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Ioannou A, Kay J, Tomson J. A standardised pathway increases clinicians' confidence and ability to manage implantable cardioverter defibrillator shocks. Am J Emerg Med 2021; 49:434-436. [PMID: 33715906 DOI: 10.1016/j.ajem.2021.02.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 02/28/2021] [Accepted: 02/28/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Adam Ioannou
- Royal Free NHS Foundation Trust, United Kingdom.
| | - Jamie Kay
- Royal Free NHS Foundation Trust, United Kingdom
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Abstract
Atrial fibrillation is the most common sustained arrhythmia encountered in primary care practice and represents a significant burden on the health care system with a higher than expected hospitalization rate from the emergency department. The first goal of therapy is to assess the patient's symptoms and hemodynamic status. There are multiple acute management strategies for atrial fibrillation including heart rate control, immediate direct-current cardioversion, or pharmacologic cardioversion. Given the variety of approaches to acute atrial fibrillation, it is often difficult to consistently provide cost-effectiveness care. The likelihood of spontaneous conversion of acute atrial fibrillation to sinus rhythm is reported to be really high. Although active cardioversion of recent-onset atrial fibrillation is generally considered to be safe, the question arises of whether the strategy of immediate treatment for a condition that is likely to resolve spontaneously is acceptable for hemodynamically stable patients. Based on published data, non-managed acute treatment of atrial fibrillation appears to be cost-saving. The observation of a patient with recent-onset atrial fibrillation in a dedicated unit within the emergency department reduces the need for acute cardioversion in almost two-thirds of the patients, and reduces the median length of stay, without negatively affecting long-term outcome, thus reducing the related health care costs. However, to let these results broadly applicable, defined treatment algorithms and access to prompt follow-up are needed, which may not be practical in all settings.
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Affiliation(s)
- Giovanni Luca Botto
- Department of Electrophysiology and Clinical Arrhythmology, ASST Rhodense, Rho and Garbagnate M.se Hospitals, C.so Europa 250, Rho, 20017, Milan, Italy.
| | - Giovanni Tortora
- Department of Electrophysiology and Clinical Arrhythmology, ASST Rhodense, Rho and Garbagnate M.se Hospitals, C.so Europa 250, Rho, 20017, Milan, Italy
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Abstract
Symptomatic atrial fibrillation (AF) is a common cause of emergency department (ED) referrals. In case of hemodynamic stability, the choice to either perform early cardioversion (pharmacologic or electrical) or to prescribe rate-lowering drugs and differ any attempts to restore sinus rhythm (i.e., wait-and-see approach) has been widely debated. Results of the recent Rate Control versus Electrical Cardioversion Trial 7-Acute Cardioversion versus Wait and See (RACE 7 ACWAS) have been considered a strong argument in favor of the wait-and-see approach. In this debate, we discuss several issues that would support early cardioversion, ranging from patients' satisfaction and costs to concerns about safety. Furthermore, the wait-and-see approach may translate into a missed opportunity to encourage widespread use of a "pill-in-the-pocket" home treatment: this underused option could allow rapid solving of many AF episodes, potentially avoiding future ED referrals. Our opinion is that a delayed cardioversion may introduce unneeded complications in the straightforward management of a common clinical problem. Therefore, early cardioversion should continue to be the preferred option because of its proven efficacy, safety and convenience.
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Affiliation(s)
- Alessandro Capucci
- Cardiology and Arrhythmology Clinic, Marche Polytechic University, University Hospital "Ospedali Riuniti", Ancona, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, Marche Polytechic University, University Hospital "Ospedali Riuniti", Ancona, Italy.
