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Nordseth T, Eftestøl T, Aramendi E, Kvaløy JT, Skogvoll E. Extracting physiologic and clinical data from defibrillators for research purposes to improve treatment for patients in cardiac arrest. Resusc Plus 2024; 18:100611. [PMID: 38524146 PMCID: PMC10960142 DOI: 10.1016/j.resplu.2024.100611] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Background A defibrillator should be connected to all patients receiving cardiopulmonary resuscitation (CPR) to allow early defibrillation. The defibrillator will collect signal data such as the electrocardiogram (ECG), thoracic impedance and end-tidal CO2, which allows for research on how patients demonstrate different responses to CPR. The aim of this review is to give an overview of methodological challenges and opportunities in using defibrillator data for research. Methods The successful collection of defibrillator files has several challenges. There is no scientific standard on how to store such data, which have resulted in several proprietary industrial solutions. The data needs to be exported to a software environment where signal filtering and classifications of ECG rhythms can be performed. This may be automated using different algorithms and artificial intelligence (AI). The patient can be classified being in ventricular fibrillation or -tachycardia, asystole, pulseless electrical activity or having obtained return of spontaneous circulation. How this dynamic response is time-dependent and related to covariates can be handled in several ways. These include Aalen's linear model, Weibull regression and joint models. Conclusions The vast amount of signal data from defibrillator represents promising opportunities for the use of AI and statistical analysis to assess patient response to CPR. This may provide an epidemiologic basis to improve resuscitation guidelines and give more individualized care. We suggest that an international working party is initiated to facilitate a discussion on how open formats for defibrillator data can be accomplished, that obligates industrial partners to further develop their current technological solutions.
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Affiliation(s)
- Trond Nordseth
- Department of Anesthesia and Intensive Care Medicine. St. Olav Hospital, NO-7006 Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Trygve Eftestøl
- Department of Electrical Engineering and Computer Science, University of Stavanger, NO-4036 Stavanger, Norway
| | - Elisabete Aramendi
- Department of Communication Engineering, University of the Basque Country, Bilbao, Spain
| | - Jan Terje Kvaløy
- Department of Mathematics and Physics, University of Stavanger, NO-4036 Stavanger, Norway
| | - Eirik Skogvoll
- Department of Anesthesia and Intensive Care Medicine. St. Olav Hospital, NO-7006 Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway
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2
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Haddad Momeni M, Zitting A, Jäämuru V, Turunen R, Penttilä P, Buchko GW, Hiltunen S, Maiorova N, Koivula A, Sapkota J, Marjamaa K, Master ER. Insights into the action of phylogenetically diverse microbial expansins on the structure of cellulose microfibrils. Biotechnol Biofuels Bioprod 2024; 17:56. [PMID: 38654330 DOI: 10.1186/s13068-024-02500-w] [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] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Microbial expansins (EXLXs) are non-lytic proteins homologous to plant expansins involved in plant cell wall formation. Due to their non-lytic cell wall loosening properties and potential to disaggregate cellulosic structures, there is considerable interest in exploring the ability of microbial expansins (EXLX) to assist the processing of cellulosic biomass for broader biotechnological applications. Herein, EXLXs with different modular structure and from diverse phylogenetic origin were compared in terms of ability to bind cellulosic, xylosic, and chitinous substrates, to structurally modify cellulosic fibrils, and to boost enzymatic deconstruction of hardwood pulp. RESULTS Five heterogeneously produced EXLXs (Clavibacter michiganensis; CmiEXLX2, Dickeya aquatica; DaqEXLX1, Xanthomonas sacchari; XsaEXLX1, Nothophytophthora sp.; NspEXLX1 and Phytophthora cactorum; PcaEXLX1) were shown to bind xylan and hardwood pulp at pH 5.5 and CmiEXLX2 (harboring a family-2 carbohydrate-binding module) also bound well to crystalline cellulose. Small-angle X-ray scattering revealed a 20-25% increase in interfibrillar distance between neighboring cellulose microfibrils following treatment with CmiEXLX2, DaqEXLX1, or NspEXLX1. Correspondingly, combining xylanase with CmiEXLX2 and DaqEXLX1 increased product yield from hardwood pulp by ~ 25%, while supplementing the TrAA9A LPMO from Trichoderma reesei with CmiEXLX2, DaqEXLX1, and NspEXLX1 increased total product yield by over 35%. CONCLUSION This direct comparison of diverse EXLXs revealed consistent impacts on interfibrillar spacing of cellulose microfibers and performance of carbohydrate-active enzymes predicted to act on fiber surfaces. These findings uncover new possibilities to employ EXLXs in the creation of value-added materials from cellulosic biomass.
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Affiliation(s)
- Majid Haddad Momeni
- Department of Bioproducts and Biosystems, Aalto University, Kemistintie 1, 02150, Espoo, Finland.
| | - Aleksi Zitting
- Department of Bioproducts and Biosystems, Aalto University, Kemistintie 1, 02150, Espoo, Finland
| | - Vilma Jäämuru
- Department of Bioproducts and Biosystems, Aalto University, Kemistintie 1, 02150, Espoo, Finland
| | - Rosaliina Turunen
- Department of Bioproducts and Biosystems, Aalto University, Kemistintie 1, 02150, Espoo, Finland
| | - Paavo Penttilä
- Department of Bioproducts and Biosystems, Aalto University, Kemistintie 1, 02150, Espoo, Finland
| | - Garry W Buchko
- Earth and Biological Sciences Directorate, Pacific Northwest National Laboratory, Richland, WA, 99354, USA
- School of Molecular Biosciences, Washington State University, Pullman, WA, 99164, USA
| | - Salla Hiltunen
- NE Research Center, UPM Pulp Research and Innovations, 53200, Lappeenranta, Finland
| | - Natalia Maiorova
- VTT Technical Research Centre of Finland Ltd, P.O. Box 1000, 02044-VTT, Espoo, Finland
| | - Anu Koivula
- VTT Technical Research Centre of Finland Ltd, P.O. Box 1000, 02044-VTT, Espoo, Finland
| | - Janak Sapkota
- NE Research Center, UPM Pulp Research and Innovations, 53200, Lappeenranta, Finland
| | - Kaisa Marjamaa
- VTT Technical Research Centre of Finland Ltd, P.O. Box 1000, 02044-VTT, Espoo, Finland
| | - Emma R Master
- Department of Bioproducts and Biosystems, Aalto University, Kemistintie 1, 02150, Espoo, Finland.
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, 200 College Street, Toronto, ON, M5S 3E5, Canada.
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3
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Haskell SE, Hoyme D, Zimmerman MB, Reeder R, Girotra S, Raymond TT, Samson RA, Berg M, Berg RA, Nadkarni V, Atkins DL. Association between survival and number of shocks for pulseless ventricular arrhythmias during pediatric in-hospital cardiac arrest in a national registry. Resuscitation 2024; 198:110200. [PMID: 38582444 DOI: 10.1016/j.resuscitation.2024.110200] [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: 12/28/2023] [Revised: 03/13/2024] [Accepted: 03/30/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Annually 15,200 children suffer an in-hospital cardiac arrest (IHCA) in the US. Ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT) is the initial rhythm in 10-15% of these arrests. We sought to evaluate the association of number of shocks and early dose escalation with survival for initial VF/pVT in pediatric IHCA. METHODS Using 2000-2020 data from the American Heart Association's (AHA) Get with the Guidelines®-Resuscitation (GWTG-R) registry, we identified children >48 hours of life and ≤18 years who had an IHCA from initial VF/pVT and received defibrillation. RESULTS There were 251 subjects (37.7%) who received a single shock and 415 subjects (62.3%) who received multiple shocks. Baseline and cardiac arrest characteristics did not differ between those who received a single shock versus multiple shocks except for duration of arrest and calendar year. The median first shock dose was consistent with AHA dosing recommendations and not different between those who received a single shock versus multiple shocks. Survival was improved for those who received a single shock compared to multiple shocks. However, no difference in survival was noted between those who received 2, 3, or ≥4 shocks. Of those receiving multiple shocks, no difference was observed with early dose escalation. CONCLUSIONS In pediatric IHCA, most patients with initial VF/pVT require more than one shock. No distinctions in patient or pre-arrest characteristics were identified between those who received a single shock versus multiple shocks. Subjects who received a single shock were more likely to survive to hospital discharge even after adjusting for duration of resuscitation.
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Affiliation(s)
- Sarah E Haskell
- University of Iowa Carver College of Medicine, Iowa City, IA, United States.
| | - Derek Hoyme
- University of Wisconsin Madison School of Medicine, Madison, WI, United States
| | | | - Ron Reeder
- University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Saket Girotra
- UT Southwestern Medical Center, Dallas, TX, United States
| | - Tia T Raymond
- Medical City Children's Hospital, Dallas, TX, United States
| | | | - Marc Berg
- Stanford School of Medicine, Palo Alto, CA, United States
| | - Robert A Berg
- Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Vinay Nadkarni
- Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Dianne L Atkins
- University of Iowa Carver College of Medicine, Iowa City, IA, United States
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4
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Moghaddam MK, Gheshlagh FG, Moezzi M. Extraction and characterization of cellulose microfibers from cornhusk for application as reinforcing agent in biocomposite. Int J Biol Macromol 2024; 264:130669. [PMID: 38453110 DOI: 10.1016/j.ijbiomac.2024.130669] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
This study aims to extract and characterize cellulose microfibers from cornhusk, an agricultural by-product. The extracted fibers will then be used as a reinforcing agent in a biocomposite made of thermoplastic corn starch. The process of extracting cellulose microfibers involved two treatments: sequential alkali treatment (using sodium hydroxide at 120 °C for 120 min) and peroxide bleach treatment (using hydrogen peroxide at 90 °C for 60 min). Various techniques such as Fourier transform infrared (FTIR), X-Ray diffraction (XRD), scanning electron microscopy (SEM), and thermogravimetric analysis (TGA) were employed to characterize the extracted fibers. The properties of the composite were examined through tensile strength tests, contact angle measurements, and UV-Vis spectrophotometry. The study found that cellulose microfibers were successfully extracted from cornhusks, with a diameter of 7 to 30 μm and a crystallinity of 65 %. The treated fibers showed gradual degradation between 150 °C and 350 °C, indicating a lower amount of non-cellulosic substances compared to untreated cornhusks. Adding 10 % of the microfibers to the thermoplastic starch composite increased the tensile stress at breaking and the Young's modulus, but decreased the contact angle of water droplets and the film's transparency.
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Affiliation(s)
| | | | - Meysam Moezzi
- Textile Engineering Department, University of Bonab, Bonab 5551395133, Iran
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5
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Laden G, Mathew B, Ananthasayanam A. Time to shock people. Diving Hyperb Med 2024; 54:73-74. [PMID: 38507914 DOI: 10.28920/dhm54.1.73-74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/18/2023] [Indexed: 03/22/2024]
Affiliation(s)
- Gerard Laden
- Clinical Hyperbaric Facility, Hull and East Riding Hospital, Anlaby, UK
- Corresponding author: Mr Gerard Laden, Clinical Hyperbaric Facility, Hull and East Riding Hospital, Anlaby, UK
| | - Bruce Mathew
- Clinical Hyperbaric Facility, Hull and East Riding Hospital, Anlaby, UK
| | - Ananthakrishnan Ananthasayanam
- Clinical Hyperbaric Facility, Hull and East Riding Hospital, Anlaby, UK
- Department of Surgery, Hull University Teaching Hospitals, NHS Trust, Hull, UK
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6
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Tabner A, Johnson G, Bryson P. Response to Laden et al. Diving Hyperb Med 2024; 54:74-75. [PMID: 38507915 DOI: 10.28920/dhm54.1.74-75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 12/03/2023] [Indexed: 03/22/2024]
Affiliation(s)
- Andrew Tabner
- Emergency Department, Royal Derby Hospital, Uttoxeter Road, Derby, UK, DE22 3NE
- University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK, NG7 2UH
- Corresponding author: Dr Andrew Tabner, Emergency Department, Royal Derby Hospital, Uttoxeter Road, Derby, UK, DE22 3NE,
| | - Graham Johnson
- Emergency Department, Royal Derby Hospital, Uttoxeter Road, Derby, UK, DE22 3NE
- University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK, NG7 2UH
| | - Philip Bryson
- On behalf of the authorship team
- TAC Healthcare, Wellheads Crescent, Aberdeen, Scotland AB21 7GA
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Cheskes S, Drennan IR, Turner L, Pandit SV, Dorian P. The impact of alternate defibrillation strategies on shock-refractory and recurrent ventricular fibrillation: A secondary analysis of the DOSE VF cluster randomized controlled trial. Resuscitation 2024:110186. [PMID: 38522736 DOI: 10.1016/j.resuscitation.2024.110186] [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: 01/29/2024] [Revised: 03/10/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND The DOSE VF randomized controlled trial (RCT) employed a pragmatic definition of refractory ventricular fibrillation (VF after three successive shocks). However, it remains unclear whether the underlying rhythm during the first three shocks was shock-refractory or recurrent VF. OBJECTIVE To explore the relationship between alternate defibrillation strategies employed during the DOSE VF RCT and the type of VF, either shock-refractory VF or recurrent VF, on patient outcomes. METHODS We performed a secondary analysis of the DOSE VF RCT. We categorized cases as shock-refractory or recurrent VF based on pre-randomization shocks (shocks 1-3). We then analyzed all subsequent (post-randomization) shocks to assess the impact of standard, vector change (VC) or double sequential external defibrillation (DSED) shocks on clinical outcomes employing logistic regression adjusted for Utstein variables, antiarrhythmics, and epinephrine. RESULTS We included 345 patients; 60 (17%) shock-refractory VF, and 285 (83%) recurrent VF. Patients in recurrent VF had greater survival than shock-refractory VF (OR: 2.76 95% CI [1.04, 7.27]). DSED was superior to standard defibrillation for survival overall, and for patients with shock-refractory VF (28.6% vs 0%, p = 0.041) but not for those in recurrent VF. DSED was superior to standard defibrillation for return of spontaneous circulation (ROSC) and neurologic survival for shock-refractory and recurrent VF. VC defibrillation was not superior for survival or ROSC overall, for shock-refractory, or recurrent VF groups, but was superior for VF termination across all groups. CONCLUSION DSED appears to be the superior defibrillation strategy in the DOSE VF trial, irrespective of whether the preceding VF is shock-refractory or recurrent.
