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Wang SA, Lee HW, Ko YC, Sun JT, Matsuyama T, Lin CH, Hsieh MJ, Chiang WC, Ma MHM. Effect of crew ratio of advanced life support-trained personnel on patients with out-of-hospital cardiac arrest: A systematic review and meta-analysis. J Formos Med Assoc 2024; 123:561-570. [PMID: 37838538 DOI: 10.1016/j.jfma.2023.10.008] [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] [Received: 03/03/2023] [Revised: 07/04/2023] [Accepted: 10/03/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND/PURPOSE This review aimed to investigate the effect of crew ratios of on-scene advanced life support (ALS)-trained personnel on patients with out-of-hospital cardiac arrest (OHCA). METHODS We systematically searched PubMed, Ovid EMBASE, and the Cochrane Central Register of Controlled Trials databases from the inception date until September 30, 2022, for eligible studies. Two reviewers independently screened the studies for relevance, extracted data, and quality. We compared the effect of the ratio of on-scene ALS-trained personnel >50 % to those with a ratio ≤50 % among prehospital personnel on the clinical outcomes of OHCA patients. The primary outcome was survival-to-discharge and secondary outcomes were any return of spontaneous circulation (ROSC), sustained ROSC (≥2 h), and favourable neurological outcome at discharge (cerebral performance category scores: 1 or 2). Pooled odds ratios (ORs) were calculated, and the certainty of evidence was assessed. RESULTS From 10,864 references, we identified four non-randomised studies, including 16,475 patients. Two studies were performed in Japan and two in Taiwan. There were significant differences in survival-to-discharge (OR: 1.24, 95 % confidence interval [CI]: 1.07-1.44, I2: 7 %), any ROSC (OR:1.22, 95 % CI: 1.04-1.43, I2: 74 %) and sustained ROSC (OR: 1.39, 95 % CI: 1.16-1.65, I2: 40 %), but insignificant differences in favourable neurological outcome at discharge. The overall certainty of evidence was rated as very low for all outcomes. CONCLUSION Prehospital ALS care with a ratio of on-scene ALS-trained personnel >50 % could improve OHCA patient outcomes than crew ratios ≤50 %. Further studies are required to reach a robust conclusion.
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Affiliation(s)
- Shao-An Wang
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hong-Wei Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ying-Chih Ko
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jen-Tang Sun
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Ju Hsieh
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan
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Team L, Bloomer MJ, Redley B. Nurses' roles and responsibilities in cardiac advanced life support: A single-site eDelphi study. Nurs Crit Care 2024; 29:466-476. [PMID: 36938931 DOI: 10.1111/nicc.12897] [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: 06/09/2022] [Revised: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Nurses are often the first responders to in-hospital cardiac arrest in postoperative cardiac surgical patients. Poor clarity about role expectations and responsibilities can hinder nurses' performance during cardiac advanced life support (CALS) procedures. AIM To seek expert consensus on nurses' roles and responsibilities in CALS for patients in postoperative cardiac surgical patients. STUDY DESIGN A two-round modified eDelphi survey. Delphi items were informed by guideline literature, an audit of resuscitation records and expert interviews. Panellists, drawn from a single site of a large tertiary health service in metropolitan Melbourne, included nurses, doctors and surgeons familiar with the management of cardiac arrest in post-operative cardiac surgical patients. RESULTS The two rounds of the modified eDelphi generated 55 responses. A consensus of >80% agreement was reached for 24 of the 41 statements in Round 2. All items related to nurses' roles and responsibilities during nurses pre- and post-arrest phases reached consensus. In contrast, only 29% (n = 4/14) of items related to peri-arrest, and 36% of those related to nurse scope of practise in CALS arrest (n = 4/11) reached consensus. CONCLUSION The study's aim was only partially achieved. Findings indicate high agreement about nurses' roles and responsibilities before and immediately after a cardiac arrest, but limited clarity about nurses' roles when implementing the CALS protocol, such as resternotomy and internal cardiac massage. There is an urgent need to address uncertainty about nurses' roles and scope of practice in CALS, which is essential to the recognition of nurses' contribution to the cardiac specialty workforce. RELEVANCE TO CLINICAL PRACTISE Uncertainty about nurses 'roles and responsibilities when implementing the CALS protocol may hinder their performance to their full scope of practice, leading to poor patient outcomes.
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Affiliation(s)
- Lydia Team
- Monash Health, Clayton, Victoria, Australia
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
| | - Melissa J Bloomer
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Health, Woolloongabba, Queensland, Australia
| | - Bernice Redley
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research-Monash Health Partnership, Monash Health, Clayton, Victoria, Australia
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Yang HC, Park SM, Lee KJ, Jo YH, Kim YJ, Lee DK, Jang DH. Delayed arrival of advanced life support adversely affects the neurological outcome in a multi-tier emergency response system. Am J Emerg Med 2023; 71:1-6. [PMID: 37315438 DOI: 10.1016/j.ajem.2023.06.001] [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: 04/05/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/16/2023] Open
Abstract
AIM Prehospital management of out-of-hospital cardiac arrest (OHCA) is based on basic life support, with the addition of advanced life support (ALS) if possible. This study aimed to investigate the effect of delayed arrival of ALS on neurological outcomes of patients with OHCA at hospital discharge. METHODS This was a retrospective study of a registry of patients with OHCA. A multi-tier emergency response system was established in the study area. ALS was initiated when the second-arrival team arrived at the scene. A restricted cubic spline curve was used to investigate the relationship between the response time interval of the second-arrival team and neurological outcomes at hospital discharge. Multivariable logistic regression analysis was performed to assess the independent association between the response time interval of the second-arrival team and neurological outcomes of patients at hospital discharge. RESULTS A total of 3186 adult OHCA patients who received ALS at the scene were included in the final analysis. A restricted cubic spline curve showed that a long response time interval of the second-arrival team was correlated with a high likelihood of poor neurological outcomes. Meanwhile, multivariable logistic regression analysis showed that a long response time interval of the second-arrival team was independently associated with poor neurological outcomes (odds ratio, 1.10; 95% confidence interval, 1.03-1.17). CONCLUSION In a multi-tiered prehospital emergency response system, the delayed arrival of ALS was associated with poor neurological outcomes at hospital discharge.
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Affiliation(s)
- Hae Chul Yang
- Department of Emergency Medicine, Seoul National University Bundang Hospital 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea; Ajou University Graduate School of Public Health 206, World Cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do 16499, Republic of Korea
| | - Seung Min Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Kui Ja Lee
- Department of Emergency Medical Services, Kyungdong University, Wonju, Gangwon 26495, 815, Gyeonhwon-ro, Munmak-eup, Wonju-si, Gangwon-do 26495, Republic of Korea
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Yu Jin Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Dong Keon Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Dong-Hyun Jang
- Department of Public Healthcare Service, Seoul National University Bundang Hospital 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea.
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Mikiewicz M, Polok K, Szczeklik W, Górka A, Kosiński S. Sudden Cardiac Arrests in the Polish Tatra Mountains: A Retrospective Study. Wilderness Environ Med 2023; 34:128-134. [PMID: 36710127 DOI: 10.1016/j.wem.2022.11.005] [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: 08/26/2022] [Revised: 11/07/2022] [Accepted: 11/29/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Achieving the optimal survival rate for sudden cardiac arrest in mountains is challenging. The odds of surviving are influenced mainly by distance, response time, and organization of the emergency medical system. The aim of this study was to analyze the epidemiology and outcomes of patients with out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation was performed in the Polish Tatra Mountains. METHODS This was a retrospective analysis of data on sudden cardiac arrest collected from the database of the Tatra Mountain Rescue Service and local emergency medical system from 2001 to 2021. RESULTS A total of 74 cases of sudden cardiac arrest were recorded. The mortality rate was 88% (65/74). Return of spontaneous circulation was achieved in 22 (30%) patients. A group of survivors was characterized by more frequent use of an automated external defibrillator (AED) (56% vs 14%, P=0.011), a shorter interval between cardiac arrest and emergency team arrival (12 vs 20 min, P=0.005), and a shorter time to initiation of advanced life support (ALS) (12 vs 22 min, P=0.004). All survivors had a shockable initial rhythm. The majority of survivors (8/9, 89%) had a good or moderate neurological outcome. CONCLUSIONS This study confirms poor survival rate after sudden cardiac arrest in the mountain area. The use of AED, shockable initial rhythm, and shorter time interval to emergency team arrival and ALS initiation are associated with better outcomes.