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Goldstein NE, Mather H, McKendrick K, Gelfman LP, Hutchinson MD, Lampert R, Lipman HI, Matlock DD, Strand JJ, Swetz KM, Kalman J, Kutner JS, Pinney S, Morrison RS. Improving Communication in Heart Failure Patient Care. J Am Coll Cardiol 2019; 74:1682-1692. [PMID: 31558252 PMCID: PMC7000126 DOI: 10.1016/j.jacc.2019.07.058] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/01/2019] [Accepted: 07/08/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Although implantable cardioverter-defibrillators (ICDs) reduce sudden death, these patients die of heart failure (HF) or other diseases. To prevent shocks at the end of life, clinicians should discuss deactivating the defibrillation function. OBJECTIVES The purpose of this study was to determine if a clinician-centered teaching intervention and automatic reminders increased ICD deactivation discussions and increased device deactivation. METHODS In this 6-center, single-blinded, cluster-randomized, controlled trial, primary outcomes were proportion of patients: 1) having ICD deactivation discussions; and 2) having the shocking function deactivated. Secondary outcomes included goals of care conversations and advance directive completion. RESULTS A total of 525 subjects were included with advanced HF who had an ICD: 301 intervention and 224 control. At baseline, 52% (n = 272) were not candidates for advanced therapies (i.e., cardiac transplant or mechanical circulatory support). There were no differences in discussions (41 [14%] vs. 26 [12%]) or deactivation (33 [11%] vs. 26 [12%]). In pre-specified subgroup analyses of patients who were not candidates for advanced therapies, the intervention increased deactivation discussions (32 [25%] vs. 16 [11%]; odds ratio: 2.90; p = 0.003). Overall, 99 patients died; there were no differences in conversations or deactivations among decedents. SECONDARY OUTCOMES Among all participants, there was an increase in goals of care conversations (47% intervention vs. 38% control; odds ratio: 1.53; p = 0.04). There were no differences in completion of advance directives. CONCLUSIONS The intervention increased conversations about ICD deactivation and goals of care. HF clinicians were able to apply new communication techniques based on patients' severity of illness. (An Intervention to Improve Implantable Cardioverter-Defibrillator Deactivation Conversations [WISDOM]; NCT01459744).
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Affiliation(s)
- Nathan E Goldstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; James J. Peters Veterans Affairs Medical Center, Bronx, New York.
| | - Harriet Mather
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Karen McKendrick
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Laura P Gelfman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Mathew D Hutchinson
- Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine Tucson, Tucson, Arizona
| | - Rachel Lampert
- Department of Internal Medicine, Section of Cardiology, Yale University School of Medicine, New Haven, Connecticut
| | - Hannah I Lipman
- Hackensack University Medical Center, Hackensack, New Jersey; Hackensack Meridian School of Medicine at Seton Hall, Nutley, New Jersey
| | - Daniel D Matlock
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado; VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, Colorado
| | - Jacob J Strand
- Division of General Internal Medicine, Department of Medicine, Center for Palliative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Keith M Swetz
- Birmingham Veterans Affairs Medical Center, Department of Medicine and UAB Center for Palliative and Supportive Care, University of Alabama Birmingham, Birmingham, Alabama
| | - Jill Kalman
- Lenox Hill Hospital, Northwell Health, New York, New York
| | - Jean S Kutner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Sean Pinney
- Division of Cardiology, Samuel Bronfman Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - R Sean Morrison
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; James J. Peters Veterans Affairs Medical Center, Bronx, New York
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Tampieri A, Cipriano V, Mucci F, Rusconi AM, Lenzi T, Cenni P. Safety of cardioversion in atrial fibrillation lasting less than 48 h without post-procedural anticoagulation in patients at low cardioembolic risk. Intern Emerg Med 2018; 13:87-93. [PMID: 28025766 DOI: 10.1007/s11739-016-1589-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
Abstract
Currently, there is no unified consensus on short-term anticoagulation after cardioversion of atrial fibrillation lasting less than 48 h in low-cardioembolic-risk patients. The aim of this study is to evaluate the rate of transient ischemic attacks, stroke and death in this subset of patients after cardioversion without post-procedural anticoagulation. In a prospective observational study, patients with recent-onset AF undergoing cardioversion attempts in the Emergency Department were evaluated over the past 3 years. Inclusion criteria were conversion to sinus rhythm, low thromboembolic risk defined by a CHA2DS2VASc score of 0-1 points for males (0-2 points for females aged over 65 years), and hospital discharge without anticoagulant treatment. Patients with severe valvular heart disease, underlying systemic causes of AF, and those discharged with anticoagulant therapy were excluded. The main outcomes measured were TIA, stroke and death at thirty days' follow-up after discharge. During the study period, 218 successful cardioversions, obtained both electrically and pharmacologically, were performed on 157 patients. One hundred and eleven patients were males (71%), the mean age was 55.2 years (±standard deviation 10.7), 99 patients (63%) reported a CHA2DS2VASc score of 0, and the remaining 58 (37%) had a risk profile of 1 point. Of these, latter 8 were females (5%) older than 65 years (risk score 2 points). At the thirty days outcome, none of the 150 enrolled patients who completed a follow-up visit has reported TIA or stroke, nor died, in the overall 211 successful cardioversions evaluated. In our study, the rate of thromboembolic events after cardioversion of recent-onset AF of less than 48 h duration, in patients with a 0-1 CHA2DS2VASc risk profile (females 0-2), appeared to be extremely low even in absence of post-procedural anticoagulation. These findings seem to confirm data from previous studies, and suggest that routine post-procedural short-term anticoagulation may be considered as an overtreatment in this very low-risk subset of patients.