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Affiliation(s)
- Sheldon Cheskes
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Centre for Prehospital Medicine, Toronto, Ontario, Canada; Sunnybrook Research Institute and Department of Emergency Services, Sunnybrook Health Science Centre, Toronto, Ontario, Canada; Department of Family and Community Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michaels Hospital, Toronto, ON, Canada.
| | - Ian R Drennan
- Sunnybrook Research Institute and Department of Emergency Services, Sunnybrook Health Science Centre, Toronto, Ontario, Canada; Department of Family and Community Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Linda Turner
- Sunnybrook Centre for Prehospital Medicine, Toronto, Ontario, Canada
| | | | - Paul Dorian
- Division of Cardiology, Unity Health, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
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8
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Gao M, Liu C, Gehman S, Burgett K, Kompare E, Fink B, Jorgenson DB. The diagnostic accuracy of a shock advisory algorithm in automated external defibrillators in the presence of real-world artifacts. Resuscitation 2024; 198:110173. [PMID: 38467301 DOI: 10.1016/j.resuscitation.2024.110173] [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: 01/23/2024] [Revised: 02/27/2024] [Accepted: 03/05/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND The current standards for shock advisory algorithms in AEDs require performance testing on artifact-free ECGs. However, AED analysis in the real world is more challenging due to potential artifacts from various sources (e.g., patient handling, and electromagnetic interference). This retrospective data analysis reports the real-world performance and behavior of a shock advisory algorithm used in three AED models with the presence of artifacts. METHODS ECG rhythm analyses recorded during the use of three AED models (HS1, FRx and FR3) were reviewed. The shock recommendations made in the AEDs were compared to the expert annotations of reviewers. The effects of real-world artifacts and the handling by the algorithm were analyzed. RESULTS Among the 3,941 analyses, 619 were annotated as shockable rhythms, and 2,912 were non-shockable. The overall sensitivity and specificity were 97.1% (601/619), and 99.9% (2,908/2,912), respectively. Artifacts were detected by the algorithm in 23.3% (918/3,941) of the analysis periods. The algorithm performance for the analysis periods with artifacts detected was 95.2% (80/84) for sensitivity and 100.0% (687/687) for specificity. In the remaining analysis periods with no artifacts detected, the sensitivity was 97.4% (521/535), and specificity was 99.8% (2,221/2,225). CONCLUSIONS The performance of this shock advisory algorithm during real-world resuscitations with or without artifacts, exceeded AHA recommendations and the requirements in international standards. The high sensitivity and specificity demonstrate the effectiveness and safety of this algorithm in all three AED models.
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Affiliation(s)
- Mengqi Gao
- Philips Healthcare, Bothell, WA, United States.
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9
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Bragg S, Brown B, DeCastro AO. Arrhythmias and Sudden Cardiac Death. Prim Care 2024; 51:143-154. [PMID: 38278568 DOI: 10.1016/j.pop.2023.07.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Ventricular tachyarrhythmias remain a major cause of sudden cardiac arrest (SCA) that leads to sudden cardiac death (SCD). Primary prevention strategies to prevent SCD include promoting a healthy lifestyle, following United States Preventive Service Task Force recommendations related to cardiovascular disease, and controlling comorbid conditions. For a patient experiencing SCA, early cardiopulmonary resuscitation and defibrillation should be performed. Implantable cardioverter defibrillators are more effective at secondary prevention compared with drug therapy but medications such as amiodarone, beta-blockers, and sotalol may be helpful adjuncts to reduce the risk of SCD or improve a patient's symptoms (eg, palpitations and inappropriate defibrillator shocks).
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Affiliation(s)
- Scott Bragg
- Department of Clinical Pharmacy and Outcomes Sciences, Medical University of South Carolina (MUSC) College of Pharmacy and MUSC College of Medicine, 173 Ashley Avenue, CP 240, MSC 141, Charleston, SC 29425, USA; Medical University of South Carolina (MUSC) College of Medicine, MUSC Department of Family Medicine, 135 Cannon Street, Suite 405, Charleston, SC 29425, USA.
| | - Brandon Brown
- Medical University of South Carolina (MUSC) College of Medicine, MUSC Department of Family Medicine, 135 Cannon Street, Suite 405, Charleston, SC 29425, USA
| | - Alexei O DeCastro
- Medical University of South Carolina (MUSC) College of Medicine, MUSC Department of Family Medicine, 135 Cannon Street, Suite 405, Charleston, SC 29425, USA
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10
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Uşurelu CD, Frone AN, Oprică GM, Raduly MF, Ghiurea M, Neblea EI, Nicolae CA, Filip X, Teodorescu M, Panaitescu DM. Preparation and functionalization of cellulose nanofibers using a naturally occurring acid and their application in stabilizing linseed oil/water Pickering emulsions. Int J Biol Macromol 2024; 262:129884. [PMID: 38336328 DOI: 10.1016/j.ijbiomac.2024.129884] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
Finding efficient and environmental-friendly methods to produce and chemically modify cellulose nanofibers (CNFs) remains a challenge. In this study, lactic acid (LA) treatment followed by microfluidization was employed for the isolation and functionalization of CNFs. Small amounts of HCl (0.01, 0.1, and 0.2 M) were used alongside LA to intensify cellulose hydrolysis. FTIR spectroscopy and solid-state 13C NMR confirmed the successful functionalization of CNFs with lactyl groups during isolation, while SEM, AFM, and rheological tests revealed that the addition of HCl governed the fibers' sizes and morphology. Notably, the treatment with LA and 0.2 M HCl resulted in a more efficient defibrillation, yielding smaller nanofibers sizes (62 nm) as compared to the treatment with LA or HCl alone (90 and 108 nm, respectively). The aqueous suspension of CNFs treated with LA and 0.2 M HCl showed the highest viscosity and storage modulus. LA-modified CNFs were tested as stabilizers for linseed oil/water (50/50 v/v) emulsions. Owing to the lactyl groups grafted on their surface and higher aspect ratio, CNFs produced with 0.1 and 0.2 M HCl led to emulsions with increased stability (a creaming index increase of only 3 % and 1 %, respectively, in 30 days) and smaller droplets sizes of 23.4 ± 1.2 and 35.5 ± 0.5 μm, respectively. The results showed that LA-modified CNFs are promising stabilizers for Pickering emulsions.
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Affiliation(s)
- Cătălina-Diana Uşurelu
- National Institute for Research and Development in Chemistry and Petrochemistry, 202 Splaiul Independentei, 060021 Bucharest, Romania; Faculty of Chemical Engineering and Biotechnology, National University of Science and Technology Politehnica Bucharest, 1-7 Gh. Polizu Street, 011061 Bucharest, Romania
| | - Adriana Nicoleta Frone
- National Institute for Research and Development in Chemistry and Petrochemistry, 202 Splaiul Independentei, 060021 Bucharest, Romania.
| | - Gabriela-Mădălina Oprică
- National Institute for Research and Development in Chemistry and Petrochemistry, 202 Splaiul Independentei, 060021 Bucharest, Romania; Faculty of Chemical Engineering and Biotechnology, National University of Science and Technology Politehnica Bucharest, 1-7 Gh. Polizu Street, 011061 Bucharest, Romania
| | - Monica Florentina Raduly
- National Institute for Research and Development in Chemistry and Petrochemistry, 202 Splaiul Independentei, 060021 Bucharest, Romania
| | - Marius Ghiurea
- National Institute for Research and Development in Chemistry and Petrochemistry, 202 Splaiul Independentei, 060021 Bucharest, Romania
| | - Elena Iulia Neblea
- National Institute for Research and Development in Chemistry and Petrochemistry, 202 Splaiul Independentei, 060021 Bucharest, Romania
| | - Cristian-Andi Nicolae
- National Institute for Research and Development in Chemistry and Petrochemistry, 202 Splaiul Independentei, 060021 Bucharest, Romania
| | - Xenia Filip
- National Institute for Research and Development of Isotopic and Molecular Technologies, 67-103 Donath Street, 400293 Cluj-Napoca, Romania
| | - Mircea Teodorescu
- Faculty of Chemical Engineering and Biotechnology, National University of Science and Technology Politehnica Bucharest, 1-7 Gh. Polizu Street, 011061 Bucharest, Romania
| | - Denis Mihaela Panaitescu
- National Institute for Research and Development in Chemistry and Petrochemistry, 202 Splaiul Independentei, 060021 Bucharest, Romania.
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11
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Liu Y, Zhou T, Yang Q, Lu Y, Yang Z, Jiang J. An acoustic method (Spectral Flux) to analyze ECG signals for optimizing timing for defibrillation in a porcine model of ventricular fibrillation. Resusc Plus 2024; 17:100572. [PMID: 38370316 PMCID: PMC10869897 DOI: 10.1016/j.resplu.2024.100572] [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: 10/31/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/20/2024] Open
Abstract
Aim Spectral Flux (SF), which is based on common algorithms in the audio processing field, was applied to quantitatively analyze ECG signals to optimize the timing of defibrillation. With the aim of proving the performance in optimizing the timing of defibrillation, SF was compared with Amplitude Spectrum Area (AMSA) in a porcine model of ventricular fibrillation (VF) in a retrospective analysis experiment. Methods A total of 56 male domestic pigs, weighing 40 ± 5 kg, were induced to undergo VF. Animals were then left untreated for 10 min, and after 6 min of cardiopulmonary resuscitation (CPR) defibrillation was performed. The respective SF and AMSA values were calculated every minute during VF and CPR. Comparisons were made through receiver operating characteristic (ROC) curves, one-way analyses of variance (one-way ANOVA), and scatterplots for the successful initial defibrillation sample (positive samples, Group R) and the failed initial defibrillation sample (negative samples, Group N) to illustrate the performance in optimizing the timing of defibrillation for the AMSA and SF methods. Result Values of SF and AMSA gradually decreased during the 10 min VF period and increased in during the 6 min CPR period. The scatterplots showed that both metrics had the ability to distinguish positive and negative samples (p < .001). Meanwhile, ROC curves showed that SF (area under the curve, AUC = 0.798, p < .001) had the same ability as AMSA (AUC = 0.737, p < .001) to predict the successful defibrillation (Z = 1.35, p = 0.177). Moreover, when comparing the values for AMSA and SF between the successful initial defibrillation samples (Group R) and the failed initial defibrillation samples (Group N), the results showed that the values of both AMSA and SF in Group R were significantly higher than those in Group N (p < .001). Conclusion In the present study, SF method had the same ability as AMSA to predict successful defibrillation with significantly higher values in cases of successful defibrillation than the instances in which defibrillation failed. Additionally, SF method might be more stable than AMSA for filtering out the higher frequency interference signals due to the narrower frequency range and had higher specificity and predictive accuracy than AMSA. So SF method had high clinical potential to optimize the timing of defibrillation. Nevertheless, further animal and clinical studies are still needed to confirm the effectiveness and practicality of SF as a predictive module for defibrillators in clinical practice.
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Affiliation(s)
- Yuanshan Liu
- Department of Emergency, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tianen Zhou
- Department of Emergency, the First People’s Hospital of Foshan, Foshan, China
| | - Qiyu Yang
- School of Automation, Guangdong University of Technology, Guangzhou, China
| | - Yujing Lu
- School of Automation, Guangdong University of Technology, Guangzhou, China
| | - Zhengfei Yang
- Department of Emergency, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun Jiang
- Department of Emergency, the First People’s Hospital of Foshan, Foshan, China
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12
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Pocock H, Deakin CD, Lall R, Michelet F, Sun C, Smith D, Hill C, Rai J, Starr K, Brown M, Rodriguez-Bachiller I, Perkins GD. Prehospital optimal shock energy for defibrillation (POSED): A cluster randomised controlled feasibility trial. Resusc Plus 2024; 17:100569. [PMID: 38370312 PMCID: PMC10869912 DOI: 10.1016/j.resplu.2024.100569] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/15/2024] [Accepted: 01/25/2024] [Indexed: 02/20/2024] Open
Abstract
Background We explored the feasibility of a large-scale UK ambulance services trial of optimal defibrillation shock energy for out-of-hospital cardiac arrest. The primary objective of this feasibility study was to establish the number of eligible patients and the number recruited. Secondary outcomes were adherence to allocated treatment and data completeness. Methods We conducted a three-arm parallel group cluster randomised controlled feasibility study in a single ambulance service in southern England. Adult patients in out-of-hospital cardiac arrest treated for a shockable rhythm were included. Zoll X series defibrillators (clusters) were randomised to deliver 120-150-200 J, 150-200-200 J, or 200-200-200 J shock strategies. Results Between March 2022 and February 2023, we randomised 38 eligible patients (120-150-200 J (n = 12), 150-200-200 J (n = 10), 200-200-200 J (n = 16)) to the study. The recruitment rate per cluster was 0.07 per month. The median patient age was 71 years (IQR 59-81 years); 79% were male. Twenty-eight cardiac arrests (74%) occurred in a private residence, 29 (76%) were witnessed and 32 (84%) patients received bystander CPR. Treatment adherence was 93% and completeness of clinical and electrical outcomes was 86%. At 30 days, 3/36 (8.3%) patients survived; we were unable to collect survival outcomes for two patients. Defibrillation data collection became difficult when defibrillators became separated from their allocated vehicles. Conclusion We have demonstrated the feasibility of a cluster randomised controlled trial of optimal shock energy for defibrillation in a UK ambulance service. We have identified possible solutions to issues relating to trial design.
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Affiliation(s)
- Helen Pocock
- South Central Ambulance NHS Foundation Trust, Talisman Way, Bicester, Oxfordshire OX26 6HR, UK
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UK
| | - Charles D Deakin
- South Central Ambulance NHS Foundation Trust, Talisman Way, Bicester, Oxfordshire OX26 6HR, UK
- University Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire, UK
| | - Ranjit Lall
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UK
| | - Felix Michelet
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UK
| | - Chu Sun
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UK
| | - Deb Smith
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UK
| | - Catherine Hill
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UK
| | - Jeskaran Rai
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UK
| | - Kath Starr
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UK
| | - Martina Brown
- South Central Ambulance NHS Foundation Trust, Talisman Way, Bicester, Oxfordshire OX26 6HR, UK
| | | | - Gavin D. Perkins
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, Warwickshire, UK
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2GW, Warwickshire, UK
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Lakkis B, Mansour F, Joly P, Vella AM, Coutu B. Humerus fracture during unsuccessful induction of ventricular fibrillation for subcutaneous implantable cardioverter-defibrillator testing. HeartRhythm Case Rep 2024; 10:166-168. [PMID: 38404969 PMCID: PMC10885729 DOI: 10.1016/j.hrcr.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Affiliation(s)
- Bassel Lakkis
- Division of Cardiac Electrophysiology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, Canada
| | - Fadi Mansour
- Division of Cardiac Electrophysiology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, Canada
| | - Philippe Joly
- Division of Cardiac Electrophysiology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, Canada
| | - Anna M. Vella
- Division of Cardiac Electrophysiology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, Canada
| | - Benoit Coutu
- Division of Cardiac Electrophysiology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, Canada
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Sarkisian L, Isse YA, Gerke O, Obling LER, Paulin Beske R, Grand J, Schmidt H, Højgaard HF, Meyer MAS, Borregaard B, Hassager C, Kjaergaard J, Møller JE. Survival and neurological outcome after bystander versus lay responder defibrillation in out-of-hospital cardiac arrest: A sub-study of the BOX trial. Resuscitation 2024; 195:110059. [PMID: 38013147 DOI: 10.1016/j.resuscitation.2023.110059] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND AIM Bystander defibrillation is associated with increased survival with good neurological outcome after out-of-hospital cardiac arrest (OHCA). Dispatch of lay responders could increase defibrillation rates, however, survival with good neurological outcome in these remain unknown. The aim was to compare long-term survival with good neurological outcome in bystander versus lay responder defibrillated OHCAs. METHODS This is a sub-study of the BOX trial, which included OHCA patients from two Danish tertiary cardiac intensive care units from March 2017 to December 2021. The main outcome was defined as 3-month survival with good neurological performance (Cerebral Performance Category of 1or 2, on a scale from 1 (good cerebral performance) to 5 (death or brain death)). For this study EMS witnessed OHCAs were excluded. RESULTS Of the 715 patients, a lay responder arrived before EMS in 125 cases (16%). In total, 81 patients were defibrillated by a lay responder (11%), 69 patients by a bystander (10%) and 565 patients by the EMS staff (79%). The 3-month survival with good neurological outcome was 65% and 81% in the lay responder and bystander defibrillated groups, respectively (P = 0.03). CONCLUSION In patients with OHCA, 3-month survival with good neurological outcome was higher in bystander defibrillated patients compared with lay responder defibrillated patients.
