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Ali S, Moors X, van Schuppen H, Mommers L, Weelink E, Meuwese CL, Kant M, van den Brule J, Kraemer CE, Vlaar APJ, Akin S, Lansink-Hartgring AO, Scholten E, Otterspoor L, de Metz J, Delnoij T, van Lieshout EMM, Houmes RJ, Hartog DD, Gommers D, Dos Reis Miranda D. A national multi centre pre-hospital ECPR stepped wedge study; design and rationale of the ON-SCENE study. Scand J Trauma Resusc Emerg Med 2024; 32:31. [PMID: 38632661 PMCID: PMC11022459 DOI: 10.1186/s13049-024-01198-x] [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: 01/22/2024] [Accepted: 03/16/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The likelihood of return of spontaneous circulation with conventional advanced life support is known to have an exponential decline and therefore neurological outcome after 20 min in patients with a cardiac arrest is poor. Initiation of venoarterial ExtraCorporeal Membrane Oxygenation (ECMO) during resuscitation might improve outcomes if used in time and in a selected patient category. However, previous studies have failed to significantly reduce the time from cardiac arrest to ECMO flow to less than 60 min. We hypothesize that the initiation of Extracorporeal Cardiopulmonary Resuscitation (ECPR) by a Helicopter Emergency Medical Services System (HEMS) will reduce the low flow time and improve outcomes in refractory Out of Hospital Cardiac Arrest (OHCA) patients. METHODS The ON-SCENE study will use a non-randomised stepped wedge design to implement ECPR in patients with witnessed OHCA between the ages of 18-50 years old, with an initial presentation of shockable rhythm or pulseless electrical activity with a high suspicion of pulmonary embolism, lasting more than 20, but less than 45 min. Patients will be treated by the ambulance crew and HEMS with prehospital ECPR capabilities and will be compared with treatment by ambulance crew and HEMS without prehospital ECPR capabilities. The primary outcome measure will be survival at hospital discharge. The secondary outcome measure will be good neurological outcome defined as a cerebral performance categories scale score of 1 or 2 at 6 and 12 months. DISCUSSION The ON-SCENE study focuses on initiating ECPR at the scene of OHCA using HEMS. The current in-hospital ECPR for OHCA obstacles encompassing low survival rates in refractory arrests, extended low-flow durations during transportation, and the critical time sensitivity of initiating ECPR, which could potentially be addressed through the implementation of the HEMS system. When successful, implementing on-scene ECPR could significantly enhance survival rates and minimize neurological impairment. TRIAL REGISTRATION Clinicaltyrials.gov under NCT04620070, registration date 3 November 2020.
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Affiliation(s)
- Samir Ali
- Department of Intensive Care, Erasmus University Medical Centre, Dr. Molewaterplein 40, Rotterdam, 3015 GD, the Netherlands.
- Department of Anaesthesiology, Erasmus Medical Centre, Rotterdam, 3015 GD, the Netherlands.
- Ministry of Defence, Royal Netherlands Air Force, Breda, 4820 ZB, the Netherlands.
| | - Xavier Moors
- Department of Anaesthesiology, Erasmus Medical Centre, Rotterdam, 3015 GD, the Netherlands
- Helicopter Emergency Medical Services, Trauma Centre Zuid-West Nederland, Erasmus University Medical Centre, Rotterdam, 3045 AS, the Netherlands
| | - Hans van Schuppen
- Helicopter Emergency Medical Services, Netwerk Acute Zorg Noordwest, Amsterdam University Medical Centre, Amsterdam, 1081 HV, the Netherlands
| | - Lars Mommers
- Helicopter Emergency Medical Service, Radboud University Medical Centre, Nijmegen, 6525 GA, the Netherlands
- Department of Anaesthesiology, Maastricht University Medical Centre, Maastricht, 6229 HX, the Netherlands
| | - Ellen Weelink
- Helicopter Emergency Medical Service, University Medical Centre Groningen, Groningen, 9713 GZ, the Netherlands
| | - Christiaan L Meuwese
- Department of Intensive Care, Erasmus University Medical Centre, Dr. Molewaterplein 40, Rotterdam, 3015 GD, the Netherlands
| | - Merijn Kant
- Department of Intensive Care, Amphia Hospital, Breda, 4818 CK, the Netherlands
| | - Judith van den Brule
- Department of Intensive Care Medicine, Radboud University Medical Centre, Nijmegen, 6525 GA, the Netherlands
| | - Carlos Elzo Kraemer
- Department of Intensive Care Medicine, Leiden University Medical Centre, Leiden, 2333 ZA, the Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care Medicine, Amsterdam University Medical Centre, Amsterdam, 1105 AZ, the Netherlands
| | - Sakir Akin
- Department of Intensive Care, Haga Teaching Hospital, the Hague, 2545 AA, the Netherlands
| | | | - Erik Scholten
- Department of Intensive Care, St. Antonius Hospital, Nieuwegein, 3435 CM, the Netherlands
| | - Luuk Otterspoor
- Department of Intensive Care, Catharina Hospital, Eindhoven, 5623 EJ, the Netherlands
| | - Jesse de Metz
- Department of Intensive Care, OLVG, 1091 AC, Amsterdam, the Netherlands
| | - Thijs Delnoij
- Department of Intensive Care, Maastricht University Medical Centre, Maastricht, 6229 HX, the Netherlands
| | - Esther M M van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, 3015 GD, the Netherlands
| | - Robert-Jan Houmes
- Helicopter Emergency Medical Services, Trauma Centre Zuid-West Nederland, Erasmus University Medical Centre, Rotterdam, 3045 AS, the Netherlands
| | - Dennis den Hartog
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, 3015 GD, the Netherlands
| | - Diederik Gommers
- Department of Intensive Care, Erasmus University Medical Centre, Dr. Molewaterplein 40, Rotterdam, 3015 GD, the Netherlands
| | - Dinis Dos Reis Miranda
- Department of Intensive Care, Erasmus University Medical Centre, Dr. Molewaterplein 40, Rotterdam, 3015 GD, the Netherlands
- Helicopter Emergency Medical Services, Trauma Centre Zuid-West Nederland, Erasmus University Medical Centre, Rotterdam, 3045 AS, the Netherlands
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da Rosa Decker SR, Marzzani LE, de Ferreira PR, Rosa PRM, Brauner JS, Rosa RG, Bertoldi EG. Assessing the cost-effectiveness of capnography for end-tidal CO 2 monitoring during in-hospital cardiac arrest: A middle-income country perspective analysis. Am Heart J Plus 2024; 40:100373. [PMID: 38510503 PMCID: PMC10946019 DOI: 10.1016/j.ahjo.2024.100373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 03/22/2024]
Abstract
Study objective To evaluate the cost-effectiveness of EtCO2 monitoring during in-hospital cardiorespiratory arrest (CA) care outside the intensive care unit (ICU) and emergency room department. Design We performed a cost-effectiveness analysis based on a simple decision model cost analysis and reported the study using the CHEERS checklist. Model inputs were derived from a retrospective Brazilian cohort study, complemented by information obtained through a literature review. Cost inputs were gathered from both literature sources and contacts with hospital suppliers. Setting The analysis was carried out from the perspective of a tertiary referral hospital in a middle-income country. Participants The study population comprised individuals experiencing in-hospital CA who received cardiopulmonary resuscitation (CPR) by rapid response team (RRT) in a hospital ward, not in the ICU or emergency room department. Interventions Two strategies were assumed for comparison: one with an RRT delivering care without capnography during CPR and the other guiding CPR according to the EtCO2 waveform. Main outcome measures Incremental cost-effectiveness rate (ICER) to return of spontaneous circulation (ROSC), hospital discharge, and hospital discharge with good neurological outcomes. Results The ICER for EtCO2 monitoring during CPR, resulting in an absolute increase of one more case with ROSC, hospital discharge, and hospital discharge with good neurological outcome, was calculated at Int$ 515.78 (361.57-1201.12), Int$ 165.74 (119.29-248.4), and Int$ 240.55, respectively. Conclusion In managing in-hospital CA in the hospital ward, incorporating EtCO2 monitoring is likely a cost-effective measure within the context of a middle-income country hospital with an RRT.
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Affiliation(s)
- Sérgio Renato da Rosa Decker
- Programa de Pós-graduação em Cardiologia e Ciências Cardiovasculares, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Serviço de Medicina Interna, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | | | - Paulo Ricardo Mottin Rosa
- Serviço de Medicina Interna, Hospital Moinhos de Vento, Porto Alegre, Brazil
- Departamento de Medicina Interna, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil
| | - Janete Salles Brauner
- Departamento de Medicina Interna, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil
| | - Regis Goulart Rosa
- Serviço de Medicina Interna, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Eduardo Gehling Bertoldi
- Programa de Pós-graduação em Cardiologia e Ciências Cardiovasculares, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, Brazil
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Ali S, Meuwese CL, Moors XJR, Donker DW, van de Koolwijk AF, van de Poll MCG, Gommers D, Dos Reis Miranda D. Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: an overview of current practice and evidence. Neth Heart J 2024; 32:148-155. [PMID: 38376712 PMCID: PMC10951133 DOI: 10.1007/s12471-023-01853-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 02/21/2024] Open
Abstract
Cardiac arrest (CA) is a common and potentially avoidable cause of death, while constituting a substantial public health burden. Although survival rates for out-of-hospital cardiac arrest (OHCA) have improved in recent decades, the prognosis for refractory OHCA remains poor. The use of veno-arterial extracorporeal membrane oxygenation during cardiopulmonary resuscitation (ECPR) is increasingly being considered to support rescue measures when conventional cardiopulmonary resuscitation (CPR) fails. ECPR enables immediate haemodynamic and respiratory stabilisation of patients with CA who are refractory to conventional CPR and thereby reduces the low-flow time, promoting favourable neurological outcomes. In the case of refractory OHCA, multiple studies have shown beneficial effects in specific patient categories. However, ECPR might be more effective if it is implemented in the pre-hospital setting to reduce the low-flow time, thereby limiting permanent brain damage. The ongoing ON-SCENE trial might provide a definitive answer regarding the effectiveness of ECPR. The aim of this narrative review is to present the most recent literature available on ECPR and its current developments.
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Affiliation(s)
- Samir Ali
- Department of Intensive Care, Erasmus University Medical Centre, Rotterdam, The Netherlands.
- Department of Anaesthesiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
- Ministry of Defence, Royal Netherlands Air Force, Breda, The Netherlands.
| | - Christiaan L Meuwese
- Department of Intensive Care, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Xavier J R Moors
- Department of Anaesthesiology, Erasmus Medical Centre, Rotterdam, The Netherlands
- Helicopter Emergency Medical Services, Trauma Centre Zuid-West Nederland, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Dirk W Donker
- Cardiovascular and Respiratory Physiology, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- Department of Intensive Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Anina F van de Koolwijk
- Department of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marcel C G van de Poll
- Department of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Diederik Gommers
- Department of Intensive Care, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Dinis Dos Reis Miranda
- Department of Intensive Care, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Helicopter Emergency Medical Services, Trauma Centre Zuid-West Nederland, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Smith SE, Sikora AN, Fulford M, Rogers KC. Long-Term Retention of Advanced Cardiovascular Life Support Knowledge and Confidence in Doctor of Pharmacy Students. Am J Pharm Educ 2024; 88:100609. [PMID: 37866521 DOI: 10.1016/j.ajpe.2023.100609] [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] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/03/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE This study aimed to evaluate the impact of American Heart Association (AHA) advanced cardiovascular life support (ACLS) education and training on long-term retention of ACLS knowledge and confidence in Doctor of Pharmacy (PharmD) students. METHODS This multicenter study included PharmD students who received ACLS training through different means: 1-hour didactic lecture (didactic), 1-hour didactic lecture with 2-hour skills practice (didactic + skills), and comprehensive AHA ACLS certification through an elective course (elective-certification). Students completed a survey before training, immediately after training, and at least 6-12 months after training to assess demographics and ACLS confidence and knowledge. The primary outcome was a passing score, defined as ≥ 84% on the long-term knowledge assessment. Secondary outcomes included overall knowledge score and perceived confidence, assessed using the Dreyfus model. RESULTS The long-term assessment was completed by 160 students in the didactic group, 66 in the didactic + skills group, and 62 in the elective-certification group. Six (4%), 8 (12%), and 14 (23%) received a passing score on the long-term knowledge assessment in the didactic, didactic + skills, and elective-certification groups, respectively. The median (IQR) scores on the long-term knowledge assessment were 50% (40-60), 60% (50-70), and 65% (40-80) in the 3 groups. On the long-term assessment, confidence was higher in the elective-certification group, demonstrated by more self-ratings of competent, proficient, and expert, and fewer self-ratings of novice and advanced beginner. CONCLUSION Long-term retention of ACLS knowledge was low in all groups, but was higher in students who received AHA ACLS certification through an ACLS elective course.
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Affiliation(s)
- Susan E Smith
- University of Georgia College of Pharmacy, Athens, GA, USA.
| | | | | | - Kelly C Rogers
- University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA
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Kassabry MF. The effect of simulation-based advanced cardiac life support training on nursing students' self-efficacy, attitudes, and anxiety in Palestine: a quasi-experimental study. BMC Nurs 2023; 22:420. [PMID: 37946174 PMCID: PMC10633911 DOI: 10.1186/s12912-023-01588-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Cardiac Arrest (CA) is one of the leading causes of death, either inside or outside hospitals. Recently, the use of creative teaching strategies, such as simulation, has gained popularity in Cardio Pulmonary Resuscitation (CPR) instruction. This study aimed to assess the effect of High-Fidelity Simulation (HFS) training on nursing students' self-efficacy, attitude, and anxiety in the context of Advanced Cardiac Life Support (ACLS). METHODOLOGY The study design is quasi-experimental employing a pre-test and post-test approach during April and May 2023. A convenient sample of 60 undergraduate nursing students in a 4-year class from a nursing college at the Arab American University/ Palestine (AAUP) participated in this study. The data were analyzed using a paired sample t-test in SPSS program version 26. Three data collection tools were used pre- and post-intervention; the Resuscitation Self-Efficacy Scale (RSES), The Attitudinal instrument, and the State Anxiety Inventory (SAI). RESULTS The total number of nursing students was 60, out of them (56.7%) were female, while the mean age was (22.2) years. Improvements were seen in all four domains of self-efficacy following HFS training: recognition, debriefing, recording, responding and rescuing, and reporting. (t (59) = 26.80, p < 0.001, confidence interval [29.32, 34.05]). After receiving HFS training on ACLS, the post-intervention for the same group attitude scores significantly increased from 32.83 (SD = 15.35) to 54.58 (SD = 8.540) for emotion, from 6.72 (SD = 2.44) to 10.40 (SD = 1.40) for behavior, and from 7.03 (SD = 2.03) to 10.33 (SD = 1.42) for cognitive. The anxiety level decreased post-simulation from 3.53 (SD = 0.3) to 2.14 (SD = 0.65), which was found to be statistically significant (t(59) = 16.68, p < 0.001, 95% CI [1.22 to 1.55]). Female students (M = 73.18), students who observed a real resuscitation (M = 71.16), and who were satisfied with their nursing major (M = 72.17) had significantly higher self-efficacy scores post-simulation. CONCLUSION The HFS can be recommended as an effective training strategy among nursing students. The ACLS training-based HFS was effective in improving the students' self-efficacy and attitudes and decreasing their anxiety.