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Affiliation(s)
- Andrea Tampieri
- Emergency Department, S.Maria della Scaletta Hospital, via Montericco 4, Imola, 40026, Bologna, Italy.
| | - Valentina Cipriano
- Emergency Department, S.Maria della Scaletta Hospital, via Montericco 4, Imola, 40026, Bologna, Italy
| | - Fabrizio Mucci
- Emergency Department, S.Maria della Scaletta Hospital, via Montericco 4, Imola, 40026, Bologna, Italy
| | | | - Tiziano Lenzi
- Emergency Department, S.Maria della Scaletta Hospital, via Montericco 4, Imola, 40026, Bologna, Italy
| | - Patrizia Cenni
- Emergency Department, S.Maria della Scaletta Hospital, via Montericco 4, Imola, 40026, Bologna, Italy
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Bonora A, Turcato G, Franchi E, Taioli G, Dilda A, Zerman G, Maccagnani A, Pistorelli C, Olivieri O. Efficacy and safety in pharmacological cardioversion of recent-onset atrial fibrillation: a propensity score matching to compare amiodarone vs class IC antiarrhythmic drugs. Intern Emerg Med 2017; 12:853-859. [PMID: 27384766 DOI: 10.1007/s11739-016-1497-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/22/2016] [Indexed: 10/21/2022]
Abstract
The acute management of recent-onset (<48 h) atrial fibrillation (AF) is still debated. Aim of our study was to compare efficacy and safety of intravenously administered class IC antidysrhythmic agents vs amiodarone in a propensity score matched series of patients acutely treated for AF in the emergency department. During a 3-year period, we retrospectively evaluated all episodes of recent-onset (<48 h) AF pharmacologically treated for sinus rhythm restoration in the emergency department. By means of a propensity score matching considering the main statistically different covariates, we selected two accurately matched treatment groups. We analysed the differences between amiodarone and class IC group in terms of efficacy and safety that is conversion to sinus rhythm rates within 12 and 48 h after starting treatment, time to conversion, and adverse drug effects. An overall number of 817 episodes of recent-onset AF were collected (amiodarone group = 406, class IC group = 411). After matching, we obtained 358 episodes equally divided (amiodarone group = 179 and class IC group = 179). Conversion rates within 12 h were 139 (53.1 %) in amiodarone group and 95 (72.6 %) in class IC group (p < 0.05). Median time for cardioversion was 420 min (331.6-508.3 CI 95 %) in amiodarone and 55 min (44.9-65.1 CI 95 %) in class IC group (p < 0.05). The incidence of adverse events in both groups was very low and equally distributed (p = ns). Intravenously administration of class IC agents, when compared with amiodarone, proved to be more rapid and effective, and equally safe in the acute management of recent-onset AF.