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Affiliation(s)
- Maciej Mikiewicz
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland; Tatra Mountains Rescue Service, Zakopane, Poland.
| | - Kamil Polok
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | | | - Sylweriusz Kosiński
- Tatra Mountains Rescue Service, Zakopane, Poland; Department of Interdisciplinary Intensive Care, Jagiellonian University Medical College, Kraków, Poland
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Matsui S, Kitamura T, Kurosawa H, Kiyohara K, Tanaka R, Sobue T, Nitta M. Application of adult prehospital resuscitation rules to pediatric out of hospital cardiac arrest. Resuscitation 2023; 184:109684. [PMID: 36586503 DOI: 10.1016/j.resuscitation.2022.109684] [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: 10/25/2022] [Revised: 12/13/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Prehospital termination of resuscitation (TOR) rules can be recommended for adults with out-of-hospital cardiac arrests (OHCAs). This study aimed to investigate whether adult basic life support (BLS) and advanced life support (ALS) TOR rules can predict neurologically unfavorable one-month outcome for pediatric OHCA patients. METHODS From a nationwide population-based observational cohort study, we extracted data of consecutive pediatric OHCA patients (0-17 years old) from January 1, 2005, to December 31, 2011. The BLS TOR rule has three criteria, whereas the ALS TOR rule includes two additional criteria. We selected pediatric OHCA patients that met all criteria for each TOR rule and calculated the specificity and positive predictive value (PPV) of each TOR rule for identifying pediatric OHCA patients who did not have neurologically favorable one-month outcome. RESULTS Of the 12,740 pediatric OHCA patients eligible for the evaluation of the BLS TOR rule, 10,803 patients met the BLS TOR rule, with a specificity of 0.785 and a PPV of 0.987 for predicting a lack of neurologically favorable one-month survival. Of the 2,091 for the ALS TOR rule, 381 patients met the ALS TOR rule, with a specificity of 0.986 and a PPV of 0.997 for predicting neurologically unfavorable one-month outcome. CONCLUSIONS The adult BLS and ALS TOR rules had a high PPV for predicting pediatric OHCA patients without a neurologically favorable survival at one month after onset.
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Affiliation(s)
- Satoshi Matsui
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan; Division of Emergency Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Kurosawa
- Division of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Kosuke Kiyohara
- Department of Food Science, Otsuma Women's University, Tokyo, Japan
| | - Ryojiro Tanaka
- Division of Emergency Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masahiko Nitta
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan; Department of Pediatrics, Osaka Medical and Pharmaceutical University, Osaka, Japan; Division of Patient Safety, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan.
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Vierhout T, Blaseg N, Moodie T, McCauley R, Singh A, Larson E, Stys A, Stys T. Impact of Emergency Medical Service Provider Training and Institutional Volume Experience on ST-Elevation Myocardial Infarction Patient Outcomes in Rural Setting. S D Med 2022; 75:342-346. [PMID: 36745980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Rural sites provide management challenges for ST-elevation myocardial infarction (STEMI) patients. The impact of emergency medical service (EMS) training and institutional volume experience on STEMI outcomes was examined. METHODS All STEMI patients transferred to Sanford from 32 sites in rural South Dakota from 2010-2019 were analyzed. "Time to electrocardiogram (EKG)" (TEKG) and "Time from EKG to Thrombolytics" (TThrom) were calculated. Sites were compared based on EMS training (advanced life support (ALS) vs. basic life support (BLS)) and institutional volume experience (less than or equal to five vs. greater than five STEMI). RESULTS 514 STEMI patients from 32 sites in South Dakota were analyzed. Average TEKG was 20 (±15) and 14 (±10) minutes for ALS and BLS trained services, respectively (p=0.25). More experienced sites had an average TEKG of 26 (±15) minutes, while sites with ≤ five STEMI patients had an average time of 15 (±13) minutes. TThrom did not differ significantly between sites based on our metrics. CONCLUSION The present study concludes that EMS provider training (BLS vs ALS) and institutional volume experience do not significantly impact patient-related outcomes when treating STEMI patients. This result is possibly attributed to increased educational efforts for rural health care providers in general and the establishment of the South Dakota statewide STEMI Network "Mission: Lifeline" which standardized STEMI care and improved connectivity between remote responders and the larger PCI-capable facilities.
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Affiliation(s)
- Thomas Vierhout
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Nate Blaseg
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Travis Moodie
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | | | - Aditya Singh
- Sanford Heart Hospital, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Eric Larson
- Department of Internal Medicine, Division of General Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Adam Stys
- ardiovascular Disease and Interventional Cardiology Fellowship Program, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Tomasz Stys
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
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Herreros B, Ruiz de Luna R, de la Calle N, Gayoso D, Martínez P, Olaciregui Dague K, Palacios G. Operation of a triage committee for advanced life support during the COVID-19 pandemic. Philos Ethics Humanit Med 2022; 17:5. [PMID: 35292071 PMCID: PMC8923824 DOI: 10.1186/s13010-022-00117-1] [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: 08/11/2021] [Accepted: 01/20/2022] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND During the first weeks of March 2020 in Spain, the cases of severe respiratory failure progressively increased, generating an imbalance between the clinical needs for advanced life support (ALS) measures and the effective availability of ALS resources. To address this problem, the creation of triage committees (TC) was proposed, whose main function is to select the best candidates to receive ALS. The main objective of our study is to describe the clinical characteristics of the patients evaluated by the TC of the Alcorcón Foundation University Hospital (AFUH) during the first wave of SARS CoV-2. Other objectives are to determine if there are differences between the patients considered candidates / not candidates for ALS and to analyze the functioning of the TC. METHODS Retrospective observational study of all patients assessed by the AFUH TC. RESULTS There were 19 meetings, in which 181 patients were evaluated, 65.4% male and with a mean age of 70.1 years. 31% had some degree of functional dependence, the Barthel median was 100 and Charlson 4. 58.5% were not considered a candidate for ALS at that time. The patients considered candidates to receive ALS were younger (72 vs 66; p < 0.001), had less comorbidity (Charlson 4 vs 3; p < 0.001) and had a better previous functional situation. A median of 5 physicians participated in each meeting and, after being assessed by the TC, 13.6% received ALS: 29.3% of those considered candidates for ALS and 2% of the non-candidates. CONCLUSIONS The patients evaluated by the TC had a mean age of 70 years, high comorbidity and almost a third had some degree of functional dependence. More than half were not considered candidates for ALS at that time, these patients being older, with more comorbidity and a worse previous functional situation. TC decisions, based on objective clinical criteria, were almost always respected. Public institutions must get involved in triage procedures, which should and in our opinion must include the creation of TC in health centers. The implementation of Anticipated Decision programs (ADP) would help enable patients affected by triage decisions to participate in them.
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Affiliation(s)
- Benjamín Herreros
- Internal Medicine Unit, Alcorcón Foundation University Hospital, Alcorcón, Spain
- Francisco Vallés Institute of Clinical Ethics, European University, Madrid, Spain
| | - Rafael Ruiz de Luna
- Intensive Medicine Unit, Alcorcón Foundation University Hospital, Madrid, Spain
| | - Natalia de la Calle
- Intensive Medicine Unit, Alcorcón Foundation University Hospital, Madrid, Spain
| | - Diego Gayoso
- Internal Medicine Unit, Alcorcón Foundation University Hospital, Alcorcón, Spain
| | - Paula Martínez
- Internal Medicine Unit, Alcorcón Foundation University Hospital, Alcorcón, Spain
| | | | - Gregorio Palacios
- Internal Medicine Unit, Alcorcón Foundation University Hospital, Alcorcón, Spain
- Francisco Vallés Institute of Clinical Ethics, European University, Madrid, Spain
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Brangan K, Day MP. Updated AHA Basic and Advanced Cardiac Life Support guidance with COVID-19 considerations. Nursing 2022; 52:28-33. [PMID: 35196279 PMCID: PMC8862670 DOI: 10.1097/01.nurse.0000820020.00324.b0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
ABSTRACT The American Heart Association released an updated Basic and Advanced Cardiac Life Support guidance that incorporates the latest knowledge regarding COVID-19 and its transmissibility. This article details the new guidance, including strategies for reducing provider risk and exposure and for special patient-care situations.
