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Álvarez de la Cadena-Sillas J, Asensio-Lafuente E, Martínez-Dunker D, Urzúa-Gonzalez A, Celaya-Cota M, Aguilera-Mora LF, Lainez-Zelaya J, Hernández-Garcia L, González-Cruz EH. Out of hospital cardiac arrest, first steps to know and follow in Mexico to have cardioprotected territories. A point of view of a group of experts. Arch Cardiol Mex 2024; 94:174-180. [PMID: 38306447 DOI: 10.24875/acm.23000072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/28/2023] [Indexed: 02/04/2024] Open
Abstract
Sudden cardiac death is a common occurrence. Out-of-hospital cardiac arrest is a global public health problem suffered by ≈3.8 million people annually. Progress has been made in the knowledge of this disease, its prevention, and treatment; however, most events occur in people without a previous diagnosis of heart disease. Due to its multifactorial and complex nature, it represents a challenge in public health, so it led us to work in a consensus to achieve the implementation of cardioprotected areas in Mexico as a priority mechanism to treat these events. Public access cardiopulmonary resuscitation (CPR) and early defibrillation require training of non-medical personnel, who are usually the first responders in the chain of survival. They should be able to establish a basic and efficient CPR and use of the automatic external defibrillator (AED) until the emergency services arrive at the scene of the incident. Some of the current problems in Mexico and alternative solutions for them are addressed in the present work.
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Affiliation(s)
- Jorge Álvarez de la Cadena-Sillas
- Práctica Privada San Miguel Allende, San Miguel Allende, Guanajuato, México
- Servicio de Cardiología, de Corazón de Querétaro, Querétaro, México
| | | | | | - Agustín Urzúa-Gonzalez
- Servicio de Cardiología, Unidades Médicas de Alta Especialidad T1, Instituto Mexicano del Seguro Social, León, Guanajuato, México
| | | | | | - José Lainez-Zelaya
- Servicio de Cardiología, Hospital Alta Especialidad, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Zapata, Morelos, México
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Raphalen JH, Soumagnac T, Delord M, Bougouin W, Georges JL, Paul M, Legriel S. Long-term heart function in cardiac-arrest survivors. Resusc Plus 2023; 16:100481. [PMID: 37859632 PMCID: PMC10582774 DOI: 10.1016/j.resplu.2023.100481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/21/2023] Open
Abstract
Purpose To assess outcomes and predictors of long-term myocardial dysfunction after cardiac arrest (CA) of cardiac origin. Methods We retrospectively included consecutive, single-center, prospective-registry patients who survived to hospital discharge for adult out-of-hospital and in-hospital CA of cardiac origin in 2005-2019. The primary objective was to collect the 1-year New York Heart Association Functional Class (NYHA-FC) and major adverse cardiovascular events (MACE). Results Of 135 patients, 94 (72%) had their NYHA-FC determined after 1 year, including 75 (75/94, 80%) who were I, 17 (17/94, 18%) II, 2 (2/94, 2%) III, and none IV. The echocardiographic left ventricular ejection fraction was abnormal in 87/130 (67%) patients on day 1, 52/123 (42%) at hospital discharge, and 17/52 (33%) at 6 months. During the median follow-up of 796 [283-1975] days, 38/119 (32%) patients experienced a MACE. These events were predominantly related to acute heart failure (13/38) or ischemic cardiovascular events (16/38), with acute coronary syndrome being the most prevalent among them (8/16). Pre-CA cardiovascular disease was a risk factor for 1-year NYHA-FC > I (P = 0.01), absence of bystander cardiopulmonary resuscitation was significantly associated with NYHA-FC > I at 1 year. Conclusion Most patients had no heart-failure symptoms a year after adult out-of hospital or in-hospital CA of cardiac origin, and absence of bystander cardiopulmonary resuscitation was the only treatment component significantly associated with NYHA-FC > I at 1 year. Nearly a third experienced MACE and the most common types of MACE were ischemic cardiovascular events and acute heart failure. Early left ventricular dysfunction recovered within 6 months in half the patients with available values.