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Affiliation(s)
- Antonio Bonora
- Emergency and Intensive Care Department, Azienda Ospedaliera Universitaria Integrata, Piazzale L.A. Scuro, 10, Verona, 37134, Italy.
| | - Gianni Turcato
- Postgraduate School of Emergency Medicine, University of Verona, Piazzale L.A. Scuro, 10, Verona, 37134, Italy
| | - Elena Franchi
- Department of Cardiology, Azienda Ospedaliera Universitaria Integrata, Piazzale L.A. Scuro, 10, Verona, 37134, Italy
| | - Gabriele Taioli
- Postgraduate School of Emergency Medicine, University of Verona, Piazzale L.A. Scuro, 10, Verona, 37134, Italy
| | - Alice Dilda
- Emergency and Intensive Care Department, Azienda Ospedaliera Universitaria Integrata, Piazzale L.A. Scuro, 10, Verona, 37134, Italy
| | - Germana Zerman
- Emergency and Intensive Care Department, Azienda Ospedaliera Universitaria Integrata, Piazzale L.A. Scuro, 10, Verona, 37134, Italy
| | - Antonio Maccagnani
- Emergency and Intensive Care Department, Azienda Ospedaliera Universitaria Integrata, Piazzale L.A. Scuro, 10, Verona, 37134, Italy
| | - Claudio Pistorelli
- Emergency and Intensive Care Department, Azienda Ospedaliera Universitaria Integrata, Piazzale L.A. Scuro, 10, Verona, 37134, Italy
| | - Oliviero Olivieri
- Department of Internal Medicine, Azienda Ospedaliera Universitaria Integrata, Piazzale L.A. Scuro, 10, Verona, 37134, Italy
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Costantino G, Podda GM, Falsetti L, Iannone P, Lages A, Marra AM, Masala M, Reiakvam OM, Savva F, Schovanek J, van Bree S, da Silva Chora IJ, Privitera G, Ragozzino S, von Rotz M, Woittiez L, Davidson C, Montano N. Guidelines on the management of atrial fibrillation in the emergency department: a critical appraisal. Intern Emerg Med 2017; 12:693-703. [PMID: 27905006 DOI: 10.1007/s11739-016-1580-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/19/2016] [Indexed: 01/24/2023]
Abstract
Several guidelines often exist on the same topic, sometimes offering divergent recommendations. For the clinician, it can be difficult to understand the reasons for this divergence and how to select the right recommendations. The aim of this study is to compare different guidelines on the management of atrial fibrillation (AF), and provide practical and affordable advice on its management in the acute setting. A PubMed search was performed in May 2014 to identify the three most recent and cited published guidelines on AF. During the 1-week school of the European School of Internal Medicine, the attending residents were divided in five working groups. The three selected guidelines were compared with five specific questions. The guidelines identified were: the European Society of Cardiology guidelines on AF, the Canadian guidelines on emergency department management of AF, and the American Heart Association guidelines on AF. Twenty-one relevant sub-questions were identified. For five of these, there was no agreement between guidelines; for three, there was partial agreement; for three data were not available (issue not covered by one of the guidelines), while for ten, there was complete agreement. Evidence on the management of AF in the acute setting is largely based on expert opinion rather than clinical trials. While there is broad agreement on the management of the haemodynamically unstable patient and the use of drugs for rate-control strategy, there is less agreement on drug therapy for rhythm control and no agreement on several other topics.
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Affiliation(s)
- Giorgio Costantino
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Dipartimento di Medicina Interna, Allergologia Immunologia Clinica, Università degli Studi di Milano, Via F. Sforza 34, Milan, Italy.