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Affiliation(s)
- Maysa Fareed Kassabry
- Nursing College, Arab American University, Arab American University- Palestine, P.O Box 240, 13 Zababdeh, Jenin, Palestine.
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Ahn JY, Ryoo HW, Moon S, Jung H, Park J, Lee WK, Kim JY, Lee DE, Kim JH, Lee SH. Prehospital factors associated with out-of-hospital cardiac arrest outcomes in a metropolitan city: a 4-year multicenter study. BMC Emerg Med 2023; 23:125. [PMID: 37880656 PMCID: PMC10601319 DOI: 10.1186/s12873-023-00899-3] [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: 07/19/2023] [Accepted: 10/21/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Prehospital factors play a vital role in out-of-hospital cardiac arrest (OHCA) survivability, and they vary between countries and regions. We investigated the prehospital factors associated with OHCA outcomes in a single metropolitan city in the Republic of Korea. METHODS This study included adult medical OHCA patients enrolled prospectively, using data from the citywide OHCA registry for patients registered between 2018 and 2021. The primary outcome was survival to hospital discharge. Multivariable logistic regression analysis was conducted to determine the factors associated with the study population's clinical outcomes, adjusting for covariates. We performed a sensitivity analysis for clinical outcomes only for patients without prehospital return of spontaneous circulation prior to emergency medical service departure from the scene. RESULTS In multivariable logistic regression analysis, older age (odds ratio [OR] 0.96; 95% confidence interval [CI] 0.95-0.97), endotracheal intubation (adjusted odds ratio [aOR] 0.29; 95% [CIs] 0.17-0.51), supraglottic airway (aOR 0.29; 95% CI 0.17-0.51), prehospital mechanical chest compression device use (OR 0.13; 95% CI 0.08-0.18), and longer scene time interval (OR 0.96; 95% CI 0.93-1.00) were negatively associated with survival. Shockable rhythm (OR 24.54; 95% CI 12.99-42.00), pulseless electrical activity (OR 3.11; 95% CI 1.74-5.67), and witnessed cardiac arrest (OR 1.59; 95% CI 1.07-2.38) were positively associated with survival. In the sensitivity analysis, endotracheal intubation, supraglottic airway, prehospital mechanical chest compression device use, and longer scene time intervals were associated with significantly lower survival to hospital discharge. CONCLUSIONS Regional resuscitation protocol should be revised based on the results of this study, and modifiable prehospital factors associated with lower survival of OHCA should be improved.
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Affiliation(s)
- Jae Yun Ahn
- Department of Emergency Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hyun Wook Ryoo
- Department of Emergency Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Sungbae Moon
- Department of Emergency Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Haewon Jung
- Department of Emergency Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jungbae Park
- Department of Emergency Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Won Kee Lee
- Department of Biostatistics, School of Medicine, Medical Research Collaboration Center, Kyungpook National University, Daegu, Republic of Korea
| | - Jong-Yeon Kim
- Department of Public Health, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Dong Eun Lee
- Department of Emergency Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jung Ho Kim
- Department of Emergency Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Sang-Hun Lee
- Department of Emergency Medicine, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
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Won KJ, Tsu LV, Saldivar S, Beuttler R, Walsh A. The effect of interprofessional simulations on pharmacy and physician assistant students' learning of advanced cardiac life support concepts. Curr Pharm Teach Learn 2023:S1877-1297(23)00104-1. [PMID: 37202330 DOI: 10.1016/j.cptl.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 04/07/2023] [Accepted: 05/09/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND The Interprofessional Education Collaborative (IPEC) defined core competencies for IPE in 2011, and use of simulation in interprofessional education (IPE) continues to be developed in prelicensure health education programs. INTERPROFESSIONAL EDUCATION ACTIVITY In this prospective, observational study, interprofessional student teams addressed reversible causes of cardiac arrest in weekly simulations during an Emergency Medicine course. Each simulation was followed by sequential team debriefs, first regarding the IPEC core competencies of interprofessional communication, teamwork, and roles and responsibilities, and second regarding the patient-related content of the case. DISCUSSION Twenty-eight pharmacy students and 60 physician assistant students completed the course. A didactic knowledge exam was administered before, immediately after, and 150 days after the course. Both disciplines' exam scores significantly increased from baseline to the end of the course and from baseline to the 150-day follow-up. Students also completed the validated Interprofessional Perceptions Survey before and after the course. Both disciplines demonstrated significant increases in Team Value, Efficiency and Interprofessional Accommodation components. IMPLICATIONS Participation in this simulation-based course resulted in 150-day retention of advanced cardiovascular life support knowledge and improved interprofessional perceptions in both pharmacy and physician assistant students.
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Affiliation(s)
- Kimberly J Won
- Department of Pharmacy Practice, Chapman University School of Pharmacy, United States
| | - Laura V Tsu
- Department of Pharmacy Practice, Chapman University School of Pharmacy, United States.
| | - Stephanie Saldivar
- Physician Assistant Studies Program, Chapman University Crean College of Health and Behavioral Sciences, United States
| | | | - Anne Walsh
- Physician Assistant Studies Program, Chapman University Crean College of Health and Behavioral Sciences, United States
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Lutz J, Levenbrown Y, Hossain MJ, Hesek A, Massa KE, Keith JP, Shaffer TH. Impact of intravenous fluid administration on cardiac output and oxygenation during cardiopulmonary resuscitation. Intensive Care Med Exp 2023; 11:13. [PMID: 36959337 PMCID: PMC10036707 DOI: 10.1186/s40635-023-00497-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/07/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND The effect of intravenous fluid (IVF) administration during cardiopulmonary resuscitation (CPR) is an unexplored factor that may improve cardiac output (CO) during CPR. The aim of this study was to determine the effect of IVF administration on CO and oxygenation during CPR. METHODS This experimental animal study was performed in a critical care animal laboratory. Twenty-two Landrace-Yorkshire female piglets weighing 27-37 kg were anesthetized, intubated, and placed on positive pressure ventilation. Irreversible cardiac arrest was induced with bupivacaine. CPR was performed with a LUCAS 3 mechanical compression device. Pigs were randomized into IVF or no-IVF groups. Pigs in the IVF group were given 20 mL/kg of Plasma-Lyte (Baxter International, Deerfield, IL USA), infused from 15 to 35 min of CPR. CPR was maintained for 50 min with serial measurements of CO obtained using ultrasound dilution technology and partial pressure of oxygen (PaO2). RESULTS A mixed-effects repeated measures analysis of variance was used to compare within-group, and between-group mean changes in CO and PaO2 over time. CO and PaO2 for the piglets were measured at 10-min intervals during the 50 min of CPR. CO was greater in the IVF compared with the control group at all time points during and after the infusion of the IVF. Mean PaO2 decreased with time; however, at no time was there a significant difference in PaO2 between the IVF and control groups. CONCLUSIONS Administration of IVF during CPR resulted in a significant increase in CO during CPR both during and after the IVF infusion. There was no statistically significant decrease in PaO2 between the IVF and control groups.
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Affiliation(s)
- Jennifer Lutz
- Division of Pediatric Critical Care, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA
- Department of Pediatrics, Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA, USA
| | - Yosef Levenbrown
- Division of Pediatric Critical Care, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA.
- Department of Pediatrics, Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA, USA.
| | - Md Jobayer Hossain
- Nemours Biomedical Research, Nemours Children's Health, Wilmington, DE, USA
- Department of Applied Economics and Statistics, University of Delaware, Newark, DE, USA
| | - Anne Hesek
- Nemours Biomedical Research, Nemours Children's Health, Wilmington, DE, USA
| | - Kelly E Massa
- Department of Respiratory Care, Nemours Children's Health, Wilmington, DE, USA
| | - James P Keith
- Department of Respiratory Care, Nemours Children's Health, Wilmington, DE, USA
| | - Thomas H Shaffer
- Department of Pediatrics, Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA, USA
- Nemours Biomedical Research/Research Lung Center, Nemours Children's Health, Wilmington, DE, USA
- Department of Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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Kacha AK, Hicks MH, Mahrous C, Dalton A, Ben-Jacob TK. Management of Intraoperative Cardiac Arrest. Anesthesiol Clin 2023; 41:103-119. [PMID: 36871994 DOI: 10.1016/j.anclin.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Perioperative arrests are both uncommon and heterogeneous and have not been described or studied to the same extent as cardiac arrest in the community. These crises are usually witnessed, frequently anticipated, and involve a rescuer physician with knowledge of the patient's comorbidities and coexisting anesthetic or surgically related pathophysiology ultimately leading to better outcomes. This article reviews the most probable causes of intraoperative arrest and their management.
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Affiliation(s)
- Aalok K Kacha
- Department of Anesthesia and Critical Care, Section of Critical Care Medicine, University of Chicago, 5841 South Maryland Avenue, MC 4028, Chicago, IL 60637, USA; Department of Surgery, Section of Transplant Surgery, University of Chicago, 5841 South Maryland Avenue, MC 4028, Chicago, IL 60637, USA.
| | - Megan Henley Hicks
- Department of Anesthesiology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Christopher Mahrous
- Department of Anesthesiology, Cooper Medical School of Rowan University, One Cooper Plaza, Dorrance 2nd Floor, Camden, NJ 08103, USA
| | - Allison Dalton
- Department of Anesthesia and Critical Care, Section of Critical Care Medicine, University of Chicago, 5841 South Maryland Avenue, MC 4028, Chicago, IL 60637, USA
| | - Talia K Ben-Jacob
- Department of Anesthesiology, Division of Critical Care, Cooper Medical School of Rowan University, One Cooper Plaza, Dorrance 2nd Floor, Camden, NJ 08103, USA
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Adal O, Emishaw S. Knowledge and attitude of healthcare workers toward advanced cardiac life support in Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia, 2022. SAGE Open Med 2023; 11:20503121221150101. [PMID: 36685795 PMCID: PMC9850119 DOI: 10.1177/20503121221150101] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/20/2022] [Indexed: 01/18/2023] Open
Abstract
Objective The aim of this study was to investigate the knowledge and attitude regarding advanced cardiac life support among healthcare workers, 2022. Methods A cross-sectional study was conducted from March to May 2022 among healthcare workers who were working in Felege Hiwot Comprehensive Specialized Hospital Bahir Dar, Ethiopia. All physicians and nurses who were willing to participate this study were involved. A structured self-administered questionnaire was used for data collection. The data were entered into the statistical software Epi Data version 4.6.0.4 and analyzed with statistical package for social science version 26. Logistic regression analysis was used to differentiate the effects of each independent variable on the dependent variable. Results Among the total study participants (400) with a response rate of 96%, most (238) (59.5%) healthcare workers (nurses and physicians) had poor knowledge toward advanced cardiac life support. Two hundred twenty-five (56.25%) healthcare workers had positive attitude. Being a physician, having more than 6 years of work experience, working in an emergency department for more than 10 years, and having advanced cardiac life support training all contribute to superior knowledge of advanced cardiac life support. Conclusion Most healthcare workers, especially, nurses, have under estimated knowledge and a negative attitude toward advanced cardiac life support. This implies they require knowledge building and attitude empowerment regarding advanced cardiac life support. Being a physician, having training in advanced cardiac life support, having work experience of more than 6 years, and working in an emergency unit for more than 10 years were positively associated with better knowledge of advanced cardiac life support among healthcare workers.
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Affiliation(s)
- Ousman Adal
- Ousman Adal, Department of Emergency,
College of Medicine and Health Sciences, Bahir Dar University, P.O. Box 75,
Bahir Dar 6000, Ethiopia.
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Vianna CDA, Campos JF, de Oliveira HC, Machado DM, de Bakker GB, da Silva RC, Brandão MAG. Can support surfaces characteristics influence high-quality chest compression? manikin experiment with a mechanical device. Heart Lung 2023; 57:180-185. [PMID: 36228538 DOI: 10.1016/j.hrtlng.2022.09.023] [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: 05/02/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Support surfaces variables, such as size, material, and density, can determine chest compression depth in cardiopulmonary resuscitation. OBJECTIVE to analyze the force required to do a high-quality chest compression concerning different surfaces in CPR. METHOD This experimental study was developed using a Little Anne manikin and a mechanical device to perform chest compressions. Nine sets of surfaces were tested and compared to a control. RESULTS 230 experimental tests were done in sets of bed or stretcher + mattress and presence or absence of different backboards. In the control condition, the average force to reach 5 cm of depth was 42.14±0.97 (kgf). Set 9, compatible with a narrow stretcher with a thin mattress, had the best surfaces to reach recommended depth, with or without a backboard. All other sets required significantly more force for high-quality chest compression. Regression analysis confirms that backboard size is not significant for the force for high-quality chest compression. CONCLUSION There is an association of dimensions and types of beds or stretchers and mattresses with a force increase. Type and dimensions of the backboard are not relevant for the force required, regardless of the characteristics of the set of the bed or stretcher and mattress.
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Affiliation(s)
- Carla de Azevedo Vianna
- Anna Nery School of Nursing, Federal University of Rio de Janeiro. Rio de Janeiro, Brazil. Rua Afonso Cavalcanti, 275/ Cidade Nova Rio de Janeiro, Brazil, ZIPCODE: 20211-110; Pró-Cardíaco Hospital, Rio de Janeiro, Brazil. Rua General Polidoro 192, Botafogo / Rio de Janeiro, Brazil, ZIPCODE: 22280-003.
