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Gianni A, Botteri M, Stirparo G, Mattesi G, Zorzi A, Villa GF. The impact of the Italian law mandating an automatic external defibrillator in all sports venues on sudden cardiac arrest resuscitation rates. Eur J Prev Cardiol 2024; 31:e16-e18. [PMID: 37758503 DOI: 10.1093/eurjpc/zwad313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/04/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Alessandro Gianni
- Department of Cardiac, Thoracic, Vascular and Public Health Sciences, University of Padova, Via Giustiniani, 2, Padova 35128, Italy
| | | | | | - Giulia Mattesi
- Department of Cardiac, Thoracic, Vascular and Public Health Sciences, University of Padova, Via Giustiniani, 2, Padova 35128, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, Vascular and Public Health Sciences, University of Padova, Via Giustiniani, 2, Padova 35128, Italy
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Abstract
Ischemic heart disease and non-ischemic dilated cardiomyopathy are the most common causes of arrhythmic sudden cardiac death (SCD). Implantable cardioverter defibrillator (ICD) therapy is the only strategy that proved to be effective in preventing SCD in high-risk individuals while the role of antiarrhythmic drugs is limited to symptoms relief. Current guidelines recommend selecting candidates to ICD implantation based on etiology, symptoms of heart failure (NYHA class), and severely depressed left ventricular ejection fraction, but these parameters are neither sensitive nor specific. The review addresses the mechanisms of SCD in patients with heart failure of either ischemic or non-ischemic etiology, risk stratification, and strategies for prevention of SCD in the clinical practice (including optimization of heart failure therapy, avoidance of triggering factors, antiarrhythmic drugs, ICD therapy, early resuscitation, and public access defibrillators).
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Affiliation(s)
- Domenico Corrado
- Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani 2, 35121, Padova, Italy.
| | - Alessandro Zorzi
- Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani 2, 35121, Padova, Italy
| | - Emilio Vanoli
- Molecular Medicine Department, Università degli Studi di Pavia, Pavia, Italy.,Cardiovascular Department, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Edoardo Gronda
- Cardiovascular Department, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
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Yozgat CY, Yesilbas O, Iscan A, Yurtsever I, Temur HO, Bayramova N, Ergun G, Tekin N, Yozgat Y. Development of Antiarrhythmic Therapy-Resistant Ventricular Tachycardia, Ventricular Fibrillation, and Premature Ventricular Contractions in a 15-Year-Old Patient. J Pediatr Intensive Care 2020; 11:72-76. [DOI: 10.1055/s-0040-1715851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/04/2020] [Indexed: 10/23/2022] Open
Abstract
AbstractSudden cardiac arrest (SCA) is the sudden cessation of regular cardiac activity so that the victim becomes unresponsive, with no signs of circulation and no normal breathing. Asystole, ventricular tachycardia (VT), ventricular fibrillation (VF), and pulseless electrical activity are the underlying rhythm disturbances in the pediatric age group. If appropriate interventions (cardiopulmonary resuscitation-CPR and/or defibrillation or cardioversion) are not performed rapidly, this condition progresses to sudden death. There have not been many reported cases of the approach and treatment of cardiac arrhythmias after SCA. Herein, we would like to report a case of a 15-year-old female patient with dilated cardiomyopathy (DCM) who was admitted to our clinic a year ago, and while her left ventricular systolic functions were improved, SCA suddenly occurred. Since the SCA event occurred in another city, intravenous treatment of amiodarone was done immediately and was switch to continuous infusion dose of amiodarone until the patient arrived at our institution's pediatric intensive care unit (PICU) 3 hours later. During the patient's 20-day PICU hospitalization, she developed pulseless VT and VF from time to time. The patient's pulseless VT and VF attacks were brought under control by the use of a defibrillator and added antiarrhythmic drugs (amiodarone, flecainide, esmolol, and propafenone). Intriguingly, therapy-resistance bigeminy with premature ventricular contractions (PVCs) continued despite all these treatments. The patient did not have adequate blood pressure measured by invasive arterial blood pressure monitoring while having bigeminy PVCs. The intermittent bigeminy PVCs ameliorated rapidly after intermittent boluses of lidocaine. In the end, multiple antiarrhythmic therapies and intermittent bolus lidocaine doses were enough to bring her cardiac arrhythmias after SCA under control. This case illustrates that malign PVC's should be taken very seriously, since they may predispose to the development of VT or VF. Also, this case highlights the importance of close vigilance of arterial pressure tracings of patients with bigeminy PVCs which develop after SCA and should not be accepted as normal.