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Affiliation(s)
- Laura Sarkisian
- Research Unit of Cardiology, Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark; OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
| | - Yusuf Abdi Isse
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense C, Denmark.
| | - Laust Emil Roelsgaard Obling
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Ramus Paulin Beske
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Johannes Grand
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Henrik Schmidt
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Odense University Hospital, Department of Anesthesiology, J.B. Winsløws Vej 4, 5000 Odense C, Denmark.
| | | | - Martin Abild Stengaard Meyer
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Britt Borregaard
- Research Unit of Cardiology, Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense C, Denmark.
| | - Christian Hassager
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Jesper Kjaergaard
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Jacob Eifer Møller
- Research Unit of Cardiology, Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense C, Denmark.
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15
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Zhou H, Zhu Y, Zhang Z, Mei Y, Lv J, Zhang G, Li W, Chen X. Ventricular fibrillation/ventricular tachycardia within 72 h of VA-ECMO: incidence, outcomes, risk factors, and management. ESC Heart Fail 2024; 11:524-532. [PMID: 38088144 PMCID: PMC10804197 DOI: 10.1002/ehf2.14615] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/01/2023] [Accepted: 11/17/2023] [Indexed: 01/24/2024] Open
Abstract
AIMS Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an important technique for the treatment of refractory cardiogenic shock and cardiac arrest; however, the early management of ventricular fibrillation/ventricular tachycardia (VF/VT), within 72 h of VA-ECMO, and its effects on patient prognosis remain unclear. METHODS AND RESULTS We retrospectively analysed patients at the First Affiliated Hospital of Nanjing Medical University who underwent VA-ECMO between January 2017 and March 2022. The patients were divided into two groups, VF/VT and nVF/VT, based on whether or not VF/VT occurred within 72 h after the initiation of VA-ECMO. We utilized logistic regression analysis to evaluate the independent risk factors for VF/VT in patients undergoing VA-ECMO and to ascertain whether the onset of VF/VT affected 28 day survival rate, length of intensive care unit stay, and/or other clinical prognostic factors. Subgroup analysis was performed for the VF/VT group to determine whether defibrillation affected prognosis. In the present study, 126 patients were included, 65.87% of whom were males (83/126), with a mean age of 46.89 ± 16.23, a 28 day survival rate of 57.14% (72/126), an incidence rate of VF/VT within 72 h of VA-ECMO initiation of 27.78% (35/126), and 80% of whom (28/35) received extracorporeal cardiopulmonary resuscitation. The incidence of VF/VT resulting from cardiac arrest at an early stage was significantly higher than that of refractory cardiogenic shock (80% vs. 20%; P = 0.022). The restricted cubic spline model revealed a U-shaped relationship between VF/VT incidence and initial heart rate (iHR), and multivariate logistic regression analysis showed that an iHR > 120 b.p.m. [odds ratio (OR) 6.117; 95% confidence interval (CI) 1.672-22.376; P = 0.006] and hyperlactataemia (OR 1.125; 95% CI 1.016-1.246; P = 0.023) within 1 h of VA-ECMO initiation were independent risk factors for the occurrence of VF/VT. VF/VT was not found to be associated with the 28 day survival of patients undergoing VA-ECMO support, nor did it affect other secondary endpoints. Defibrillation did not alter the overall prognosis in patients with VF/VT during VA-ECMO. CONCLUSIONS An iHR > 120 b.p.m. and hyperlactataemia were independent risk factors for the occurrence of VF/VT within 72 h of VA-ECMO initiation. The occurrence of VF/VT does not affect, nor does defibrillation in these patients improve the overall patient prognosis. TRIAL REGISTRATION ChiCTR1900026105.
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Affiliation(s)
- Hao Zhou
- Emergency DepartmentNanjing Medical University First Affiliated Hospital and Jiangsu Province HospitalGuangzhou Street 300NanjingJiangsu ProvinceChina
| | - Yi Zhu
- Emergency DepartmentNanjing Medical University First Affiliated Hospital and Jiangsu Province HospitalGuangzhou Street 300NanjingJiangsu ProvinceChina
| | - Zhongman Zhang
- Emergency DepartmentNanjing Medical University First Affiliated Hospital and Jiangsu Province HospitalGuangzhou Street 300NanjingJiangsu ProvinceChina
| | - Yong Mei
- Emergency DepartmentNanjing Medical University First Affiliated Hospital and Jiangsu Province HospitalGuangzhou Street 300NanjingJiangsu ProvinceChina
| | - Jinru Lv
- Emergency DepartmentNanjing Medical University First Affiliated Hospital and Jiangsu Province HospitalGuangzhou Street 300NanjingJiangsu ProvinceChina
| | - Gang Zhang
- Emergency DepartmentNanjing Medical University First Affiliated Hospital and Jiangsu Province HospitalGuangzhou Street 300NanjingJiangsu ProvinceChina
| | - Wei Li
- Emergency DepartmentNanjing Medical University First Affiliated Hospital and Jiangsu Province HospitalGuangzhou Street 300NanjingJiangsu ProvinceChina
| | - Xufeng Chen
- Emergency DepartmentNanjing Medical University First Affiliated Hospital and Jiangsu Province HospitalGuangzhou Street 300NanjingJiangsu ProvinceChina
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16
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Rahimi M, Drennan IR, Turner L, Dorian P, Cheskes S. The impact of double sequential shock timing on outcomes during refractory out-of-hospital cardiac arrest. Resuscitation 2024; 194:110082. [PMID: 38092182 DOI: 10.1016/j.resuscitation.2023.110082] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Animal studies suggest the efficacy of double sequential external defibrillation (DSED) may depend on the interval between the two shocks, or "DSED interval". No human studies have examined this concept. OBJECTIVES To determine the relationship between DSED interval and termination of ventricular fibrillation (VFT), return of spontaneous circulation (ROSC), survival to hospital discharge, and favourable neurological status (MRS ≤ 2) for patients in refractory VF. METHODS We performed a retrospective review of adult (≥18 years) out-of-hospital cardiac arrest between January 2015 and May 2022 with refractory VF who received ≥1 DSED shock. DSED interval was divided into four pre-defined categories. We examined the association between DSED interval and patient outcomes using general estimated equation logistic regression or Fisher's exact test. RESULTS Among 106 included patients, 303 DSED shocks were delivered (median 2, IQR 1-3). DSED intervals of 75-125 ms (OR 0.39, 95% CI 0.16-0.98), 125-500 ms (OR 0.36, 95% CI 0.16-0.82), and >500 ms (OR 0.27, 95% CI 0.11-0.63) were associated with lower probability of VF termination compared to <75 ms interval. DSED interval of >75 ms was associated with lower probability of ROSC compared to <75 ms interval (OR 0.37, 95% CI 0.14-0.98). No association was noted between DSED interval and survival to hospital discharge or neurologic outcome. CONCLUSIONS Among patients in refractory VF a DSED interval of less than 75 ms was associated with improved rates of VF termination and ROSC. No association was noted between DSED interval and survival to hospital discharge or neurologic outcome.
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Affiliation(s)
- Mahbod Rahimi
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Ian R Drennan
- Sunnybrook Centre for Prehospital Medicine, Toronto, Ontario, Canada; Sunnybrook Research Institute, Sunnybrook Health Science Centre, Toronto, Ontario, Canada; Department of Family and Community Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Linda Turner
- Sunnybrook Centre for Prehospital Medicine, Toronto, Ontario, Canada
| | - Paul Dorian
- Division of Cardiology, Unity Health, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Sheldon Cheskes
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Centre for Prehospital Medicine, Toronto, Ontario, Canada; Sunnybrook Research Institute, Sunnybrook Health Science Centre, Toronto, Ontario, Canada; Department of Family and Community Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michaels Hospital, Toronto, Ontario, Canada.
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17
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McCusker RJ, Wheelwright J, Smith TJ, Myler CS, Sinz E. Diagnosis and Treatment of New-Onset Perioperative Atrial Fibrillation. Adv Anesth 2023; 41:179-204. [PMID: 38251618 DOI: 10.1016/j.aan.2023.06.007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
This article reviews medical and surgical risk factors for developing atrial fibrillation (AF), the most common sustained dysrhythmia in the United States. Evidence for assessment and management of patients with AF, including AF newly identified in the preoperative clinic, immediately preoperatively, intraoperatively, and unstable AF, is presented. A stepwise approach to guide anesthetic decision-making in the assessment of newly identified preoperative AF is proposed. Anesthetic considerations, including the potential impacts of anesthetic and vasopressor selection, and current evidence related to rate control and rhythm control via pharmacologic or electrical cardioversion as well as anticoagulation strategies are discussed.
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18
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Yap SC, Oosterwerff EFJ, Boersma LVA, van der Stuijt W, Lenssen A, Hahn SJ, Knops RE. Acute human defibrillation performance of a subcutaneous implantable cardioverter-defibrillator with an additional coil electrode. Heart Rhythm 2023; 20:1649-1656. [PMID: 37579867 DOI: 10.1016/j.hrthm.2023.08.009] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND The subcutaneous implantable cardioverter-defibrillator (S-ICD) delivers 80 J shocks from an 8 cm left-parasternal coil to a 59 cm3 left lateral pulse generator (PG). A system that defibrillates with lower energy could significantly reduce PG size. Computer modeling and animal studies suggested that a second shock coil either parallel to the left-parasternal coil or transverse from the xiphoid to the PG pocket would significantly reduce the defibrillation threshold. OBJECTIVE The purpose of this study was to acutely assess the defibrillation efficacy of parallel and transverse configurations in patients receiving an S-ICD. METHODS Testing was performed in patients receiving a conventional S-ICD system. Success at 65 J was required before investigational testing. A second electrode was temporarily inserted from the xiphoid incision connected to the PG with an investigational Y-adapter. Phase 1 (n = 11) tested the parallel configuration. Phase 2 (n = 21) tested both parallel and transverse configurations in random order. RESULTS This study enrolled 35 patients (28 males (80%); mean age 51 ± 17 years; left ventricular ejection fraction 40% ± 15%; body mass index 26 ± 4 kg/m2; prior myocardial infarction 46%; congestive heart failure 49%; cardiomyopathy 63%). Compared to the conventional S-ICD system, mean shock impedance decreased for both parallel (69 ± 15 Ω vs 86 ± 20 Ω; n = 33; P < .001) and transverse (56 ± 14 Ω vs 81 ± 21 Ω; n = 20; P < .001) configurations. Shock success rates at 20, 30, and 40 J were 55%, 79%, 97%, and 25%, 70%, 90% for parallel and transverse configurations, respectively. Defibrillation threshold testing was well tolerated with no serious adverse events. CONCLUSION Adding a second shock coil, particularly in the parallel configuration, significantly reduced the impedance and had a high likelihood of defibrillation success at energies ≤40 J. This may enable the development of a smaller S-ICD.
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Affiliation(s)
- Sing-Chien Yap
- Department of Cardiology, Thorax Center, Cardiovascular Institute, Erasmus Medisch Centrum, Rotterdam, The Netherlands.
| | | | - Lucas V A Boersma
- Department of Cardiology, St Antonious Ziekenhuis, Nieuwegein, The Netherlands; Department of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Willeke van der Stuijt
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | | | - Reinoud E Knops
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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19
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Siddiqui FJ, Fook-Chong S, Shahidah N, Tan CK, Poh JY, Ng WM, Quah D, Ng YY, Leong BSH, Ong MEH. Technology activated community first responders in Singapore: Real-world care delivery & outcome trends. Resusc Plus 2023; 16:100486. [PMID: 37859630 PMCID: PMC10582741 DOI: 10.1016/j.resplu.2023.100486] [Citation(s) in RCA: 1] [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] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Community first responders (CFRs) strengthen the Chain of Survival for out-of-hospital cardiac arrest (OHCA) care. Considerable efforts have been invested in Singapore's CFR program, during the years 2016-2020, by developing an app-based activation system called myResponder. This paper reports on national CFR response indicators to evaluate the real-world impact of these efforts. METHODS We matched data from the Singapore Civil Defence Force's CFR registry with the Pan Asian Resuscitation Outcomes Study (PAROS) registry data to calculate performance indicators. These included the number of CFRs receiving and accepting an issued alert per OHCA event. Also calculated were the fraction of OHCA events where CFRs received an issued alert, or accepted the alert, and arrived at the scene either before or after EMS. We also present trends of these indicators and compare the prevalence of these fractions between the CFR-attended and CFR-unattended OHCA events. RESULTS Of 6577 alerted OHCA events, 42.7% accepted an alert, 50% of these arrived at the scene and 71% of them arrived before EMS. Almost all CFR response indicators improved over time even for the pandemic year (2020). The fraction of OHCA events where >2 CFRs received an alert increased from 62% to 96%; the same figure for accepting an alert did not change much but >2 CFRs arriving at the scene increased from 0% to 7.5%. The fraction of OHCA events with an automated external defibrillator applied and defibrillation performed by CFR increased from 4.2% to 10.3% and 1.6% to 3%, respectively. Statistically significant differences were observed in these indicators when CFR-attended and CFR-unattended OHCA events were compared. CONCLUSION This real-world study shows that activating CFRs using mobile technology can improve community response to OHCA and are bearing fruit in Singapore at a national level. Some targets for improvement and future research are highlighted in this report.