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Affiliation(s)
- Karen Brangan
- Karen Jean Craig-Brangan is the owner, president, and CEO of EMS Educational Services, Inc. in Cheltenham, Pa. Mary Patricia Day is a certified registered nurse anesthetist at Temple University Hospital in Philadelphia, Pa
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Updated AHA Basic and Advanced Cardiac Life Support guidance with COVID-19 considerations. Nursing 2022; 52:33-4. [PMID: 35239605 DOI: 10.1097/01.NURSE.0000823944.47191.f5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Yang W, Charlton G, Ma C, Ratwatte SD, Langford K, Ward L, Jackson J, Huynh R, Dawson C, Kim JCH, Yeong C, Kol M, Shah A, Yu C. The role of simulation in preparing the healthcare workforce for providing guideline adapted advanced cardiac life support for COVID-19 patients. Intern Med J 2021; 51:620-621. [PMID: 33890376 PMCID: PMC8251357 DOI: 10.1111/imj.15203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/16/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Wesley Yang
- Cardiology Department, Intensive Care Department, Anaesthetics DepartmentConcord Repatriation General HospitalSydneyNew South WalesAustralia
| | - Gabriella Charlton
- Cardiology Department, Intensive Care Department, Anaesthetics DepartmentConcord Repatriation General HospitalSydneyNew South WalesAustralia
| | - Christine Ma
- Cardiology Department, Intensive Care Department, Anaesthetics DepartmentConcord Repatriation General HospitalSydneyNew South WalesAustralia
| | - Seshika D. Ratwatte
- Cardiology Department, Intensive Care Department, Anaesthetics DepartmentConcord Repatriation General HospitalSydneyNew South WalesAustralia
| | - Kiri Langford
- Cardiology Department, Intensive Care Department, Anaesthetics DepartmentConcord Repatriation General HospitalSydneyNew South WalesAustralia
| | - Louise Ward
- Cardiology Department, Intensive Care Department, Anaesthetics DepartmentConcord Repatriation General HospitalSydneyNew South WalesAustralia
| | - John Jackson
- Cardiology Department, Intensive Care Department, Anaesthetics DepartmentConcord Repatriation General HospitalSydneyNew South WalesAustralia
| | - Ronald Huynh
- Cardiology Department, Intensive Care Department, Anaesthetics DepartmentConcord Repatriation General HospitalSydneyNew South WalesAustralia
| | - Christopher Dawson
- Cardiology Department, Intensive Care Department, Anaesthetics DepartmentConcord Repatriation General HospitalSydneyNew South WalesAustralia
| | - James C. H. Kim
- Cardiology Department, Intensive Care Department, Anaesthetics DepartmentConcord Repatriation General HospitalSydneyNew South WalesAustralia
| | - Clarence Yeong
- Cardiology Department, Intensive Care Department, Anaesthetics DepartmentConcord Repatriation General HospitalSydneyNew South WalesAustralia
| | - Mark Kol
- Cardiology Department, Intensive Care Department, Anaesthetics DepartmentConcord Repatriation General HospitalSydneyNew South WalesAustralia
| | - Asim Shah
- Cardiology Department, Intensive Care Department, Anaesthetics DepartmentConcord Repatriation General HospitalSydneyNew South WalesAustralia
| | - Christopher Yu
- Cardiology Department, Intensive Care Department, Anaesthetics DepartmentConcord Repatriation General HospitalSydneyNew South WalesAustralia
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Gue YX, Adatia K, Kanji R, Potpara T, Lip GYH, Gorog DA. Out-of-hospital cardiac arrest: A systematic review of current risk scores to predict survival. Am Heart J 2021; 234:31-41. [PMID: 33387469 DOI: 10.1016/j.ahj.2020.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/19/2020] [Indexed: 11/19/2022]
Abstract
IMPORTANCE The arrest and the post-arrest period are an incredibly emotionally traumatic time for family and friends of the affected individual. There is a need to assess prognosis early in the patient pathway to offer objective, realistic and non-emotive information to the next-of-kin regarding the likelihood of survival. OBJECTIVE To present a systematic review of the clinical risk scores available to assess patients on admission following out-of-hospital cardiac arrest (OHCA) which can predict in-hospital mortality. EVIDENCE REVIEW A systematic search of online databases Embase, MEDLINE and Cochrane Central Register of Controlled Trials was conducted up until 20th November 2020. FINDINGS Out of 1,817 initial articles, we identified a total of 28 scoring systems, with 11 of the scores predicting mortality following OHCA included in this review. The majority of the scores included arrest characteristics (initial rhythm and time to return of spontaneous circulation) as prognostic indicators. Out of these, the 3 most clinically-useful scores, namely those which are easy-to-use, comprise of commonly available parameters and measurements, and which have high predictive value are the OHCA, NULL-PLEASE, and rCAST scores, which appear to perform similarly. Of these, the NULL-PLEASE score is the easiest to calculate and has also been externally validated. CONCLUSIONS Clinicians should be aware of these risk scores, which can be used to provide objective, nonemotive and reproducible information to the next-of-kin on the likely prognosis following OHCA. However, in isolation, these scores should not form the basis for clinical decision-making.
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Affiliation(s)
- Ying X Gue
- University of Hertfordshire, Hertfordshire, United Kingdom; Cardiology Department, East and North Hertfordshire NHS Trust, Stevenage, United Kingdom; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Krishma Adatia
- Cardiology Department, East and North Hertfordshire NHS Trust, Stevenage, United Kingdom
| | - Rahim Kanji
- Cardiology Department, East and North Hertfordshire NHS Trust, Stevenage, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Tatjana Potpara
- Clinical Centre of Serbia & School of Medicine, Belgrade University, Serbia, Belgrade
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Diana A Gorog
- University of Hertfordshire, Hertfordshire, United Kingdom; Cardiology Department, East and North Hertfordshire NHS Trust, Stevenage, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom.
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Abstract
OBJECTIVE This study evaluated the competence of Advanced Cardiac Life Support certified personnel at hands-on ACLS skills. METHODS The observational, cross-sectional study assessed participants' subjective confidence and objective skills using the ACLS mega code examination. Testing was performed with a Laerdal manikin and standardized code carts. RESULTS Participants had a 12% (6% to 22%, 95% CI) pass rate for the stable tachyarrhythmia scenario and a 57% (44% to 69%, 95% CI) pass rate for the unstable tachyarrhythmia scenario. The most significant skills missed were appropriate medications and postconversion maintenance in the stable scenario and appropriate energy selection and successful shock delivery for the unstable scenario. CONCLUSIONS ACLS providers feel confident in their ACLS skills; however, actual performance demonstrated poor performance in the management of patients with stable and unstable tachyarrhythmias. The recommendation is to observe initial and recertification ACLS classes to investigate the standard to which these core skills are being taught and evaluated.
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Affiliation(s)
- Jason J Good
- Jason J. Good practices in the ED at Wright-Patterson Medical Center at Wright Patterson Air Force Base in Dayton, Ohio. Michael J. Rabener is program director of the US Air Force Emergency Medicine PA DSc Residency at the San Antonio (Tex.) Military Medical Center. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Palatnick W, Jelic T. Calcium channel blocker and beta blocker overdose, and digoxin toxicity management. Emerg Med Pract 2020; 22:1-42. [PMID: 33136356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
While relatively uncommon, an overdose of calcium channel blockers, beta blockers, or digoxin can result in significant morbidity and mortality, and management can be complex. An acute overdose will require different management strategies than chronic toxicity while on therapeutic dosing. Toxicity from these agents must be considered in bradycardic and hypotensive patients. This supplement provides an evidence-based overview of emergency department management of calcium channel blocker overdose, beta blocker overdose, and digoxin toxicity, and focuses on the caveats of treatment for each.
