS We analysed 1015 patients who from 2003 to 2010 underwent out-of-hospital CPR administered by emergency medical services serving 300,000 inhabitants. Inclusion criteria for further analysis were nontraumatic background of CA and patients >18 years of age. One hundred and forty-five arterial blood gas analyses including oxygen partial pressure (paO2) measurement were obtained during CPR. RESULTS We observed a highly significant increase in hospital admission rates associated with increases in paO2 in steps of 100 mmHg (13.3 kPa). Subsequently, data were clustered according to previously described cutoffs (≤ 60 mmHg [8 kPa]], 61-300 mmHg [8.1-40 kPa], >300 mmHg [>40 kPa]). Baseline variables (age, sex, initial rhythm, rate of bystander CPR and collapse-to-CPR time) of the three compared groups did not differ significantly. Rates of hospital admission after CA were 18.8%, 50.6% and 83.3%, respectively. In a multivariate analysis, logistic regression revealed significant prognostic value for paO2 and the duration of CPR. CONCLUSION This study presents novel human data on the arterial paO2 during CPR in conjunction with the rate of hospital admission. We describe a significantly increased rate of hospital admission associated with increasing paO2. We found that the previously described potentially harmful effects of hyperoxia after return of spontaneous circulation were not reproduced for paO2 measured during CPR. CLINICAL TRIAL REGISTRATION n/a.
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Chest-Compression-Only Bystander Cardiopulmonary Resuscitation in the 30:2 Compression-to-Ventilation Ratio Era. Circ J 2013; 77:2742-50. [DOI: 10.1253/circj.cj-13-0457] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Lamhaut L, Spaulding C. Will the Combination of Public Education and Medical Innovation Improve the Outcomes of Sudden Cardiac Death? Circ J 2013; 77:2696-7. [DOI: 10.1253/circj.cj-13-0995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Lionel Lamhaut
- Centre d’expertise de la mort subite, Inserm UMR-S970, Paris Cardiovascular Research Centre, Paris Descartes University
- D.A.R. and SAMU de Paris, Hôpital Necker, Assistance Publique Hôpitaux de Paris, and Paris Descartes University
| | - Christian Spaulding
- Centre d’expertise de la mort subite, Inserm UMR-S970, Paris Cardiovascular Research Centre, Paris Descartes University
- Cardiology Department, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris and Paris Descartes University
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Markewitz A. Temporäre Schrittmachertherapie bei herzchirurgischen Operationen. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2012. [DOI: 10.1007/s00398-012-0955-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hui D, Morrison LJ, Windrim R, Lausman AY, Hawryluck L, Dorian P, Lapinsky SE, Halpern SH, Campbell DM, Hawkins P, Wax RS, Carvalho JCA, Dainty KN, Maxwell C, Jeejeebhoy FM. The American Heart Association 2010 guidelines for the management of cardiac arrest in pregnancy: consensus recommendations on implementation strategies. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2012; 33:858-863. [PMID: 21846443 DOI: 10.1016/s1701-2163(16)34991-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Dini Hui
- Department of Obstetrics and Gynaecology, Division of Maternal Fetal Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto ON
| | - Laurie J Morrison
- Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto ON; Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto ON
| | - Rory Windrim
- Department of Obstetrics and Gynaecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, University of Toronto, Toronto ON
| | - Andrea Y Lausman
- Department of Obstetrics and Gynaecology, St. Michael's Hospital, University of Toronto, Toronto ON
| | - Laura Hawryluck
- Critical Care, Toronto General Hospital, University of Toronto, Toronto ON
| | - Paul Dorian
- Department of Medicine, Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto ON
| | - Stephen E Lapinsky
- Interdepartmental Division of Critical Care, University of Toronto, Intensive Care Unit, Mount Sinai Hospital, Toronto ON
| | - Stephen H Halpern
- Obstetrics and Gynaecology, Anaesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto ON
| | - Douglas M Campbell
- Department of Paediatrics, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto ON
| | - Paul Hawkins
- Department of Emergency Services, Sunnybrook Health Sciences Centre, University of Toronto, Toronto ON
| | - Randy S Wax
- Departments of Emergency Medicine and Critical Care, Lakeridge Health Corporation and Interdepartmental Division of Critical Care, University of Toronto, Oshawa ON
| | - Jose C A Carvalho
- Departments of Anaesthesia and Pain Management and Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto ON
| | - Katie N Dainty
- Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto ON
| | - Cynthia Maxwell
- Department of Obstetrics and Gynaecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, University of Toronto, Toronto ON
| | - Farida M Jeejeebhoy
- Division of Cardiology, William Osler Health Centre, Department of Medicine, University of Toronto, Toronto ON
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