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Affiliation(s)
- Jean-Herlé Raphalen
- Intensive Care Unit, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, 149 rue de Sèvres, 75015 Paris, France
| | - Tal Soumagnac
- Intensive Care Unit, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, 149 rue de Sèvres, 75015 Paris, France
| | - Marc Delord
- Clinical Research Center, Versailles Hospital, 77 rue de Versailles, 78150 Le Chesnay, France
- Department of Population Health Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Wulfran Bougouin
- Intensive Care Unit, Jacques Cartier Hospital, 6 Av. du Noyer Lambert, 91300 Massy, France
- INSERM U970, Team 4, Sudden Death Expertise Center, 75015 Paris, France
| | - Jean-Louis Georges
- Cardiology Department, Versailles Hospital, 77 rue de Versailles, 78150 Le Chesnay, France
| | - Marine Paul
- Intensive Care Unit, Versailles Hospital, 77 rue de Versailles, 78150 Le Chesnay, France
| | - Stéphane Legriel
- Intensive Care Unit, Versailles Hospital, 77 rue de Versailles, 78150 Le Chesnay, France
- UVSQ, INSERM, Paris-Saclay University, CESP, PsyDev Team, 94800 Villejuif, France
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Charlton K, Scott J, Blair L, Scott S, McClelland G, Davidson T, Burrow E, Mason A. Public attitudes towards bystander CPR and their association with social deprivation: Findings from a cross sectional study in North England. Resusc Plus 2022; 12:100330. [PMID: 36407569 PMCID: PMC9672441 DOI: 10.1016/j.resplu.2022.100330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/26/2022] [Accepted: 10/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background Bystander cardiopulmonary resuscitation (BCPR) is undertaken in only 40% of out of hospital cardiac arrests (OHCAs) in the UK. Lower rates of BCPR and public access defibrillator (PAD) use have been correlated with lower socio-economic status (SES). The aim of this study was to examine knowledge and attitudes towards BCPR and PAD's using a study specific questionnaire, and to understand how these potentially interact with individual characteristics and SES. Methods Cross-sectional study between July-December 2021 across areas of varying SES in North England. Results Six hundred and one individuals completed the survey instrument (mean age = 51.9 years, 52.2 % female). Increased age was associated with being less willing to call 999 (p < 0.001) and follow call handler advice (p < 0.001). Female respondents were less comfortable performing BCPR than male respondents (p = 0.006). Individuals from least deprived areas were less likely to report comfort performing CPR, (p = 0.016) and less likely to know what a PAD is for, (p = 0.025). Higher education level was associated with increased ability to recognise OHCA (p = 0.005) and understanding of what a PAD is for (p < 0.001). Individuals with higher income were more likely to state they would follow advice regarding BCPR (p = 0.017) and report comfort using a PAD (p = 0.029). Conclusion Individual characteristics such as age and ethnicity, rather than SES, are indicators of knowledge, willingness, and perceived competency to perform BCPR. Policy makers should avoid using SES alone to target interventions. Future research should examine how cultural identity and social cohesion intersect with these characteristics to influence willingness to perform BCPR.
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Affiliation(s)
- Karl Charlton
- North East Ambulance Service NHS Foundation Trust, Bernicia House, Newburn Riverside, Newcastle upon Tyne NE15 8NY, UK
- Corresponding author.
| | - Jason Scott
- Northumbria University, Sutherland Building, Northumberland Road, Newcastle upon Tyne NE1 8ST, UK
| | - Laura Blair
- North East Ambulance Service NHS Foundation Trust, Bernicia House, Newburn Riverside, Newcastle upon Tyne NE15 8NY, UK
| | - Stephanie Scott
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 4LP, UK
| | - Graham McClelland
- North East Ambulance Service NHS Foundation Trust, Bernicia House, Newburn Riverside, Newcastle upon Tyne NE15 8NY, UK
| | - Tom Davidson
- Centre of Excellence in Paramedic Practice, Institute of Health, University of Cumbria, Fusehill Street, Carlisle CA1 2HH, UK
| | - Emma Burrow
- North East Ambulance Service NHS Foundation Trust, Bernicia House, Newburn Riverside, Newcastle upon Tyne NE15 8NY, UK
| | - Alex Mason
- North East Ambulance Service NHS Foundation Trust, Bernicia House, Newburn Riverside, Newcastle upon Tyne NE15 8NY, UK
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Sterie AC, Jox RJ, Rubli Truchard E. Decision-making ethics in regards to life-sustaining interventions: when physicians refer to what other patients decide. BMC Med Ethics 2022; 23:91. [PMID: 36056340 PMCID: PMC9440599 DOI: 10.1186/s12910-022-00828-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health decisions occur in a context with omnipresent social influences. Information concerning what other patients decide may present certain interventions as more desirable than others. OBJECTIVES To explore how physicians refer to what other people decide in conversations about the relevancy of cardio-pulmonary resuscitation (CPR) or do-not-attempt-resuscitation orders (DNAR). METHODS We recorded forty-three physician-patient admission interviews taking place in a hospital in French-speaking Switzerland, during which CPR is discussed. Data was analysed with conversation analysis. RESULTS Reference to what other people decide in regards to CPR is used five times, through reported speech. The reference is generic, and employed as a resource to deal with trouble encountered with the patient's preference, either because it is absent or potentially incompatible with the medical recommendation. In our data, it is a way for physicians to present decisional paths and to steer towards the relevancy of DNAR orders ("Patients tell us 'no futile care'"). By calling out to a sense of membership, it builds towards the patient embracing norms that are associated with a desirable or relevant social group. CONCLUSIONS Introducing DNAR decisions in terms of what other people opt for is a way for physicians to bring up the eventuality of allowing natural death in a less overt way. Formulating treatment choices in terms of what other people do has implications in terms of supporting autonomous and informed decision making, since it nudges patients towards conformity with what is presented as the most preferable choice on the basis of social norms.