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Affiliation(s)
- Wesley Palatnick
- Department of Emergency Medicine, University of Manitoba; Department of Emergency Medicine, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Tomislav Jelic
- Department of Emergency Medicine, University of Manitoba; Department of Emergency Medicine, Health Sciences Centre, Winnipeg, Manitoba, Canada
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Bingham AL, Kavelak HL, Hollands JM, Finn LA, Delic JJ, Schroeder N, Cawley MJ. Advanced cardiac life support certification for student pharmacists improves simulated patient survival. Curr Pharm Teach Learn 2020; 12:975-980. [PMID: 32565000 DOI: 10.1016/j.cptl.2020.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 02/09/2020] [Accepted: 04/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND PURPOSE Basic life support (BLS) and advanced cardiac life support (ACLS) skills performance, as well as simulated patient survival, were compared for student pharmacist teams with and without at least one member with American Heart Association (AHA) ACLS certification. EDUCATIONAL ACTIVITY AND SETTING Doctor of pharmacy students in their third professional year completed a high-fidelity mannequin simulation. Within the previous year, 30 of 184 students (16%) completed ACLS certification. Rapid response teams (n = 31) of five to six members were formed through random student assignment. Two AHA instructors recorded and assessed performance using a checklist adapted from the AHA's standardized forms for BLS and ACLS assessment. Teams with and without ACLS certified members were compared for skills performance and simulated patient survival (i.e. correct performance of all BLS and ACLS skills). FINDINGS Teams with ACLS certified members (n = 21) were superior to teams without certified members (n = 10) for correct performance of all observed BLS and ACLS skills, including pulse assessment and medication selection for cardiovascular support. For teams who had ACLS certified members, simulated patient survival was 86% higher. The study groups did not differ in their ability to calculate a correct vasopressor infusion rate if warranted. SUMMARY BLS and ACLS skills performance were improved by AHA ACLS certification. Additionally, simulated patient survival was improved for teams with students who had at least one ACLS certified member.
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Affiliation(s)
- Angela L Bingham
- Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences, 600 S. 43rd Street, Philadelphia, PA 19104, United States.
| | - Haley L Kavelak
- Department of Pharmacy, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA 18015, United States.
| | - James M Hollands
- Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences, 600 S. 43rd Street, Philadelphia, PA 19104, United States.
| | - Laura A Finn
- Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences, 600 S. 43rd Street, Philadelphia, PA 19104, United States.
| | - Justin J Delic
- Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences, 600 S. 43rd Street, Philadelphia, PA 19104, United States.
| | - Nicole Schroeder
- Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences, 600 S. 43rd Street, Philadelphia, PA 19104, United States
| | - Michael J Cawley
- Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences, 600 S. 43rd Street, Philadelphia, PA 19104, United States
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Riera J, Argudo E, Ruiz-Rodríguez JC, Rodríguez-Lecoq R, Ferrer R. Full neurological recovery 6 h after cardiac arrest due to accidental hypothermia. Lancet 2020; 395:e89. [PMID: 32416783 DOI: 10.1016/s0140-6736(20)30751-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/02/2020] [Accepted: 03/20/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Jordi Riera
- Department of Critical Care, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain.
| | - Eduard Argudo
- Department of Critical Care, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain
| | - Juan Carlos Ruiz-Rodríguez
- Department of Critical Care, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain
| | - Rafael Rodríguez-Lecoq
- Department of Cardiac Surgery, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain
| | - Ricard Ferrer
- Department of Critical Care, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain
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Curtis JR, Kross EK, Stapleton RD. The Importance of Addressing Advance Care Planning and Decisions About Do-Not-Resuscitate Orders During Novel Coronavirus 2019 (COVID-19). JAMA 2020; 323:1771-1772. [PMID: 32219360 DOI: 10.1001/jama.2020.4894] [Citation(s) in RCA: 175] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- J Randall Curtis
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle
| | - Erin K Kross
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle
| | - Renee D Stapleton
- Larner College of Medicine, Division of Pulmonary and Critical Care Medicine, University of Vermont, Burlington
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Duff JP, Topjian AA, Berg MD, Chan M, Haskell SE, Joyner BL, Lasa JJ, Ley SJ, Raymond TT, Sutton RM, Hazinski MF, Atkins DL. 2019 American Heart Association Focused Update on Pediatric Advanced Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics 2020; 145:peds.2019-1361. [PMID: 31727859 DOI: 10.1542/peds.2019-1361] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This 2019 focused update to the American Heart Association pediatric advanced life support guidelines follows the 2018 and 2019 systematic reviews performed by the Pediatric Life Support Task Force of the International Liaison Committee on Resuscitation. It aligns with the continuous evidence review process of the International Liaison Committee on Resuscitation, with updates published when the International Liaison Committee on Resuscitation completes a literature review based on new published evidence. This update provides the evidence review and treatment recommendations for advanced airway management in pediatric cardiac arrest, extracorporeal cardiopulmonary resuscitation in pediatric cardiac arrest, and pediatric targeted temperature management during post-cardiac arrest care. The writing group analyzed the systematic reviews and the original research published for each of these topics. For airway management, the writing group concluded that it is reasonable to continue bag-mask ventilation (versus attempting an advanced airway such as endotracheal intubation) in patients with out-of-hospital cardiac arrest. When extracorporeal membrane oxygenation protocols and teams are readily available, extracorporeal cardiopulmonary resuscitation should be considered for patients with cardiac diagnoses and in-hospital cardiac arrest. Finally, it is reasonable to use targeted temperature management of 32°C to 34°C followed by 36°C to 37.5°C, or to use targeted temperature management of 36°C to 37.5°C, for pediatric patients who remain comatose after resuscitation from out-of-hospital cardiac arrest or in-hospital cardiac arrest.
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Yamac AH. Diffuse myocardial calcification in a drug addict, complicating advanced life support. J PAK MED ASSOC 2019; 69:1372-1375. [PMID: 31511728] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Myocardial calcification is a rare echocardiographic finding, which is often found in patients who have suffered from a myocardial infarction. Rarely, myocardial calcification may be present in individuals without a significant medical history. Until today, there has not been a published case report emphasising the relation between myocardial calcification and cocaine usage. Herein, we report a case of a young male with diffuse calcification of the left ventricular myocardium, who had an addiction to cocaine. This case highlights an uncommon etiology for myocardial calcification and it may lead to further studies about cardiotoxic effects of cocaine.
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Affiliation(s)
- Chana A Sacks
- From the Departments of Medicine (C.A.S., G.A.A.), Radiology (S.K.), Surgery (P.T.M.), and Pathology (E.D.P.), Massachusetts General Hospital, and the Departments of Medicine (C.A.S., G.A.A.), Radiology (S.K.), Surgery (P.T.M.), and Pathology (E.D.P.), Harvard Medical School - both in Boston
| | - Shahmir Kamalian
- From the Departments of Medicine (C.A.S., G.A.A.), Radiology (S.K.), Surgery (P.T.M.), and Pathology (E.D.P.), Massachusetts General Hospital, and the Departments of Medicine (C.A.S., G.A.A.), Radiology (S.K.), Surgery (P.T.M.), and Pathology (E.D.P.), Harvard Medical School - both in Boston
| | - Peter T Masiakos
- From the Departments of Medicine (C.A.S., G.A.A.), Radiology (S.K.), Surgery (P.T.M.), and Pathology (E.D.P.), Massachusetts General Hospital, and the Departments of Medicine (C.A.S., G.A.A.), Radiology (S.K.), Surgery (P.T.M.), and Pathology (E.D.P.), Harvard Medical School - both in Boston
| | - George A Alba
- From the Departments of Medicine (C.A.S., G.A.A.), Radiology (S.K.), Surgery (P.T.M.), and Pathology (E.D.P.), Massachusetts General Hospital, and the Departments of Medicine (C.A.S., G.A.A.), Radiology (S.K.), Surgery (P.T.M.), and Pathology (E.D.P.), Harvard Medical School - both in Boston
| | - Eva D Patalas
- From the Departments of Medicine (C.A.S., G.A.A.), Radiology (S.K.), Surgery (P.T.M.), and Pathology (E.D.P.), Massachusetts General Hospital, and the Departments of Medicine (C.A.S., G.A.A.), Radiology (S.K.), Surgery (P.T.M.), and Pathology (E.D.P.), Harvard Medical School - both in Boston
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Abstract
INTRODUCTION Although cardiac arrest during airline flights is relatively uncommon, the unusual setting, limited resources, and the variability of the skills in medical volunteers present unique challenges. Survival in patients who suffer a witnessed arrest with a shockable rhythm who are treated promptly has improved since the advent of widely available automated external defibrillators (AEDs). In general, the chances of survival from an out-of-hospital cardiac arrest (OHCA) are greater when ventricular fibrillation (VF) is seen as the initial rhythm or if there is return of spontaneous circulation (ROSC). Not all in-flight cardiac arrests are witnessed because cabin crew or fellow passengers might simply assume that the victim is sleeping. Based upon a review of the literature on resuscitation after OHCA, we recommend that automatic external defibrillators be carried on all commercial airline flights, regardless of duration. Patients presenting with shockable rhythm (e.g., VF, unstable ventricular tachycardia) have the best prognosis for survival and usually require diversion of the aircraft for advanced cardiac life support (ACLS). Because diversion may require interruption of cardiopulmonary resuscitation (CPR) and may impact flight safety, the volunteer rescuer, cabin crew, flight crew, and medical consultation services should discuss the possible outcome and operational considerations before recommending a diversion for a patient with a nonshockable rhythm. The recommendations in this article were developed by members of the Air Transport Medicine and Aerospace Human Performance Committees and approved by the Council of the Aerospace Medical Association.Ruskin KJ, Ricaurte EM, Alves PM. Medical guidelines for airline travel: management of in-flight cardiac arrest. Aerosp Med Hum Perform. 2018; 89(8):754-759.