| | - Gian Marco Podda
- Unità di Medicina 3, Dipartimento di medicina Interna, ASST Santi Paolo e Carlo, Milan, Italy
| | - Lorenzo Falsetti
- Medicina Interna Generale e Semintensiva, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Primiano Iannone
- Dipartimento di Emergenza, Ospedale del Tigullio, ASL4 Chiavarese, Lavagna, Genoa, Italy
| | - Ana Lages
- The 22nd European Summer School of Internal Medicine, Muravera, Cagliari, Italy
| | | | - Maristella Masala
- Azienda Ospedaliera Universitaria AOU Sassari Medicina Interna, Sassari, Italy
| | | | - Florentia Savva
- The 22nd European Summer School of Internal Medicine, Muravera, Cagliari, Italy
| | - Jan Schovanek
- The 22nd European Summer School of Internal Medicine, Muravera, Cagliari, Italy
| | - Sjoerd van Bree
- The 22nd European Summer School of Internal Medicine, Muravera, Cagliari, Italy
| | | | - Graziella Privitera
- The 22nd European Summer School of Internal Medicine, Muravera, Cagliari, Italy
| | - Silvio Ragozzino
- The 22nd European Summer School of Internal Medicine, Muravera, Cagliari, Italy
| | - Matthias von Rotz
- The 22nd European Summer School of Internal Medicine, Muravera, Cagliari, Italy
| | - Lycke Woittiez
- The 22nd European Summer School of Internal Medicine, Muravera, Cagliari, Italy
| | | | - Nicola Montano
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Dipartimento di Medicina Interna, Allergologia Immunologia Clinica, Università degli Studi di Milano, Via F. Sforza 34, Milan, Italy
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Varley L, Howard L. BET 2: Trendelenburg position helps to cardiovert patients in SVT back to sinus rhythm. Arch Emerg Med 2017; 34:189-190. [PMID: 28232630 PMCID: PMC5502234 DOI: 10.1136/emermed-2017-206590.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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10
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Rehatschek G, Muench M, Schenk I, Dittrich W, Schewe JC, Dirk C, Hering R. Mechanical LUCAS resuscitation is effective, reduces physical workload and improves mental performance of helicopter teams. Minerva Anestesiol 2016; 82:429-437. [PMID: 26576860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Physical and mental workload during cardiopulmonary resuscitation (CPR) is challenging under extreme working conditions. We hypothesized that the mechanical chest-compression device Lund University Cardiac Assist System (LUCAS) increases the effectiveness of CPR, decreases the physical workload and improves the mental performance of the emergency medical service (EMS) staff during simulated emergency helicopter flights. METHODS During simulated helicopter flights, 12 EMS teams performed manual or LUCAS-CPR on a manikin at random order. Compression depth, rate, overall time of compressions, application of drugs and defibrillation were recorded to test the quality of CPR. Heart rate monitoring of EMS members was used as a surrogate of physical workload. Cognitive performance was evaluated shortly after each flight by a questionnaire and a memory test about medical and extraneous items presented to the teams during the flights. RESULTS Overall times of chest-compressions were similar, compression rate (101.7±9.6/min) was lower and compressions were deeper (3.9±0.2cm) with LUCAS as compared to manual CPR (113.3±19.3/min and 3.7±0.4cm) (P<0.01, respectively). Heart rates of the EMS staff were increased after manual as compared to mechanical CPR (100.1±21.0 vs. 80.4±11.3, P<0.01). Results of the questionnaire (93.6±6.9% vs. 87.0±7.3% correct answers, P<0.01) and memory test (22.4±15.4% vs. 11.3±7.5%, P<0.02) were significantly better after LUCAS resuscitation. Dosing of drugs, application intervals and rate of correct handling of drugs and defibrillation were not different between LUCAS or manual CPR. CONCLUSIONS During simulated helicopter flights LUCAS-CPR improved the efficacy of chest-compressions, was physically less demanding and provided enhanced cognitive performance of the EMS team as compared to manual CPR.