| | - Juliana Faria Campos
- Anna Nery School of Nursing, Federal University of Rio de Janeiro. Rio de Janeiro, Brazil. Rua Afonso Cavalcanti, 275/ Cidade Nova Rio de Janeiro, Brazil, ZIPCODE: 20211-110
| | - Hudson Carmo de Oliveira
- Anna Nery School of Nursing, Federal University of Rio de Janeiro. Rio de Janeiro, Brazil. Rua Afonso Cavalcanti, 275/ Cidade Nova Rio de Janeiro, Brazil, ZIPCODE: 20211-110
| | - Debora Mazioli Machado
- Anna Nery School of Nursing, Federal University of Rio de Janeiro. Rio de Janeiro, Brazil. Rua Afonso Cavalcanti, 275/ Cidade Nova Rio de Janeiro, Brazil, ZIPCODE: 20211-110; Pró-Cardíaco Hospital, Rio de Janeiro, Brazil. Rua General Polidoro 192, Botafogo / Rio de Janeiro, Brazil, ZIPCODE: 22280-003
| | - Gabriela Barcellos de Bakker
- Anna Nery School of Nursing, Federal University of Rio de Janeiro. Rio de Janeiro, Brazil. Rua Afonso Cavalcanti, 275/ Cidade Nova Rio de Janeiro, Brazil, ZIPCODE: 20211-110; Americas Medical City Hospital, Rio de Janeiro, Brazil. Rua Jorge Cury 550, Barra da Tijuca / Rio de Janeiro, Brazil, ZIPCODE: 22775-00
| | - Rafael Celestino da Silva
- Anna Nery School of Nursing, Federal University of Rio de Janeiro. Rio de Janeiro, Brazil. Rua Afonso Cavalcanti, 275/ Cidade Nova Rio de Janeiro, Brazil, ZIPCODE: 20211-110
| | - Marcos Antônio Gomes Brandão
- Anna Nery School of Nursing, Federal University of Rio de Janeiro. Rio de Janeiro, Brazil. Rua Afonso Cavalcanti, 275/ Cidade Nova Rio de Janeiro, Brazil, ZIPCODE: 20211-110
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Madavan KT. Effectiveness and perception of demonstration-observation- assistance-performance (DOAP) versus video-assisted learning (VAL) in training advanced cardiac life support (ACLS) among medical interns - A comparative study. J Educ Health Promot 2022; 11:412. [PMID: 36824401 PMCID: PMC9942143 DOI: 10.4103/jehp.jehp_1663_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 10/14/2022] [Indexed: 05/30/2023]
Abstract
BACKGROUND Demonstration-Observation-Assistance-Performance (DOAP) and Video-Assisted Learning (VAL) are small-group teaching/learning methods (TLM) in medical education. Comparison studies between the two are scanty. There is a gap in knowledge, skills, and attitude among medical interns toward Advanced Cardiac Life Support (ACLS). The author studied the effectiveness of DOAP and VAL in training ACLS using mannequins and automated external defibrillator (AED)-simulators among interns in 2021. MATERIALS AND METHODS This descriptive study was done in the Emergency Department of a tertiary teaching hospital in South India. Out of 80 medical interns, 39 and 41 were allocated to ACLS training by DOAP (Group 1) and VAL (Group 2), respectively, by convenient sampling with random allocation, with the use of mannequins and AED-Simulators (10 interventions in each small group; three-five participants in each session). Pre-validated pre-test and posttest multiple-choice questionnaires (MCQs) and attitude questionnaires, OSCE by two blinded assessors, and perception by Likert-based questionnaire were analyzed with appropriate statistical analysis. RESULTS The mean pretest and posttest MCQs and Attitude and OSCE scores of DOAP and VAL showed no statistically significant difference between them (MCQ pre-test 44.51 (11.43); 42.54 (6.56); p = 0.350 and MCQ posttest, 78.97 (8.59); 77.22 (11.29); p = 0.438; OSCE 40.51 (2.43) and 40.63 (1.92); p = 0.804; Attitude: 11 (3), 11 (2); p = 0.567; 14 (2), 14 (3); p = 0.095). MCQ post-tests showed improved scores (p < 0.001) in both the methods and the standardized mean difference based on the MCQ scores for the DOAP group was 3.02, and for the VAL group 3, showed the effectiveness of both methods. Perception scores showed learners' interest and positive feedback to both methods and ACLS. CONCLUSION Both DOAP and VAL were equally effective TLMs in imparting knowledge, skills, and attitude to medical interns with positive feedback. In DOAP, the learner performs under supervision and clarifies doubts. As repeatable and cost-effective, VAL is useful in resource-limited settings. Both can be used as complementary methods in training ACLS. The attitude of learners towards ACLS improved with training.
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Wanjari M, Patil M. Fatal polymorphic ventricular tachycardia in a primary health center setting: A case report. J Family Med Prim Care 2022; 11:6526-6528. [PMID: 36618220 PMCID: PMC9810852 DOI: 10.4103/jfmpc.jfmpc_438_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/05/2022] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
Polymorphic ventricular tachycardia (PVT) is a lethal cardiac arrhythmia. It requires medical intervention, including defibrillation, or imminent death may result. A 26-year-old male patient presented to the emergency department with complaints of syncope while working on the farm; later diagnostic testing indicated PVT. As cardiovascular disorders are becoming increasingly prevalent in urban as well as rural areas, it is a need of time to make our facilities well equipped for resuscitation measures by implementing advanced cardiac life support.
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Affiliation(s)
- Mayur Wanjari
- Department of Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi (M), Wardha, Maharashtra, India,Address for correspondence: Dr. Mayur Wanjari, Research Associate, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi (M), Wardha - 442 004, Maharashtra, India. E-mail:
| | - Manoj Patil
- Department of Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi (M), Wardha, Maharashtra, India
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Castro-Portillo E, López-Izquierdo R, Sanz-García A, Ortega GJ, Delgado-Benito JF, Castro Villamor MA, Sánchez-Soberón I, Del Pozo Vegas C, Martín-Rodríguez F. Role of prehospital point-of-care N-terminal pro-brain natriuretic peptide in acute life-threatening cardiovascular disease. Int J Cardiol 2022; 364:126-132. [PMID: 35716940 DOI: 10.1016/j.ijcard.2022.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/18/2022] [Accepted: 06/10/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The evidence about the use of natriuretic peptides (NP) to predict mortality in the pre-hospital setting is limited. The main objective of this study is to assess the ability of point-of-care testing (POCT) N-terminal portion of B-type natriuretic peptide (NT-proBNP) to predict 2-day in-hospital mortality of acute cardiovascular diseases (ACVD). METHODS We conducted a multicentric, prospective, observational study in adults with ACVD transferred by ambulance to emergency departments (ED). The primary outcome was 2-day in-hospital mortality. The discrimination capacity of the NT-proBNP was performed through a prediction model trained using a derivation cohort and evaluated by the area under the curve (AUC) of the receiver operating characteristic on a validation cohort. RESULTS A total of 1006 patients were recruited. The median age was 75 (IQR 63-84) years and 421 (41.85%) were females. The 2-day in-hospital mortality was 5.8% (58 cases). The predictive validity of NT-proBNP, for 2-day mortality reached the following AUC: 0.823 (95%CI: 0.758-0.889, p < 0.001), and the optimal specificity and sensitivity were 73.1 and 82.7. Predictive power of NT-proBNP obtained an AUC 0.549 (95%CI: 0.432-0.865, p 0.215) for acute heart failure, AUC 0.893 (95%CI: 0.617-0.97, p < 0.001) for ischemic heart disease, AUC 0.714 (95%CI: 0.55-0.87, p = 0.0069) for arrhythmia and AUC 0.927 (95%CI: 0.877-0.978, p < 0,001) for syncope. CONCLUSION POCT NT-proBNP has proven to be a strong predictor of early mortality in ACVD, showing an excellent predictive capacity in cases of syncope. However, this biomarker does not appear to be useful for predicting outcome in patients with acute heart failure.
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Affiliation(s)
| | - Raúl López-Izquierdo
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain; Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
| | - Ancor Sanz-García
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain; Data Analysis Unit, Health Research Institute, Hospital de la Princesa, Madrid (IIS-IP), Spain.
| | - Guillermo J Ortega
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa, Madrid (IIS-IP), Spain; CONICET, Argentina; Science and Technology department, National University of Quilmes, Argentina
| | - Juan F Delgado-Benito
- Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain; Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
| | - Miguel A Castro Villamor
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
| | | | - Carlos Del Pozo Vegas
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain; Emergency Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Francisco Martín-Rodríguez
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain; Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
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Lloyd C, Mohar C, Priano J. Hypokalemic Cardiac Arrest: Narrative Review of Case Reports and Current State of Science. J Emerg Nurs 2022:S0099-1767(21)00338-X. [PMID: 35144826 DOI: 10.1016/j.jen.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/23/2021] [Accepted: 12/26/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE Hypokalemic cardiac arrest is an uncommon occurrence in the emergency department. Electrocardiogram findings related to hypokalemic cardiac arrest include prolonged QT, U waves, and preventricular contractions leading to Torsades de Pointes and then arrest. Literature evaluating the prevalence of hypokalemic cardiac arrest is scarce, and its management is lacking. This review provides a summary of current literature, recommendations from current guidelines, and proposed management strategies of hypokalemic cardiac arrest. SUMMARY Intravenous potassium administration is the treatment for hypokalemic cardiac arrest. Although the treatment for hypokalemic cardiac arrest is known, there is limited evidence on the proper procedure for administering intravenous potassium appropriately and safely. Owing to the time-sensitive nature of treating hypokalemic cardiac arrest, rapid administration of intravenous potassium (10 mEq/100 mL of potassium chloride over 5 minutes) is warranted. Concerns regarding rapid potassium administration are not without merit; however, a risk-benefit analysis and potential mitigation strategies for unwanted side effects need to be considered if hypokalemic cardiac arrest is to remain a reversible cause. It is imperative to identify hypokalemia as the cause for arrest as soon as possible and administer potassium before systemic acidosis, ischemia, and irreversible cell death. CONCLUSIONS More evidence is necessary to support treatment recommendations for hypokalemic cardiac arrest; however, it is the authors' opinion that, if identified early during cardiac arrest, intravenous potassium should be administered to treat a reversible cause for cardiac arrest.
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Wyckoff MH, Singletary EM, Soar J, Olasveengen TM, Greif R, Liley HG, Zideman D, Bhanji F, Andersen LW, Avis SR, Aziz K, Bendall JC, Berry DC, Borra V, Böttiger BW, Bradley R, Bray JE, Breckwoldt J, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Cheng A, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Davis PG, de Almeida MF, de Caen AR, de Paiva EF, Deakin CD, Djärv T, Douma MJ, Drennan IR, Duff JP, Eastwood KJ, Epstein JL, Escalante R, Fabres JG, Fawke J, Finn JC, Foglia EE, Folke F, Freeman K, Gilfoyle E, Goolsby CA, Grove A, Guinsburg R, Hatanaka T, Hazinski MF, Heriot GS, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hung KKC, Hsu CH, Ikeyama T, Isayama T, Kapadia VS, Kawakami M, Kim HS, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lockey AS, Malta Hansen C, Markenson D, Matsuyama T, McKinlay CJD, Mehrabian A, Merchant RM, Meyran D, Morley PT, Morrison LJ, Nation KJ, Nemeth M, Neumar RW, Nicholson T, Niermeyer S, Nikolaou N, Nishiyama C, O'Neil BJ, Orkin AM, Osemeke O, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reynolds JC, Ristagno G, Roehr CC, Sakamoto T, Sandroni C, Sawyer T, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Smyth MA, Soll RF, Sugiura T, Taylor-Phillips S, Trevisanuto D, Vaillancourt C, Wang TL, Weiner GM, Welsford M, Wigginton J, Wyllie JP, Yeung J, Nolan JP, Berg KM. 2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2021; 169:229-311. [PMID: 34933747 PMCID: PMC8581280 DOI: 10.1016/j.resuscitation.2021.10.040] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.
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Dewolf P, Vanneste M, Desruelles D, Wauters L. Measuring non-technical skills during prehospital advanced cardiac life support: A pilot study. Resusc Plus 2021; 8:100171. [PMID: 34693380 PMCID: PMC8517196 DOI: 10.1016/j.resplu.2021.100171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 11/05/2022] Open
Abstract
Aim To analyse non-technical skills of mobile medical teams during out-of-hospital cardiac arrests (OHCA) using the validated Team Emergency Assessment Measure (TEAM) tool. To research the correlation between non-technical skills and patient outcome. Methods Adult patients who experienced an out-of-hospital cardiac arrest between July 2016, and June 2018, and were treated by a mobile medical team from the University Hospital Leuven, were eligible for the study. Resuscitations were video recorded from the team leader’s perspective. Video recordings were reviewed and scored by emergency physicians, using the TEAM evaluation form. Results In total 114 OHCAs were analysed. The mean TEAM score was 34.4/44 (SD = 5.5). The mean item score was 3.1/4 (SD = 0.8). On average, ‘effective team communication’ had the lowest score (2.4), while ‘acting with composure and control’ and ‘following of approved standards/guidelines’ scored the highest (3.4). The average non-technical skills theme scores were 2.9 (SD = 0.9) for ‘Leadership’, 3.1 (SD = 0.8) for ‘Teamwork’ and 3.3 (SD = 0.7) for ‘Task management’. ‘Leadership’ was rated significantly lower than ‘Teamwork’ (p = 0.004) and ‘Task management’ (p < 0.001). No significant correlation was found between TEAM and return of spontaneous circulation (p = 0.574) or one month survival (p = 0.225). Conclusion The mean overall TEAM score was categorized as good. Task management scored high, while leadership and team communication received lower scores. Future training programs should thus focus on improving leadership and communication. In this pilot study no correlation was found between non-technical skills and survival.
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Affiliation(s)
- Philippe Dewolf
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.,KULeuven, University, Faculty of Medicine, Belgium
| | - Maïté Vanneste
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Didier Desruelles
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Lina Wauters
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
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Abstract
Cardiac arrest is a significant cause of morbidity and mortality in the United States. Cardiac arrest can occur in the community or among hospitalized patients. There are many commonalities between in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest; however, significant differences exist. Optimizing outcomes for patients with IHCA depends on high-quality care supported by the best available evidence. It is essential that critical care nurses are familiar with the evidence related to IHCA. This article focuses on a review of the evidence on IHCA, focusing on practical implications for critical care nursing practice.
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Spinelli G, Brogi E, Sidoti A, Pagnucci N, Forfori F. Assessment of the knowledge level and experience of healthcare personnel concerning CPR and early defibrillation: an internal survey. BMC Cardiovasc Disord 2021; 21:195. [PMID: 33879072 PMCID: PMC8056553 DOI: 10.1186/s12872-021-02009-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 04/12/2021] [Indexed: 11/24/2022] Open
Abstract
Background In‐hospital cardiac arrest (IHCA) is a major public health problem with significant mortality. Rapid cardiopulmonary resuscitation and early defibrillation is extremely connected to patient outcome. In this study, we aimed to assess the effects of a basic life support and defibrillation course in improving knowledge in IHCA management. Methods We performed a prospective observational study recruiting healthcare personnel working at Azienda Ospedaliero Universitaria Pisana, Pisa, Italy. Study consisted in the administration of two questionnaires before and after BLS-D course. The course was structured as an informative meeting and it was held according to European Resuscitation Council guidelines. Results 78 participants completed pre- and post-course questionnaires. Only 31.9% of the participants had taken part in a BLS-D before our study. After the course, we found a significative increase in the percentage of participants that evaluated their skills adequate in IHCA management (17.9% vs 42.3%; p < 0.01) and in the correct use of defibrillator (38.8% vs 67.9% p < 0.001). However, 51.3% of respondents still consider their preparation not entirely appropriate after the course. Even more, we observed a significant increase in the number of corrected responses after the course, especially about sequence performed in case of absent vital sign, CPR maneuvers and use of defibrillator. Conclusions The training course resulted in significant increase in the level of knowledge about the general management of IHCA in hospital staff. Therefore, a simple intervention such as an informative meetings improved significantly the knowledge about IHCA and, consequently, can lead to a reduction of morbidity and mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02009-2.
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Affiliation(s)
- G Spinelli
- Department of Anesthesia and Intensive Care, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - E Brogi
- Department of Anesthesia and Intensive Care, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - A Sidoti
- Department of Anesthesia and Intensive Care, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - N Pagnucci
- Department of Anesthesia and Intensive Care, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - F Forfori
- Department of Anesthesia and Intensive Care, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
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Debaty G, Lamhaut L, Aubert R, Nicol M, Sanchez C, Chavanon O, Bouzat P, Durand M, Vanzetto G, Hutin A, Jaeger D, Chouihed T, Labarère J. Prognostic value of signs of life throughout cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest. Resuscitation 2021; 162:163-170. [PMID: 33609608 DOI: 10.1016/j.resuscitation.2021.02.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/22/2021] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Prognostication of refractory out-of-hospital cardiac arrest (OHCA) is essential for selecting the population that may benefit from extracorporeal cardiopulmonary resuscitation (ECPR). We aimed to examine the prognostic value of signs of life before or throughout conventional CPR for individuals undergoing ECPR for refractory OHCA. METHODS Pooling the original data from three cohort studies, we estimated the prevalence of signs of life, for individuals with refractory OHCA resuscitated with ECPR. We performed multivariable logistic regression to examine the independent associations between the occurrence of signs of life and 30-day survival with a CPC score ≤ 2. RESULTS The analytical sample consisted of 434 ECPR recipients. The prevalence of any sign of life was 61%, including pupillary light reaction (48%), gasping (32%), or increased level of consciousness (13%). Thirty-day survival with favorable neurological outcome was 15% (63/434). In multivariable analysis, the adjusted odds ratios of 30-day survival with favorable neurological outcome were 7.35 (95% confidence interval [CI], 2.71-19.97), 5.86 (95% CI, 2.28-15.06), 4.79 (95% CI, 2.16-10.63), and 1.75 (95% CI, 0.95-3.21) for any sign of life, pupillary light reaction, increased level of consciousness, and gasping, respectively. CONCLUSION The assessment of signs of life before or throughout CPR substantially improves the accuracy of a multivariable prognostic model in predicting 30-day survival with favorable neurological outcome. The lack of any sign of life might obviate the provision of ECPR for patients without shockable cardiac rhythm.