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Affiliation(s)
| | | | - Nur Shahidah
- Pre-hospital & Emergency Research Centre, Duke-NUS Medical School, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Colin K Tan
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore
| | - Jinn Yang Poh
- Volunteer & Community Partnership Department, Singapore Civil Defence Force, Singapore
| | - Wei Ming Ng
- Emergency Medicine Department, Ng Teng Fong General Hospital, Singapore
| | - Dennis Quah
- Operations Department, Singapore Civil Defence Force, Singapore
| | - Yih Yng Ng
- Digital and Smart Health Office, Ng Teng Fong Centre for Healthcare Innovation, Tan Tock Seng Hospital, Singapore
- Department of Preventive and Population Medicine, Tan Tock Seng Hospital, Singapore
| | - Benjamin SH Leong
- Emergency Medicine Department, National University Hospital, Singapore
| | - Marcus EH Ong
- Health Services & Systems Research, Duke-NUS Medical School, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
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Abstract
The Wolf Creek Conference, initiated in 1975, is a well-established tradition providing a unique forum for robust intellectual exchange between thought leaders and scientists from academia and industry focused on advancing the science and practice of cardiac arrest resuscitation. The Wolf Creek XVII Conference was hosted by the Max Harry Weil Institute for Critical Care Research and Innovation in Ann Arbor, Michigan, USA on June 15-17, 2023. A major focus of the conference proceedings was to identify and prioritize the knowledge gaps, barriers to translation, and research priorities for six major domains in the field of resuscitation: (1) automated cardiac arrest diagnosis, (2) amplifying lay-responder response, (3) mobile AEDs, (4) physiology-guided CPR, (5) extracorporeal support, and (6) neuroprotection. In addition, industry scientists were given the opportunity to present and discuss cutting edge innovations. Finally, building off of the conference's theme of "The Future of Cardiac Arrest Resuscitation", the Weil Institute introduced the "Wolf Creek Innovator in Cardiac Arrest and Resuscitation Award" to recognize early career investigators who were challenging current paradigms in resuscitation science. Similar to the early Wolf Creek Conferences, the goal was to fuel active discussion and debate among leading experts to determine where future research efforts should be focused. This manuscript provides an overview of the Wolf Creek XVII conference, and the individual manuscripts within this special edition of Resuscitation Plus describe the conference proceedings and outcomes in more detail. It is our intent that these publications will provide a roadmap for important academic and commercial advances in the field of cardiac arrest resuscitation.
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Affiliation(s)
- Robert W. Neumar
- Department of Emergency Medicine and Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, USA
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21
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Abstract
The Wolf Creek Conference is a seminal meeting of resuscitation researchers that has significantly influenced scientific advances and patient care in the field of cardiac arrest resuscitation over nearly half a century. Originating in 1975 at the Wolf Creek Lodge in Georgia, the conference was founded by Drs. James Elam, James Jude, and Peter Safar with the aim of improving clinical practices in cardiopulmonary resuscitation (CPR) by stimulating laboratory and clinical research. Over 17 conferences to date, the scope has broadened to encompass the growing field of resuscitation science, participation has expanded to include thought leaders and scientists from both academia and industry, and the proceedings have catalyzed numerous innovations in field. This narrative review highlights the genesis, objectives, proceedings, and impact of the Wolf Creek Conference from 1975 to the present.
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Affiliation(s)
- Robert W. Neumar
- Department of Emergency Medicine and Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Wanchun Tang
- Department of Emergency Medicine and Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, USA
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Wann DG, Baird AS, Wang NC, Mulukutla SR, Thoma FW, Sezer A, Canterbury AM, Barakat AF, Gardner MW, Skowronski JN, Aronis KN, Voigt AH, Jain SK, Saba SF, Bhonsale A, Estes NM, Keebler ME, Hickey GW, Bazaz RR, Kancharla K. Association of pre-left ventricular assist device defibrillator shocks for ventricular arrhythmia with clinical outcomes after left ventricular assist device implantation. Heart Rhythm O2 2023; 4:708-714. [PMID: 38034894 PMCID: PMC10685166 DOI: 10.1016/j.hroo.2023.10.002] [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] [Indexed: 12/02/2023] Open
Abstract
Background Implantable cardioverter-defibrillation (ICD) shocks after left ventricular assist device therapy (LVAD) are associated with adverse clinical outcomes. Little is known about the association of pre-LVAD ICD shocks on post-LVAD clinical outcomes and whether LVAD therapy affects the prevalence of ICD shocks. Objectives The purpose of this study was to determine whether pre-LVAD ICD shocks are associated with adverse clinical outcomes post-LVAD and to compare the prevalence of ICD shocks before and after LVAD therapy. Methods Patients 18 years or older with continuous-flow LVADs and ICDs were retrospectively identified within the University of Pittsburgh Medical Center system from 2006-2020. We analyzed the association between appropriate ICD shocks within 1 year pre-LVAD with a primary composite outcome of death, stroke, and pump thrombosis and secondary outcomes of post-LVAD ICD shocks and ICD shock hospitalizations. Results Among 309 individuals, average age was 57 ± 12 years, 87% were male, 80% had ischemic cardiomyopathy, and 42% were bridge to transplantation. Seventy-one patients (23%) experienced pre-LVAD shocks, and 69 (22%) experienced post-LVAD shocks. The overall prevalence of shocks pre-LVAD and post-LVAD were not different. Pre-LVAD ICD shocks were not associated with the composite outcome. Pre-LVAD ICD shocks were found to predict post-LVAD shocks (hazard ratio [HR] 5.7; 95% confidence interval [CI] 3.42-9.48; P <.0001) and hospitalizations related to ICD shocks from ventricular arrhythmia (HR 10.34; 95% CI 4.1-25.7; P <.0001). Conclusion Pre-LVAD ICD shocks predicted post-LVAD ICD shocks and hospitalizations but were not associated with the composite outcome of death, pump thrombosis, or stroke at 1 year. The prevalence of appropriate ICD shocks was similar before and after LVAD implantation in the entire cohort.
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Affiliation(s)
- Daniel G. Wann
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew S. Baird
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
| | - Norman C. Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Suresh R. Mulukutla
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Floyd W. Thoma
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ahmet Sezer
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ann M. Canterbury
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amr F. Barakat
- Cardiology Department, Ascension St. Vincent’s Medical Center, Jacksonville, Florida
| | | | - Jenna N. Skowronski
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Konstantinos N. Aronis
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew H. Voigt
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sandeep K. Jain
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Samir F. Saba
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Aditya Bhonsale
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - N.A. Mark Estes
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mary E. Keebler
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Gavin W. Hickey
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Raveen R. Bazaz
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Krishna Kancharla
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Gentile FR, Wik L, Isasi I, Baldi E, Aramendi E, Steen-Hansen JE, Fasolino A, Compagnoni S, Contri E, Palo A, Primi R, Bendotti S, Currao A, Quilico F, Vicini Scajola L, Lopiano C, Savastano S. Amplitude spectral area of ventricular fibrillation and defibrillation success at low energy in out-of-hospital cardiac arrest. Intern Emerg Med 2023; 18:2397-2405. [PMID: 37556074 DOI: 10.1007/s11739-023-03386-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/25/2023] [Indexed: 08/10/2023]
Abstract
The optimal energy for defibrillation has not yet been identified and very often the maximum energy is delivered. We sought to assess whether amplitude spectral area (AMSA) of ventricular fibrillation (VF) could predict low energy level defibrillation success in out-of-hospital cardiac arrest (OHCA) patients. This is a multicentre international study based on retrospective analysis of prospectively collected data. We included all OHCAs with at least one manual defibrillation. AMSA values were calculated by analyzing the data collected by the monitors/defibrillators used in the field (Corpuls 3 and Lifepak 12/15) and using a 2-s-pre-shock electrocardiogram interval. We run two different analyses dividing the shocks into three tertiles (T1, T2, T3) based on AMSA values. 629 OHCAs were included and 2095 shocks delivered (energy ranging from 100 to 360 J; median 200 J). Both in the "extremes analysis" and in the "by site analysis", the AMSA values of the effective shocks at low energy were significantly higher than those at high energy (p = 0.01). The likelihood of shock success increased significantly from the lowest to the highest tertile. After correction for age, call to shock time, use of mechanical CPR, presence of bystander CPR, sex and energy level, high AMSA value was directly associated with the probability of shock success [T2 vs T1 OR 3.8 (95% CI 2.5-6) p < 0.001; T3 vs T1 OR 12.7 (95% CI 8.2-19.2), p < 0.001]. AMSA values are associated with the probability of low-energy shock success so that they could guide energy optimization in shockable cardiac arrest patients.
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Affiliation(s)
- Francesca R Gentile
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Lars Wik
- Division of Prehospital Emergency Medicine, Oslo University Hospital, National Service of Competence for Prehospital Acute Medicine (NAKOS), Ullevål Hospital, Oslo, Norway
- Prehospital Clinic, Doctor car, Oslo University Hospital HF, Ullevål Hospital, Oslo, Norway
| | - Iraia Isasi
- BioRes Group, University of the Basque Country, Bilbao, Spain
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | | | | | - Alessandro Fasolino
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Sara Compagnoni
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Enrico Contri
- AAT 118 Pavia, Agenzia Regionale Urgenza Emergenza at Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Palo
- AAT 118 Pavia, Agenzia Regionale Urgenza Emergenza at Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberto Primi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Sara Bendotti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Alessia Currao
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Federico Quilico
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Luca Vicini Scajola
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Clara Lopiano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
- University of Pavia, Pavia, Italy
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy.
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Marsh-Armstrong BP, Seng E, Ting-Wei F, Saka S, Greenberg M. Effectiveness of rescue Me CPR! smartphone app providing real-time guidance to untrained bystanders performing CPR. Heliyon 2023; 9:e20908. [PMID: 37867873 PMCID: PMC10589871 DOI: 10.1016/j.heliyon.2023.e20908] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023] Open
Abstract
Background Out-of-hospital cardiac arrest (OHCA) is a persistent global health challenge, owing, in part, to low rates of population CPR training. Smartphone applications have the potential to widely disseminate CPR basic training to a populace, but other studies have found multiple limitations in previously developed CPR guidance applications (CPR-GA). This study aims to use medical simulation to assess the relative CPR performance of novices using the 'Rescue Me CPR!' (RMC) app, a custom CPR-GA designed by this research team, to novices using 'PG-CPR!' (PGC), the most downloaded CPR-GA available in the USA, and to CPR certified medical personnel. Methods In a prospective randomized experimental trial of 60 individuals, subjects were either given the RMC app, the PGC app, or had active CPR certification. They were presented a cardio-pulmonary arrest scenario and were observed while performing CPR on a high-fidelity manikin. Data was collected through four cycles of CPR, during which time 24 pertinent performance metrics and CPR steps were timed and recorded. These metrics were assessed on their own and used to calculate average time to compressions, average chest compression fraction, and rate of high-quality CPR for each study group. Results CPR certified subjects called 911 in 100 % of simulation cases, started compressions 34 ± 10 s after first seeing the simulated patient, had an average chest compression fraction of 0.52, and performed high-quality CPR in 25 % of aggregate compression cycles. PGC app users called 911 in 70 % of simulation cases, started compressions 86 ± 17 s after first seeing the simulated patient, had an average chest compression fraction that could not be assessed due to inconsistent pauses during CPR, and performed high-quality CPR in 2.5 % of aggregate compression cycles. RMC app users called 911 in 100 % of simulation cases, started compressions 55 ± 6 s after first seeing the simulated patient, had an average chest compression fraction of 0.48, and performed high-quality CPR in 50 % of aggregate compression cycles. Conclusion The results of this study demonstrate that in all studied metrics, except time-to-first-compression, CPR provided by individuals using the RMC app is statistically equivalent or superior to CPR performed by a CPR certified individual and, in almost every metric, superior to CPR performed by users of the most downloaded android CPR guidance application, PG-CPR.
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Affiliation(s)
| | - Eri Seng
- University of California San Diego, La Jolla, CA, 92037, USA
| | - Fan Ting-Wei
- University of California San Diego, La Jolla, CA, 92037, USA
| | - Stella Saka
- University of California San Diego, La Jolla, CA, 92037, USA
| | - Mark Greenberg
- University of California San Diego, La Jolla, CA, 92037, USA
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25
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Ruggeri L, Fumagalli F, Merigo G, Magliocca A, Ristagno G. Amplitude spectrum area measured in real-time during cardiopulmonary resuscitation - How does this technology work? Resuscitation 2023; 191:109941. [PMID: 37625578 DOI: 10.1016/j.resuscitation.2023.109941] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023]
Abstract
Amplitude spectrum area (AMSA) is one of the most accurate predictors of defibrillation outcome. Details on functioning and use of the available technology to measure AMSA during cardiopulmonary resuscitation (CPR) in the real clinical scenario are described. During chest compression (CC) pauses for ventilations, AMSA is promptly calculated and values displayed through a modified defibrillator. In addition, real-time AMSA analysis has the additional promise to monitor CPR quality, being AMSA threshold values contingent on CC depth. Future larger studies employing this new technology are now needed to demonstrate the impact of AMSA on survival of cardiac arrest.
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Affiliation(s)
- Laura Ruggeri
- Department of Acute Brain and Cardiovascular Injury, Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milan, Italy
| | - Francesca Fumagalli
- Department of Acute Brain and Cardiovascular Injury, Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milan, Italy
| | - Giulia Merigo
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Aurora Magliocca
- Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Giuseppe Ristagno
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Italy.
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26
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Arkles J, Delaughter C, D'Souza B. A novel artificial intelligence based algorithm to reduce wearable cardioverter-defibrillator alarms. J Interv Card Electrophysiol 2023; 66:1723-1728. [PMID: 36790576 DOI: 10.1007/s10840-023-01497-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/27/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND The wearable cardioverter defibrillator (WCD) is an important tool in mitigating sudden cardiac death (SCD). The WCD provides patient alarms for detected arrhythmias or electrical noise/artifact. Some patients experience frequent alarms for artifact. We sought to evaluate the effects of a novel artificial intelligence algorithm to reduce alarms related to electrical noise or artifact (advanced arrhythmia discrimination algorithm, AArD). METHODS A retrospective review of a large commercial database of prescribed WCD. Patients prescribed the WCD during the years 2017 (discrimination algorithm, DA group) or during 2019 (advanced arrhythmia discrimination algorithm, AArD) were analyzed. A total of 96,000 patients were sampled, 48,000 in the control group (using standard direct algorithm, DA) and compared to 48,000 in the intervention AArD (4000 per group per month) for 12 months. The AArD further discriminates ECG signals based on a machine-learning algorithm utilizing intensity and frequency beyond the standard DA. Outcomes regarding alarms, arrhythmias, and safety were analyzed. RESULTS The AArD algorithm was associated with a significant decrease in frequency of alarms over the course of WCD use; 54% of patients in the AARD versus 27% of DA had 0 alarms (P < .001). In the entire cohort, there was a 56% relative reduction in alarms with the use of AArD. Appropriate arrhythmia treatment time was not significantly different between the groups (44 s DA vs 45 s AArD [p = ns]). CONCLUSIONS A novel artificial intelligence algorithm reduces alarms without delaying appropriate therapy for VT/VF. These changes may improve compliance and quality of life in patients with a WCD.