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Affiliation(s)
- Gregor Rehatschek
- Department of Anesthesia, Intensive Care, Emergency and Pain Medicine, Kreiskrankenhaus Mechernich GmbH, Mechernich, Germany -
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Callaway CW, Soar J, Aibiki M, Böttiger BW, Brooks SC, Deakin CD, Donnino MW, Drajer S, Kloeck W, Morley PT, Morrison LJ, Neumar RW, Nicholson TC, Nolan JP, Okada K, O'Neil BJ, Paiva EF, Parr MJ, Wang TL, Witt J. Part 4: Advanced Life Support: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2016; 132:S84-145. [PMID: 26472860 DOI: 10.1161/cir.0000000000000273] [Citation(s) in RCA: 241] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kleinman ME, Brennan EE, Goldberger ZD, Swor RA, Terry M, Bobrow BJ, Gazmuri RJ, Travers AH, Rea T. Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2016; 132:S414-35. [PMID: 26472993 DOI: 10.1161/cir.0000000000000259] [Citation(s) in RCA: 610] [Impact Index Per Article: 76.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Travers AH, Perkins GD, Berg RA, Castren M, Considine J, Escalante R, Gazmuri RJ, Koster RW, Lim SH, Nation KJ, Olasveengen TM, Sakamoto T, Sayre MR, Sierra A, Smyth MA, Stanton D, Vaillancourt C. Part 3: Adult Basic Life Support and Automated External Defibrillation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2016; 132:S51-83. [PMID: 26472859 DOI: 10.1161/cir.0000000000000272] [Citation(s) in RCA: 153] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This review comprises the most extensive literature search and evidence evaluation to date on the most important international BLS interventions, diagnostics, and prognostic factors for cardiac arrest victims. It reemphasizes that the critical lifesaving steps of BLS are (1) prevention, (2) immediate recognition and activation of the emergency response system, (3) early high-quality CPR, and (4) rapid defibrillation for shockable rhythms. Highlights in prevention indicate the rational and judicious deployment of search-and-rescue operations in drowning victims and the importance of education on opioid-associated emergencies. Other 2015 highlights in recognition and activation include the critical role of dispatcher recognition and dispatch-assisted chest compressions, which has been demonstrated in multiple international jurisdictions with consistent improvements in cardiac arrest survival. Similar to the 2010 ILCOR BLS treatment recommendations, the importance of high quality was reemphasized across all measures of CPR quality: rate, depth, recoil, and minimal chest compression pauses, with a universal understanding that we all should be providing chest compressions to all victims of cardiac arrest. This review continued to focus on the interface of BLS sequencing and ensuring high-quality CPR with other important BLS interventions, such as ventilation and defibrillation. In addition, this consensus statement highlights the importance of EMS systems, which employ bundles of care focusing on providing high-quality chest compressions while extricating the patient from the scene to the next level of care. Highlights in defibrillation indicate the global importance of increasing the number of sites with public-access defibrillation programs. Whereas the 2010 ILCOR Consensus on Science provided important direction for the “what” in resuscitation (ie, what to do), the 2015 consensus has begun with the GRADE methodology to provide direction for the quality of resuscitation. We hope that resuscitation councils and other stakeholders will be able to translate this body of knowledge of international consensus statements to build their own effective resuscitation guidelines.
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Link MS, Berkow LC, Kudenchuk PJ, Halperin HR, Hess EP, Moitra VK, Neumar RW, O'Neil BJ, Paxton JH, Silvers SM, White RD, Yannopoulos D, Donnino MW. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2016; 132:S444-64. [PMID: 26472995 DOI: 10.1161/cir.0000000000000261] [Citation(s) in RCA: 794] [Impact Index Per Article: 99.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wilkoff BL, Fauchier L, Stiles MK, Morillo CA, Al-Khatib SM, Almendral J, Aguinaga L, Berger RD, Cuesta A, Daubert JP, Dubner S, Ellenbogen KA, Estes NAM, Fenelon G, Garcia FC, Gasparini M, Haines DE, Healey JS, Hurtwitz JL, Keegan R, Kolb C, Kuck KH, Marinskis G, Martinelli M, Mcguire M, Molina LG, Okumura K, Proclemer A, Russo AM, Singh JP, Swerdlow CD, Teo WS, Uribe W, Viskin S, Wang CC, Zhang S. 