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Affiliation(s)
- Guillaume Debaty
- University Grenoble Alpes/CNRS/TIMC-IMAG UMR 5525, Grenoble, France; Department of Emergency Medicine, Grenoble Alpes University Hospital, Grenoble, France.
| | - Lionel Lamhaut
- Adult Intensive Care Unit, Department of Anaesthesiology - SAMU de Paris, Assistance Publique - Hopitaux de Paris, Paris, France; INSERM U970, Unité 4 SDEC, Paris, France
| | - Romain Aubert
- University Grenoble Alpes/CNRS/TIMC-IMAG UMR 5525, Grenoble, France
| | - Mathilde Nicol
- University Grenoble Alpes/CNRS/TIMC-IMAG UMR 5525, Grenoble, France
| | - Caroline Sanchez
- University Grenoble Alpes/CNRS/TIMC-IMAG UMR 5525, Grenoble, France
| | - Olivier Chavanon
- Department of Cardiac Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Pierre Bouzat
- Department Anesthesia and Critical Care, University Hospital, Grenoble, France
| | - Michel Durand
- Department Anesthesia and Critical Care, University Hospital, Grenoble, France
| | - Gérald Vanzetto
- Department of Cardiology, Grenoble Alpes University Hospital, Grenoble, France
| | - Alice Hutin
- Adult Intensive Care Unit, Department of Anaesthesiology - SAMU de Paris, Assistance Publique - Hopitaux de Paris, Paris, France; INSERM U970, Unité 4 SDEC, Paris, France
| | - Deborah Jaeger
- Emergency Department, University Hospital of Nancy, Nancy, France; INSERM, UMRS 1116, University Hospital of Nancy, Vandoeuvre les Nancy, France
| | - Tahar Chouihed
- Emergency Department, University Hospital of Nancy, Nancy, France; INSERM, UMRS 1116, University Hospital of Nancy, Vandoeuvre les Nancy, France
| | - José Labarère
- University Grenoble Alpes/CNRS/TIMC-IMAG UMR 5525, Grenoble, France; Quality of Care Unit, CIC 1406, INSERM, Grenoble Alpes University Hospital, Grenoble, France
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21
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Duhem H, Moore JC, Rojas-Salvador C, Salverda B, Lick M, Pepe P, Labarere J, Debaty G, Lurie KG. Improving post-cardiac arrest cerebral perfusion pressure by elevating the head and thorax. Resuscitation 2021; 159:45-53. [PMID: 33385469 DOI: 10.1016/j.resuscitation.2020.12.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 10/12/2020] [Revised: 12/04/2020] [Accepted: 12/15/2020] [Indexed: 01/17/2023]
Abstract
AIM The optimal head and thorax position after return of spontaneous circulation (ROSC) following cardiac arrest (CA) is unknown. This study examined whether head and thorax elevation post-ROSC is beneficial, in a porcine model. METHODS Protocol A: 40 kg anesthetized pigs were positioned flat, after 7.75 min of untreated CA the heart and head were elevated 8 and 12 cm, respectively, above the horizontal plane, automated active compression decompression (ACD) plus impedance threshold device (ITD) CPR was started, and 2 min later the heart and head were elevated 10 and 22 cm, respectively, over 2 min to the highest head up position (HUP). After 30 min of CPR pigs were defibrillated and randomized 10 min later to four 5-min epochs of HUP or flat position. Multiple physiological parameters were measured. In Protocol B, after 6 min of untreated VF, pigs received 6 min of conventional CPR flat, and after ROSC were randomized HUP versus Flat as in Protocol A. The primary endpoint was cerebral perfusion pressure (CerPP). Multivariate analysis-of-variance (MANOVA) for repeated measures was used. Data were reported as mean ± SD. RESULTS In Protocol A, intracranial pressure (ICP) (mmHg) was significantly lower post-ROSC with HUP (9.1 ± 5.5) versus Flat (18.5 ± 5.1) (p < 0.001). Conversely, CerPP was higher with HUP (62.5 ± 19.9) versus Flat (53.2 ± 19.1) (p = 0.004), respectively. Protocol A and B results comparing HUP versus Flat were similar. CONCLUSION Post-ROSC head and thorax elevation in a porcine model of cardiac arrest resulted in higher CerPP and lower ICP values, regardless of VF duration or CPR method. IACUC PROTOCOL NUMBER 19-09.
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Affiliation(s)
- Helene Duhem
- University Grenoble Alps/CNRS/CHU Grenoble Alpes/TIMC-IMAG UMR 5525, Grenoble, France
| | - Johanna C Moore
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN, USA; Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | | | - Bayert Salverda
- Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Michael Lick
- Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Paul Pepe
- Dallas County Fire Rescue, Dallas, TX, USA; Palm Beach County Fire Rescue, West Palm Beach, FL and Broward Sheriff's Office, Fire Rescue Department Fort Lauderdale, FL, USA
| | - Jose Labarere
- University Grenoble Alps/CNRS/CHU Grenoble Alpes/TIMC-IMAG UMR 5525, Grenoble, France
| | - Guillaume Debaty
- University Grenoble Alps/CNRS/CHU Grenoble Alpes/TIMC-IMAG UMR 5525, Grenoble, France.
| | - Keith G Lurie
- Hennepin Healthcare Research Institute, Minneapolis, MN, USA; Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA
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Benoit JL, Stolz U, McMullan JT, Wang HE. Duration of exposure to a prehospital advanced airway and neurological outcome for out-of-hospital cardiac arrest: A retrospective cohort study. Resuscitation 2021; 160:59-65. [PMID: 33482266 DOI: 10.1016/j.resuscitation.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/23/2020] [Accepted: 01/07/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) studies have focused on the benefits and harms of placing an intra-arrest advanced airway, but few studies have evaluated the benefits and harms after successful placement. We hypothesize that increased time in the tumultuous prehospital environment after intra-arrest advanced airway placement results in reduced patient survival. METHODS This was a secondary analysis of adult, non-traumatic, OHCA patients with an advanced airway placed in the PRIMED trial. The exposure variable was the time interval between successful advanced airway placement and Emergency Department (ED) arrival. The outcome was cerebral performance category (CPC) 1 or 2 at hospital discharge. Multivariable logistic regression, adjusted for Utstein variables and resuscitation-associated time intervals, was used to estimate adjusted odds ratios (aOR). RESULTS The cohort of complete cases included 4779 patients. The median time exposed to a prehospital advanced airway was 27 min (IQR 20-35). The total prehospital time was 39.4 min (IQR 32.3-48.1). An advanced airway was placed intra-arrest in 3830 cases (80.1%) and post-return of spontaneous circulation (post-ROSC) in 949 cases (19.9%). Overall, 486 (10.2%) of the cohort achieved the CPC outcome, but this was higher in the post-ROSC (21.7%) versus intra-arrest (7.5%) cohort. CPC was not associated with the time interval from advanced airway placement to ED arrival in the intra-arrest airway cohort (aOR 0.98, 95%CI 0.94-1.01). CONCLUSIONS In OHCA patients who receive an intra-arrest advanced airway, longer time intervals exposed to a prehospital advanced airway are not associated with reduced patient survival.
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Affiliation(s)
- Justin L Benoit
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Uwe Stolz
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jason T McMullan
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Henry E Wang
- Department of Emergency Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
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23
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Sanfilippo F, Murabito P, Messina A, Dezio V, Busalacchi D, Ristagno G, Cecconi M, Astuto M. Cerebral regional oxygen saturation during cardiopulmonary resuscitation and return of spontaneous circulation: A systematic review and meta-analysis. Resuscitation 2020; 159:19-27. [PMID: 33333181 DOI: 10.1016/j.resuscitation.2020.12.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/21/2020] [Accepted: 12/01/2020] [Indexed: 12/29/2022]
Abstract
AIM Predicting the return of spontaneous circulation (ROSC) during cardiopulmonary resuscitation in victims of cardiac arrest (CA) remains challenging. Cerebral regional oxygen saturation (rSO2) measured during resuscitation is feasible, and higher initial and overall values seem associated with ROSC. However, these observations were limited to the analysis of few small single-centre studies. There is a growing number of studies evaluating the role of cerebral rSO2 in the prediction of ROSC. METHODS We conducted an updated meta-analysis aimed at investigating the association of initial and overall values of cerebral rSO2 with ROSC after CA. We performed subgroups analyses according to the location of CA and conducted a secondary analysis according to the country where the study was conducted (resuscitation practice varies greatly for out-of-hospital CA). RESULTS We included 17 studies. Higher initial rSO2 values (11 studies, n = 2870, 16.6% achieved ROSC) were associated with ROSC: Mean Difference (MD) -11.54 [95%Confidence Interval (CI)-20.96, -2.12]; p = 0.02 (I2 = 97%). The secondary analysis confirmed this finding when pooling together European and USA studies, but did not for Japanese studies (p = 0.06). One multi-centre Japanese study was an outlier with large influence on 95%CI. Higher overall rSO2 values during resuscitation (9 studies, n = 894, 33.7% achieving ROSC) were associated with ROSC: MD-10.38; [-13.73, -7.03]; p < 0.00001 (I2 = 77%). All studies were conducted in Europe/USA. CONCLUSIONS This updated meta-analysis confirmed the association between higher initial and overall values of cerebral rSO2 and ROSC after CA. However, we found geographical differences, since this association was not present when Japanese studies were analysed separately.
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Affiliation(s)
- Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Catania, Italy.
| | - Paolo Murabito
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Catania, Italy; Department of General Surgery and Medical-Surgical Specialties, Section of Anesthesia and Intensive Care, University of Catania, Catania, Italy; School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, Italy
| | - Antonio Messina
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Veronica Dezio
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, Italy
| | - Diana Busalacchi
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, Italy
| | - Giuseppe Ristagno
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Cecconi
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Marinella Astuto
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Catania, Italy; Department of General Surgery and Medical-Surgical Specialties, Section of Anesthesia and Intensive Care, University of Catania, Catania, Italy; School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, Italy
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24
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Taylor B, Joshi B, Hutchison L, Manivel V. Echocardiography does not prolong peri-shock pause in cardiopulmonary resuscitation using the COACH-RED protocol with non-expert sonographers in simulated cardiac arrest. Resusc Plus 2020; 4:100047. [PMID: 34223322 PMCID: PMC8244492 DOI: 10.1016/j.resplu.2020.100047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Focused echocardiography during peri-shock pause (PSP) can prognosticate and detect reversible causes in cardiac arrest but minimising interruptions to chest compressions improves outcome. The COACH-RED protocol was adapted from the COACHED protocol to systematically incorporate echocardiography into rhythm check without prolonging PSP beyond the recommended 10 s. The primary objective of this study was to test the feasibility of emergency nurses learning to perform all roles in the COACH-RED protocol. PSP duration and change in participant confidence were secondary outcomes. METHODS After an initial two-hour workshop, five ALS-trained nurses were assessed for the correct use of COACH-RED protocol, without critical error, in three simulated cardiac arrest scenarios of four cycles each. Assessments were repeated on days 7 and 35. On day 35, three COACHED scenarios were also assessed for comparison. Participant roles per scenario and cardiac rhythm per cycle were randomised. Participants completed questionnaires on their confidence levels. Sessions were videotaped for accurate measurement of PSP duration and results tabulated for simple comparison. Statistical analysis was not performed due to small sample size. RESULTS There were no critical errors, two minor team-leading errors and two minor echosonography errors. Minor errors occurred in separate scenarios resulting in a 100% pass rate overall by predetermined criteria. Echocardiographic recordings were 100% adequate. Overall median PSP was 9.35 s for COACH-RED and 6.94 s for COACHED. Sub-group analysis of COACH-RED revealed median PSP 10.80 s in shockable rhythms and 8.74 s (∼2 s less) in non-shockable rhythms. Mean participant confidence in performing COACH-RED improved from 1.6 to 4.6, on a 5-point scale. CONCLUSION The COACH-RED protocol can be effectively performed by ALS-trained nurses, in all roles of this protocol, including echocardiography, in a simulated environment, after a single training session. Using this protocol, focused echocardiography does not prolong PSP beyond 10 s.
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Key Words
- ALS, Advanced Life Support
- ARC, Australian Resuscitation Council
- Advanced cardiac life support
- CPR, Cardiopulmonary resuscitation
- Cardiac arrest
- Cardiopulmonary resuscitation
- ED, Emergency Department
- Echocardiography
- Education
- IQR, Interquartile Range
- Nursing
- PEA, Pulseless Electrical Activity
- PSP, Peri-Shock Pause
- SAH, Sydney Adventist Hospital
- Simulation training
- VF, Ventricular Fibrillation
- VT, Ventricular Tachycardia
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Affiliation(s)
- Benjamin Taylor
- Emergency Care, Sydney Adventist Hospital, Wahroonga, NSW 2076, Australia
| | - Bhushan Joshi
- Emergency Care, Sydney Adventist Hospital, Wahroonga, NSW 2076, Australia
| | - Leanne Hutchison
- Emergency Care, Sydney Adventist Hospital, Wahroonga, NSW 2076, Australia
| | - Vijay Manivel
- Emergency Care, Sydney Adventist Hospital, Wahroonga, NSW 2076, Australia
- The University of Sydney, Sydney, NSW 2000, Australia
- Emergency Department, Nepean Hospital, Kingswood, NSW 2747, Australia
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25
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Vanwulpen M, Wolfskeil M, Duchatelet C, Hachimi-Idrissi S. Do manual chest compressions provide substantial ventilation during prehospital cardiopulmonary resuscitation? Am J Emerg Med 2021; 39:129-31. [PMID: 33039236 DOI: 10.1016/j.ajem.2020.09.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/13/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Chest compressions have been suggested to provide passive ventilation during cardiopulmonary resuscitation. Measurements of this passive ventilatory mechanism have only been performed upon arrival of out-of-hospital cardiac arrest patients in the emergency department. Lung and thoracic characteristics rapidly change following cardiac arrest, possibly limiting the effectiveness of this mechanism after prolonged resuscitation efforts. Goal of this study was to quantify passive inspiratory tidal volumes generated by manual chest compression during prehospital cardiopulmonary resuscitation. MATERIALS AND METHODS A flowsensor was used during adult out-of-hospital cardiac arrest cases attended by a prehospital medical team. Adult, endotracheally intubated, non-traumatic cardiac arrest patients were eligible for inclusion. Immediately following intubation, the sensor was connected to the endotracheal tube. The passive inspiratory tidal volumes generated by the first thirty manual chest compressions performed following intubation (without simultaneous manual ventilation) were calculated. RESULTS 10 patients (5 female) were included, median age was 64 years (IQR 56, 77 years). The median compression frequency was 111 compression per minute (IQR 107, 116 compressions per minute). The median compression depth was 5.6 cm (IQR 5.4 cm, 6.1 cm). The median inspiratory tidal volume generated by manual chest compressions was 20 mL (IQR 13, 28 mL). CONCLUSION Using a flowsensor, passive inspiratory tidal volumes generated by manual chest compressions during prehospital cardiopulmonary resuscitation, were quantified. Chest compressions alone appear unable to provide adequate alveolar ventilation during prehospital treatment of cardiac arrest.