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Affiliation(s)
- Jeffrey Arkles
- Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Benjamin D'Souza
- Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
- Penn Presbyterian Medical Center, Heart and Vascular Pavilion, 51 N. 39th Street, 4th floor, Philadelphia, PA, 19104, USA.
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27
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Phan J, Cherrett C, Subbiah R, Lee W. When logic fails. Heart Rhythm O2 2023; 4:668-670. [PMID: 37936672 PMCID: PMC10626179 DOI: 10.1016/j.hroo.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Affiliation(s)
- Justin Phan
- Department of Cardiology, St Vincent’s Hospital Sydney, Darlinghurst, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia
| | - Callum Cherrett
- Department of Cardiology, St Vincent’s Hospital Sydney, Darlinghurst, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Rajesh Subbiah
- Department of Cardiology, St Vincent’s Hospital Sydney, Darlinghurst, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia
| | - William Lee
- Department of Cardiology, St Vincent’s Hospital Sydney, Darlinghurst, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia
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28
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Jean Louis C, Cildoz M, Echarri A, Beaumont C, Mallor F, Greif R, Baigorri M, Reyero D. Police as first reponders improve out-of-hospital cardiac arrest survival. BMC Emerg Med 2023; 23:102. [PMID: 37670267 PMCID: PMC10481462 DOI: 10.1186/s12873-023-00876-w] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Police forces are abundant circulating and might arrive before the emergency services to Out-of-Hospital-Cardiac-Arrest victims. If properly trained, they can provide basic life support and early defibrillation within minutes, probably increasing the survival of the victims. We evaluated the impact of local police as first responders on the survival rates of out-of-hospital cardiac arrest victims in Navarra, Spain, over 7 years. METHODS A retrospective analysis of an ongoing Out-of-Hospital Cardiac registry to compare the characteristics and survival of Out-of-Hospital-Cardiac-Arrest victims attended to in first place by local police, other first responders, and emergency ambulance services between 2014 and 2020. RESULTS Of 628 cases, 73.7% were men (aged 68.9 ± 15.8), and 26.3% were women (aged 65,0 ± 14,7 years, p < 0.01). Overall survival of patients attended to by police in the first place was 17.8%, other first responders 17.4% and emergency services 13.5% with no significant differences (p > 0.1). Time to initiating cardiopulmonary resuscitation is significant for survival. When police arrived first and started CPR before the emergency services, they arrived at a mean of 5.4 ± 3 min earlier (SD = 3.10). This early police intervention showed an increase in the probability of survival by 10.1%. CONCLUSIONS The privileged location and the sole amount of personnel of local police forces trained in life support and their fast delivery of defibrillators as first responders can improve the survival of out-of-hospital cardiac arrest victims.
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Affiliation(s)
- Clint Jean Louis
- Emergency Advanced Ambulance Physician, Prehospital Emergency Services, Navarra Health Services, Avenida Pamplona No.2. 4ª, Barañain, Navarra España, 31010, Spain.
- Regional Coordinator Cardiac-Arrest Code, Citizen Empowerment Program, Navarra Health Services, Pamplona, Navarra, Spain.
- European Resuscitation Council (ERC) Research NET, Brussels, Belgium.
| | - Marta Cildoz
- Department of Statistics and Operational Research, Public University of Navarra, Pamplona, Navarra, Spain
| | - Alfredo Echarri
- Emergency Advanced Ambulance Physician, Prehospital Emergency Services, Navarra Health Services, Avenida Pamplona No.2. 4ª, Barañain, Navarra España, 31010, Spain
- Head of Emergency Transportation Services, Prehospital Emergency Services, Navarra Health Services, Pamplona, Navarra, Spain
| | - Carlos Beaumont
- Emergency Physician, Emergency Department, University Hospital of Navarra, Pamplona, Navarra, Spain
| | - Fermin Mallor
- Department of Statistics and Operational Research, Public University of Navarra, Pamplona, Navarra, Spain
| | - Robert Greif
- European Resuscitation Council (ERC) Research NET, Brussels, Belgium
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Miguel Baigorri
- Department of Statistics and Operational Research, Public University of Navarra, Pamplona, Navarra, Spain
| | - Diego Reyero
- Emergency Advanced Ambulance Physician, Prehospital Emergency Services, Navarra Health Services, Avenida Pamplona No.2. 4ª, Barañain, Navarra España, 31010, Spain
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Jaureguibeitia X, Coult J, Sashidhar D, Blackwood J, Kutz JN, Kudenchuk PJ, Rea TD, Kwok H. Instantaneous amplitude: Association of ventricular fibrillation waveform measures at time of shock with outcome in out-of-hospital cardiac arrest. J Electrocardiol 2023; 80:11-16. [PMID: 37086596 DOI: 10.1016/j.jelectrocard.2023.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/07/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Prompt defibrillation is key to successful resuscitation from ventricular fibrillation out-of-hospital cardiac arrest (VF-OHCA). Preliminary evidence suggests that the timing of shock relative to the amplitude of the VF ECG waveform may affect the likelihood of resuscitation. We investigated whether the VF waveform amplitude at the time of shock (instantaneous amplitude) predicts outcome independent of other validated waveform measures. METHODS We conducted a retrospective study of VF-OHCA patients ≥18 old. We evaluated three VF waveform measures for each shock: instantaneous amplitude at the time of shock, and maximum amplitude and amplitude spectrum area (AMSA) over a 3-s window preceding the shock. Linear mixed-effects modeling was used to determine whether instantaneous amplitude was associated with shock-specific return of organized rhythm (ROR) or return of spontaneous circulation (ROSC) independent of maximum amplitude or AMSA. RESULTS The 566 eligible patients received 1513 shocks, resulting in ROR of 62.0% (938/1513) and ROSC of 22.3% (337/1513). In unadjusted regression, an interquartile increase in instantaneous amplitude was associated with ROR (Odds ratio [OR] [95% confidence interval] = 1.27 [1.11-1.45]) and ROSC (OR = 1.27 [1.14-1.42]). However, instantaneous amplitude was not associated with ROR (OR = 1.13 [0.97-1.30]) after accounting for maximum amplitude, nor with ROR (OR = 1.00 [0.87-1.15]) or ROSC (OR = 1.05 [0.93-1.18]) after accounting for AMSA. By contrast, AMSA and maximum amplitude remained independently associated with ROR and ROSC. CONCLUSIONS We did not observe an independent association between instantaneous amplitude and shock-specific outcomes. Efforts to time shock to the maximal amplitude of the VF waveform are unlikely to affect resuscitation outcome.
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Affiliation(s)
- Xabier Jaureguibeitia
- Department of Communications Engineering, University of the Basque Country, Bilbao, Spain.
| | - Jason Coult
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Diya Sashidhar
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
| | - Jennifer Blackwood
- Division of Emergency Medical Services, Public Health Seattle & King County, Seattle, WA, USA
| | - J Nathan Kutz
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
| | - Peter J Kudenchuk
- Division of Emergency Medical Services, Public Health Seattle & King County, Seattle, WA, USA; Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Thomas D Rea
- Department of Medicine, University of Washington, Seattle, WA, USA; Division of Emergency Medical Services, Public Health Seattle & King County, Seattle, WA, USA
| | - Heemun Kwok
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA
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Shrestha R, Indrasena BSH, Subedi P, Lamsal D, Moulton C, Aylott J. Evaluation of junior doctors' retention of knowledge and skills after simulation training in shockable rhythm cardiac arrest in a low-resource setting in Nepal. Resusc Plus 2023; 15:100448. [PMID: 37649875 PMCID: PMC10463246 DOI: 10.1016/j.resplu.2023.100448] [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] [Indexed: 09/01/2023] Open
Abstract
Aims To test junior doctors' abilities to retain advanced life support psychomotor skills and theoretical knowledge in management of shockable rhythm cardiac arrest. Methods A repeated measure pre-post study design was used with 43 junior doctors, recruited after notifying them with robust method of attraction through flyers, brochures, email and phone calls. Written and performance tests, initial pre-test, immediate post-training, 30-days post-training and 60-days post-training, using simulation-based scenarios with a low-fidelity manikin were used with recording performance of ALS. Instrumentation Resuscitation Council UK ALS algorithms and guidelines1 were used in a simulated testing environment. Results There was a highly significant improvement in knowledge immediately after training (p < 0.00), with a net gain of marks from a mean value of 63.2% before training to 87.7% after training by 24.5% (95% CI 19.4, 29.6).There was a gradual decline of retained knowledge with time from immediate post-training over, 30-days and 60-days post-training (p < 0.00). The simulation pre-training assessments and immediate post-training assessments results were statistically significant (p < .00). The mean difference was 44.1% (95% CI 50.11, 38.10). There was a statistically significant decline of the competency with time (p < .00). Unlike for the knowledge test, the drop was significant on the 30th day (p < .00) with a mean difference of -10.5% (95% CI -13.55, -7.40). Conclusion The training of junior doctors in shockable rhythm cardiac arrest in a low resource setting, improved knowledge and skills in the participants after training. However, retention of knowledge declined at 30 days and more significantly after 60 days and retention of skill was declined more significantly at 30 days.
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Affiliation(s)
- Rojina Shrestha
- Department of Emergency Medicine, Chitwan Medical College Teaching Hospital, Chitwan, Nepal
| | - Buddhike Sri Harsha Indrasena
- Institute for Quality Improvement, World Academy of Medical Leadership, Sheffield, UK
- Department of General Surgery, Provincial General Hospital, Badulla, Sri Lanka
| | - Prakash Subedi
- Department of Emergency Medicine, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
- Institute of Medicine, QiMET Medical Institute (QMI), QiMET International Ltd., Sheffield, UK
| | - Dayaram Lamsal
- Department of Emergency Medicine, Chitwan Medical College Teaching Hospital and QIMET Nepal, Chitwan, Nepal
| | - Chris Moulton
- Department of Emergency Medicine, Royal Bolton Hospital, Bolton, UK
| | - Jill Aylott
- Institute for Quality Improvement, World Academy of Medical Leadership, Sheffield, UK
- Institute of Medicine, QiMET Medical Institute (QMI), QiMET International Ltd., Sheffield, UK
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Dreyfuss A, Carlson GK. Defibrillation in the Cardiac Arrest Patient. Emerg Med Clin North Am 2023; 41:529-542. [PMID: 37391248 DOI: 10.1016/j.emc.2023.03.006] [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] [Indexed: 07/02/2023]
Abstract
Defibrillation is one of the few interventions known to favorably impact survival in cardiac arrest. In witnessed arrest, survival improves with defibrillation as early as possible, whereas it may improve outcomes to administer high-quality chest compressions for 90 seconds before defibrillation in unwitnessed arrest. Minimizing pre-, peri-, and post-shock pauses has been shown to have mortality benefits. Refractory ventricular fibrillation has high mortality rates, and there is ongoing research into promising adjunctive treatment modalities. There remains no consensus on optimal pad positioning and defibrillation energy level, however, recent data suggest anteroposterior pad placement may be superior to anterolateral placement.
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Affiliation(s)
- Andrea Dreyfuss
- Department of Emergency Medicine, Hennepin Hospital, 701 Park Avenue, Minneapolis, MN 55415, USA.
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Monkhouse C, Wharmby A, Carter Z, Hunter R, Dhinoja M, Chow A, Creta A, Honarbakhsh S, Ahsan S, Orini M, Lambiase PD. Exploiting SMART pass filter deactivation detection to minimize inappropriate subcutaneous implantable cardioverter defibrillator therapies: a real-world single-centre experience and management guide. Europace 2023; 25:euad040. [PMID: 37001913 PMCID: PMC10227655 DOI: 10.1093/europace/euad040] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/23/2023] [Indexed: 08/24/2023] Open
Abstract
AIMS The SMART Pass™ (SP) algorithm is a high-pass filter that aims to reduce inappropriate therapy (IT) in subcutaneous internal cardiac defibrillator (S-ICD), but SP can deactivate due to low amplitude sensed R waves or asystole. The association between IT and SP deactivation and management strategies were evaluated, hypothesizing SP deactivation increases the risk of IT and device re-programming, or lead/generator re-positioning could reduce this risk. METHODS AND RESULTS Retrospective single-centre audit of Emblem™ S-ICD devices implanted 2016 to 2020 utilizing health records and remote monitoring data. Cox regression models evaluated associations between SP deactivation and IT. A total of 348 patients (27 ± 16.6 months follow-up) were studied: 73% primary prevention. Thirty-eight patients (11.8%) received 83 shocks with 27 patients (7.8%) receiving a total of 44 IT. Causes of IT were oversensing (98%) and aberrantly conducted atrial fibrillation (2%). SP deactivation occurred in 32 of 348 patients (9%) and was significantly associated with increased risk of IT (hazard ratio 5.36, 95% CI 2.37-12.13). SP deactivation was due to low amplitude R waves (94%), associated with a higher defibrillation threshold at implant and presence of arrhythmogenic right ventricular cardiomyopathy. No further IT occurred 16 ± 15.5 months after corrective interventions, with changing the sensing vector being successful in 59% of cases. CONCLUSION To reduce the risk of IT, the cause of the SP deactivation should be investigated, and appropriate reprogramming, device, or lead modifications made. Utilizing the alert for SP deactivation and electrograms could pro-actively prevent IT.