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Lai PF, Wu PA. [Using an Information System to Optimize the ACLS Process at the Emergency Department]. Hu Li Za Zhi 2018; 65:24-29. [PMID: 30066320 DOI: 10.6224/jn.201808_65(4).05] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The best first-aid treatment for cardiac arrest patients is advanced cardiac life support (ACLS) in terms both of saving lives and of reducing the incidence of sequelae. The American Heart Association (AHA) published updated ACLS guidelines for care in 2015. These updated guidelines emphasized the importance of teamwork in resuscitation, noting that, in addition to standard procedures, team members should be familiar with their distinct roles and should cooperate together during emergent situations. Implementing ACLS is not easy due to stress and unfamiliarity with the process and thus often achieves less-than-optimal results in practice. However, ACLS is a standard approach that uses the same procedures to address different cardiac arrest situations. Therefore, we wanted to use an information system to assist the medical team to fully implement the ACLS process. The information system helps the medical team perform resuscitation actions more intensively and precisely while avoiding problems and mistakes due to forgetfulness / unfamiliarity, facilitating an optimal resuscitation effort. Concurrently, electronic medical and nursing records are completed automatically, avoiding the need for medical staff to compile these records afterwards. This information system helps save time and effort and improves precision. Furthermore, data analysis is more convenient, which facilitates the effective management and supervision of resuscitation quality. The information system performs timing, prompting, and guidance in accordance with the ACLS process and records the procedures that will used in emergency treatment (i.e., chest compression frequency, establishment of intravenous route, placement of endotracheal tubes, electric shock, drug type, dose) with a simple click of a mouse. Finally, the associated medical record is completed and logged as soon as the automatically generated file is uploaded. All hospital staffs may use this information system to assist in the implementation of advanced CPR. The system improves the quality of the first aid measures applied in life support, reduces the burden on clinics and medical staff, and streamlines the preparation and submission of medical records.
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Affiliation(s)
- Pei-Fang Lai
- PhD, MD, Director, Department of Emergency Medicine, Hualien Tzu Chi Hospital, Taiwan, ROC.
| | - Ping-An Wu
- MD, Vice Superintendent and Director, Department of Imaging Medicine, Hualien Tzu Chi Hospital, Taiwan, ROC
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Viejo-Moreno R, García-Fuentes C, Chacón-Alves S, Terceros-Almanza LJ, Montejo-González JC, Chico-Fernández M. [Emergency treatment for traumatic cardiac arrest: prognostic factors and hospital outcome]. Emergencias 2018; 29:87-92. [PMID: 28825249] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To identify prehospital and on-arrival factors associated with hospital outcome in patients with traumatic cardiac arrest (TCA) discharged with recovered spontaneous circulation from the emergency department. MATERIAL AND METHODS Multipurpose prospective cohort study of patients with TCA who recovered after treatment at a tertiary care hospital emergency department between 2003 and 2016. We gathered data on epidemiologic variables, type and cause of injuries, and prehospital and hospital emergency care. The outcome was overall hospital mortality. RESULTS A total of 130 TCA cases were included; 123 patients (94.6%) had received blunt trauma injuries and 65 (50%) had been in traffic accidents. The mean (SD) age was 39 (16) years, and 96 (73.8%) were male. Fifty patients (65%) were in asystole and 42 (32.3%) had pulseless electrical activity. Sixteen (12.3%) survived to be discharged; 13 of the survivors (81.3%) had recovered neurological activity. Factors that were independently associated with hospital mortality were asystole on arrival of first responders (odds ratio [OR], 25; 95% CI, 2.5-247; P=.006), nonreactive pupils on arrival at the hospital (OR, 13; 95% CI, 2.0-79; P=.006), and an Injury Severity Score over 25 (OR, 13; 95% CI, 1.8-94; P=.011). CONCLUSION Twelve percent of patients in this cohort survived to discharge after TCA and 8 out of 10 of the surviving patients recovered neurologically. Asystole at start of prehospital care, nonreactive pupils on hospital arrival, and a severity score over 25 may indicate poor prognosis after TCA.
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Affiliation(s)
- Rubén Viejo-Moreno
- Unidad de Cuidados Intensivos de Trauma y Emergencias (UCITE), Servicio de Medicina Intensiva, Hospital 12 de Octubre, Madrid, España
| | - Carlos García-Fuentes
- Unidad de Cuidados Intensivos de Trauma y Emergencias (UCITE), Servicio de Medicina Intensiva, Hospital 12 de Octubre, Madrid, España
| | - Silvia Chacón-Alves
- Unidad de Cuidados Intensivos de Trauma y Emergencias (UCITE), Servicio de Medicina Intensiva, Hospital 12 de Octubre, Madrid, España
| | - Luis J Terceros-Almanza
- Unidad de Cuidados Intensivos de Trauma y Emergencias (UCITE), Servicio de Medicina Intensiva, Hospital 12 de Octubre, Madrid, España
| | - Juan Carlos Montejo-González
- Unidad de Cuidados Intensivos de Trauma y Emergencias (UCITE), Servicio de Medicina Intensiva, Hospital 12 de Octubre, Madrid, España
| | - Mario Chico-Fernández
- Unidad de Cuidados Intensivos de Trauma y Emergencias (UCITE), Servicio de Medicina Intensiva, Hospital 12 de Octubre, Madrid, España
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Dieckmann P, Birkvad Rasmussen M, Issenberg SB, Søreide E, Østergaard D, Ringsted C. Long-term experiences of being a simulation-educator: A multinational interview study. Med Teach 2018; 40:713-720. [PMID: 29793384 DOI: 10.1080/0142159x.2018.1471204] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The long-term reactions, experiences and reflections of simulation educators have not been explored. In a semistructured, exploratory interview study, the experiences of simulation educators in either Advanced Life Support (ALS) or Crisis Resource Management (CRM) courses in Denmark, Norway and the USA were analyzed. Three overarching themes were identified: (1) general reflections on simulation-based teaching, (2) transfer of knowledge and skills from the simulation setting to clinical settings and (3) more overarching transformations in simulation educators, simulation participants, and the healthcare system. Where ALS was deemed as high on the efficiency dimension of learning, CRM courses were described as high on the innovation dimension. General reflections, transfer and transformations described were related to differences in course principles. The results are relevant for career planning, faculty development and understanding simulation as social practice.
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Affiliation(s)
- P Dieckmann
- a Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources, Capital Region of Denmark , Copenhagen , Denmark
- b Department of Clinical Medicine , University of Copenhagen , Copenhagen , Denmark
| | - M Birkvad Rasmussen
- a Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources, Capital Region of Denmark , Copenhagen , Denmark
| | - S B Issenberg
- c University of Miami Gordon Center for Simulation and Innovation in Medical Education , Miami , USA
| | - E Søreide
- d Stavanger University Hospital, Critical Care and Anesthesiology Research Group , Stavanger , Norway
- e Department of Clinical Medicine , University of Bergen , Bergen , Norway
| | - D Østergaard
- a Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources, Capital Region of Denmark , Copenhagen , Denmark
- b Department of Clinical Medicine , University of Copenhagen , Copenhagen , Denmark
| | - C Ringsted
- f Center for Health Science Education , University of Aarhus , Aarhus , Denmark
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Liu JZ, Ye S, Cheng YW, Yao P, Hao D, Cao Y. Why might ALS have negative effects on patients with out-of-hospital cardiac arrest? Am J Emerg Med 2018; 36:2322-2323. [PMID: 29884590 DOI: 10.1016/j.ajem.2018.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 04/12/2018] [Accepted: 04/12/2018] [Indexed: 02/05/2023] Open
Affiliation(s)
- Jun-Zhao Liu
- Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Sheng Ye
- Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan-Wei Cheng
- Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Peng Yao
- Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Di Hao
- Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu Cao
- Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Tsuchida RE, Meurer WJ. More questions than answers - ALS interventions for out of hospital cardiac arrest. Am J Emerg Med 2017; 36:498-500. [PMID: 29217179 DOI: 10.1016/j.ajem.2017.11.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/27/2017] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ryan E Tsuchida
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States.
| | - William J Meurer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; Department of Neurology, University of Michigan, Ann Arbor, MI, United States; Stroke Program, University of Michigan, Ann Arbor, MI, United States; Michigan Center for Integrative Research on Critical Care, University of Michigan, Ann Arbor, MI, United States; Frankel Cardiovascular Center, University of Michigan, United States.