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Affiliation(s)
- Anca-Cristina Sterie
- Chair of Geriatric Palliative Care, Palliative and Supportive Care Service and Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. .,Service of Palliative and Supportive Care, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Ralf J Jox
- Institute of Humanities in Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Eve Rubli Truchard
- Chair of Geriatric Palliative Care, Palliative and Supportive Care Service and Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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5
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Alhussein RM, Albarrak MM, Alrabiah AA, Aljerian NA, Bin Salleeh HM, Hersi AS, Wani TA, Al Aseri ZA. Knowledge of non-healthcare individuals towards cardiopulmonary resuscitation: a cross-sectional study in Riyadh City, Saudi Arabia. Int J Emerg Med 2021; 14:11. [PMID: 33568064 PMCID: PMC7876786 DOI: 10.1186/s12245-021-00335-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 02/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background Most sudden cardiac arrests occur at home, with low rates of bystander cardiopulmonary resuscitation being performed. We aimed to assess knowledge of cardiopulmonary resuscitation among individuals in Riyadh City, Saudi Arabia, who are not involved in health care. Methods A community-based cross-sectional study was conducted between January and February 2020 in 4 different areas in Riyadh City: North, South, East, and West. The participants were surveyed using a validated self-administered questionnaire. The Statistical Package for Social Sciences version 25.0 was used for inferential statistics and binary logistic regression analysis. Results A total of 856 participants completed the questionnaire, 51.8% were unaware of cardiopulmonary resuscitation. Only 4.4% of the participants had attended a formal cardiopulmonary resuscitation training course, 5.1% were campaign attendees, and 38.7% acquired their experience through the media. Having a higher level of education was positively associated with having knowledge of cardiopulmonary resuscitation. The main concern among attendees of cardiopulmonary resuscitation training courses and campaigns was legal issues, whereas inadequate knowledge was the major barrier for those who had learned about cardiopulmonary resuscitation through the media. Conclusion The level of knowledge of cardiopulmonary resuscitation among non-health care individuals in Riyadh City was found to be insufficient. Therefore, coordinated efforts among different authorities should be considered to implement a structured strategy aiming to increase awareness and knowledge of cardiopulmonary resuscitation among non-health care individuals.
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Affiliation(s)
| | | | - Abdulaziz A Alrabiah
- Department of Emergency Medicine, College of Medicine, King Saud University, P.O. Box 7805, Riyadh, 11472, Kingdom of Saudi Arabia
| | - Nawfal A Aljerian
- Department of Emergency Medicine, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard, Riyadh, Saudi Arabia.,Medical Referrals Center-Ministry of Health, Riyadh, Saudi Arabia
| | - Hashim M Bin Salleeh
- Department of Emergency Medicine, College of Medicine, King Saud University, P.O. Box 7805, Riyadh, 11472, Kingdom of Saudi Arabia
| | - Ahmad S Hersi
- Department of Cardiac Sciences, College of Medicine, King Saud University, P.O. Box 7805, Riyadh, 11472, Kingdom of Saudi Arabia
| | - Tariq A Wani
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Zohair A Al Aseri
- College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia. .,Departments of Emergency Medicine and Critical Care, College of Medicine, King Saud University, P.O. Box 7805, Riyadh, 11472, Kingdom of Saudi Arabia.
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Jörgens M, Königer J, Kanz KG, Birkholz T, Hübner H, Prückner S, Zwissler B, Trentzsch H. Testing mechanical chest compression devices of different design for their suitability for prehospital patient transport - a simulator-based study. BMC Emerg Med 2021; 21:18. [PMID: 33541280 PMCID: PMC7860178 DOI: 10.1186/s12873-021-00409-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/18/2021] [Indexed: 11/21/2022] Open
Abstract
Background Mechanical chest compression (mCPR) offers advantages during transport under cardiopulmonary resuscitation. Little is known how devices of different design perform en-route. Aim of the study was to measure performance of mCPR devices of different construction-design during ground-based pre-hospital transport. Methods We tested animax mono (AM), autopulse (AP), corpuls cpr (CC) and LUCAS2 (L2). The route had 6 stages (transport on soft stretcher or gurney involving a stairwell, trips with turntable ladder, rescue basket and ambulance including loading/unloading). Stationary mCPR with the respective device served as control. A four-person team carried an intubated and bag-ventilated mannequin under mCPR to assess device-stability (displacement, pressure point correctness), compliance with 2015 ERC guideline criteria for high-quality chest compressions (frequency, proportion of recommended pressure depth and compression-ventilation ratio) and user satisfaction (by standardized questionnaire). Results All devices performed comparable to stationary use. Displacement rates ranged from 83% (AM) to 11% (L2). Two incorrect pressure points occurred over 15,962 compressions (0.013%). Guideline-compliant pressure depth was > 90% in all devices. Electrically powered devices showed constant frequencies while muscle-powered AM showed more variability (median 100/min, interquartile range 9). Although physical effort of AM use was comparable (median 4.0 vs. 4.5 on visual scale up to 10), participants preferred electrical devices. Conclusion All devices showed good to very good performance although device-stability, guideline compliance and user satisfaction varied by design. Our results underline the importance to check stability and connection to patient under transport.
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Affiliation(s)
- Maximilian Jörgens
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Schillerstr. 53, 80336, München, Germany
| | - Jürgen Königer
- LAKUMED Klinken - Krankenhaus Vilsbiburg, Klinik für Anästhesie und Intensivmedizin, Vilsbiburg; Ärztlicher Leiter Rettungsdienst (ÄLRD), Landshut District, Germany
| | - Karl-Georg Kanz
- Klinikum rechts der Isar der Technischen Universität München, Klinik und Poliklinik für Unfallchirurgie, München; Ärztlicher Bezirksbeauftragter Rettungsdienst (ÄBRD) Northwest Upper Bavaria, München, Germany
| | - Torsten Birkholz
- Universitätsklinikum Erlangen, Anästhesiologische Klinik, Erlangen; former Ärztlicher Leiter Rettungsdienst (ÄLRD), Amberg District, Germany
| | - Heiko Hübner
- Medical Director of Emergency Services, Zweckverband für Rettungsdienst und Feuerwehralarmierung Allgäu, Kempten, Germany
| | - Stephan Prückner
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Schillerstr. 53, 80336, München, Germany
| | - Bernhard Zwissler
- Klinik für Anästhesiologie, Klinikum der Universität München, LMU München, Munich, Germany
| | - Heiko Trentzsch
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Schillerstr. 53, 80336, München, Germany.