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Affiliation(s)
| | - Osman Yesilbas
- Department of Pediatric Critical Care Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Akin Iscan
- Department of Pediatric Neurology, Bezmialem Vakif University, Istanbul, Turkey
| | - Ismail Yurtsever
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Hafize Otcu Temur
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Nigar Bayramova
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Gokce Ergun
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Nur Tekin
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Yilmaz Yozgat
- Department of Pediatric Cardiology, Bezmialem Vakif University, Istanbul, Turkey
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Lupo R, Giordano G, Artioli G, Calabrò A, Caldararo C, Zacchino S, Conte L, Santoro P, Carriero MC, Carvello M. The use of an automatic defibrillator by non-sanitary personnel in sport areas: an Observational Study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:79-84. [PMID: 32573509 PMCID: PMC7975832 DOI: 10.23750/abm.v91i6-s.9484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/07/2020] [Indexed: 11/27/2022]
Abstract
Introduction: In industrialized countries, sudden cardiac death is a serious public health problem that accounts for about 15% to 20% of all deaths, with an incidence of 0.5 to 3 deaths per 100,000 athletes. In recent years, although both first aid prevention programs and the availability of External Automatic Defibrillator (AED) in public places have increased, few data are available with respect to real knowledge about the use of such devices. The aim of this study is to detect the level of knowledge and skills in the use of automatic external defibrillators among sports and management staff in sports facilities. Materials and Methods: A cross-sectional, multicentre study conducted in 16 sports facilities in the Province of Lecce, Italy, and targeted to all the athletic and managerial staff of these sports facilities. Information was obtained through a validated questionnaire consisting of 27 items. Results: 339 participants of which 59.3% male (n=201) (average=33.6; SD=13.1). 51.6% (n=175) were informed about the presence of the defibrillator, only 38.1% (n=129) declared to know where it was placed and 43.7% (n=96) considered it to be quite or very accessible. The majority of them (78.8%; n=267) were never involved in a training course and declared limited knowledge about the use of this device. Conclusions: Respondents stated that they have poor knowledge and skills in the use of the defibrillator, its operation and maintenance, which could reduce the positive outcomes of early treatment. Further studies should be conducted, although it may be appropriate to implement specific training courses for personnel working in sports centres. (www.actabiomedica.it)
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Affiliation(s)
- Roberto Lupo
- Nurse at the Hospital "San Giuseppe da Copertino", ASL (Local Health Authority) Lecce, Italy.
| | - Giulia Giordano
- Nurse at the "Azienda Socio Sanitaria Territoriale" (A.S.S.T), Melegnano e Martesana, Italy.
| | | | - Antonino Calabrò
- Nurse at the Hospital "Nuovo Ospedale degli Infermi" ASL (Local Health Authority) Biella, Italy.
| | - Cosimo Caldararo
- Director for professional activities and internship of Bachelor of Science (BSc) in Nursing, University of Bari, Lecce (LE).
| | - Simone Zacchino
- Nurse at the Psychiatric Rehabilitation Community "Sorgente S.R.L" Presicce (Lecce), Italy.
| | - Luana Conte
- Laboratory of Interdisciplinary Research Applied to Medicine (DReAM), University of Salento and ASL (Local Health Authority), Lecce, Italy. Laboratory of Biomedical Physics and Environment, Department of Mathematics and Physics "E. De Giorgi", University of Salento, Lecce, Italy..
| | | | | | - Maicol Carvello
- Didactic tutor of Bachelor of Science (BSc) in Nursing, University of Bologna, Faenza (BO), Italy.