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Centofanti P, Attisani M, La Torre M, Ricci D, Boffini M, Baronetto A, Simonato E, Clerici A, Rinaldi M. Left Ventricular Unloading during Peripheral Extracorporeal Membrane Oxygenator Support: A Bridge To Life In Profound Cardiogenic Shock. J Extra Corpor Technol 2017; 49:201-205. [PMID: 28979045 PMCID: PMC5621585] [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] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 03/22/2017] [Indexed: 06/07/2023]
Abstract
A limit of peripheral veno-arterial Extracorporeal Membrane Oxigenator (VA-ECMO) is the inadequate unloading of the left ventricle. The increase of end-diastolic pressure reduces the possibility of a recovery and may cause severe pulmonary edema. In this study, we evaluate our results after implantation of VA-ECMO and Transapical Left Ventricular Vent (TLVV) as a bridge to recovery, heart transplantation or long-term left ventricular assit devices (LVAD). From 2011 to 2014, 24 consecutive patients with profound cardiogenic shock were supported by peripheral VA-ECMO as bridge to decision. In all cases, TLVV was implanted after a mean period of 12.2 ± 3.4 hours through a left mini-thoracotomy and connected to the venous inflow line of the VA-ECMO. Thirty-day mortality was 37.5% (9/24). In all patients, hemodynamics improved after TLVV implantation with an increased cardiac output, mixed venous saturation and a significant reduced heart filling pressures (p < .05). Recovery of the cardiac function was observed in 11 patients (11/24; 45.8%). Three patients were transplanted (3/24; 12.5%) and three patients (3/24; 12.5%) underwent LVAD implantation as destination therapy, all these patients were discharged from the hospital in good clinical conditions. In these critical patients, systematic TLVV improved hemodynamic seemed to provide better in hospital survival and chance of recovery, compared to VA-ECMO results in the treatment of cardiogenic shock reported in the literature . TLVV is a viable alternative to standard VA-ECMO to identify the appropriate long-term strategy (heart transplantation or long-term VAD) reducing the risk of treatment failure. A larger and multicenter experience is mandatory to validate these hypothesis.
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Affiliation(s)
| | - Matteo Attisani
- Division of Cardiac Surgery, University of Turin, Turin, Italy
| | | | - Davide Ricci
- Division of Cardiac Surgery, University of Turin, Turin, Italy
| | - Massimo Boffini
- Division of Cardiac Surgery, University of Turin, Turin, Italy
| | | | - Erika Simonato
- Division of Cardiac Surgery, University of Turin, Turin, Italy
| | - Alberto Clerici
- Division of Cardiac Surgery, University of Turin, Turin, Italy
| | - Mauro Rinaldi
- Division of Cardiac Surgery, University of Turin, Turin, Italy
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Anselmi A, Flécher E. Extracorporeal cardiopulmonary resuscitation for out-of-hospital refractory cardiac arrest: A word of caution. J Thorac Cardiovasc Surg 2016; 151:1217-8. [PMID: 26995628 DOI: 10.1016/j.jtcvs.2015.11.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 11/19/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Erwan Flécher
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
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Wesley K, Wesley K. ALS VS. BLS. JEMS 2016; 41:28. [PMID: 26901958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Abstract
Although perimortem delivery has been recorded in the medical literature for millennia, the procedural intent has evolved to the current fetocentric approach, predicating timing of delivery following maternal cardiopulmonary arrest to optimize neonatal outcome. We suggest a call to action to reinforce the concept that if the uterus is palpable at or above the umbilicus, preparations for delivery should be made simultaneous with initiation of maternal resuscitative efforts; if maternal condition is not rapidly reversible, hysterotomy with delivery should be performed regardless of fetal viability or elapsed time since arrest. Cognizant of the difficulty in determining precise timing of arrest in clinical practice, if fetal status is already compromised further delay while attempting to assess fetal heart rate, locating optimal surgical equipment, or transporting to an operating room will result in unnecessary worsening of both maternal and fetal condition. Even if intrauterine demise has already occurred, maternal resuscitative efforts will typically be markedly improved following delivery with uterine decompression. Consequently we suggest that perimortem cesarean delivery be renamed "resuscitative hysterotomy" to reflect the mutual optimization of resuscitation efforts that would potentially provide earlier and more substantial benefit to both mother and baby.
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Affiliation(s)
- Carl H Rose
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN.
| | - Arij Faksh
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Kyle D Traynor
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Daniel Cabrera
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN
| | | | - Brian C Brost
- Department of Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston-Salem, NC
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Murphy NJ, Quinlan JD. Trauma in pregnancy: assessment, management, and prevention. Am Fam Physician 2014; 90:717-722. [PMID: 25403036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Trauma complicates one in 12 pregnancies, and is the leading nonobstetric cause of death among pregnant women. The most common traumatic injuries are motor vehicle crashes, assaults, falls, and intimate partner violence. Nine out of 10 traumatic injuries during pregnancy are classified as minor, yet 60% to 70% of fetal losses after trauma are a result of minor injuries. In minor trauma, four to 24 hours of tocodynamometric monitoring is recommended. Ultrasonography has low sensitivity, but high specificity, for placental abruption. The Kleihauer-Betke test should be performed after major trauma to determine the degree of fetomaternal hemorrhage, regardless of Rh status. To improve the effectiveness of cardiopulmonary resuscitation, clinicians should perform left lateral uterine displacement by tilting the whole maternal body 25 to 30 degrees. Unique aspects of advanced cardiac life support include early intubation, removal of all uterine and fetal monitors, and performance of perimortem cesarean delivery. Proper seat belt use reduces the risk of maternal and fetal injuries in motor vehicle crashes. The lap belt should be placed as low as possible under the protuberant portion of the abdomen and the shoulder belt positioned off to the side of the uterus, between the breasts and over the midportion of the clavicle. All women of childbearing age should be routinely screened for intimate partner violence.
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Affiliation(s)
| | - Jeffrey D Quinlan
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Abstract
This article discusses the general methods used to assess patients before, during, and after operative procedures, sedation, or general anesthesia by the oral and maxillofacial surgery team. The details about specific disease processes will be discussed in other articles. These methods and modalities are not standards, but are commonly used in offices and clinics in the United States where sedation and anesthesia are provided.
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De Landtsheer Q, Labriola L, Houssiau F, Jacquet LM, Hantson P. Acute heart failure after thrombotic thrombocytopenic purpura successfully treated by ECLS. Transfus Med 2013; 23:199-201. [PMID: 23387941 DOI: 10.1111/tme.12012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 06/04/2012] [Accepted: 01/12/2013] [Indexed: 12/13/2022]
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Nitzschke R, Schmidt GN. Electroencephalography during out-of-hospital cardiopulmonary resuscitation. J Emerg Med 2012; 43:659-662. [PMID: 20828974 DOI: 10.1016/j.jemermed.2010.05.098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Revised: 04/14/2010] [Accepted: 05/30/2010] [Indexed: 05/29/2023]
Abstract
BACKGROUND At the present time there is no parameter that can estimate the quality of cerebral perfusion and possible success of cerebral resuscitation during advanced cardiac life support (ACLS) efforts. In recent years, various attempts have been made to use electroencephalography (EEG)-based cerebral neuromonitoring to assess the effectiveness of cardiopulmonary resuscitation (CPR). OBJECTIVES The Cerebral State Monitor M3 (Danmeter A/S, Odense, Denmark) is a portable, single-channel EEG monitor that provides the user with different EEG-based parameters and the raw waveform EEG to measure cerebral activity. CASE REPORT We report two cases of out-of-hospital CPR with single-channel EEG monitoring conducted parallel to ACLS with external chest compressions. We demonstrate an artifact in waveform EEG recordings that is caused by the external chest compressions, and that leads to a miscalculation of the Burst Suppression Ratio and Cerebral State Index. CONCLUSION These cases suggest that digitally processed EEG-monitoring is not a useful tool during CPR.