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Mohd Y, Kumar A, Sheikh I, Fatima A, Bhoi S, Jamshed N, Aggarwal P. Calming the storm - Stellate ganglion block in refractory ventricular arrhythmia in the emergency department. Am J Emerg Med 2021; 45:685.e5-685.e8. [PMID: 33436317 DOI: 10.1016/j.ajem.2020.12.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Yaseen Mohd
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Akshay Kumar
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Irtiqa Sheikh
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Afroz Fatima
- 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.
| | - Nayer Jamshed
- 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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Baldi E, Contri E, Böttiger BW. The need to overcome the lack of CPR competencies in healthcare students in Europe. Int J Cardiol 2020; 320:100. [PMID: 32682008 DOI: 10.1016/j.ijcard.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/03/2020] [Indexed: 11/24/2022]
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Lu JP, Che CH, Huang HP. [Comparison of the accuracy of predicting prognosis of brain function in patients after cardiopulmonary cerebral resuscitation with two kinds of electroencephalogram techniques combined with neuron-specific enolase]. Zhonghua Yi Xue Za Zhi 2020; 100:1629-1633. [PMID: 32486597 DOI: 10.3760/cma.j.cn112137-20190911-02011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To compare the accuracy of electroencephalography (EEG) grading or amplitude-integrated electroencephalography (aEEG) grading combined with NSE in predicting brain function prognosis after cardiopulmonary cerebral resuscitation (CPR) in adults. Methods: The patients who were admitted to Fujian Medical University Union Hospital after CPR from January 2015 to June 2019 were enrolled. Demographic data, Glasgow coma scale (GCS), blood neuron specific enolase (NSE), EEG grading and aEEG grading were collected. The main clinical outcome was the prognosis of brain function (Glasgow-Pittsburgh cerebral performance category, CPC) in patients at 3 months after CPR. Accordingly, the patients were divided into two groups: favorable prognosis group and poor prognosis group, and relevant parameters were compared between the two groups. The predictive ability of EEG grading or aEEG grading combined with NSE for brain function prognosis was evaluated by receiver operating characteristic (ROC) curve. Results: A total of 57 patients were enrolled, with 34 males and 23 females. The average age was (65±19) years old. In terms of Young EEG scales, there was 16 grade 1 cases (28.1%), 24 grade 2-5 cases (42.1%) and 17 grade 6 cases (29.8%), respectively. As for aEEG grading, there was 11 grade Ⅰ cases (19.3%), 25 grade Ⅱ cases (43.9%) and 21 grade Ⅲ cases (36.8%), respectively. There was no significant difference of age, sex, length of stay between the two groups (all P>0.05). However, there was significant difference of EEG grading scale, aEEG grading, GCS grading and NSE between the two groups (all P<0.05). The area under curve (AUC) of NSE, EEG grading and aEEG grading for predicting brain function prognosis was 0.81, 0.82 and 0.85, respectively (all P<0.01). In aEEG grading combined with NSE group, the AUC of was 0.92, and the optimal cut-off point was 4.5, with a sensitivity of 95.8% and a specificity of 79.0%. In EEG grading combined with NSE group, the AUC was 0.90, and the optimal cut-off point was 3.6, with a sensitivity of 92.1% and a specificity of 77.0%. Conclusions: aEEG grading combined with NSE is more accurate in predicting prognosis in patients with cardiopulmonary cerebral resuscitation when compared to EEG grading. Considering its feasibility, aEEG grading combined with NSE is more suitable for clinical application.