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Affiliation(s)
| | - Amy Wharmby
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
| | - Zoe Carter
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
| | - Ross Hunter
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
| | - Mehul Dhinoja
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
| | - Anthony Chow
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
| | - Antonio Creta
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
| | | | - Syed Ahsan
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
| | - Michele Orini
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
- Institute of Cardiovascular Science, University College London (UCL), 62 Huntley Street, London EC1A 7BE, UK
| | - Pier D Lambiase
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
- Institute of Cardiovascular Science, University College London (UCL), 62 Huntley Street, London EC1A 7BE, UK
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Heist EK, Knops RE, Yap SC, Boersma LVA, Friedman DJ, Poole JE, Stahl W, Belalcazar A. Reduction in defibrillation threshold by modifications to the subcutaneous implantable-cardioverter defibrillator coil. Heart Rhythm 2023; 20:783-785. [PMID: 36773794 DOI: 10.1016/j.hrthm.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/20/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Affiliation(s)
- E Kevin Heist
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts.
| | - Reinoud E Knops
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Daniel J Friedman
- Department of Cardiology, Electrophysiology Section, Duke University Hospital, Durham, North Carolina
| | - Jeanne E Poole
- Department of Cardiology, University of Washington, Seattle, Washington
| | - Wyatt Stahl
- Boston Scientific, St. Paul, Minneapolis, Minnesota
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Berger JM, Sengupta JD, Bank AJ, Casey SA, Witt D, Sharkey SW, Stanberry LI, Hauser RG. Causes and Clinical Consequences of Inappropriate Shocks Experienced by Patients Wearing a Cardioverter-Defibrillator. Heart Rhythm 2023:S1547-5271(23)02101-X. [PMID: 37211148 DOI: 10.1016/j.hrthm.2023.03.1604] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND The LifeVest® wearable cardioverter-defibrillator (WCD) prevents sudden cardiac death in at-risk patients who are not candidates for an implantable defibrillator. The WCD's safety and efficacy may be impacted by inappropriate shocks (IAS). OBJECTIVE Assess causes and clinical consequences of WCD inappropriate shocks in survivors of IAS events. METHODS The FDA Manufacturers and User Facility Device Experience (MAUDE) database was searched for IAS adverse events (AE) that were reported during 2021 and 2022. RESULTS A total of 2,568 IAS-AE were found (average # IAS/event: 1.5±1.9; range: 1-48). IAS were caused by tachycardias (1,255, 48.9%), motion artifacts (840, 32.7%), and oversensing (OS) of low-level electrical signals (473, 18.4%) (p<0.001). Tachycardias included atrial fibrillation (AF; 828,32.2%), supraventricular tachycardia (SVT; 333,13.0%), and non-sustained ventricular tachycardia/fibrillation (NSVT/VF; 87, 3.4%). Activities responsible for motion-induced IAS included riding a motorcycle, lawnmower, or tractor (n=128). IAS induced sustained VT or VF in 19 patients that were subsequently terminated by appropriate WCD shocks.Thirty patients fell and suffered physical injuries. Conscious patients (n=1905) did not use the response buttons to abort shocks (47.9%) or used them improperly (20.2%). IAS resulted in 1,190 emergency room visits or hospitalizations, and 17.3% (421/2440) of patients discontinued the WCD after experiencing IAS, especially multiple IAS. CONCLUSIONS The LifeVest WCD may deliver IAS caused by AF, SVT, NSVT/VF, motion artifacts and oversensing of electrical signals. These shocks may be arrhythmogenic, result in injuries, precipitate WCD discontinuation, and they consume medical resources. Improved WCD sensing, rhythm discrimination, and methods to abort IAS are needed.
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Affiliation(s)
- Justin M Berger
- The Joseph F. Novogratz Family Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN 55407, USA
| | - Jay D Sengupta
- The Joseph F. Novogratz Family Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN 55407, USA
| | - Alan J Bank
- The Joseph F. Novogratz Family Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN 55407, USA
| | - Susan A Casey
- The Joseph F. Novogratz Family Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN 55407, USA
| | - Dawn Witt
- The Joseph F. Novogratz Family Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN 55407, USA
| | - Scott W Sharkey
- The Joseph F. Novogratz Family Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN 55407, USA
| | - Larissa I Stanberry
- The Joseph F. Novogratz Family Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN 55407, USA
| | - Robert G Hauser
- The Joseph F. Novogratz Family Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN 55407, USA.
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Abstract
Cardiac arrhythmias are a leading cause of morbidity and mortality in the developed world, estimated to be responsible for hundreds of thousands of deaths annually. Our understanding of the electrophysiological mechanisms of such arrhythmias has grown since they were formally characterized in the late nineteenth century, and this has led to the development of numerous devices and therapies that have markedly improved outcomes for patients affected by such conditions. Despite these advancements, the application of a single large shock remains the clinical standard for treating deadly tachyarrhythmias. Such defibrillating shocks are undoubtedly effective in terminating such arrhythmias; however, they are applied without forewarning, contributing to the patient's stress and anxiety; they can be intensely painful; and they can have adverse psychological and physiological effects on patients. In recent years, there has been interest in developing defibrillation protocols that can terminate arrhythmias without crossing the human pain threshold for energy delivery, generally estimated to be between 0.1 and 1 J. In this article, we review existing literature on the development of such low-energy defibrillation methods and their underlying mechanisms, in an attempt to broadly describe the current landscape of these technologies.
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Affiliation(s)
- Skylar Buchan
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, 6770 Bertner Avenue, Houston, TX, 77030, USA
| | - Ronit Kar
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, 6770 Bertner Avenue, Houston, TX, 77030, USA.,Department of Biomedical Engineering, The University of Texas At Austin, Austin, TX, 78712, USA
| | - Mathews John
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, 6770 Bertner Avenue, Houston, TX, 77030, USA
| | - Allison Post
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, 6770 Bertner Avenue, Houston, TX, 77030, USA
| | - Mehdi Razavi
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, 6770 Bertner Avenue, Houston, TX, 77030, USA. .,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA.
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Sem M, Mastrangelo E, Lightfoot D, Aves T, Lin S, Mohindra R. The ability of machine learning algorithms to predict defibrillation success during cardiac arrest: A systematic review. Resuscitation 2023; 185:109755. [PMID: 36842672 DOI: 10.1016/j.resuscitation.2023.109755] [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: 01/04/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 02/28/2023]
Abstract
OBJECTIVE To evaluate the existing knowledge on the effectiveness of machine learning (ML) algorithms inpredicting defibrillation success during in- and out-of-hospital cardiac arrest. METHODS MEDLINE, Embase, CINAHL and Scopus were searched from inception to August 30, 2022. Studies were included that utilized ML algorithms for prediction of successful defibrillation, observed as return of spontaneous circulation (ROSC), survival to hospital or discharge, or neurological status at discharge.Studies were excluded if involving a trauma, an unknown underlying rhythm, an implanted cardiac defibrillator or if focused on the prediction or onset of cardiac arrest. Risk of bias was assessed using the PROBAST tool. RESULTS There were 2399 studies identified, of which 107 full text articles were reviewed and 15 observational studies (n = 5680) were included for final analysis. 29 ECG waveform features were fed into 15 different ML combinations. The best performing ML model had an accuracy of 98.6 (98.5 - 98.7)%, with 4 second ECG intervals. An algorithm incorporating end-tidal CO2 reported an accuracy of 83.3% (no CI reported). Meta-analysis was not performed due to heterogeneity in study design, ROSC definitions, and characteristics. CONCLUSION Machine learning algorithms, specifically Neural Networks, have been shown to have potential to predict defibrillation success for cardiac arrest with high sensitivity and specificity.Due to heterogeneity, inconsistent reporting, and high risk of bias, it is difficult to conclude which, if any, algorithm is optimal. Further clinical studies with standardized reporting of patient characteristics, outcomes, and appropriate algorithm validation are still required to elucidate this. PROSPERO 2020 CRD42020148912.
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Affiliation(s)
- Matthew Sem
- Department of Family and Community Medicine, University of Toronto, 4001 Leslie Street, Toronto, ON M2K 1E1, Canada.
| | - Emanuel Mastrangelo
- Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - David Lightfoot
- Health Sciences Library, Unity Health Toronto, 209 Victoria Street, Toronto, ON M5B 1T8, Canada
| | - Theresa Aves
- Li Ka Shing Institute, St. Michael's Hospital, 36 Queen Street East, Toronto, ON M5B 1W8, Canada
| | - Steve Lin
- Department of Emergency Medicine, St. Michael's Hospital, 209 Victoria Street, Toronto, ON M5B 1T8, Canada
| | - Rohit Mohindra
- Department of Emergency Medicine, North York General Hospital, 4001 Leslie Street, Toronto, ON M2K 1E1, Canada
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Yin RT, Taylor TG, de Graaf C, Ekkel MM, Chapman FW, Koster RW. Automated external defibrillator electrode size and termination of ventricular fibrillation in out-of-hospital cardiac arrest. Resuscitation 2023; 185:109754. [PMID: 36842678 DOI: 10.1016/j.resuscitation.2023.109754] [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: 12/29/2022] [Revised: 02/07/2023] [Accepted: 02/20/2023] [Indexed: 02/28/2023]
Abstract
Smaller electrodes allow more options for design of automated external defibrillator (AED) user interfaces. However, previous studies employing monophasic-waveform defibrillators found that smaller electrode sizes have lower defibrillation shock success rates. We hypothesize that, for impedance-compensated, biphasic truncated exponential (BTE) shocks, smaller electrodes increase transthoracic impedance (TTI) but do not adversely affect defibrillation success rates. METHODS AND RESULTS: In this prospective before-and-after clinical study, Amsterdam police and firefighters used AEDs with BTE waveforms: an AED with larger electrodes in 2016-2017 (113 cm2), and an AED with smaller electrodes in 2017-2020 (65 cm2). We analyzed 157 and 178 patient cases with an initial shockable rhythm where the larger and smaller electrodes were used, respectively. A single 200-J shock terminated ventricular fibrillation (VF) in 86% of patients treated with large electrodes and 89% of patients treated with smaller electrodes. Small electrodes had a non-inferior first shock defibrillation success rate compared to large electrodes, with a difference of 3% (95% CI: -3% -9%) with the lower confidence limit remaining above the defined non-inferiority threshold. TTI was significantly higher for the smaller electrodes (median: 100 Ω) compared to the larger electrodes (median: 88 Ω) (p < 0.001). CONCLUSIONS: For AEDs with impedance-compensating BTE waveforms, TTI was higher for smaller electrodes than the large electrode electrodes. Overall defibrillation shock success for AEDs with smaller electrodes was non-inferior to the AEDs with larger electrodes.
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Affiliation(s)
- Rose T Yin
- Stryker Emergency Care, Redmond, WA 98052, USA.
| | | | - Corina de Graaf
- Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands
| | - Mette M Ekkel
- Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Rudolph W Koster
- Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands
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Scholz SS, Wähnert D, Jansen G, Sauzet O, Latka E, Rehberg S, Thies KC. AED delivery at night - Can drones do the Job? A feasibility study of unmanned aerial systems to transport automated external defibrillators during night-time. Resuscitation 2023; 185:109734. [PMID: 36791989 DOI: 10.1016/j.resuscitation.2023.109734] [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: 01/19/2023] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND In their recent guidelines the European Resuscitation Council have recommended the use of Unmanned Aerial systems (UAS) to overcome the notorious shortage of AED. Exploiting the full potential of airborne AED delivery would mandate 24 h UAS operability. However, current systems have not been evaluated for nighttime use. The primary goal of our study was to evaluate the feasibility of night-time AED delivery by UAS. The secondary goal was to obtain and compare operational and safety data of night versus day missions. METHODS We scheduled two (one day, one night) flights each to ten different locations to assess the feasibility of AED delivery by UAS during night-time. We also compared operational data (mission timings) and safety data (incidence of critical events) of night versus day missions. RESULTS All missions were completed without safety incident. The flights were performed automatically without pilot interventions, apart from manually choosing the landing site and correcting the descent. Flight distances ranged from 910 m to 6.960 m, corresponding mission times from alert to AED release between 3:48 min and 11:20 min. Night missions (T¯m:night = 7:26 ± 2:29 min) did not take longer than day missions (T¯m:day = 7:59 ± 2:27 min). Despite slightly inferior visibility of the target site, night landings (T¯land:night = 64 ± 15 sec) were on average marginally quicker than day landings (T¯land:day = 69 ± 11sec). CONCLUSIONS Our results demonstrate the feasibility of UAS supported AED delivery during nighttime. Operational and safety data indicate no major differences between day- and night-time use. Future research should focus on integration of drone technology into the chain of survival.
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Komori A, Iriyama H, Abe T. Impact of defibrillation with automated external defibrillator by bystander before defibrillation by emergency medical system personnel on neurological outcome of out-of-hospital cardiac arrest with non-cardiac etiology. Resusc Plus 2023; 13:100363. [PMID: 36814461 PMCID: PMC9939706 DOI: 10.1016/j.resplu.2023.100363] [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: 01/17/2023] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
Aim of the study Although defibrillation using automated external defibrillator (AED) by bystander prior to emergency medical system (EMS) arrival was associated with favorable outcomes in out-of-hospital cardiac arrest (OHCA) of cardiac cause, whether it improves outcomes of OHCA due to non-cardiac cause is not clear. We aimed to investigate the impact of defibrillation with AED by bystander before defibrillation by EMS personnel on the outcomes of OHCA of presumed non-cardiac cause. Methods This was a retrospective cohort study using the All-Japan Utstein registry (reference period: 2013 to 2017). We included adult patients with OHCA of presumed non-cardiac cause, who had initial shockable rhythm, and who received witnessed arrest bystander cardiopulmonary resuscitation (CPR). Exposure variable was defibrillation with AED by bystander in comparison with initial defibrillation by EMS. Logistic regression analyses were conducted to assess the association between bystander AED shock and favorable neurological outcome (Cerebral Performance Category scale 1 or 2) at one month. Results Among the 1,053 patients included for analysis, 57 (5.4%) received bystander AED shock. There was no statistically significant difference in the rate of favorable neurological outcome at one month between groups [9 (15.8%) vs 109 (10.9%), p = 0.26]. Logistic regression analysis adjusted for characteristics, intervention, and time course of CPR showed no association between bystander AED shock and favorable neurological outcome [OR (95% CI): 1.63 (0.70-3.77), p = 0.25]. Conclusion In this study, defibrillation with AED by bystander before defibrillation by EMS personnel was not associated with the favorable outcomes of OHCA of presumed non-cardiac cause.
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Affiliation(s)
- Akira Komori
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan,Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan,Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan,Corresponding author at: Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, 1187-299, Kaname, Tsukuba, Ibaraki 300-2622, Japan.
| | - Hiroki Iriyama
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan,Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan,Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
| | - Toshikazu Abe
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan,Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
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Stupca K, Scaturo N, Shomo E, King T, Frank M. Esmolol, vector change, and dose-capped epinephrine for prehospital ventricular fibrillation or pulseless ventricular tachycardia. Am J Emerg Med 2023; 64:46-50. [PMID: 36436299 DOI: 10.1016/j.ajem.2022.11.019] [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: 07/31/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Refractory ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT) cardiac arrest describes a subset of patients who do not respond to standard Advanced Cardiac Life Support (ACLS) interventions and are associated with poor outcomes. Esmolol administration and vector change defibrillation have shown promise in improving outcomes in these patients, however evidence is limited. OBJECTIVES This study compares clinical outcomes between patients with prehospital refractory VF/pVT who received an Emergency Medical Service (EMS) bundle, comprised of esmolol administration, vector change defibrillation, and dose-capped epinephrine at 3 mg, to patients who received standard ACLS interventions. METHODS This multicenter, retrospective, cohort study evaluated medical records between October 18, 2017 and March 15, 2022. Patients were enrolled if they experienced a prehospital cardiac arrest with the rhythm VF or pVT, had received at least three standard defibrillations, at least 3 mg of epinephrine, and 300 mg of amiodarone. Patients who received the EMS bundle after its implementation were compared to patients who received standard ACLS interventions prior to its implementation. The primary outcome was sustained return of spontaneous circulation (ROSC), defined as ROSC lasting 20 min without recurrence of cardiac arrest. Secondary outcomes included the incidence of any ROSC, survival to hospital arrival, survival at hospital discharge, and neurologically intact survival at hospital discharge. RESULTS Eighty-three patients were included in the study. Thirty-six were included in the pre-EMS bundle group and 47 patients were included in the post-EMS bundle group. Patients in the pre-EMS bundle group achieved significantly higher rates of sustained ROSC (58.3% vs 17%, p < 0.001), any ROSC (66.7% vs 19.1%, p < 0.001), and survival to hospital arrival (55.6% vs 17%, p < 0.001). The rates of survival to hospital discharge (16.7% vs 6.4%, p = 0.17) and neurologically intact survival at hospital discharge (5.9% vs 4.3%, p = 1.00) were not significantly different between groups. CONCLUSIONS Patients who received the EMS bundle achieved sustained ROSC significantly less often and were less likely to have pulses at hospital arrival. The incidence of neurologically intact survival was low and similar between groups.