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Affiliation(s)
- Rainer Nitzschke
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Lavinio A, Scudellari A, Gupta AK. Hemorrhagic shock resulting in cardiac arrest: is therapeutic hypothermia contraindicated? Minerva Anestesiol 2012; 78:969-970. [PMID: 22415438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Abstract
AbstractIntroduction:Emergency medical services have invested substantial resources to establish advanced life support (ALS) programs. However, it is unclear whether ALS care provides better outcomes to patients compared to basic life support (BLS) care.Objective:To evaluate the current evidence regarding the benefits of ALS.Methods:Electronic medical databases were searched to identify articles that directly compared ALS versus BLS care. A total of 455 articles were found. Articles were excluded for the following reasons: (1) the article was not written in English; (2) BLS response was not compared to an ALS response; (3) a physician or nurse was included as part of the ALS response; (4) it was an aeromedical response; or (5) defibrillation was included in the ALS, but not the BLS, scope of care. Twenty-one articles met the inclusion criteria for this literature review.Results:Results were divided into four categories: (1) trauma; (2) cardiac arrest; (3) myocardial infarction; and (4) altered mental status.Trauma:The majority of articles showed that ALS provided no benefits over BLS in urban trauma patients. In fact, most studies showed higher mortality rates for trauma patients receiving ALS care. Further research is needed to evaluate the benefits of ALS for rural trauma patients, and whether ALS care improves outcomes in subgroups of urban trauma patients.Cardiac Arrest:Cardiac arrest studies show that early CPR plus early defibrillation provide the greatest improvement in survival. However, most cardiac arrest research includes defibrillation as an ALS skill which has now moved into the BLS scope of care. The 2004 multi-center OPALS study provided good evidence that ALS does not improve cardiac arrest survival over early defibrillation. Further research is needed to address whether any ALS interventions improve cardiac arrest outcome.Myocardial Infarction:Only one study directly compared the outcome of BLS and ALS care on myocardial infarction. The study found no difference in outcomes between BLS and ALS care in an urban setting.Advanced Life Support:Only one study directly compared the outcome of BLS and ALS care on patients with altered mental status. The study found that the same number of patients had improved to “alert” on arrival at the emergency department, but there was a decreased length of emergency department stay for patients treated by ALS for hypoglycemia.Limitations:This review article does not take into account the benefits of ALS interventions, such as thrombolytics, dextrose, or nitroglycerin, since no studies directly compared these interventions to BLS care. Furthermore, only one study in this literature review was a large, multi-center trial.Conclusions:ALS shows little, if any, benefits for urban trauma patients. Cardiac arrest studies show that ALS does not provide additional benefits over BLS-defibrillation care, but more research is needed in this area. In two small studies, ALS care did not provide benefits over BLS care for patients with myocardial infarctions or altered mental status. Larger-scale studies are needed to evaluate which specific ALS interventions improve patient outcomes.
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Affiliation(s)
- Derek L Isenberg
- Tulane School of Medicine, 1430 Tulane Ave., Box F19, New Orleans, LA 70112, USA.
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Shin TG, Jo IJ, Song HG, Sim MS, Song KJ. Improving survival rate of patients with in-hospital cardiac arrest: five years of experience in a single center in Korea. J Korean Med Sci 2012; 27:146-52. [PMID: 22323861 PMCID: PMC3271287 DOI: 10.3346/jkms.2012.27.2.146] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 11/15/2011] [Indexed: 01/31/2023] Open
Abstract
The aim of this study was to describe the cause of the recent improvement in the outcomes of patients who experienced in-hospital cardiac arrest. We retrospectively analyzed the in-hospital arrest registry of a tertiary care university hospital in Korea between 2005 and 2009. Major changes to the in-hospital resuscitation policies occurred during the study period, which included the requirement of extensive education of basic life support and advanced cardiac life support, the reformation of cardiopulmonary resuscitation (CPR) team with trained physicians, and the activation of a medical emergency team. A total of 958 patients with in-hospital cardiac arrest were enrolled. A significant annual trend in in-hospital survival improvement (odds ratio = 0.77, 95% confidence interval 0.65-0.90) was observed in a multivariate model. The adjusted trend analysis of the return of spontaneous circulation, six-month survival, and survival with minimal neurologic impairment upon discharge and six-months afterward revealed similar results to the original analysis. These trends in outcome improvement throughout the study were apparent in non-ICU (Intensive Care Unit) areas. We report that the in-hospital survival of cardiac arrest patients gradually improved. Multidisciplinary hospital-based efforts that reinforce the Chain of Survival concept may have contributed to this improvement.
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Affiliation(s)
- Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyoung Gon Song
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Seob Sim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keun Jeong Song
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lysenko KI, Dezhurnĭ LI, Neudakhin GV. [Scientific approach to establishing system of providing first aid care in the Russian Federation]. Vestn Ross Akad Med Nauk 2012:10-14. [PMID: 22712269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The article is devoted to evaluation of situation with providing first aid in the Russian Federation. It discusses the necessity to establish first aid system in the Russian Federation and formulates it's principles. The need in establishing such system is caused by necessity to draw a wide range of persons, including those who are not medically educated, to provide first aid service to patients. Also substantiated the need of development and adoption of the legislation that adjusts different aspects of first aid, as well as alteration in a current legislation. Proved the necessity of establishment and functioning of the intersectional coordination council. Consideration is given to principles of functioning of the training system for first aid providers. Principles, which will help to provide them with first aid tools, are substantiated.
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Lehot JJ, Long-Him-Nam N, Bastien O. [Extracorporeal life support for treating cardiac arrest]. Bull Acad Natl Med 2011; 195:2025-2036. [PMID: 22930866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Percutaneous extracorporeal life support (ECLS) is now widespread for treating acute cardiac failure. ECLS has been used for treating in-hospital and out of hospital cardiac arrests. A systematic review of literature was performed in order to assess the results. Nine studies of in-hospital cardiac arrests were published between 2003 and January 31, 2011. They included 724 patients, 208 of which survived without significant neurological sequelae (28.7 %). In the other patients, the initial disease and the consequences of low flow brought multiorgan failure, or ECLS resulted in haemorrhage and ischaemia. Low flow lasted between 42 and 105 min (mean 54min). ECLS was used after out of hospital cardiac arrests in 3 studies published between 2008 and January 31, 2011. They included 110 patients of which only 6 survived (4.4 %) despite strict inclusion criteria. Low flow lasted between 60 and 120 min (mean 98 min.) According to these results the use of ECLS should be encouraged after in-hospital cardiac arrest and training in cardiorespiratory resuscitation should be improved in global population and health professionals.
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Affiliation(s)
- Jean-Jacques Lehot
- Anesthésie Réanimation, Hospices civil, de Lyon, Groupement Hospitalier Est - 69677 Bron cedex.
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41
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Zider B. Are pigs the right model for lipid resuscitation? AANA J 2011; 79:453-454. [PMID: 22400409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Smith BD. Bringing ALS to the mountain. A joint effort leads to a higher level of care at a Nevada ski resort. EMS World 2011; 40:32-34. [PMID: 22171465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Barry D Smith
- Regional Emergency Medical Services Authority (REMSA), Reno, NV, USA.