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Affiliation(s)
- J P Lu
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - C H Che
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - H P Huang
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 350001, China
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10
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Ebner F, Riker RR, Haxhija Z, Seder DB, May TL, Ullén S, Stammet P, Hirsch K, Forsberg S, Dupont A, Friberg H, McPherson JA, Søreide E, Dankiewicz J, Cronberg T, Nielsen N. The association of partial pressures of oxygen and carbon dioxide with neurological outcome after out-of-hospital cardiac arrest: an explorative International Cardiac Arrest Registry 2.0 study. Scand J Trauma Resusc Emerg Med 2020; 28:67. [PMID: 32664989 PMCID: PMC7362652 DOI: 10.1186/s13049-020-00760-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 07/02/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Exposure to extreme arterial partial pressures of oxygen (PaO2) and carbon dioxide (PaCO2) following the return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) is common and may affect neurological outcome but results of previous studies are conflicting. METHODS Exploratory study of the International Cardiac Arrest Registry (INTCAR) 2.0 database, including 2162 OHCA patients with ROSC in 22 intensive care units in North America and Europe. We tested the hypothesis that exposure to extreme PaO2 or PaCO2 values within 24 h after OHCA is associated with poor neurological outcome at discharge. Our primary analyses investigated the association between extreme PaO2 and PaCO2 values, defined as hyperoxemia (PaO2 > 40 kPa), hypoxemia (PaO2 < 8.0 kPa), hypercapnemia (PaCO2 > 6.7 kPa) and hypocapnemia (PaCO2 < 4.0 kPa) and neurological outcome. The secondary analyses tested the association between the exposure combinations of PaO2 > 40 kPa with PaCO2 < 4.0 kPa and PaO2 8.0-40 kPa with PaCO2 > 6.7 kPa and neurological outcome. To define a cut point for the onset of poor neurological outcome, we tested a model with increasing and decreasing PaO2 levels and decreasing PaCO2 levels. Cerebral Performance Category (CPC), dichotomized to good (CPC 1-2) and poor (CPC 3-5) was used as outcome measure. RESULTS Of 2135 patients eligible for analysis, 700 were exposed to hyperoxemia or hypoxemia and 1128 to hypercapnemia or hypocapnemia. Our primary analyses did not reveal significant associations between exposure to extreme PaO2 or PaCO2 values and neurological outcome (P = 0.13-0.49). Our secondary analyses showed no significant associations between combinations of PaO2 and PaCO2 and neurological outcome (P = 0.11-0.86). There was no PaO2 or PaCO2 level significantly associated with poor neurological outcome. All analyses were adjusted for relevant co-variates. CONCLUSIONS Exposure to extreme PaO2 or PaCO2 values in the first 24 h after OHCA was common, but not independently associated with neurological outcome at discharge.
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Affiliation(s)
- Florian Ebner
- Lund University, Helsingborg Hospital, Department of Clinical Sciences Lund, Anesthesia and Intensive Care, Charlotte Yhlens Gata 10, S-251 87, Helsingborg, Sweden.
| | - Richard R Riker
- Department of Critical Care Services, Maine Medical Center, Portland, ME, USA
| | - Zana Haxhija
- Department of Critical Care Services, Maine Medical Center, Portland, ME, USA
| | - David B Seder
- Department of Critical Care Services, Maine Medical Center, Portland, ME, USA
| | - Teresa L May
- Department of Critical Care Services, Maine Medical Center, Portland, ME, USA
| | - Susann Ullén
- Clinical Studies Sweden, Skane University Hospital, Lund, Sweden
| | - Pascal Stammet
- Medical and Health Directorate, National Fire and Rescue Corps, Luxembourg City, Luxembourg
| | - Karen Hirsch
- Stanford Neurocritical Care Program, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Sune Forsberg
- Department of Intensive Care, Norrtälje Hospital, Center for Resuscitation,Karolinska Institute, Solna, Sweden
| | - Allison Dupont
- Department of Cardiology, Northeast Georgia Medical Center, Gainesville, GA, USA
| | - Hans Friberg
- Department of Clinical Sciences, Anesthesiology and Intensive Care, Lund University, Skane University Hospital, Malmö, Sweden
| | | | - Eldar Søreide
- Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Josef Dankiewicz
- Department of Clinical Sciences Lund, Cardiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Tobias Cronberg
- Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Niklas Nielsen
- Lund University, Helsingborg Hospital, Department of Clinical Sciences Lund, Anesthesia and Intensive Care, Charlotte Yhlens Gata 10, S-251 87, Helsingborg, Sweden
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Bylow H, Karlsson T, Claesson A, Lepp M, Lindqvist J, Herlitz J. Self-learning training versus instructor-led training for basic life support: A cluster randomised trial. Resuscitation 2019; 139:122-132. [PMID: 30926451 DOI: 10.1016/j.resuscitation.2019.03.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/22/2019] [Accepted: 03/16/2019] [Indexed: 11/30/2022]
Abstract
AIM To compare the effectiveness of two basic life support (BLS) training interventions. METHODS This experimental trial enrolled 1301 lay people in BLS training. The participants were cluster randomised to either self-learning training or to traditional instructor-led training. Both groups used the Mini-Anne Kit (Laerdal Medical, Stavanger, Norway) and standardised film instructions. After training, the participants practical skills were measured on a Resusci Anne manikin and an AED trainer with the PC SkillReporting system (Laerdal Medical, Stavanger, Norway). The primary outcome was the total score from the modified Cardiff Test of basic life support with automated external defibrillation (19-70 points), six months after training. The secondary outcomes were total score directly after training and quality of individual variables, self-assessed knowledge, confidence and willingness to act, directly and six months after training. RESULTS For primary outcome six months after training there was no statistically significant difference (p = 0.44) between the total score for the self-learning group (n = 670; median 59, IQR 55-62) compared with the instructor-led group (n = 561; median 59, IQR 55-63). The instructor-led training resulted in a statistically significant higher total score (median 61 versus 59, p < 0.0001), self-assessed knowledge and willingness to act, directly after training (secondary outcomes) compared with the self-learning training. CONCLUSIONS There was no statistically significant difference in practical skills or willingness to act when comparing self-learning training with instructor-led training six months after training in BLS. However, directly after the intervention, practical skills were better when the training was led by an instructor.