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26
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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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27
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Timerman S, Guimarães HP, Rodrigues RDR, Corrêa TD, Schubert DUC, Freitas AP, Neto ÁR, Polastri TF, Vane MF, Couto TB, Brandão ACA, Giannetti NS, Carmona MJC, Timerman T, Hajjar LA, Bacal F, Queiroga M. Recommendations for Cardiopulmonary Resuscitation (CPR) of patients with suspected or confirmed COVID-19. Braz J Anesthesiol 2020:S0104-0014(20)30094-4. [PMID: 32836520 PMCID: PMC7293473 DOI: 10.1016/j.bjane.2020.06.007] [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] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/02/2020] [Indexed: 12/14/2022]
Abstract
The care for patients suffering from cardiopulmonary arrest in a context of a COVID-19 pandemic has particularities that should be highlighted. The following recommendations from the Brazilian Association of Emergency Medicine (ABRAMEDE), the Brazilian Society of Cardiology (SBC) and the Brazilian Association of Intensive Medicine (AMIB) and the Brazilian Society of Anesthesiology (SBA), associations and societies official representatives of specialties affiliated to the Brazilian Medical Association (AMB), aim to guide the various assistant teams, in a context of little solid evidence, maximizing the protection of teams and patients. It is essential to wear full Personal Protective Equipment (PPE) for aerosols during the care of Cardiopulmonary Resuscitation (CPR) and it is imperative to consider and treat the potential causes in these patients, especially hypoxia and arrhythmias caused by changes in the QT interval or myocarditis. The installation of an advanced invasive airway must be obtained early and the use of High Efficiency Particulate Arrestance (HEPA) filters at the interface with the valve bag is mandatory; situations of occurrence of CPR during mechanical ventilation and in a prone position demand peculiarities that are different from the conventional CPR pattern. Faced with the care of a patient diagnosed or suspected of COVID-19, the care follows the national and international protocols and guidelines 2015 ILCOR (International Alliance of Resuscitation Committees), AHA 2019 Guidelines (American Heart Association) and the Update of the Cardiopulmonary Resuscitation and Emergency Care Directive of the Brazilian Society of Cardiology 2019.
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Affiliation(s)
- Sérgio Timerman
- Faculdade de Medicina da Universidade de São Paulo (FMUSP),
Hospital das Clínicas, Instituto do Coração (InCor), Centro de
Treinamento de Emergências Cardiovasculares e Ressuscitação e do Time de
Resposta Rápida, São Paulo, SP, Brazil
- Sociedade Brasileira de Cardiologia, Centro de Treinamento, Rio
de Janeiro, RJ, Brazil
- Universidade de São Paulo (USP), Ciências, São Paulo, SP,
Brazil
| | - Hélio Penna Guimarães
- Universidade de São Paulo (USP), Ciências, São Paulo, SP,
Brazil
- Associação Brasileira de Medicina de Emergência (ABRAMEDE),
Fortaleza, CE, Brazil
- Hospital Israelita Albert Einstein, Departamento de Pacientes
Graves (DPG), São Paulo, SP, Brazil
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de
Medicina, Departamento de Medicina, São Paulo, SP, Brazil
| | - Roseny dos Reis Rodrigues
- Hospital Israelita Albert Einstein, Departamento de Pacientes
Graves (DPG), São Paulo, SP, Brazil
- Universidade de São Paulo (USP), Medicina, São Paulo, SP,
Brazil
| | - Thiago Domingos Corrêa
- Universidade de São Paulo (USP), Ciências, São Paulo, SP,
Brazil
- Hospital Israelita Albert Einstein, Departamento de Pacientes
Graves (DPG), São Paulo, SP, Brazil
| | - Daniel Ujakow Correa Schubert
- Instituto D’Or de Pesquisa e Ensino-RJ, Rio de Janeiro, RJ,
Brazil
- Hospital Estadual Getúlio Vargas, SES-RJ, Emergencista da Sala
Vermelha, Rio de Janeiro, RJ, Brazil
| | - Ana Paula Freitas
- Associação Brasileira de Medicina de Emergência (ABRAMEDE),
Fortaleza, CE, Brazil
- Hospitais Mãe de Deus, Departamento de Emergência, Porto Alegre,
RS, Brazil
- Hospital de Pronto Socorro de Porto Alegre, Residência de
Medicina de Emergência, Porto Alegre, RS, Brazil
- Universidade Federal do Rio Grande do Sul (UFRGS), Ciências
Médicas, Porto Alegre, RS, Brazil
| | - Álvaro Rea Neto
- Associação de Medicina Intensiva Brasileira (AMIB), Comitê de
Medicina Intensiva Cardiológica, São Paulo, SP, Brazil
- Universidade Federal do Paraná (UFPR), Medicina, Curitiba, PR,
Brazil
- Centro de Estudos e Pesquisas em Terapia Intensiva (Cepeti),
Curitiba, PR, Brazil
| | - Thatiane Facholi Polastri
- Faculdade de Medicina da Universidade de São Paulo (FMUSP),
Hospital das Clínicas, Instituto do Coração (InCor), American Heart
Association do Centro de Treinamento de Emergências Cardiovasculares e
Ressuscitação, São Paulo, SP, Brazil
| | - Matheus Fachini Vane
- Universidade de São Paulo (USP), Hospital das Clínicas (HC),
Faculdade de Medicina (FM), São Paulo, SP, Brazil
- Faculdade de Ciências Médicas de São José dos Campos (HUMANITAS),
São José dos Campos, SP, Brazil
| | - Thomaz Bittencourt Couto
- Sociedade Brasileira de Anestesiologia (SBA), Curso Suporte
Avançado de Vida Anestesia (SAVA), Rio de Janeiro, RJ, Brazil
- Sociedade Brasileira de Anestesiologia (SBA), Rio de Janeiro, RJ,
Brazil
- Universidade Estadual Paulista (UNESP), Anestesiologia, Botucatu,
SP, Brazil
- Universidade do Vale do Sapucaí (UNIVÀS), Pouso Alegre, MG,
Brazil
| | - Antonio Carlos Aguiar Brandão
- Universidade de São Paulo (USP), Ciências, São Paulo, SP,
Brazil
- Hospital Israelita Albert Einstein, Centro de Simulação
Realística, São Paulo, SP, Brazil
- Faculdade Israelita de Ciências da Saúde Albert Einstein, São
Paulo, SP, Brazil
- Faculdade de Medicina da Universidade de São Paulo (FMUSP),
Hospital das Clínicas, Instituto da Criança e do Adolescente (ICr), São
Paulo, SP, Brazil
| | - Natali Schiavo Giannetti
- Faculdade de Medicina da Universidade de São Paulo (FMUSP),
Hospital das Clínicas, Instituto do Coração (InCor), Centro de
Treinamento de Emergências Cardiovasculares e Ressuscitação e do Time de
Resposta Rápida, São Paulo, SP, Brazil
| | - Maria José Carvalho Carmona
- Faculdade de Medicina da Universidade de São Paulo (FMUSP),
Hospital das Clínicas, Diretora da Divisão de Anestesiologia do Instituto
Central, São Paulo, SP, Brazil
| | - Thiago Timerman
- Intensivista do Hospital Sancta Maggiore, Cursos BLS e ACLS da
AHA, São Paulo, SP, Brazil
| | - Ludhmila Abrahão Hajjar
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São
Paulo, SP, Brazil
- Sociedade Brasileira de Cardiologia (SBC), Rio de Janeiro, RJ,
Brazil
- Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo,
SP, Brazil
- Instituto do Coração (InCor), São Paulo, SP, Brazil
| | - Fernando Bacal
- Sociedade Brasileira de Cardiologia (SBC), Rio de Janeiro, RJ,
Brazil
- Faculdade de Medicina da Universidade de São Paulo (FMUSP),
Hospital das Clínicas, Instituto do Coração (InCor), Núcleo de
Transplantes, São Paulo, SP, Brazil
| | - Marcelo Queiroga
- Sociedade Brasileira de Cardiologia (SBC), Rio de Janeiro, RJ,
Brazil
- Hospital Alberto Urquiza Wanderley, Departamento de Cardiologia
Intervencionista, João Pessoa, PE, Brazil
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Crowley CP, Salciccioli JD, Kim EY. The association between ACLS guideline deviations and outcomes from in-hospital cardiac arrest. Resuscitation 2020; 153:65-70. [PMID: 32502576 PMCID: PMC7750980 DOI: 10.1016/j.resuscitation.2020.05.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/19/2020] [Accepted: 05/26/2020] [Indexed: 11/15/2022]
Abstract
AIM OF STUDY In hospital cardiac arrests occur at a rate of 1-5 per 1000 admissions and are associated with significant morbidity and mortality. We aimed to investigate the association between deviations from ACLS protocol and patient outcomes. METHODS This retrospective review was conducted at a single academic medical center. Data was collected on patients who suffered cardiac arrest from December 2015-November 2019. Our primary endpoint was return of spontaneous circulation. Secondary endpoints included survival to discharge and discharge with favorable neurological outcomes. RESULTS 108 patients were included, 74 obtained return of spontaneous circulation, and 23 survived to discharge. The median number of deviations from the ACLS protocol per event in ROSC group was 1 (IQR 0-3) compared to 6.5 (IQR 4-12) in non-ROSC group (p < .0001). The probability of obtaining ROSC was 96% with 0-2 deviations per event, 59% with 2-5 deviations per event, and 11% with greater than 6 deviations per event (p < .0001). The median deviation per event in patients who survived to discharge was 0 (IQR 0-1) vs. 3 (IQR 1-6, p < .0001) in those who did not. Lastly, survival to discharge with a favorable neurological outcome may be associated we less deviations per event (p < .006). CONCLUSION Our findings highlight the importance of adherence to the ACLS protocol. We found that deviations from the algorithm are associated with decreased rates of ROSC and survival to discharge. Additionally, higher rates of protocol deviations may be associated with higher rates of neurological impairments after cardiac arrest.
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Affiliation(s)
- Conor P Crowley
- Critical Care Department, Mount Auburn Hospital, 330 Mount Auburn St., Cambridge MA 02138, USA.
| | - Justin D Salciccioli
- Critical Care Department, Mount Auburn Hospital, 330 Mount Auburn St., Cambridge MA 02138, USA
| | - Edy Y Kim
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA
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Frenzel JE, Mackowick M, Gores G, Ramstad M. Measuring health care students' attitudes toward interprofessional learning, perceptions of effectiveness as an interprofessional team member, and competence in managing adult cardiac arrest. Curr Pharm Teach Learn 2019; 11:1178-1183. [PMID: 31783966 DOI: 10.1016/j.cptl.2019.07.011] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 04/27/2019] [Accepted: 07/24/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND PURPOSE Interprofessional education can be used to prepare healthcare graduates for teamwork. Simulations, when used with interprofessional education, create realistic clinical situations that promote teamwork. Faculty assessed changes in pharmacy and nursing students' competence in treating adult cardiac arrest and perceived readiness for interprofessional learning and teamwork. EDUCATIONAL ACTIVITY AND SETTING Eighty-three pharmacy students and 57 nursing students participated in a high fidelity simulation focused on adult cardiac arrest as an expectation of their respective courses. This study took place at a single campus College of Health Professions located at a public land grant institution. FINDINGS The Readiness for Health Care Students for Interprofessional Learning Scale (RIPLS) and Team Skills Scale (TSS) were used to develop a survey administered prepost simulation. A paired t-test indicated statistically significant increases of mean values prepost (p < 0.001) for: teamwork and collaboration, professional identity, team skills, and competence. An independent sample t-test found no differences by gender or degree. DISCUSSION This research supports using simulation in interprofessional education to increase competence and promote changes in attitudes toward interprofessional learning and teamwork. SUMMARY An interprofessional simulation increased student's perceived competence and positively increased perceptions of learning and working with other health profession students.
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Affiliation(s)
- Jeanne E Frenzel
- School of Pharmacy, Department of Pharmacy Practice, NDSU Dept. 2660, North Dakota State University, Fargo, ND 58102, United States..
| | - Margaret Mackowick
- School of Nursing, Department of Nursing, NDSU Dept. 2670, North Dakota State University, Fargo, ND 58102, United States..
| | - Gail Gores
- School of Nursing, Department of Nursing, NDSU Dept. 2670, North Dakota State University, Fargo, ND 58102, United States..
| | - Marsha Ramstad
- School of Nursing, Department of Nursing, NDSU Dept. 2670, North Dakota State University, Fargo, ND 58102, United States..
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Rodriguez-Ruiz E, Martínez-Puga A, Carballo-Fazanes A, Abelairas-Gómez C, Rodríguez-Nuñez A. Two new chest compression methods might challenge the standard in a simulated infant model. Eur J Pediatr 2019; 178:1529-1535. [PMID: 31446464 DOI: 10.1007/s00431-019-03452-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/18/2019] [Accepted: 08/13/2019] [Indexed: 11/29/2022]
Abstract
Paediatric cardiorespiratory arrest is a rare event that requires a fast, quality intervention. High-quality chest compressions are an essential prognostic factor. The aim of this prospective, randomized and crossover study in infant manikin 2-min cardiorespiratory resuscitation scenario is to quantitatively compare the quality of the currently recommended method in infants (two-thumb-encircling hand techniques) with two new methods (the new two-thumb and the knocking-fingers techniques) using a 15:2 compression-to-ventilation ratio. Ten qualified health professionals were recruited. Variables analysed were mean rate and the ratio of compressions in the recommended rate range, mean depth and the ratio of compressions within the depth range recommendations, ratio of compressions with adequate chest release and ratio of compressions performed with the fingers in the correct position. Ratios of correct compressions for depth, rate, chest release and hand position were always above 70% regardless of the technique used. Reached mean depth and mean rate were similar to the 3 techniques. No statistically significant differences were found in any of the variables analysed.Conclusion: In an infant manikin, professionals are able to perform chest compressions with the new techniques with similar quality to that obtained with the standard method. What is Known: • Quality chest compressions are an essential prognostic factor in paediatric cardiorespiratory arrest. • It has been reported poor results when studied cardiorespiratory resuscitation quality in infants applying the recommended methods. What is New: • In a simulated scenario, quality of chest compressions performed with two new techniques (nTTT and KF) is similar to that obtained with the currently recommended method (TTHT).