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Ko PY, Scott JM, Mihai A, Grant WD. Comparison of a modified longitudinal simulation-based advanced cardiovascular life support to a traditional advanced cardiovascular life support curriculum in third-year medical students. Teach Learn Med 2011; 23:324-30. [PMID: 22004316 DOI: 10.1080/10401334.2011.611763] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND Simulation is an effective tool for teaching medical students in cardiac arrest management. PURPOSE The purpose of this article is to compare the efficacy of a traditional Advanced Cardiovascular Life Support (ACLS) course versus a modified longitudinal ACLS course using high-fidelity simulation in medical students. METHODS One group enrolled in a 2-day traditional ACLS course while another group participated in independent learning over 2 weeks and 2 simulation sessions using Laerdal Sim-Man. The modified curriculum also included environmental fidelity with simulation, access to materials electronically, smaller class sizes, and integration of real experiences in the Emergency Department into their learning. Student performance was measured with a scripted, videotaped mega code, followed by a survey. RESULTS We enrolled 21 students in a traditional ACLS program and 29 students in the simulation-based program (15 and 26 videos available for analysis). There was no difference in Time to Initiate CPR or Time to Shock between the groups, but the modified curriculum group demonstrated higher performance scores. They also felt better prepared to run the code during a simulation and in a hospital setting compared to students in the traditional ACLS curriculum. CONCLUSIONS Students in a modified longitudinal simulation-based ACLS curriculum demonstrated better proficiency in learning ACLS compared to a traditional curriculum.
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Affiliation(s)
- Paul Y Ko
- Department of Emergency Medicine, Upstate Medical University, Syracuse, New York, USA.
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Hutton D. Cardiac arrest and the 2010 advanced cardiac life support guidelines--part IV. Plast Surg Nurs 2011; 31:169-173. [PMID: 22157608 DOI: 10.1097/psn.0b013e31823c38c3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The chance of a successful outcome with any cardiac arrest is prompt initiation of hands-only compression at a rate of at least 100 per min, to a depth of 2 in.,with full chest recoil, and no more than a 10-s interruption of compressions. The priority, regardless of being in a private clinic or in a facility using a team approach,is to start compressions and maintain effective compressions with minimal interruptions. Most cardiac arrests are related to ventricular fibrillation and the chance of successfully defibrillating this rhythm is highest at the beginning of the arrest. For every minute a patient is in ventricular fibrillation, his or her chance of survival greatly decreases (Traverset al., 2010). This is why it is extremely important to defibrillate immediately. Once a patient has return of spontaneous circulation,postresuscitation care needs to be implemented. The biggest reason for a patient to develop ventricular fibrillation is an acute coronary syndrome, and this is why the new guidelines have outlined transferring a post arrest patient to a cardiac catheterization laboratory to perform an emergency angiogram and angioplasty. Part of this post arrest management also includes therapeutic hypothermia in those patients who remain comatose after return of spontaneous circulation. This article has reviewed a case study of a postoperative patient who developed ventricular fibrillation and the priorities of care according to the 2010 ACLS guidelines. Watch for more ACLS-based case studies in upcoming articles.
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Nehus E, Goebel J, Mitsnefes M, Lorts A, Laskin B. Intensive hemodialysis for cardiomyopathy associated with end-stage renal disease. Pediatr Nephrol 2011; 26:1909-12. [PMID: 21626221 DOI: 10.1007/s00467-011-1921-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 05/05/2011] [Accepted: 05/06/2011] [Indexed: 11/26/2022]
Abstract
Heart and kidney dysfunction often coexist, and increasing evidence supports the interaction of these two organs, as demonstrated by the clinical condition known as cardiorenal syndrome (CRS). We report a pediatric patient with end-stage renal disease (ESRD) who developed a dilated cardiomyopathy and decompensated heart failure after undergoing unilateral nephrectomy and while on maintenance peritoneal dialysis. He showed marked improvement in his cardiac function with the addition of intensive hemodialysis. We discuss the pathophysiology of cardiorenal syndrome in patients with ESRD and suggest that intensive dialysis may be an effective therapy for this condition.
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Affiliation(s)
- Edward Nehus
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 7022, Cincinnati, OH 45229, USA.
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Ko PCI, Cheng MT, Huang EPC, Chiang WC, Ma MHM. Basic life support equipped with automated external defibrillator may not be categorized the same as traditional basic life support in meta-analysis. Resuscitation 2011; 82:e7; author reply e9-10. [PMID: 21946055 DOI: 10.1016/j.resuscitation.2011.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 06/24/2011] [Indexed: 11/18/2022]
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Yuan YJ, Xue FS, Wang Q, Liu JH, Xiong J, Liao X. Comparison of the tracheal intubation using Macintosh laryngoscope and GlideScope® videolaryngoscope by advanced cardiac life support providers in a manikin study. Minerva Anestesiol 2011; 77:558-561. [PMID: 21540813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Bushey BA, Auld VH, Volk JE, Vacchiano CA. Combined lipid emulsion and ACLS resuscitation following bupivacaine- and hypoxia-induced cardiovascular collapse in unanesthetized swine. AANA J 2011; 79:129-138. [PMID: 21560976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This study examined whether combining lipid emulsion and advanced cardiac life support (ACLS) improves survival in an unanesthetized swine model of bupivacaine- and hypoxia-induced cardiovascular collapse. Arterial and venous catheters and a tracheostomy were surgically placed in 26 swine receiving inhalation anesthesia. After a 1-hour recovery period, bupivacaine (5 mg/kg) was administered intravenously over 15 seconds. Following 1 minute of observation and 3 minutes of mechanical airway obstruction, during which all animals exhibited complete cardiovascular collapse, ACLS was initiated. Animals were randomized to receive either intravenous saline or 20% lipid emulsion commencing with the initiation ofACLS. Survival was defined as a return of spontaneous circulation (ROSC) with unsupported blood pressure greater than 60 mm Hg for 10 minutes after 25 minutes of resuscitation effort. Data collection included electrocardiogram, arterial blood pressure, and arterial and mixed venous oxygen saturations. There was no significant difference in survival between the saline group (4/12, 33%) and lipid emulsion group (6/12, 50%; P > .05). Additionally, there was no significant difference between groups of surviving animals in the time to ROSC (P > .05). The combination of lipid emulsion and ACLS did not improve survival from bupivacaine- and hypoxia-induced cardiovascular collapse in unanesthetized swine.
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Fleming S, Thompson M, Stevens R, Heneghan C, Plüddemann A, Maconochie I, Tarassenko L, Mant D. Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies. Lancet 2011; 377:1011-8. [PMID: 21411136 PMCID: PMC3789232 DOI: 10.1016/s0140-6736(10)62226-x] [Citation(s) in RCA: 742] [Impact Index Per Article: 57.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although heart rate and respiratory rate in children are measured routinely in acute settings, current reference ranges are not based on evidence. We aimed to derive new centile charts for these vital signs and to compare these centiles with existing international ranges. METHODS We searched Medline, Embase, CINAHL, and reference lists for studies that reported heart rate or respiratory rate of healthy children between birth and 18 years of age. We used non-parametric kernel regression to create centile charts for heart rate and respiratory rate in relation to age. We compared existing reference ranges with those derived from our centile charts. FINDINGS We identified 69 studies with heart rate data for 143,346 children and respiratory rate data for 3881 children. Our centile charts show decline in respiratory rate from birth to early adolescence, with the steepest fall apparent in infants under 2 years of age; decreasing from a median of 44 breaths per min at birth to 26 breaths per min at 2 years. Heart rate shows a small peak at age 1 month. Median heart rate increases from 127 beats per min at birth to a maximum of 145 beats per min at about 1 month, before decreasing to 113 beats per min by 2 years of age. Comparison of our centile charts with existing published reference ranges for heart rate and respiratory rate show striking disagreement, with limits from published ranges frequently exceeding the 99th and 1st centiles, or crossing the median. INTERPRETATION Our evidence-based centile charts for children from birth to 18 years should help clinicians to update clinical and resuscitation guidelines. FUNDING National Institute for Health Research, Engineering and Physical Sciences Research Council.
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Affiliation(s)
- Susannah Fleming
- Oxford University, Department of Primary Health Care, Rosemary Rue Building, Old Road Campus, Headington, Oxford, UK
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Di Pisa M, Chiaramonte G, Arcadipane A, Burgio G, Traina M. Air embolism during endoscopic retrograde cholangiopancreatography in a pediatric patient. Minerva Anestesiol 2011; 77:90-92. [PMID: 21150852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This is a case of a venous air embolism in a pediatric patient with splenomesenteric portal shunt for portal cavernoma, who underwent endoscopic retrograde cholangiopancreatography under inhalator general anesthesia, without using N2O. There is ample data in the literature about the occurrence of venous air embolism during an endoscopic procedure. We believe it is important to call attention to this rare, but possible, and sometimes fatal, complication.
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Affiliation(s)
- M Di Pisa
- Department of Gastroenterology, IsMeTT, UPMC, Palermo, Italy.
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