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Affiliation(s)
- Helene Bylow
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
| | - Thomas Karlsson
- Health Metrics Unit, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Andreas Claesson
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institute, Stockholm, Sweden
| | - Margret Lepp
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Østfold University College, Halden, Norway; School of Nursing and Midwifery, Griffith University, Australia
| | | | - Johan Herlitz
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Centre of Registers Västra Götaland, Gothenburg, Sweden; Prehospen-Centre of Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden
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12
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Ryu SM, Park SM. Unexpected complication during extracorporeal membrane oxygenation support: Ventilator associated systemic air embolism. World J Clin Cases 2018; 6:274-278. [PMID: 30211207 PMCID: PMC6134283 DOI: 10.12998/wjcc.v6.i9.274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/31/2018] [Accepted: 06/08/2018] [Indexed: 02/05/2023] Open
Abstract
Systemic air embolism through a bronchovenous fistula (BVF) has been described in patients undergoing positive-pressure ventilation. However, no report has mentioned the potential risks of systemic air embolism through a BVF in patients undergoing extracorporeal membrane oxygenation (ECMO). Positive-pressure ventilation and ECMO support in patients with lung injury can increase the risk of systemic air embolism through a BVF. Increased alveolar pressure, decreased pulmonary venous pressure, and anticoagulation are thought to be the factors that contribute to this complication. Here, we present a case of systemic air embolism in a patient with ECMO and mechanical ventilator support.
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Affiliation(s)
- Se-Min Ryu
- Department of Thoracic and Cardiovascular Surgery, Kangwon National University Hospital, School of Medicine, Kangwon National Univerity, Chuncheon 24289, South Korea
| | - Sung-Min Park
- Department of Thoracic and Cardiovascular Surgery, Kangwon National University Hospital, School of Medicine, Kangwon National Univerity, Chuncheon 24289, South Korea
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13
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Weigeldt M, Lahmann S, Krieger K, Buttenberg S, Stephan V, Stiller B, Stengel D. Pediatric out-of-hospital cardiac arrest caused by left coronary-artery agenesis with primary shockable rhythm. Am J Emerg Med 2017; 35:1718-23. [PMID: 28549578 DOI: 10.1016/j.ajem.2017.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/09/2017] [Accepted: 05/10/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To illustrate a rare cause of out-of-hospital cardiac arrest in children, its differential diagnoses, emergency and subsequent treatment at various steps in the rescue chain, and potential outcomes. CASE PRESENTATION A 4-year-old boy with unknown agenesis of the left coronary ostium sustained out-of-hospital cardiac arrest. Bystander cardio-pulmonary resuscitation was initiated and defibrillation was performed via an automated external defibrillator (AED) shortly after paramedics arrived at the scene, restoring sinus rhythm and spontaneous circulation. After admission to the intensive care unit the child was intubated for airway and seizure control. Further diagnostic work-up by angiography revealed agenesis of the left coronary artery. After initial seizures, the boy's neurological recovery was complete. He subsequently underwent successful internal mammary artery in-situ bypass surgery to the trunk of the left coronary artery. One year after cardiac arrest, the patient had completely recovered with no physical or intellectual sequelae. A catheter examination proved excellent growth of the bypass and good cardiac function. CONCLUSIONS This case illustrates the long term outcome after agenesis of the LCA while reiterating that prompt access to pediatric defibrillation may be lifesaving-albeit in a minority of pediatric OHCA.
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14
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Gaieski DF, Agarwal AK, Abella BS, Neumar RW, Mechem C, Cater SW, Shofer FS, Leary M, Pajerowski WP, Becker LB, Carr B, Merchant R, Band RA. Adult out-of-hospital cardiac arrest in philadelphia from 2008-2012: An epidemiological study. Resuscitation 2017; 115:17-22. [PMID: 28343957 DOI: 10.1016/j.resuscitation.2017.03.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 03/16/2017] [Accepted: 03/17/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Wide variation in out-of-hospital cardiac arrest (OHCA) survival has been reported, with low survival in urban settings. We sought to describe the epidemiology of OHCA in Philadelphia, Pennsylvania, the fifth largest U.S. city, and identify potential areas for targeted interventions to improve survival. METHODS AND RESULTS Retrospective chart review of adult, non-traumatic, OHCA occurring in Philadelphia between 2008 and 2012. We determined incidence and epidemiological factors including: demographics, initial cardiac rhythm, bystander cardiopulmonary resuscitation, automated external defibrillator use, return of spontaneous circulation and 30-day survival. 5198 cases of adult, non-traumatic OHCA were identified. The incidence was 81.5/100,000. The majority of cases occurred in a residence (76.2%); 30.4% were witnessed events; the initial cardiac rhythm was pulseless ventricular tachycardia or ventricular fibrillation in 6.2% of cases, pulseless electrical activity in 21.0%, asystole in 38.3% and was unknown or undocumented in the remaining 34.5%. Multivariate logistic regression analysis demonstrated increased 30-day survival with younger age, shockable cardiac rhythms, and daytime arrest. 30-day survival was 8.1% for EMS-assessed patients and 8.6% for EMS-transported patients. CONCLUSIONS Philadelphia's reported incidence is consistent with urban settings although the survival rate is higher than other urban centers.