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Affiliation(s)
- Kyle Stupca
- Department of Pharmaceutical Care Services, Sarasota Memorial Hospital, 1700 S Tamiami Trl, Sarasota, FL 34239, USA.
| | - Nicholas Scaturo
- Department of Pharmaceutical Care Services, Sarasota Memorial Hospital, 1700 S Tamiami Trl, Sarasota, FL 34239, USA
| | - Eileen Shomo
- Department of Pharmaceutical Care Services, Sarasota Memorial Hospital, 1700 S Tamiami Trl, Sarasota, FL 34239, USA
| | - Tonya King
- Research Institute, Sarasota Memorial Hospital, 1700 S Tamiami Trl, Sarasota, FL 34239, USA
| | - Marshall Frank
- Emergency Medicine Program, Florida State University, Sarasota Memorial Hospital, 1700 S Tamiami Trl, Sarasota, FL 34239, USA; Sarasota County Fire Department, 1660 Ringling Blvd, Sarasota, FL 34236, USA
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Yoshimoto H, Fukui K, Nishimoto Y, Kuboyama K, Oishi Y, Sekine K, Hiraide A. Annual improvement trends in resuscitation outcome of patients defibrillated by laypersons after out-of-hospital cardiac arrests and compression-only resuscitation of laypersons. Resuscitation 2023; 183:109672. [PMID: 36549434 DOI: 10.1016/j.resuscitation.2022.12.010] [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: 10/30/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
AIM We aimed to investigate the effect of compression-only cardiopulmonary resuscitation (CPR) with conventional CPR in patients who were defibrillated by laypersons. METHODS This is a population-based, nationwide observational study. Adult and children who sustained a witnessed out-of-hospital cardiac arrest and defibrillated by laypersons between 2005 to 2019 were identified on the national database. The study used trend analyses, multivariate logistic regression, and inverse probability weighting using propensity score to explore changes in one-month survival and survival with a good neurological outcome over time and the influence of compression-only CPR compared with conventional CPR. RESULTS In total, 11,402 patients defibrillated by laypersons were enrolled in this study. The percentages of compression-only resuscitation increased dramatically and more than 50% from 2012 (P < 0.001). The percentages of cases with favorable resuscitation outcomes also increased annually (P < 0.001). By regression analysis, favorable outcomes were associated with recent years, male sex, younger age, and shorter resuscitation start time. In addition, the adjusted odds ratio of compression-only CPR to conventional CPR was 1.23 with a 95% confident interval 1.13-1.34. By inverse probability weighting, compression-only CPR was superior to conventional CPR for the favorable outcomes (P < 0.001). The adjusted outcomes in each year were better in compression-only resuscitation in most of the years. The overall relative risk reduction and the number needed to treat for compression-only resuscitation compared with conventional resuscitation were 7.6% and 22.1, respectively. CONCLUSIONS In Japan, the outcomes of out-of-hospital cardiac arrest patients who were defibrillated by laypersons were considerably better in compression-only resuscitation of laypersons every year.
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Affiliation(s)
- Hiroshi Yoshimoto
- Department of Emergency Medical Science, Kyoto Tachibana University, Japan; Kyotanabe Fire Department, Tanabe 78, Kyotabane, Kyoto 610-0331, Japan
| | - Kenko Fukui
- Department of Emergency Medical Science, Kyoto Tachibana University, Japan
| | - Yasuhisa Nishimoto
- Department of Emergency Medical Science, Kyoto Tachibana University, Japan
| | - Kazutoshi Kuboyama
- Department of Emergency Medical Science, Kyoto Tachibana University, Japan
| | - Yasuo Oishi
- Department of Emergency Medical Science, Kyoto Tachibana University, Japan
| | - Kazuhiro Sekine
- Department of Emergency Medical Science, Kyoto Tachibana University, Japan
| | - Atsushi Hiraide
- Department of Emergency Medical Science, Kyoto Tachibana University, Japan.
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Lac D, Wolters MK, Leung KHB, MacInnes L, Clegg GR. Factors affecting public access defibrillator placement decisions in the United Kingdom: A survey study. Resusc Plus 2023; 13:100348. [PMID: 36686326 DOI: 10.1016/j.resplu.2022.100348] [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: 10/10/2022] [Revised: 11/30/2022] [Accepted: 12/12/2022] [Indexed: 01/09/2023] Open
Abstract
Aim This study aimed to understand current community PAD placement strategies and identify factors which influence PAD placement decision-making in the United Kingdom (UK). Methods Individuals, groups and organisations involved in PAD placement in the UK were invited to participate in an online survey collecting demographic information, facilitators and barriers to community PAD placement and information used to decide where a PAD is installed in their experiences. Survey responses were analysed through descriptive statistical analysis and thematic analysis. Results There were 106 included responses. Distance from another PAD (66%) and availability of a power source (63%) were most frequently used when respondents are deciding where best to install a PAD and historical occurrence of cardiac arrest (29%) was used the least. Three main themes were identified influencing PAD placement: (i) the relationship between the community and PADs emphasising community engagement to create buy-in; (ii) practical barriers and facilitators to PAD placement including securing consent, powering the cabinet, accessibility, security, funding, and guardianship; and (iii) 'risk assessment' methods to estimate the need for PADs including areas of high footfall, population density and type, areas experiencing health inequalities, areas with delayed ambulance response and current PAD provision. Conclusion Decision-makers want to install PADs in locations that maximise impact and benefit to the community, but this can be constrained by numerous social and infrastructural factors. The best location to install a PAD depends on local context; work is required to determine how to overcome barriers to optimal community PAD placement.
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Roberts NB, Ager E, Leith T, Lott I, Mason-Maready M, Nix T, Gottula A, Hunt N, Brent C. Current summary of the evidence in drone-based emergency medical services care. Resusc Plus 2023; 13:100347. [PMID: 36654723 PMCID: PMC9841214 DOI: 10.1016/j.resplu.2022.100347] [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: 10/17/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023] Open
Abstract
Interventions for many medical emergencies including cardiac arrests, strokes, drug overdoses, seizures, and trauma, are critically time-dependent, with faster intervention leading to improved patient outcomes. Consequently, a major focus of emergency medical services (EMS) systems and prehospital medicine has been improving the time until medical intervention in these time-sensitive emergencies, often by reducing the time required to deliver critical medical supplies to the scene of the emergency. Medical indications for using unmanned aerial vehicles, or drones, are rapidly expanding, including the delivery of time-sensitive medical supplies. To date, the drone-based delivery of a variety of time-critical medical supplies has been evaluated, generating promising data suggesting that drones can improve the time interval to intervention through the rapid delivery of automatic external defibrillators (AEDs), naloxone, antiepileptics, and blood products. Furthermore, the improvement in the time until intervention offered by drones in out-of-hospital emergencies is likely to improve patient outcomes in time-dependent medical emergencies. However, barriers and knowledge gaps remain that must be addressed. Further research demonstrating functionality in real-world scenarios, as well as research that integrates drones into the existing EMS structure will be necessary before drones can reach their full potential. The primary aim of this review is to summarize the current evidence in drone-based Emergency Medical Services Care to help identify future research directions.
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Affiliation(s)
- Nathan B. Roberts
- University of Michigan Department of Emergency Medicine, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5305, USA
- Corresponding authors at: Medical School, University of Michigan Department of Emergency Medicine, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5305, USA.
| | - Emily Ager
- University of Michigan Department of Emergency Medicine, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5305, USA
- Corresponding authors at: Medical School, University of Michigan Department of Emergency Medicine, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5305, USA.
| | - Thomas Leith
- University of Michigan Medical School, 7300 Medical Science Building I—A Wing, 1301 Catherine St, Ann Arbor, MI 48109, USA
| | - Isabel Lott
- University of Michigan Medical School, 7300 Medical Science Building I—A Wing, 1301 Catherine St, Ann Arbor, MI 48109, USA
| | - Marlee Mason-Maready
- Oakland University William Beaumont School of Medicine, 586 Pioneer Dr, Rochester, MI 48309, USA
| | - Tyler Nix
- University of Michigan, Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI 48109, USA
| | - Adam Gottula
- University of Michigan Department of Emergency Medicine, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5305, USA
- The University of Michigan, Department of Anesthesiology , University of Michigan Medical School, 1500 East Medical Center Dr. Ann Arbor, MI 48109, USA
| | - Nathaniel Hunt
- University of Michigan Department of Emergency Medicine, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5305, USA
| | - Christine Brent
- University of Michigan Department of Emergency Medicine, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5305, USA
- Corresponding authors at: Medical School, University of Michigan Department of Emergency Medicine, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5305, USA.
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Hoster C, Rahman A, Goyal A, Peigh G, Trohman R, Knight BP, Huang H, Krishnan K, Larsen T, Mazur A, Sharma P, Engelstein E, Verma N, Wasserlauf J. Subcutaneous implantable cardioverter-defibrillator implantation position predicts successful defibrillation in obese and non-obese patients. J Interv Card Electrophysiol 2023:10.1007/s10840-022-01462-z. [PMID: 36596954 DOI: 10.1007/s10840-022-01462-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/19/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Subcutaneous implantable cardioverter-defibrillators (S-ICD) are an alternative to transvenous ICDs for patients without a need for cardiac pacing. Obese patients have been proposed to be at higher risk for conversion failure with S-ICDs due to subcutaneous fat underneath the device. Optimal device positioning may promote equivalent outcomes between obese and non-obese patients by minimizing the effects of excess adipose tissue. METHODS A retrospective analysis of patients undergoing defibrillation testing at the time of S-ICD implantation was performed. The primary endpoint was the rate of successful conversion of ventricular fibrillation (VF) at the time of implant. The secondary endpoint was shock impedance. RESULTS A total of 184 patients were included in the study. The rate of successful conversion of VF was 90.3% for obese patients (n = 72) and 96.4% for non-obese patients (n = 112) (p = 0.086). Compared to non-obese patients, obese patients had a higher mean PRAETORIAN score (78.5 ± 58.1 vs. 48.8 ± 35.5, p < 0.001) and higher measured mean impedance (82.0 ohms ± 26.5 vs. 69.8 ohms ± 19.3, p < 0.001). Patients with a PRAETORIAN score < 90 all had successful defibrillation testing regardless of BMI. CONCLUSIONS In this study, a PRAETORIAN score < 90 was associated with a 100% success rate of defibrillation testing following S-ICD implantation regardless of patient body mass index (BMI). Thus, the impact of obesity on impedance and the risk of failed shocks may be minimized with close attention to implantation technique to achieve a low PRAETORIAN score.
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Affiliation(s)
- Clay Hoster
- Division of Cardiology, Rush University Medical Center, 1717 W Congress Parkway, 345 Kellogg, Chicago, IL, 60612, USA.
| | - Annas Rahman
- Division of Cardiology, Rush University Medical Center, 1717 W Congress Parkway, 345 Kellogg, Chicago, IL, 60612, USA
| | - Ansh Goyal
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Graham Peigh
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Richard Trohman
- Division of Cardiology, Rush University Medical Center, 1717 W Congress Parkway, 345 Kellogg, Chicago, IL, 60612, USA
| | - Bradley P Knight
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Henry Huang
- Division of Cardiology, Rush University Medical Center, 1717 W Congress Parkway, 345 Kellogg, Chicago, IL, 60612, USA
| | | | - Timothy Larsen
- Division of Cardiology, Rush University Medical Center, 1717 W Congress Parkway, 345 Kellogg, Chicago, IL, 60612, USA
| | - Alexander Mazur
- Division of Cardiology, Rush University Medical Center, 1717 W Congress Parkway, 345 Kellogg, Chicago, IL, 60612, USA
| | - Parikshit Sharma
- Division of Cardiology, Rush University Medical Center, 1717 W Congress Parkway, 345 Kellogg, Chicago, IL, 60612, USA
| | - Erica Engelstein
- Division of Cardiology, Rush University Medical Center, 1717 W Congress Parkway, 345 Kellogg, Chicago, IL, 60612, USA
| | - Nishant Verma
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jeremiah Wasserlauf
- Division of Cardiology, Rush University Medical Center, 1717 W Congress Parkway, 345 Kellogg, Chicago, IL, 60612, USA
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Tiwari P, Tiwari S. Detection and modulation of neurodegenerative processes using graphene-based nanomaterials: Nanoarchitectonics and applications. Adv Colloid Interface Sci 2023; 311:102824. [PMID: 36549182 DOI: 10.1016/j.cis.2022.102824] [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: 10/03/2022] [Revised: 12/02/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
Neurodegenerative disorders (NDDs) are caused by progressive loss of functional neurons following the aggregation and fibrillation of proteins in the central nervous system. The incidence rate continues to rise alarmingly worldwide, particularly in aged population, and the success of treatment remains limited to symptomatic relief. Graphene nanomaterials (GNs) have attracted immense interest on the account of their unique physicochemical and optoelectronic properties. The research over the past two decades has recognized their ability to interact with aggregation-prone neuronal proteins, regulate autophagy and modulate the electrophysiology of neuronal cells. Graphene can prevent the formation of higher order protein aggregates and facilitate the clearance of such deposits. In this review, after highlighting the role of protein fibrillation in neurodegeneration, we have discussed how GN-protein interactions can be exploited for preventing neurodegeneration. A comprehensive understanding of such interactions would contribute to the exploration of novel modalities for controlling neurodegenerative processes.