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Affiliation(s)
- Emilio Rodriguez-Ruiz
- Critical Care and Intensive Care Medicine Department,, Xerencia de Xestión Integrada de Santiago de Compostela, SERGAS, University of Santiago de Compostela, C/Choupana s/n, 15706, Santiago de Compostela, A Coruña, Spain. .,CLINURSID research group of the University of Santiago de Compostela and Life Support and Simulation research group of the Health Research Institute of Santiago (FIDIS), Santiago de Compostela, Spain.
| | - Ainhoa Martínez-Puga
- School of Nursery, University of Santiago de Compostela, 15705, Santiago de Compostela, A Coruña, Spain
| | - Aida Carballo-Fazanes
- CLINURSID research group of the University of Santiago de Compostela and Life Support and Simulation research group of the Health Research Institute of Santiago (FIDIS), Santiago de Compostela, Spain
| | - Cristian Abelairas-Gómez
- CLINURSID research group of the University of Santiago de Compostela and Life Support and Simulation research group of the Health Research Institute of Santiago (FIDIS), Santiago de Compostela, Spain.,School of Education Sciences, University of Santiago de Compostela, 15705, Santiago de Compostela, A Coruña, Spain
| | - Antonio Rodríguez-Nuñez
- CLINURSID research group of the University of Santiago de Compostela and Life Support and Simulation research group of the Health Research Institute of Santiago (FIDIS), Santiago de Compostela, Spain.,Paediatric Intensive Care Unit, University Clinical Hospital of Santiago de Compostela, SERGAS, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.,Maternal and Child Health and Development Research Network SAMID-III, Institute of Health Carlos III, Madrid, Spain
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Dahmen J, Brade M, Gerach C, Glombitza M, Schmitz J, Zeitter S, Steinhausen E. [Successful prehospital emergency thoracotomy after blunt thoracic trauma : Case report and lessons learned]. Unfallchirurg 2019; 121:839-849. [PMID: 29872865 DOI: 10.1007/s00113-018-0516-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The European Resuscitation Council guidelines for resuscitation in patients with traumatic cardiac arrest recommend the immediate treatment of all reversible causes, if necessary even prior to continuous chest compression. In the case of cardiac tamponade immediate emergency thoracotomy should also be considered. OBJECTIVE The authors report the case of a 23-year-old male patient with multiple injuries including blunt thoracic trauma, which caused a witnessed cardiac arrest. He successfully underwent prehospital emergency resuscitative thoracotomy. The lessons learned from this case on internal and external quality measures are discussed in detail. RESULTS After 60 min of technical rescue, extensive trauma life support including intubation, chest decompression and bleeding control was carried out. The cardiovascular insufficiency progressively deteriorated and under the suspicion of a cardiac tamponade a prehospital emergency thoracotomy was carried out. After successful resuscitative thoracotomy and return of spontaneous circulation (ROSC) the patient was airlifted to the next level 1 trauma center for damage control surgery (DCS). The patient could be discharged 59 days after the accident and now 2 years later is living a normal life without neurological or cardiopulmonary limitations. Airway management, chest decompression including resuscitative thoracotomy, fluid resuscitation and blood products were the key components to ensure that the patient achieved ROSC. Advanced Trauma Life Support® as well as structural prerequisites made these measures and good results for the patient possible.
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Affiliation(s)
- Janosch Dahmen
- BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland. .,Luftrettungszentrum CHRISTOPH 9, Großenbaumer Allee 250, 47249, Duisburg, Deutschland. .,Fakultät für Gesundheit, Universität Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Deutschland.
| | - Marko Brade
- BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland.,Luftrettungszentrum CHRISTOPH 9, Großenbaumer Allee 250, 47249, Duisburg, Deutschland
| | - Christian Gerach
- BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland
| | - Martin Glombitza
- BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland
| | - Jan Schmitz
- BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland
| | - Simon Zeitter
- BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland
| | - Eva Steinhausen
- BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland.,Fakultät für Gesundheit, Universität Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Deutschland
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Bharmal MI, Venturini JM, Chua RFM, Sharp WW, Beiser DG, Tabit CE, Hirai T, Rosenberg JR, Friant J, Blair JEA, Paul JD, Nathan S, Shah AP. Cost-utility of extracorporeal cardiopulmonary resuscitation in patients with cardiac arrest. Resuscitation 2019; 136:126-130. [PMID: 30716427 DOI: 10.1016/j.resuscitation.2019.01.027] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/23/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Extracorporeal cardiopulmonary resuscitation (ECPR) is a resource-intensive tool that provides haemodynamic and respiratory support in patients who have suffered cardiac arrest. In this study, we investigated the cost-utility of ECPR (cost/QALY) in cardiac arrest patients treated at our institution. METHODS We performed a retrospective review of patients who received ECPR following cardiac arrest between 2012 and 2018. All medical care-associated charges with ECPR and subsequent hospital admission were recorded. The quality-of-life of survivors was assessed with the Health Utilities Index Mark II. The cost-utility of ECPR was calculated with cost and quality-of-life data. RESULTS ECPR was used in 32 patients (15/32 in-hospital, 47%) with a median age of 55.0 years (IQR 46.3-63.3 years), 59% male and 66% African American. The median duration of ECPR support was 2.1 days (IQR 0.9-3.8 days). Survival to hospital discharge was 16%. The median score of the Health Utilities Index Mark II at discharge for the survivors was 0.44 (IQR 0.32-0.52). The median operating cost for patients undergoing ECMO was $125,683 per patient (IQR $49,751-$206,341 per patient). The calculated cost-utility for ECPR was $56,156/QALY gained. CONCLUSIONS The calculated cost-utility is within the threshold considered cost-effective in the United States (<$150,000/QALY gained). These results are comparable to the cost-effectiveness of heart transplantation for end-stage heart failure. Larger studies are needed to assess the cost-utility of ECPR and to identify whether other factors, such as patient characteristics, affect the cost-utility benefit.
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Affiliation(s)
- Murtaza I Bharmal
- Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL, 60637, United States.
| | - Joseph M Venturini
- Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL, 60637, United States
| | - Rhys F M Chua
- Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL, 60637, United States
| | - Willard W Sharp
- Section of Emergency Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 5068, Chicago, IL, 60637, United States
| | - David G Beiser
- Section of Emergency Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 5068, Chicago, IL, 60637, United States
| | - Corey E Tabit
- Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL, 60637, United States
| | - Taishi Hirai
- Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL, 60637, United States; Department of Cardiology, St Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO, 64111, United States
| | - Jonathan R Rosenberg
- Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL, 60637, United States; Department of Cardiology, NorthShore University Health System, 2650 Ridge Road, Evanston, IL, 60201, United States
| | - Janet Friant
- Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL, 60637, United States
| | - John E A Blair
- Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL, 60637, United States
| | - Jonathan D Paul
- Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL, 60637, United States
| | - Sandeep Nathan
- Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL, 60637, United States
| | - Atman P Shah
- Department of Medicine, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL, 60637, United States
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Holmberg MJ, Moskowitz A, Wiberg S, Grossestreuer AV, Yankama T, Witten L, Perman SM, Donnino MW, Andersen LW. Guideline removal of atropine and survival after adult in-hospital cardiac arrest with a non-shockable rhythm. Resuscitation 2019; 137:69-77. [PMID: 30771452 DOI: 10.1016/j.resuscitation.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/29/2019] [Accepted: 02/01/2019] [Indexed: 10/27/2022]
Abstract
AIM To determine whether the removal of atropine from the 2010 ACLS guidelines for non-shockable cardiac arrests was associated with a change in survival. METHODS Using the Get With The Guidelines®-Resuscitation registry, we included adults with an index in-hospital cardiac arrest between 2006 and 2015. The primary outcome was survival to hospital discharge. Secondary outcomes included return of spontaneous circulation and favorable functional outcome. An interrupted time-series analysis was used to compare survival before (pre-guidelines) and after (post-guidelines) introduction of the 2010 guidelines. A difference-in-difference approach was used to compare the interrupted time-series results between the non-shockable and shockable cohorts to account for guideline changes unrelated to atropine. RESULTS We included 20,499 non-shockable and 3968 shockable cardiac arrests. Patient characteristics were similar between the pre-guidelines and post-guidelines period. Atropine was used for 8653 (87%) non-shockable and 680 (35%) shockable cardiac arrests in the pre-guidelines period and 3643 (35%) non-shockable and 320 (16%) shockable cardiac arrests in the post-guidelines period. The change over time in survival from the pre-guidelines to the post-guidelines period was not significantly different for the non-shockable compared to the shockable cohort (risk difference: 2.0% [95%CI: -0.8, 4.8] per year, p = 0.17). The immediate change in survival after introducing the guidelines was also not different between the cohorts (risk difference: 3.5% [95%CI: -2.6, 9.7], p = 0.26). Results were similar for the secondary outcomes and in multiple sensitivity analyses. CONCLUSIONS The removal of atropine from the 2010 guidelines was not associated with a significant change in survival.
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Affiliation(s)
- Mathias J Holmberg
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Ari Moskowitz
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sebastian Wiberg
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne V Grossestreuer
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Tuyen Yankama
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Lise Witten
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Sarah M Perman
- Department of Emergency Medicine, University of Colorado, Denver, Colorado, USA
| | - Michael W Donnino
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Lars W Andersen
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Intensive Care Medicine, Randers Regional Hospital, Randers, Denmark
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Ranger C, Paradis MR, Morris J, Perron R, Drolet P, Cournoyer A, Paquet J, Robitaille A. Transcutaneous cardiac pacing competency among junior residents undergoing an ACLS course: impact of a modified high fidelity manikin. Adv Simul (Lond) 2018; 3:24. [PMID: 30555721 PMCID: PMC6286521 DOI: 10.1186/s41077-018-0082-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transcutaneous cardiac pacing (TCP) is recommended to treat unstable bradycardia. Simulation might improve familiarity with this low-frequency procedure. Current mannequins fail to reproduce key features of TCP, limiting their usefulness. The objective of this study was to measure the impact of a modified high-fidelity mannequin on the ability of junior residents to achieve six critical tasks for successful TCP. METHODS First-year residents from various postgraduate programs taking an advanced cardiovascular life support (ACLS) course were enrolled two consecutive years (2015 and 2016). Both cohorts received the same standardized course content. An ALS simulator® mannequin was used to demonstrate and practice TCP during the bradycardia workshop of the first cohort (control cohort, 2015) and a modified high-fidelity mannequin that reproduces key features of TCP was used for the second cohort (intervention cohort, 2016). Participants were tested after training with a simulation scenario requiring TCP. Performances were graded based on six critical tasks. The primary outcome was the successful use of TCP, defined as having completed all tasks. RESULTS Eighteen participants in the intervention cohort completed all tasks during the simulation scenario compared to none in the control cohort (36 vs 0%, p < 0.001). Participants in the intervention cohort were more likely to recognize when pacing was inefficient (86 vs 12%), obtain ventricular capture (48 vs 2%), and check for a pulse rate to confirm capture (48 vs 0%). CONCLUSIONS TCP is a difficult skill to master for junior residents. Training using a modified high-fidelity mannequin significantly improved their ability to establish TCP during a simulation scenario.
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Affiliation(s)
- Caroline Ranger
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montréal, Canada
| | - Marie-Rose Paradis
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montréal, Canada
| | - Judy Morris
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montréal, Canada
| | - Roger Perron
- Centre d’apprentissage des attitudes et des habiletés cliniques, Université de Montréal, Montréal, Canada
| | - Pierre Drolet
- Department of Anesthesiology and Centre d’apprentissage des attitudes et habiletés cliniques de l’Université de Montreal (CAAHC), Pavillon Roger-Gaudry, Université de Montréal, 2900, boul. Édouard-Montpetit, 8e étage, local N-805, Montréal, Québec H3T 1J4 Canada
| | - Alexis Cournoyer
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montréal, Canada
| | - Jean Paquet
- Hôpital Sacré-Cœur de Montréal, Montréal, Canada
| | - Arnaud Robitaille
- Department of Anesthesiology and Centre d’apprentissage des attitudes et habiletés cliniques de l’Université de Montreal (CAAHC), Pavillon Roger-Gaudry, Université de Montréal, 2900, boul. Édouard-Montpetit, 8e étage, local N-805, Montréal, Québec H3T 1J4 Canada
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Satty T, Martin-Gill C. Drugs in Out-of-Hospital Cardiac Arrest. Cardiol Clin 2018; 36:357-66. [PMID: 30293602 DOI: 10.1016/j.ccl.2018.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Managing out-of-hospital cardiac arrest involves unique challenges, including delays in the initiation of advanced interventions and a limited number of trained personnel on scene. Recent out-of-hospital randomized controlled trials, systematic reviews, and metaanalyses provide key insights into what interventions are best proven to positively impact patient outcomes from out-of-hospital cardiac arrest. We review the literature on medications used in out-of-hospital cardiac arrest and summarize evidence-based guidelines from the American Heart Association that form the basis for most emergency medical services cardiac arrest protocols across the United States.
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Couper K, Quinn T, Lall R, Devrell A, Orriss B, Seers K, Yeung J, Perkins GD. Mechanical versus manual chest compressions in the treatment of in-hospital cardiac arrest patients in a non-shockable rhythm: a randomised controlled feasibility trial (COMPRESS-RCT). Scand J Trauma Resusc Emerg Med 2018; 26:70. [PMID: 30165909 PMCID: PMC6117876 DOI: 10.1186/s13049-018-0538-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/20/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Mechanical chest compression devices consistently deliver high-quality chest compressions. Small very low-quality studies suggest mechanical devices may be effective as an alternative to manual chest compressions in the treatment of adult in-hospital cardiac arrest patients. The aim of this feasibility trial is to assess the feasibility of conducting an effectiveness trial in this patient population. METHODS COMPRESS-RCT is a multi-centre parallel group feasibility randomised controlled trial, designed to assess the feasibility of undertaking an effectiveness to compare the effect of mechanical chest compressions with manual chest compressions on 30-day survival following in-hospital cardiac arrest. Over approximately two years, 330 adult patients who sustain an in-hospital cardiac arrest and are in a non-shockable rhythm will be randomised in a 3:1 ratio to receive ongoing treatment with a mechanical chest compression device (LUCAS 2/3, Jolife AB/Stryker, Lund, Sweden) or continued manual chest compressions. It is intended that recruitment will occur on a 24/7 basis by the clinical cardiac arrest team. The primary study outcome is the proportion of eligible participants randomised in the study during site operational recruitment hours. Participants will be enrolled using a model of deferred consent, with consent for follow-up sought from patients or their consultee in those that survive the cardiac arrest event. The trial will have an embedded qualitative study, in which we will conduct semi-structured interviews with hospital staff to explore facilitators and barriers to study recruitment. DISCUSSION The findings of COMPRESS-RCT will provide important information about the deliverability of an effectiveness trial to evaluate the effect on 30-day mortality of routine use of mechanical chest compression devices in adult in-hospital cardiac arrest patients. TRIAL REGISTRATION ISRCTN38139840 , date of registration 9th January 2017.
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Affiliation(s)
- Keith Couper
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Tom Quinn
- Emergency, Cardiovascular and Critical Care Research Group, Faculty of Health, Social Care and Education, Kingston University, London and St George’s, University of London, London, UK
| | - Ranjit Lall
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | | | | | - Kate Seers
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Joyce Yeung
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gavin D. Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Abstract
Successful resuscitation from cardiac arrest depends on provision of adequate blood flow to vital organs generated by cardiopulmonary resuscitation (CPR). Measurement of end-tidal expiratory pressure of carbon dioxide (ETCO2) using capnography provides a noninvasive estimate of cardiac output and organ perfusion during cardiac arrest and can therefore be used to monitor the quality of CPR and predict return of spontaneous circulation (ROSC). In clinical observational studies, mean ETCO2 levels in patients with ROSC are higher than those in patients with no ROSC. In prolonged out of hospital cardiac arrest, ETCO2 levels <10 mmHg are consistently associated with a poor outcome, while levels above this threshold have been suggested as a criterion for considering patients for rescue extracorporeal resuscitation. An abrupt rise of ETCO2 during CPR suggests that ROSC has occurred. Finally, detection of CO2 in exhaled air following intubation is the most specific criterion for confirming endotracheal tube placement during CPR. The aetiology of cardiac arrest, variations in ventilation patterns during CPR, and the effects of drugs such as adrenaline or sodium bicarbonate administered as a bolus may significantly affect ETCO2 levels and its clinical significance. While identifying ETCO2 as a useful monitoring tool during resuscitation, current guidelines for advanced life support recommend against using ETCO2 values in isolation for decision making in cardiac arrestmanagement.