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Schmid KM, García RQ, Fernandez MM, Mould-Millman NK, Lowenstein SR. Teaching Hands-Only CPR in Schools: A Program Evaluation in San José, Costa Rica. Ann Glob Health 2018. [PMID: 30779510 PMCID: PMC6748223 DOI: 10.29024/aogh.2367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Hands-only bystander CPR increases survival from out-of-hospital cardiac arrest. Video-based CPR instruction in schools has been proposed as a means to mass-educate laypersons in Hands-only CPR™ (HOCPR), in developed as well as developing countries. Objectives: The purpose of this study is to determine whether a brief video- and mannequin-based instructional program, developed by the American Heart Association (AHA), is an effective strategy for teaching Costa Rican middle- and high-school age children to learn the steps of HOCPR. Methods: This study took place in four educational centers that spanned the entire socioeconomic spectrum within the Grand Metropolitan Area of Costa Rica. Three hundred and eight students from the sixth to eleventh grades participated. The intervention included exposure to the AHA “CPR Anytime” video and practice with CPR mannequins. Before and after the intervention, students took a four-question, multiple-choice quiz that measured their knowledge of the correct steps and proper techniques of HOCPR; a separate question assessed their level of comfort “doing CPR on someone with a cardiac arrest.” Pre- and post-intervention “percent correct” scores were compared and tested for statistical significance using paired t-tests or the McNemar test as appropriate. Improvement in knowledge and comfort levels were also compared across the different educational centers and compared with similar programs implemented in the United States. Results: The students’ overall scores (mean percent correct) on the multiple choice questions more than doubled after training (40.9% ± 1.4% before training vs. 92.5% ± 0.9% after training, p < 0.00001). Improvements were observed in each school, regardless of geographic location or socioeconomic status. Knowledge of the appropriate steps of HOCPR doubled after training (42.2% before training vs. 92.5% after training, p < 0.000001). Post-intervention, a majority (73%) of children reported comfort with performing CPR on an individual who had suffered a cardiac arrest. Conclusion: This study demonstrates the effectiveness of the AHA “CPR Anytime” program in teaching HOCPR to school-age children within the Grand Metropolitan Area of Costa Rica. Additional studies are needed to measure longer-term knowledge retention and students’ ability to perform CPR in simulated cardiac arrest settings.
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Affiliation(s)
| | | | | | | | - Steven R Lowenstein
- University of Colorado, Department of Emergency Medicine.,Colorado School of Public Health, University of Colorado, US
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Schmid KM, García RQ, Fernandez MM, Mould-Millman NK, Lowenstein SR. Teaching Hands-Only CPR in Schools: A Program Evaluation in San José, Costa Rica. Ann Glob Health 2018; 84:612-617. [PMID: 30779510 DOI: 10.9204/aogh.2367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hands-only bystander CPR increases survival from out-of-hospital cardiac arrest. Video-based CPR instruction in schools has been proposed as a means to mass-educate laypersons in Hands-only CPR™ (HOCPR), in developed as well as developing countries. OBJECTIVES The purpose of this study is to determine whether a brief video- and mannequin-based instructional program, developed by the American Heart Association (AHA), is an effective strategy for teaching Costa Rican middle- and high-school age children to learn the steps of HOCPR. METHODS This study took place in four educational centers that spanned the entire socioeconomic spectrum within the Grand Metropolitan Area of Costa Rica. Three hundred and eight students from the sixth to eleventh grades participated. The intervention included exposure to the AHA "CPR Anytime" video and practice with CPR mannequins. Before and after the intervention, students took a four-question, multiple-choice quiz that measured their knowledge of the correct steps and proper techniques of HOCPR; a separate question assessed their level of comfort "doing CPR on someone with a cardiac arrest." Pre- and post-intervention "percent correct" scores were compared and tested for statistical significance using paired t-tests or the McNemar test as appropriate. Improvement in knowledge and comfort levels were also compared across the different educational centers and compared with similar programs implemented in the United States. RESULTS The students' overall scores (mean percent correct) on the multiple choice questions more than doubled after training (40.9% ± 1.4% before training vs. 92.5% ± 0.9% after training, p < 0.00001). Improvements were observed in each school, regardless of geographic location or socioeconomic status. Knowledge of the appropriate steps of HOCPR doubled after training (42.2% before training vs. 92.5% after training, p < 0.000001). Post-intervention, a majority (73%) of children reported comfort with performing CPR on an individual who had suffered a cardiac arrest. CONCLUSION This study demonstrates the effectiveness of the AHA "CPR Anytime" program in teaching HOCPR to school-age children within the Grand Metropolitan Area of Costa Rica. Additional studies are needed to measure longer-term knowledge retention and students' ability to perform CPR in simulated cardiac arrest settings.