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Liu X, Yuan Q, Wang G, Bian Y, Xu F, Chen Y. Drones delivering automated external defibrillators: A new strategy to improve the prognosis of out-of-hospital cardiac arrest. Resuscitation 2023; 182:109669. [PMID: 36535307 DOI: 10.1016/j.resuscitation.2022.12.007] [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: 09/21/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is a serious threat to human life and health, characterized by high morbidity and mortality. However, given the limitations of the current emergency medical system (EMS), it is difficult to immediately treat patients who experience OHCA. It is well known that rapid defibrillation after cardiac arrest is essential for improving the survival rate of OHCA, yet automated external defibrillators (AED) are difficult to obtain in a timely manner. OBJECTIVE This review illustrates the feasibility and advantages of AED delivery by drones by surveying current studies on drones, explains that drones are a new strategy in OHCA, and finally proposes novel strategies to address existing problems with drone systems. RESULTS The continuous development of drone technology has been beneficial for patients who experience OHCA, as drones have demonstrated powerful capabilities to provide rapid delivery of AED. Drones have great advantages over traditional EMS, and the delivery of AED by drones for patients with OHCA is a new strategy. However, the application of this new strategy in real life still has many challenges. CONCLUSION Drones are promising and innovative tools. Many studies have demonstrated that AED delivery by drones is feasible and cost-effective; however, as a new strategy to improve the survival rate of OHCA patients, there remain problems to be solved. In the future, more in-depth investigations need to be conducted.
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47
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Mehta NK, Allam S, Mazimba S, Karim S. Racial, ethnic, and socioeconomic disparities in out-of-hospital cardiac arrest within the United States: Now is the time for change. Heart Rhythm O2 2022; 3:857-863. [PMID: 36588995 PMCID: PMC9795269 DOI: 10.1016/j.hroo.2022.07.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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] [Indexed: 12/23/2022] Open
Abstract
This review highlights the current evidence on racial, ethnic, and socioeconomic disparities in cardiac arrest outcomes within the United States. Several studies demonstrate that patients from Black, Hispanic, or lower socioeconomic status backgrounds suffer the most from disparities at multiple levels of the resuscitation pathway, including in the provision of bystander cardiopulmonary resuscitation, defibrillator usage, and postresuscitation therapies. These gaps in care may altogether lead to lower survival rates and worse neurological outcomes for these patients. A multisystem, culturally sensitive approach to improving cardiac arrest outcomes is suggested in this article.
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Affiliation(s)
- Nishaki K. Mehta
- Department of Cardiovascular Medicine, William Beaumont Hospital, Oakland University School of Medicine, Royal Oak, Michigan
- Division of Cardiovascular Medicine, University of Virginia Medical Center, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Sahitya Allam
- Department of Internal Medicine, University of Maryland Medical Center, University of Maryland School of Medicine, Baltimore, Maryland
- Address reprint requests and correspondence: Dr Sahitya Allam, 22 S Greene St, Room N3E09, Baltimore, MD 21201.
| | - Sula Mazimba
- Division of Cardiovascular Medicine, University of Virginia Medical Center, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Saima Karim
- Division of Cardiovascular Medicine, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
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48
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Lupton JR, Jui J, Neth MR, Sahni R, Daya MR, Newgard CD. Development of a clinical decision rule for the early prediction of Shock-Refractory Out-of-Hospital cardiac arrest. Resuscitation 2022; 181:60-67. [PMID: 36280216 DOI: 10.1016/j.resuscitation.2022.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 08/05/2022] [Revised: 09/16/2022] [Accepted: 10/08/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Nearly half of ventricular fibrillation or ventricular tachycardia (VF/VT) out-of-hospital cardiac arrest (OHCA) patients receive three or more shocks, often referred to as refractory VF/VT. Our objective was to derive a clinical decision rule (CDR) for the early stratification of patients into risk categories for refractory VF/VT. METHODS We included adults with non-traumatic OHCA in the Resuscitation Outcomes Consortium Epistry (2011-2015) with ≥ 1 EMS shock. We used Classification and Regression Tree analysis for CDR building using variables known at initial EMS rhythm analysis including age, sex, witness, location, bystander interventions, initial EMS rhythm, obvious non-cardiac etiology, and dispatch to arrival times. The outcome was refractory VF/VT (≥3 shocks). We calculated sensitivity, specificity, area under the receiver operating curve (AUROC), and odds ratios (OR). The rule was validated using the Portland Cardiac Arrest Epidemiologic Registry (2018-2020). RESULTS There were 17,140 eligible patients and 8,146 (47.5%) had refractory VF/VT. The optimal CDR (AUROC = 0.671) defined three groups: high-risk were any patients requiring an EMS shock after a bystander AED shock; moderate-risk were any non-EMS witnessed arrests with shockable initial EMS rhythms; and the remainder were low-risk. Refractory VF/VT increased across the low (30.7%), moderate (58.5%) and high-risk (84.8%) groups. Compared to low-risk, being moderate-risk or higher (OR [95% CI]:3.37 [3.16-3.59]; sensitivity 72.7%; specificity 55.9%) or high-risk (OR:12.63 [9.89-16.13]; sensitivity 5.4%; specificity 99.1%) had higher odds of refractory VF/VT. Results was similar in the validation cohort (n = 765, AUROC = 0.672). CONCLUSIONS Patients at higher risk for refractory VF/VT can be identified early in EMS care.
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Affiliation(s)
- Joshua R Lupton
- Department of Emergency Medicine, Oregon Health and Science University, United States.
| | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health and Science University, United States
| | - Matthew R Neth
- Department of Emergency Medicine, Oregon Health and Science University, United States
| | - Ritu Sahni
- Department of Emergency Medicine, Oregon Health and Science University, United States
| | - Mohamud R Daya
- Department of Emergency Medicine, Oregon Health and Science University, United States
| | - Craig D Newgard
- Department of Emergency Medicine, Oregon Health and Science University, United States
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Bohm P, Meyer T, Narayanan K, Schindler M, Weizman O, Beganton F, Schmied C, Bougouin W, Barra S, Dumas F, Varenne O, Cariou A, Karam N, Jouven X, Marijon E. Sports-related sudden cardiac arrest in young adults. Europace 2022; 25:627-633. [PMID: 36256586 PMCID: PMC9935050 DOI: 10.1093/europace/euac172] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 04/11/2022] [Accepted: 08/08/2022] [Indexed: 01/14/2023] Open
Abstract
AIMS Data on sports-related sudden cardiac arrest (SrSCA) among young adults in the general population are scarce. We aimed to determine the overall SrSCA incidence, characteristics, and outcomes in young adults. METHODS AND RESULTS Prospective cohort study of all cases of SrSCA between 2012 and 2019 in Germany and Paris area, France, involving subjects aged 18-35 years. Detection of SrSCA was achieved via multiple sources, including emergency medical services (EMS) reporting and web-based screening of media releases. Cases and aetiologies were centrally adjudicated. Overall, a total of 147 SrSCA (mean age 28.1 ± 4.8 years, 95.2% males) occurred, with an overall burden of 4.77 [95% confidence interval (CI) 2.85-6.68] cases per million-year, including 12 (8.2%) cases in young competitive athletes. While bystander cardiopulmonary resuscitation (CPR) was initiated in 114 (82.6%), automated external defibrillator (AED) use by bystanders occurred only in a minority (7.5%). Public AED use prior to EMS arrival (odds ratio 6.25, 95% CI 1.48-43.20, P = 0.02) was the strongest independent predictor of survival at hospital discharge (38.1%). Among cases that benefited from both immediate bystander CPR and AED use, survival rate was 90.9%. Coronary artery disease was the most frequent aetiology (25.8%), mainly through acute coronary syndrome (86.9%). CONCLUSION Sports-related sudden cardiac arrest in the young occurs mainly in recreational male sports participants. Public AED use remains disappointingly low, although survival may reach 90% among those who benefit from both bystander CPR and early defibrillation. Coronary artery disease is the most prevalent cause of SrSCA in young adults.
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Affiliation(s)
- Philipp Bohm
- Institute of Sports and Preventive Medicine, Saarland University, 66123 Saarbrücken, Germany,Department of Cardiology, University Heart Center Zurich, HerzZentrum Hirslanden Zurich Witellikerstrasse 36, CH-8008 Zurich, Switzerland
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, 66123 Saarbrücken, Germany
| | - Kumar Narayanan
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,Cardiology Department, Medicover Hospitals, Madhapur, Hyderabad, Telangana 500081, India
| | - Matthias Schindler
- Department of Cardiology, University Heart Center Zurich, HerzZentrum Hirslanden Zurich Witellikerstrasse 36, CH-8008 Zurich, Switzerland
| | - Orianne Weizman
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France
| | - Frankie Beganton
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France
| | - Christian Schmied
- Department of Cardiology, University Heart Center Zurich, HerzZentrum Hirslanden Zurich Witellikerstrasse 36, CH-8008 Zurich, Switzerland
| | - Wulfran Bougouin
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,Intensive Care Unit, Jacques cartier Hospital, 6 Av. du Noyer Lambert, 91300 Massy, France
| | - Sergio Barra
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,Cardiology Department, Hospital da Luz Arrábida, V. N. PCT de Henrique Moreira 150, 4400-346 Vila Nova de Gaia, Portugal
| | - Florence Dumas
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,Intensive Care Unit, Jacques cartier Hospital, 6 Av. du Noyer Lambert, 91300 Massy, France,Emergency Department, Cochin Hospital, 25 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Olivier Varenne
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,Intensive Care Unit, Jacques cartier Hospital, 6 Av. du Noyer Lambert, 91300 Massy, France,Cardiology Department, Cochin Hospital, 25 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Alain Cariou
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,Intensive Care Unit, Jacques cartier Hospital, 6 Av. du Noyer Lambert, 91300 Massy, France,Intensive Care Unit, Cochin Hospital, 25 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Nicole Karam
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,University of Paris, 103, Boulevard Saint-Michel, Paris, France,Cardiology Department, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
| | - Xavier Jouven
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,University of Paris, 103, Boulevard Saint-Michel, Paris, France,Cardiology Department, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
| | - Eloi Marijon
- Corresponding author. Tel: +33 6 6283 3848; fax: +33 1 5609 3047. E-mail address:
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Pocock H, Deakin CD, Lall R, Michelet F, Contreras A, Ainsworth-Smith M, King P, Devrell A, Smith DE, Perkins GD. Protocol for a cluster randomised controlled feasibility study of Prehospital Optimal Shock Energy for Defibrillation (POSED). Resusc Plus 2022; 12:100310. [PMID: 36238581 PMCID: PMC9550652 DOI: 10.1016/j.resplu.2022.100310] [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: 07/20/2022] [Revised: 09/07/2022] [Accepted: 09/14/2022] [Indexed: 11/25/2022] Open
Abstract
AIMS The Prehospital Optimal Shock Energy for Defibrillation (POSED) study will assess the feasibility of conducting a cluster randomised controlled study of clinical effectiveness in UK ambulance services to identify the optimal shock energy for defibrillation. METHODS POSED is a pragmatic, allocation concealed, open label, cluster randomised, controlled feasibility study. Defibrillators within a single UK ambulance service will be randomised in an equal ratio to deliver one of three shock strategies 120-150-200 J, 150-200-200 J, 200-200-200 J. Consecutive adults (≥18 years) presenting with out of hospital cardiac arrest requiring defibrillation will be eligible. The study plans to enrol 90 patients (30 in each group). Patients (or their relatives for non-survivors) will be informed about trial participation after the initial emergency has resolved. Survivors will be invited to consent to participate in follow-up (i.e., at 30 days or discharge).The primary feasibility outcome is the proportion of eligible patients who receive the randomised study intervention. Secondary feasibility outcomes will include recruitment rate, adherence to allocated treatment and data completeness. Clinical outcomes will include Return of an Organised Rhythm (ROOR) at 2 minutes post-shock, refibrillation rate, Return of Spontaneous Circulation (ROSC) at hospital handover, survival and neurological outcome at 30 days. CONCLUSION The POSED study will assess the feasibility of a large-scale trial and explore opportunities to optimise the trial protocol.Trial registration: ISRCTN16327029.
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Key Words
- AE, Adverse Event
- AOR, Adjusted Odds Ratio
- B-CPR, Bystander CPR
- BTE, Biphasic Truncated Exponential waveform
- CAD, Computer Aided Despatch
- CONSORT, CONsolidated Standards Of Reporting Trials
- CPMS, Central Portfolio Management System
- CPR, Cardiopulmonary Resuscitation
- CRF, Case Report Form
- Cardiopulmonary Resuscitation
- Defibrillation
- Electric Countershock
- Feasibility study
- GCP, Good Clinical Practice
- HRA, Health Research Authority
- ICA, Integrated Clinical and practitioner Academic programme
- ILCOR, International Liaison Committee on Resuscitation
- ISRCTN, International Standard Registered Clinical/social sTudy Number
- J, Joules
- JRCALC, Joint Royal Colleges Ambulance Liaison Committee
- NIHR, National Institute for Health and care Research
- OHCA, Out-of-Hospital Cardiac Arrest
- OR, Odds Ratio
- Out-of-Hospital Cardiac Arrest
- PEA, Pulseless Electrical Activity
- POSED, Prehospital Optimal Shock Energy for Defibrillation
- PPI, Patient and Public Involvement
- REC, Research Ethics Committee
- RFA, Rankin Focused Assessment
- ROOR, Return of Organised Rhythm
- ROSC, Return of Spontaneous Circulation
- SMG, Study Management Group
- SOC, Study Oversight Committee
- SPIRIT, Standard Protocol Items: Recommendations for Intervention Trials
- ToF, Termination of Fibrillation
- VF, Ventricular Fibrillation
- Ventricular Fibrillation
- WCTU, Warwick Clinical Trials Unit
- ePR, Electronic Patient Record
- mRS, Modified Rankin Scale
- pVT, Pulseless Ventricular Tachycardia
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Affiliation(s)
- Helen Pocock
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, United Kingdom,South Central Ambulance Service NHS Foundation Trust, Southern House, Sparrowgrove, Otterbourne, Winchester, SO21 2RU, United Kingdom,Corresponding author at: Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, United Kingdom.
| | - Charles D. Deakin
- South Central Ambulance Service NHS Foundation Trust, Southern House, Sparrowgrove, Otterbourne, Winchester, SO21 2RU, United Kingdom,University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, United Kingdom
| | - Ranjit Lall
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, United Kingdom
| | - Felix Michelet
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, United Kingdom
| | - Abraham Contreras
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, United Kingdom
| | - Mark Ainsworth-Smith
- South Central Ambulance Service NHS Foundation Trust, Southern House, Sparrowgrove, Otterbourne, Winchester, SO21 2RU, United Kingdom
| | - Phil King
- South Central Ambulance Service NHS Foundation Trust, Southern House, Sparrowgrove, Otterbourne, Winchester, SO21 2RU, United Kingdom
| | - Anne Devrell
- PPI Representative, Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, United Kingdom
| | - Debra E. Smith
- PPI Representative, Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, United Kingdom
| | - Gavin D. Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, United Kingdom,University Hospitals Birmingham NHS Foundation Trust, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, United Kingdom
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