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Affiliation(s)
- Claudio Sandroni
- Istituto Anestesiologia e Rianimazione Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Largo Francesco Vito, 1 - 00168 Rome, Italy.
| | - Paolo De Santis
- Istituto Anestesiologia e Rianimazione Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Largo Francesco Vito, 1 - 00168 Rome, Italy
| | - Sonia D'Arrigo
- Istituto Anestesiologia e Rianimazione Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Largo Francesco Vito, 1 - 00168 Rome, Italy
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Lee CH, Huang MY, Lee YK, Hsu CY, Su YC. Implementation of a real-time qualitative app to evaluate resuscitation performance in an Advanced Cardiac Life Support course. Tzu Chi Med J 2018; 30:165-168. [PMID: 30069125 PMCID: PMC6047333 DOI: 10.4103/tcmj.tcmj_103_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: In addition to high-quality chest compression, parameters of resuscitation efficiency such as early chest compression, early defibrillation, and decreased hands-off time are also vital in the Advanced Cardiac Life Support (ACLS) protocol. However, because of limited time and equipment in ACLS courses, efficiency of performance is difficult to evaluate. Materials and Methods: A free, easy-to-use iOS and Android app (CodeTracer®) was developed for real-time recording of cardiopulmonary resuscitation (CPR) performance. Interventions performed during resuscitation were set up as buttons. When the simulated scenario in the ACLS course began, instructors recorded every intervention and the team performed by pushing the appropriate buttons. When the scenario ended, the CodeTracer® automatically computed parameters, including the percentage of no-flow time, time to initiating CPR, and time to initiating defibrillation and also generated a graphic log for later discussion. Results: A total of 76 resuscitation episodes were recorded, 27 in the practice scenarios and 49 in the final Megacode simulations. After the course, the average percentage of no-flow time decreased 5.79%, time to initiating CPR decreased 3.05 s, and time to initiating defibrillation decreased up to 20.27 s. Of note, physicians as leaders seem to have better performance after the ACLS course than before, but the results were insignificant except for the percentage of no-flow time. Conclusions: CodeTracer® can record and calculate objective parameters for resuscitation performance in ACLS courses and can assist instructors in disseminating important concepts to participants. It can be a useful tool in ACLS courses.
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Affiliation(s)
- Chao-Hsiung Lee
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Ming-Yuan Huang
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Yi-Kung Lee
- Department of Emergency, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chen-Yang Hsu
- Department of Public Heath, National Taiwan University, Taipei, Taiwan
| | - Yung-Cheng Su
- Department of Emergency, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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Kim C, Choi HJ, Moon H, Kim G, Lee C, Cho JS, Kim S, Lee K, Choi H, Jeong W. Prehospital advanced cardiac life support by EMT with a smartphone-based direct medical control for nursing home cardiac arrest. Am J Emerg Med 2018; 37:585-589. [PMID: 30001817 DOI: 10.1016/j.ajem.2018.06.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/19/2018] [Accepted: 06/13/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To compare the survival to discharge between nursing home (NH) cardiac arrest patients receiving smartphone-based advanced cardiac life support (SALS) and basic life support (BLS). METHODS The SALS registry includes data on cardiac arrest from 7 urban and suburban areas in Korea between July 2015 and December 2016. We include adult patients (>18) with out-of-hospital cardiac arrest (OHCA) of medical causes and EMS attended and dispatched in. SALS is an advanced field resuscitation including drug administration by paramedics with video communication-based direct medical direction. Prehospital resuscitation method was key exposure (SALS, BLS). The primary outcome was survival to discharge. RESULTS A total of 616 consecutive out-of-hospital cardiopulmonary resuscitation cases in NHs were recorded, and 199 (32.3%) underwent SALS. Among the NH arrest patients, the survival discharge rate was a little higher in the SALS group than the BLS group (4.0% vs 1.7%), but the difference was not significant (P = 0.078). Survival discharge with good neurologic outcome rates was 0.5% in the SALS group and 1.0% in the BLS group (P = 0.119). On the other hand, in the non-NH group, all outcome measures significantly improved when SALS was performed compared to BLS alone (survival discharge rate: 10.0% vs 7.3%, P = 0.001; good neurologic outcome: 6.8% vs 3.3%, P < 0.001). CONCLUSIONS As a result of providing prehospital ACLS with direct medical intervention through remote video calls to paramedics, the survival to discharge rate and that with good neurologic outcome (CPC 1, 2) of non-NH patients significantly improved, however those of NH patients were not significantly increased.
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Affiliation(s)
- Changsun Kim
- Department of Emergency Medicine, Hanyang University Guri Hospital, Republic of Korea
| | - Hyuk Joong Choi
- Department of Emergency Medicine, Hanyang University Guri Hospital, Republic of Korea.
| | - Hyungjun Moon
- Department of Emergency Medicine, Soonchunhyang University Hospital, Cheonan, Republic of Korea
| | - Giwoon Kim
- Department of Emergency Medicine, Soonchunhyang University Hospital, Bucheon, Republic of Korea
| | - Choungah Lee
- Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Republic of Korea
| | - Jin Sung Cho
- Department of Emergency Medicine, Gachon University Gil Medical Center, Republic of Korea
| | - Seongjung Kim
- Department of Emergency Medicine, Chosun University Hospital, Gwangju, Republic of Korea
| | - Kyoungmi Lee
- Department of Emergency Medicine, Myongji Hospital, Republic of Korea
| | - Hanjoo Choi
- Department of Emergency Medicine, Dankook University Hospital, Republic of Korea
| | - Wonjung Jeong
- Department of Emergency Medicine, Catholic University of Korea, St. Vincent's Hospital, Republic of Korea
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Honarmand K, Mepham C, Ainsworth C, Khalid Z. Adherence to advanced cardiovascular life support (ACLS) guidelines during in-hospital cardiac arrest is associated with improved outcomes. Resuscitation 2018; 129:76-81. [PMID: 29885353 DOI: 10.1016/j.resuscitation.2018.06.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 05/26/2018] [Accepted: 06/01/2018] [Indexed: 11/23/2022]
Abstract
AIM OF THE STUDY Identifying modifiable factors associated with survival following in-hospital cardiac arrest is crucial. The purpose of this study was to determine the extent to which adherence to the 2010 American Heart Association (AHA) Advanced Cardiac Life Support (ACLS) guidelines in their entirety affects patient outcomes. In addition, we explored the role of code leader training level on patient outcomes. METHODS We conducted a retrospective review of records for cardiac arrests that occurred on hospital wards and were run by the hospital code team, at three tertiary care centres over 2 to 4 years. Deviations from the ACLS guidelines were quantified using a standardized checklist. Primary outcomes included return of spontaneous circulation (ROSC) and survival to hospital discharge. RESULTS Of 160 resuscitation events, ROSC was achieved in 75 events (46.9%) and survival to hospital discharge in 20 patients (13.1%). On average, there were 2.3 deviations from ACLS guidelines during events that led to ROSC and 3.9 deviations during events that did not lead to ROSC (p < 0.0001). There were fewer deviations during events that led to survival to hospital discharge (2.1) compared to those where the patient did not survive to hospital discharge (3.1; p = 0.016). Code leader training level was not associated with patient outcomes. Multivariable logistic regression analysis confirmed an association between deviations from ACLS guidelines and ROSC, but not for survival to hospital discharge. The latter finding may reflect a very low survival rate. CONCLUSION We found that higher numbers of deviations from ACLS guidelines were associated with a lower likelihood of ROSC and survival to hospital discharge. These findings emphasize the importance of adherence to ACLS guidelines and the need for training healthcare personnel in resuscitation guidelines in order to improve outcomes for victims of in-hospital cardiac arrest.
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Paiva EF, Paxton JH, O’Neil BJ. Data supporting the use of end-tidal carbon dioxide (ETCO2) measurement to guide management of cardiac arrest: A systematic review. Data Brief 2018; 18:1497-1508. [PMID: 29904652 PMCID: PMC5998212 DOI: 10.1016/j.dib.2018.04.075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 12/02/2022] Open
Abstract
The data presented in this article are related to the research article, "The Use of End-Tidal Carbon Dioxide (ETCO2) Measurement to Guide Management of Cardiac Arrest: A Systematic Review" [1]. This article is a systematic review and meta-analysis of existing data on the subject of whether any level of end-tidal carbon dioxide (ETCO2) measured during cardiopulmonary resuscitation (CPR) correlates with return of spontaneous circulation (ROSC) or survival in adult patients experiencing cardiac arrest in any setting. These data are made publicly available to enable critical or extended analyses.
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Affiliation(s)
- Edison F. Paiva
- University of São Paulo School of Medicine, Butantã, São Paulo 03178-200, Brazil
| | - James H. Paxton
- Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Brian J. O’Neil
- Wayne State University School of Medicine, Detroit, MI 48201, USA
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Homma Y, Shiga T, Funakoshi H, Miyazaki D, Sakurai A, Tahara Y, Nagao K, Yonemoto N, Yaguchi A, Morimura N. Association of the time to first epinephrine administration and outcomes in out-of-hospital cardiac arrest: SOS-KANTO 2012 study. Am J Emerg Med 2018; 37:241-248. [PMID: 29804789 DOI: 10.1016/j.ajem.2018.05.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/15/2018] [Accepted: 05/20/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study assessed the association between the timing of first epinephrine administration (EA) and the neurological outcomes following out-of-hospital cardiac arrests (OHCAs) with both initial shockable and non-shockable rhythms. METHODS This was a post-hoc analysis of a multicenter prospective cohort study (SOS-KANTO 2012), which registered OHCA patients in the Kanto region of Japan from January 2012 to March 2013. We included consecutive adult OHCA patients who received epinephrine. The primary result included 1-month favorable neurological outcomes defined as cerebral performance category (CPC) 1 or 2. Secondary results included 1-month survival and return of spontaneous circulation (ROSC) after arrival at the hospital. Multivariable logistic regression analysis determined the association between delay per minute of the time from call to first EA in both pre- or in-hospital settings and outcomes. RESULTS Of the 16,452 patients, 9344 were eligible for our analyses. In univariable analysis, the delay in EA was associated with decreased favorable neurological outcomes only when the initial rhythm was a non-shockable rhythm. In multivariable analyses, delay in EA was associated with decreased ROSC (adjusted odds ratio [OR] for one minute delay, 0.97; 95% confidence interval [CI], 0.96-0.98) and 1-month survival (adjusted OR, 0.95; 95% CI, 0.92-0.97) when the initial rhythm was a non-shockable rhythm, whereas during a shockable rhythm, delay in EA was not associated with decreased ROSC and 1-month survival. CONCLUSIONS While assessing the effectiveness of epinephrine for OHCA, we should consider the time-limited effects of epinephrine. Additionally, consideration of early EA based on the pathophysiology is needed.
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Affiliation(s)
- Yosuke Homma
- Department of Emergency Medicine and Critical Care, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan; Center for Clinical Epidemiology, St. Luke's International University, Tokyo, Japan.
| | - Takashi Shiga
- Department of Emergency Medicine and Critical Care, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan; Department of Emergency Medicine, International University of Health and Welfare, Tokyo, Japan
| | - Hiraku Funakoshi
- Department of Emergency Medicine and Critical Care, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Dai Miyazaki
- Advanced Emergency Medical and Critical Care Center, Japanese Redcross Maebashi Hospital, Gunma, Japan
| | - Atsushi Sakurai
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral and Cardio-vascular Center Hospital, Suita, Osaka, Japan
| | - Ken Nagao
- Cardiovascular Center, Nihon University Surugadai Hospital, Chiyoda-ku, Tokyo, Japan
| | - Naohiro Yonemoto
- Department of Biostatistics, School of Public Health, Kyoto University, Yoshida-konoe, Kyoto, Japan
| | - Arino Yaguchi
- Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Naoto Morimura
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Riessen R, Janssens U, John S, Karagiannidis C, Kluge S. [Organ assist devices in the future : Limits and perspectives]. Med Klin Intensivmed Notfmed 2018; 113:277-283. [PMID: 29632968 DOI: 10.1007/s00063-018-0420-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 03/07/2018] [Indexed: 11/30/2022]
Abstract
In the last decade, extracorporeal organ assist devices (extracorporeal membrane oxygenation [ECMO]) have been increasingly applied to treat the most severe forms of respiratory failure and cardiogenic shock, although the underlying scientific evidence is still limited and the methods carry a high risk of complications despite all technical improvements. The selection of those patients who most benefit from these devices is still a great challenge for intensivists and all other involved disciplines. Besides the severity of the acute organ failure, it is important to thoroughly evaluate etiology and treatment options of the underlying disease, comorbidities, and the functional status of the patients in an interdisciplinary team. This also includes ethical challenges. Because of the complexity of the treatment and the high organizational demands it is reasonable to concentrate ECMO treatments in specifically qualified centers and to promote a comprehensive scientific analysis of the treatment data.
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Affiliation(s)
- R Riessen
- Internistische Intensivstation, Department für Innere Medizin, Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland.
| | - U Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital, Dechant-Deckers-Str. 8, 52249, Eschweiler, Deutschland
| | - S John
- Abteilung Internistische Intensivmedizin, Medizinische Klinik 8, Paracelsus Medizinische Privatuniversität Nürnberg, Klinikum Nürnberg-Süd, Universität Erlangen-Nürnberg, Breslauer Str. 201, 90471, Nürnberg, Deutschland
| | - C Karagiannidis
- ARDS- und ECMO-Zentrum Köln-Merheim, Kliniken der Stadt Köln, Krankenhaus Merheim, Universität Witten/Herdecke, Ostmerheimer Str. 200, 51109, Köln, Deutschland
| | - S Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
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Wollborn J, Ruetten E, Schlueter B, Haberstroh J, Goebel U, Schick MA. Standardized model of porcine resuscitation using a custom-made resuscitation board results in optimal hemodynamic management. Am J Emerg Med 2018; 36:1738-1744. [PMID: 29395757 DOI: 10.1016/j.ajem.2018.01.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 01/15/2023] Open
Abstract
AIM Standardized modeling of cardiac arrest and cardiopulmonary resuscitation (CPR) is crucial to evaluate new treatment options. Experimental porcine models are ideal, closely mimicking human-like physiology. However, anteroposterior chest diameter differs significantly, being larger in pigs and thus poses a challenge to achieve adequate perfusion pressures and consequently hemodynamics during CPR, which are commonly achieved during human resuscitation. The aim was to prove that standardized resuscitation is feasible and renders adequate hemodynamics and perfusion in pigs, using a specifically designed resuscitation board for a pneumatic chest compression device. METHODS AND RESULTS A "porcine-fit" resuscitation board was designed for our experiments to optimally use a pneumatic compression device (LUCAS® II, Physio-Control Inc.), which is widely employed in emergency medicine and ideal in an experimental setting due to its high standardization. Asphyxial cardiac arrest was induced in 10 German hybrid landrace pigs and cardiopulmonary resuscitation was performed according to ERC/AHA 2015 guidelines with mechanical chest compressions. Hemodynamics were measured in the carotid and pulmonary artery. Furthermore, arterial blood gas was drawn to assess oxygenation and tissue perfusion. The custom-designed resuscitation board in combination with the LUCAS® device demonstrated highly sufficient performance regarding hemodynamics during CPR (mean arterial blood pressure, MAP 46 ± 1 mmHg and mean pulmonary artery pressure, mPAP of 36 ± 1 mmHg over the course of CPR). MAP returned to baseline values at 2 h after ROSC (80 ± 4 mmHg), requiring moderate doses of vasopressors. Furthermore, stroke volume and contractility were analyzed using pulse contour analysis (106 ± 3 ml and 1097 ± 22 mmHg/s during CPR). Blood gas analysis revealed CPR-typical changes, normalizing in the due course. Thermodilution parameters did not show persistent intravascular volume shift. CONCLUSION Standardized cardiopulmonary resuscitation is feasible in a porcine model, achieving adequate hemodynamics and consecutive tissue perfusion of consistent quality.