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Affiliation(s)
| | | | | | | | - Steven R Lowenstein
- University of Colorado, Department of Emergency Medicine.,Colorado School of Public Health, University of Colorado, US
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Zorzi A, Cipriani A, Corrado D. Circumstances of cardiac arrest during sports activity recorded on video. Eur J Prev Cardiol 2018; 25:1452-1454. [DOI: 10.1177/2047487318791289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
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Zorzi A, Corrado D. Cardiac arrest during sports activity is difficult to recognise? Let the AED do the job! Neth Heart J 2018. [PMID: 29520620 PMCID: PMC5876178 DOI: 10.1007/s12471-018-1097-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- A Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
| | - D Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
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Lin YN, Chang SS, Wang LM, Chi HT, Ueng KC, Tsai CF, Phan CS, Lu LH, Hii CH, Chung YT, Chugh SS, Chen MF, Wu TJ, Chang KC. Prehospital Predictors of Initial Shockable Rhythm in Out-of-Hospital Cardiac Arrest: Findings From the Taichung Sudden Unexpected Death Registry (THUNDER). Mayo Clin Proc 2017; 92:347-359. [PMID: 28259227 DOI: 10.1016/j.mayocp.2016.10.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/25/2016] [Accepted: 10/28/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To identify the incidence and prehospital predictors of ventricular tachycardia/ventricular fibrillation (VT/VF) as the initial arrhythmia in patients with out-of-hospital cardiac arrest (OHCA) in central Taiwan. PATIENTS AND METHODS The Taichung Sudden Unexpected Death Registry program encompasses the Taichung metropolitan area in central Taiwan, with a population of 2.7 million and 17 destination hospitals for patients with OHCA. We performed a detailed analysis of demographic characteristics, circumstances of cardiac arrest, and emergency medical service records using the Utstein Style. RESULTS From May 1, 2013, through April 30, 2014, resuscitation was attempted in 2013 individuals with OHCA, of which 384 were excluded due to trauma and noncardiac etiologies. Of the 1629 patients with presumed cardiogenic OHCA, 7.9% (n=129) had initial shockable rhythm; this proportion increased to 18.8% (61 of 325) in the witnessed arrest subgroup. Male sex (odds ratio [OR], 2.45; 95% CI, 1.46-4.12; P<.001), age younger than 65 years (OR, 2.39, 95% CI, 1.58-3.62; P<.001), public location of arrest (OR, 4.61; 95% CI, 2.86-7.44; P<.001), and witnessed status (OR, 3.98; 95% CI, 2.62-6.05; P<.001) were independent predictors of VT/VF rhythm. CONCLUSION The proportion of patients with OHCA presenting with VT/VF was generally low in this East Asian population. Of the prehospital factors associated with VT/VF, public location of OHCA was the strongest predictor of VT/VF in this population, which may affect planning and deployment of emergency medical services in central Taiwan.
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Affiliation(s)
- Yen-Nien Lin
- Division of Cardiovascular Medicine, China Medical University, Taichung, Taiwan; Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; Cardiovascular Research Laboratory, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Sheng Chang
- Division of Cardiovascular Medicine, China Medical University, Taichung, Taiwan; Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; Cardiovascular Research Laboratory, China Medical University Hospital, Taichung, Taiwan
| | - Lee-Min Wang
- Department of Emergency, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hwan-Ting Chi
- Department of Emergency, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kwo-Chang Ueng
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chin-Feng Tsai
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chee-Seong Phan
- Department of Emergency, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Li-Hua Lu
- Department of Emergency, Tung's Taichung MetroHabor Hospital, Taichung, Taiwan
| | - Choon-Hoon Hii
- Department of Emergency, Kuang Tien General Hospital, Taichung, Taiwan
| | - Yu-Ting Chung
- Department of Emergency, China Medical University Hospital, Taichung, Taiwan
| | | | - Ming-Fong Chen
- Division of Cardiovascular Medicine, China Medical University, Taichung, Taiwan; Cardiovascular Research Laboratory, China Medical University Hospital, Taichung, Taiwan
| | - Tsu-Juey Wu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.
| | - Kuan-Cheng Chang
- Division of Cardiovascular Medicine, China Medical University, Taichung, Taiwan; Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; Cardiovascular Research Laboratory, China Medical University Hospital, Taichung, Taiwan.
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