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Affiliation(s)
- David F Gaieski
- Thomas Jefferson University, Department of Emergency Medicine, United States.
| | - Anish K Agarwal
- University of Pennsylvania, Department of Emergency Medicine, United States
| | - Benjamin S Abella
- University of Pennsylvania, Department of Emergency Medicine, United States
| | - Robert W Neumar
- University of Michigan School of Medicine, Department of Emergency Medicine, United States
| | - Crawford Mechem
- University of Pennsylvania, Department of Emergency Medicine, United States; Philadelphia Fire Department, United States
| | | | - Frances S Shofer
- University of Pennsylvania, Department of Emergency Medicine, United States
| | - Marion Leary
- University of Pennsylvania, Department of Emergency Medicine, United States
| | | | - Lance B Becker
- University of Pennsylvania, Department of Emergency Medicine, United States
| | - Brendan Carr
- Thomas Jefferson University, Department of Emergency Medicine, United States
| | - Raina Merchant
- University of Pennsylvania, Department of Emergency Medicine, United States
| | - Roger A Band
- Thomas Jefferson University, Department of Emergency Medicine, United States
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15
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Haverkamp W. [Which drugs are useful during resuscitation? Which are not?]. Herzschrittmacherther Elektrophysiol 2016; 27:15-9. [PMID: 26841960 DOI: 10.1007/s00399-016-0417-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Cardiopulmonary resuscitation represents a therapeutic challenge. Evidence-based guidelines, which were updated in 2015, give detailed advice on how to treat the patient. METHODS Basic life support consists of cardiopulmonary resuscitation (30 chest compressions interrupted briefly to provide to 2 ventilations) and, if ventricular tachyarrhythmia is present, urgent cardiac defibrillation. Administration of drugs is one of the aspects of advanced life support. Vasopressors (adrenaline, vasopressin) aim to optimize coronary and cerebral perfusion. Antiarrhythmic drugs (amiodarone or lidocaine, when amiodarone is not available) are given during cardiac arrest to treat specific cardiac arrhythmias, mainly ventricular fibrillation and ventricular tachycardia. CONCLUSION However, even in current guidelines, there is growing ambivalence towards drug treatment in the setting of cardiopulmonary resuscitation. This is mainly due to a paucity of robust clinical data. Most of the studies that have addressed the efficacy and safety of drugs during resuscitation are observational studies; however, a few small randomized controlled studies also exist. Recently, two large randomized controlled studies addressing the efficacy and safety of adrenaline versus placebo and amiodarone or lidocaine versus placebo have started. Both are currently recruiting patients. The hope is that the results of these studies will help to better define the role of drugs administered during cardiopulmonary resuscitation.
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Kudenchuk PJ, Sandroni C, Drinhaus HR, Böttiger BW, Cariou A, Sunde K, Dworschak M, Taccone FS, Deye N, Friberg H, Laureys S, Ledoux D, Oddo M, Legriel S, Hantson P, Diehl JL, Laterre PF. Breakthrough in cardiac arrest: reports from the 4th Paris International Conference. Ann Intensive Care 2015; 5:22. [PMID: 26380990 PMCID: PMC4573754 DOI: 10.1186/s13613-015-0064-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 08/18/2015] [Indexed: 02/08/2023] Open
Abstract
Jean-Luc Diehl The French Intensive Care Society organized on 5th and 6th June 2014 its 4th “Paris International Conference in Intensive Care”, whose principle is to bring together the best international experts on a hot topic in critical care medicine. The 2014 theme was “Breakthrough in cardiac arrest”, with many high-quality updates on epidemiology, public health data, pre-hospital and in-ICU cares. The present review includes short summaries of the major presentations, classified into six main chapters:Epidemiology of CA Pre-hospital management Post-resuscitation management: targeted temperature management Post-resuscitation management: optimizing organ perfusion and metabolic parameters Neurological assessment of brain damages Public healthcare
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Affiliation(s)
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy.
| | - Hendrik R Drinhaus
- Department of Anaesthesiology and Intensive Care Medicine, University of Koeln, Cologne, Germany.
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University of Koeln, Cologne, Germany.
| | - Alain Cariou
- Medical Intensive Care Unit, AP-HP, Cochin Hospital, Paris, France. .,Paris Descartes University and Sorbonne Paris Cité-Medical School and INSERM U970 (Team 4), Cardiovascular Research Center, European Georges Pompidou Hospital, Paris, France.
| | - Kjetil Sunde
- Division of Emergencies and Critical Care, Department of Anaesthesiology, Surgical Intensive Care Unit Ullevål, Oslo University Hospital, Oslo, Norway.
| | - Martin Dworschak
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Vienna General Hospital, Medical University Vienna, Vienna, Austria.
| | - Fabio Silvio Taccone
- Department of Intensive Care, Laboratoire de Recherche Experimentale, Erasme Hospital, Brussels, Belgium.
| | - Nicolas Deye
- Medical Intensive Care Unit, AP-HP, Lariboisière University Hospital, Inserm U942, Paris, France.
| | - Hans Friberg
- Anaesthesiology and Intensive Care Medicine, Skåne University Hospital, Lund University, Lund, Sweden.
| | - Steven Laureys
- Coma Science Group, Cyclotron Research Centre, University of Liège and Liège 2 Department of Neurology, University Hospital of Liège, Liège, Belgium.
| | - Didier Ledoux
- Coma Science Group, Cyclotron Research Centre, University of Liège and Department of Intensive Care Medicine, University Hospital of Liège, Liège, Belgium.
| | - Mauro Oddo
- Department of Intensive Care Medicine, Faculty of Biology and Medicine, CHUV-University Hospital, Lausanne, Switzerland.
| | - Stéphane Legriel
- Intensive Care Unit, Centre Hospitalier de Versailles, Le Chesnay, France.
| | - Philippe Hantson
- Department of Intensive Care, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
| | - Jean-Luc Diehl
- Medical Intensive Care Unit, AP-HP, European Georges Pompidou Hospital, Paris Descartes University and Sorbonne Paris Cité-Medical School, Paris, France.
| | - Pierre-Francois Laterre
- Department of Intensive Care, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain Brussels, Brussels, Belgium.