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Affiliation(s)
- Jakob Wollborn
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Germany; Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Eva Ruetten
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Germany; Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Bjoern Schlueter
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Germany; Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Joerg Haberstroh
- Division of Experimental Surgery, Center for Experimental Models and Transgenic Services, Germany; Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Ulrich Goebel
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Germany; Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Martin A Schick
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Germany; Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Pareek M, Parmar V, Badheka J, Lodh N. Study of the impact of training of registered nurses in cardiopulmonary resuscitation in a tertiary care centre on patient mortality. Indian J Anaesth 2018; 62:381-384. [PMID: 29910497 PMCID: PMC5971628 DOI: 10.4103/ija.ija_17_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background and Aims: Nurses should have cardiopulmonary resuscitation (CPR) knowledge and skills to be able to implement effective interventions during in-hospital cardiac arrest. The aim of this descriptive study was to assess mortality impact after nurses' CPR training with pre-CPR training data at our institute. Methods: Training regarding CPR was given to nurses, and CPR mortality 1-year before basic life support (BLS) and advanced cardiac life support (ACLS) training were collected and compared with post-training 1-year CPR mortality. Results: A total of 632 adult patients suffering in-hospital cardiac arrest over the study period. CPR was attempted in 294 patients during the pre-BLS/ACLS training period and in 338 patients in the post-BLS/ACLS training period. In the pre-BLS/ACLS training period, 58 patients (19.7%) had return of spontaneous circulation (ROSC), while during the post-BLS/ACLS training period, 102 patients (30.1%) had ROSC (P = 0.003). Sixteen of the 58 patients (27.5%) who achieved ROSC during the pre-BLS/ACLS training period survived to hospital discharge, compared 54 out of 102 patients (52.9%) in the post-BLS/ACLS training period (P < 0.0001). There was no significant association between either the age or sex with the outcomes in the study. Conclusion: Training nurses in cardiopulmonary resuscitation resulted in a significant improvement in survival to hospital discharge after in-hospital cardiac arrest.
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Affiliation(s)
- Mayureshkumar Pareek
- Department of Anaesthesiology, P. D. U. Government Medical College, Rajkot, Gujarat, India
| | - Vandana Parmar
- Department of Anaesthesiology, P. D. U. Government Medical College, Rajkot, Gujarat, India
| | - Jigisha Badheka
- Department of Anaesthesiology, P. D. U. Government Medical College, Rajkot, Gujarat, India
| | - Nirmalyo Lodh
- Department of Anaesthesiology, P. D. U. Government Medical College, Rajkot, Gujarat, India
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Vindigni SM, Lessing JN, Carlbom DJ. Hospital resuscitation teams: a review of the risks to the healthcare worker. J Intensive Care 2017; 5:59. [PMID: 29046809 PMCID: PMC5637256 DOI: 10.1186/s40560-017-0253-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/03/2017] [Indexed: 11/11/2022] Open
Abstract
Background “Code blue” events and related resuscitation efforts involve multidisciplinary bedside teams that implement specialized interventions aimed at patient revival. Activities include performing effective chest compressions, assessing and restoring a perfusing cardiac rhythm, stabilizing the airway, and treating the underlying cause of the arrest. While the existing critical care literature has appropriately focused on the patient, there has been a dearth of information discussing the various stresses to the healthcare team. This review summarizes the available literature regarding occupational risks to medical emergency teams, characterizes these risks, offers preventive strategies to healthcare workers, and highlights further research needs. Methods We performed a literature search of PubMed for English articles of all types (randomized controlled trials, case-control and cohort studies, case reports and series, editorials and commentaries) through September 22, 2016, discussing potential occupational hazards during resuscitation scenarios. Of the 6266 articles reviewed, 73 relevant articles were included. Results The literature search identified six potential occupational risk categories to members of the resuscitation team—infectious, electrical, musculoskeletal, chemical, irradiative, and psychological. Retrieved articles were reviewed in detail by the authors. Conclusion Overall, we found there is limited evidence detailing the risks to healthcare workers performing resuscitation. We identify these risks and offer potential solutions. There are clearly numerous opportunities for further study in this field.
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Affiliation(s)
- Stephen M Vindigni
- Division of Gastroenterology, Department of Medicine, University of Washington, 1959 NE Pacific Street, Box 356424, Seattle, WA 98195-6424 USA
| | - Juan N Lessing
- Division of General Internal Medicine, Department of Medicine, University of Colorado, 13001 E 17th Place, Aurora, CO 80045 USA
| | - David J Carlbom
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195-6424 USA
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Bhatnagar V, Tandon U, Jinjil K, Dwivedi D, Kiran S, Verma R. Cardiopulmonary Resuscitation: Evaluation of Knowledge, Efficacy, and Retention in Young Doctors Joining Postgraduation Program. Anesth Essays Res 2017; 11:842-846. [PMID: 29284836 PMCID: PMC5735475 DOI: 10.4103/aer.aer_239_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: High-quality cardiopulmonary resuscitation (CPR) and rapid defibrillation the cornerstone for resuscitation from cardiac arrest and increase the incidence of return of spontaneous circulation. Regular CPR training imparted to health-care personnel increases knowledge and helps in skill enhancing. Aims: The aim of this study is to evaluate background knowledge, percentage improvement in the skills, and residual knowledge after a period of 6 months of postgraduate (PG) students as well as the efficacy of the designed teaching program for CPR. Design: The study type was interventional, nonrandomized with end point classification as efficacy study. Study Interventional model was single group assignment. Methods: A questionnaire-based study was conducted on 41 first year PG students. Their educational qualification was Bachelor of Medicine and Bachelor of Surgery. The study was conducted; 3 months after, these PG students joined hospital for their PG studies. The questionnaire designed by the Department of Anesthesiology and Critical Care was given as the pretest (before the CPR training program was initiated), posttest (immediately after the CPR training program was concluded), and residual knowledge test (conducted after 6 months of the CPR training program). After collection of data, a descriptive analysis was performed to evaluate results. Statistical Analysis: Statistical analysis was conducted for determining the test of significance using two-tailed, paired t-test. Results: The average overall score was 25.58 (±5.605) marks out of a maximum of 40 marks in the pretest, i.e., 63.97%. It improved to 33.88 (±3.38) marks in posttest, i.e., 84.74%. After 6 months in the residual knowledge test, the score declined to 26.96 (±6.09) marks, i.e., 67.4%. Conclusion: The CPR training program being conducted was adequately efficacious, but a refresher course after 6 months could help taking the knowledge and skills acquired by our PG students a long way.
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Affiliation(s)
- Vidhu Bhatnagar
- Department of Anaesthesiology and Critical Care, INHS Asvini, Mumbai, Maharashtra, India
| | - Urvashi Tandon
- Department of Anaesthesiology and Critical Care, INHS Asvini, Mumbai, Maharashtra, India
| | - Kavitha Jinjil
- Department of Anaesthesiology and Critical Care, INHS Asvini, Mumbai, Maharashtra, India
| | - Deepak Dwivedi
- Department of Anaesthesiology and Critical Care, INHS Asvini, Mumbai, Maharashtra, India
| | - S Kiran
- Department of Anaesthesiology and Critical Care, INHS Asvini, Mumbai, Maharashtra, India
| | - Rohit Verma
- Department of Anaesthesiology and Critical Care, INHS Asvini, Mumbai, Maharashtra, India
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Hagmann H, Oelmann K, Stangl R, Michels G. Is increased positive end-expiratory pressure the culprit? Autoresuscitation in a 44-year-old man after prolonged cardiopulmonary resuscitation: a case report. J Med Case Rep 2016; 10:364. [PMID: 27998300 PMCID: PMC5175319 DOI: 10.1186/s13256-016-1148-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 11/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The phenomenon of autoresuscitation is rare, yet it is known to most emergency physicians. However, the pathophysiology of the delayed return of spontaneous circulation remains enigmatic. Among other causes hyperinflation of the lungs and excessively high positive end-expiratory pressure have been suggested, but reports including cardiopulmonary monitoring during cardiopulmonary resuscitation are scarce to support this hypothesis. CASE PRESENTATION We report a case of autoresuscitation in a 44-year-old white man after 80 minutes of advanced cardiac life support accompanied by continuous capnometry and repeated evaluation by ultrasound and echocardiography. After prolonged cardiopulmonary resuscitation, refractory electromechanical dissociation on electrocardiogram and ventricular akinesis were recorded. In addition, a precipitous drop in end-tidal partial pressure of carbon dioxide was noted and cardiopulmonary resuscitation was discontinued. Five minutes after withdrawal of all supportive measures his breathing resumed and a perfusing rhythm ensued. CONCLUSIONS Understanding the underlying pathophysiology of autoresuscitation is hampered by a lack of reports including extensive cardiopulmonary monitoring during cardiopulmonary resuscitation in a preclinical setting. In this case, continuous capnometry was combined with repetitive ultrasound evaluation, which ruled out most assumed causes of autoresuscitation. Our observation of a rapid decline in end-tidal partial pressure of carbon dioxide supports the hypothesis of increased intrathoracic pressure. Continuous capnometry can be performed easily during cardiopulmonary resuscitation, also in a preclinical setting. Knowledge of the pathophysiologic mechanisms may lead to facile interventions to be incorporated into cardiopulmonary resuscitation algorithms. A drop in end-tidal partial pressure of carbon dioxide, for example, might prompt disconnection of the ventilation to allow left ventricular filling. Further reports and research on this topic are encouraged.
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Affiliation(s)
- Henning Hagmann
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany. .,Department II of Internal Medicine, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Katrin Oelmann
- Fire Department and Emergency Medical Service Cologne, Cologne, Germany
| | - Robert Stangl
- Fire Department and Emergency Medical Service Cologne, Cologne, Germany
| | - Guido Michels
- Department III of Internal Medicine, Heart Center of the University of Cologne, Cologne, Germany
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Bhardwaj A, Ikeda DJ, Grossestreuer AV, Sheak KR, Delfin G, Layden T, Abella BS, Leary M. Factors associated with re-arrest following initial resuscitation from cardiac arrest. Resuscitation 2016; 111:90-95. [PMID: 27992736 DOI: 10.1016/j.resuscitation.2016.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/06/2016] [Accepted: 12/09/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND To examine patient- and arrest-level factors associated with the incidence of re-arrest in the hospital setting, and to measure the association between re-arrest and survival to discharge. METHODS This work represents a retrospective cohort study of adult patients who were successfully resuscitated from an initial out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (ICHA) of non-traumatic origin at two urban academic medical centers. In this study, re-arrest was defined as loss of a pulse following 20min of sustained return of spontaneous circulation (ROSC). RESULTS Between 01/2005 and 04/2016, 1961 patients achieved ROSC following non-traumatic cardiac arrest. Of those, 471 (24%) experienced at least one re-arrest. In re-arrest patients, the median time from initial ROSC to first re-arrest was 5.4h (IQR: 1.1, 61.8). The distribution of initial rhythms between single- and re-arrest patients did not vary, nor did the median duration of initial arrest. Among 108 re-arrest patients with an initial shockable rhythm, 60 (56%) experienced a shockable re-arrest rhythm. Among 273 with an initial nonshockable rhythm, 31 (11%) experienced a shockable re-arrest rhythm. After adjusting for significant covariates, the incidence of re-arrest was associated with a lower likelihood of survival to discharge (OR: 0.32; 95% CI: 0.24-0.43; p<0.001). CONCLUSIONS Re-arrest is a common complication experienced by cardiac arrest patients that achieve ROSC, and occurs early in the course of their post-arrest care. Moreover, re-arrest is associated with a decreased likelihood of survival to discharge, even after adjustments for relevant covariates.
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Affiliation(s)
- Abhishek Bhardwaj
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA; Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Daniel J Ikeda
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anne V Grossestreuer
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kelsey R Sheak
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gail Delfin
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy Layden
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin S Abella
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marion Leary
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA; School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
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Kim J, Kim K, Callaway CW, Doh K, Choi J, Park J, Jo YH, Lee JH. Dynamic prediction of patient outcomes during ongoing cardiopulmonary resuscitation. Resuscitation 2016; 111:127-133. [PMID: 27658653 DOI: 10.1016/j.resuscitation.2016.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 04/23/2016] [Revised: 09/04/2016] [Accepted: 09/07/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE The probability of the return of spontaneous circulation (ROSC) and subsequent favourable outcomes changes dynamically during advanced cardiac life support (ACLS). We sought to model these changes using time-to-event analysis in out-of-hospital cardiac arrest (OHCA) patients. METHODS Adult (≥18 years old), non-traumatic OHCA patients without prehospital ROSC were included. Utstein variables and initial arterial blood gas measurements were used as predictors. The incidence rate of ROSC during the first 30min of ACLS in the emergency department (ED) was modelled using spline-based parametric survival analysis. Conditional probabilities of subsequent outcomes after ROSC (1-week and 1-month survival and 6-month neurologic recovery) were modelled using multivariable logistic regression. The ROSC and conditional probability models were then combined to estimate the likelihood of achieving ROSC and subsequent outcomes by providing k additional minutes of effort. RESULTS A total of 727 patients were analyzed. The incidence rate of ROSC increased rapidly until the 10th minute of ED ACLS, and it subsequently decreased. The conditional probabilities of subsequent outcomes after ROSC were also dependent on the duration of resuscitation with odds ratios for 1-week and 1-month survival and neurologic recovery of 0.93 (95% CI: 0.90-0.96, p<0.001), 0.93 (0.88-0.97, p=0.001) and 0.93 (0.87-0.99, p=0.031) per 1-min increase, respectively. Calibration testing of the combined models showed good correlation between mean predicted probability and actual prevalence. CONCLUSIONS The probability of ROSC and favourable subsequent outcomes changed according to a multiphasic pattern over the first 30min of ACLS, and modelling of the dynamic changes was feasible.
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Affiliation(s)
- Joonghee Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
| | - Kyuseok Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
| | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh, Iroquois Building, Suite 400 A, 3600 Forbes Avenue, Pittsburgh, PA 15261, United States
| | - Kibbeum Doh
- Medical Device Research and Development Center, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
| | - Jungho Choi
- Department of Emergency Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
| | - Jongdae Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
| | - Jae Hyuk Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
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