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17
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Infinger AE, Vandeventer S, Studnek JR. Introduction of performance coaching during cardiopulmonary resuscitation improves compression depth and time to defibrillation in out-of-hospital cardiac arrest. Resuscitation 2014; 85:1752-8. [PMID: 25277342 DOI: 10.1016/j.resuscitation.2014.09.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 09/23/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Quality cardiopulmonary resuscitation (CPR) and timely defibrillation are associated with increasing survival to hospital discharge from out-of-hospital cardiac arrest (OHCA). The objective of this study was to demonstrate that performance coaching during an OHCA would improve compression depth and time to defibrillation (TTD). METHODS This study was conducted in a single emergency medical services (EMS) agency and utilized data collected from 815 patients treated between 1/1/2012 and 12/31/2013. The intervention used multiple Plan-Do-Study-Act (PDSA) cycles to train fire captains to translate performance data into active direction. Testing began in simulation with small-scale expansions prior to system-wide implementation. Performance metrics included average (reported as a percentage) and actual compression depth (reported in millimeters), and TTD (an average in seconds). Analysis was conducted using Xbar and S control charts with standard assessment of special cause for performance data. A statistical shift was seen in means and standard deviations for both depth metrics. RESULTS Average depth of compressions improved from 69.8% (SD=28.0%) to 80.4 (SD=21.8%). Depth of compressions delivered increased from 43.6mm (SD=8.2mm) to 47.2mm (SD=8.1mm). Analysis of the S charts indicates a statistical shift in process variation for TTD. CONCLUSION Early results indicate that utilization of a CPR coach during OHCA improves compression depth and TTD. Further data are needed to assess sustainability.
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Abstract
With increasing public education in basic life support and with the widespread use of automated defibrillators, post-cardiac arrest comatose patients represent a growing part of ICU admissions. However the prognosis remains very poor and only a very low proportion of these resuscitated patients will recover and will leave the hospital without major neurological impairments. Neurological dysfunction predominantly includes disorders of consciousness, and may also include other manifestations such as seizures, myoclonus status epilepticus and other forms of movement disorders including post-anoxic myoclonus. In the most severe cases, coma may be irreversible or evolve towards a minimally conscious state, a vegetative state or even brain death. These severe conditions represent by far the leading cause of mortality and disability in such patients. Currently, early use of mild therapeutic hypothermia is the only treatment that demonstrated its ability to decrease neurological consequences and to improve the prognosis. Prognostication outcome is still mainly based on a rigorous clinical evaluation coupled with neuro-physiological investigations, but brain functional imaging could become a valuable tool in the near future. Clinical research focusing on survivors should be strongly encouraged in order to assess the mid- and long-terms outcome of survivors and to evaluate the impact of new treatments or strategies.
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Affiliation(s)
- G Geri
- Medical Intensive Care Unit, Cochin Hospital, Assistance publique des Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Faculté de médecine, université Paris Descartes & Sorbonne Paris Cité, 15, rue de l'École-de-Médecine, 75006 Paris, France; Paris Cardiovascular Research Center, European Georges-Pompidou Hospital, INSERM U970, 56, rue Leblanc, 75015 Paris, France
| | - N Mongardon
- Department of Anesthesiology and Surgical Intensive Care, Henri-Mondor Hospital, Assistance publique des Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France; Faculté de médecine, université Paris Est, 8, avenue du Général-Sarrail, 94000 Créteil, France
| | - F Daviaud
- Medical Intensive Care Unit, Cochin Hospital, Assistance publique des Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Faculté de médecine, université Paris Descartes & Sorbonne Paris Cité, 15, rue de l'École-de-Médecine, 75006 Paris, France
| | - J-P Empana
- Faculté de médecine, université Paris Descartes & Sorbonne Paris Cité, 15, rue de l'École-de-Médecine, 75006 Paris, France; Paris Cardiovascular Research Center, European Georges-Pompidou Hospital, INSERM U970, 56, rue Leblanc, 75015 Paris, France
| | - F Dumas
- Emergency Department, Cochin Hospital, Assistance publique des Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Faculté de médecine, université Paris Descartes & Sorbonne Paris Cité, 15, rue de l'École-de-Médecine, 75006 Paris, France; Paris Cardiovascular Research Center, European Georges-Pompidou Hospital, INSERM U970, 56, rue Leblanc, 75015 Paris, France
| | - A Cariou
- Medical Intensive Care Unit, Cochin Hospital, Assistance publique des Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Faculté de médecine, université Paris Descartes & Sorbonne Paris Cité, 15, rue de l'École-de-Médecine, 75006 Paris, France; Paris Cardiovascular Research Center, European Georges-Pompidou Hospital, INSERM U970, 56, rue Leblanc, 75015 Paris, France.
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