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. Europace 2015; 18:159-83. [PMID: 26585598 DOI: 10.1093/europace/euv411] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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de Caen AR, Berg MD, Chameides L, Gooden CK, Hickey RW, Scott HF, Sutton RM, Tijssen JA, Topjian A, van der Jagt ÉW, Schexnayder SM, Samson RA. Part 12: Pediatric Advanced Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015; 132:S526-42. [PMID: 26473000 PMCID: PMC6191296 DOI: 10.1161/cir.0000000000000266] [Citation(s) in RCA: 345] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Zipes DP, Calkins H, Daubert JP, Ellenbogen KA, Field ME, Fisher JD, Fogel RI, Frankel DS, Gupta A, Indik JH, Kusumoto FM, Lindsay BD, Marine JE, Mehta LS, Mendes LA, Miller JM, Munger TM, Sauer WH, Shen WK, Stevenson WG, Su WW, Tracy CM, Tsiperfal A, Williams ES, Halperin JL, Arrighi JA, Awtry EH, Bates ER, Brush JE, Costa S, Daniels L, Desai A, Drachman DE, Fernandes S, Freeman R, Ijioma N, Khan SS, Kuvin JT, Marine JE, McPherson JA, Mendes LA, Sivaram CA, Spicer RL, Wang A, Weitz HH. 2015 ACC/AHA/HRS Advanced Training Statement on Clinical Cardiac Electrophysiology (A Revision of the ACC/AHA 2006 Update of the Clinical Competence Statement on Invasive Electrophysiology Studies, Catheter Ablation, and Cardioversion). Circ Arrhythm Electrophysiol 2015; 8:1522-51. [PMID: 26386016 DOI: 10.1161/hae.0000000000000014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekvål TM, Spaulding C, Van Veldhuisen DJ. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Europace 2015; 17:1601-87. [PMID: 26318695 DOI: 10.1093/europace/euv319] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Abstract
The induction and termination of ventricular fibrillation at the time of defibrillator insertion (defibrillation testing [DT]) has traditionally been an integral component of implantable cardioverter-defibrillator (ICD) implantation. However, over the last 10 years, published series suggested a high rate of first-shock efficacy for clinical ventricular arrhythmias, even if no DT was done. Over the same time, several published reports and series have shown uncommon but serious complications related to DT. Throughout the world, there has been a steady decline in the proportion of patients receiving an ICD who undergo DT, which, in many regions, is less than 50%.
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Affiliation(s)
- Guy Amit
- McMaster University, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada
| | - Jeff S Healey
- McMaster University, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada; Population Health Research Institute, Hamilton Health Sciences, Room C3-121, DBCVSRI Building, General Site, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada.
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Zaremba T, Jakobsen AR, Søgaard M, Thøgersen AM, Riahi S. Radiotherapy in patients with pacemakers and implantable cardioverter defibrillators: a literature review. Europace 2015; 18:479-91. [PMID: 26041870 DOI: 10.1093/europace/euv135] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [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: 03/20/2015] [Accepted: 04/16/2015] [Indexed: 11/14/2022] Open
Abstract
An increasing number of patients with implantable cardiac rhythm devices undergo radiotherapy (RT) for cancer and are thereby exposed to the risk of device failure. Current safety recommendations seem to have limitations by not accounting for the risk of pacemakers and implantable cardioverter defibrillators malfunctioning at low radiation doses. Besides scant knowledge about optimal safety measures, only little is known about the exact prevalence of patients with devices undergoing RT. In this review, we provide a short overview of the principles of RT and present the current evidence on the predictors and mechanisms of device malfunctions during RT. We also summarize practical recommendations from recent publications and from the industry. Strongly associated with beam energy of photon RT, device malfunctions occur at ∼3% of RT courses, posing a substantial issue in clinical practice. Malfunctions described in the literature typically consist of transient software disturbances and only seldom manifest as a permanent damage of the device. Through close cooperation between cardiologists and oncologists, a tailored individualized approach might be necessary in this patient group in waiting time for updated international guidelines in the field.
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Affiliation(s)
- Tomas Zaremba
- Department of Cardiology, Center for Cardiovascular Research, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9000, Denmark
| | - Annette Ross Jakobsen
- Department of Medical Physics, Oncology Department, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9000, Denmark
| | - Mette Søgaard
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N 8200, Denmark
| | - Anna Margrethe Thøgersen
- Department of Cardiology, Center for Cardiovascular Research, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9000, Denmark
| | - Sam Riahi
- Department of Cardiology, Center for Cardiovascular Research, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9000, Denmark Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Sdr. Skovvej 15, Aalborg 9000, Denmark
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Kucmin T, Płowaś-Goral M, Nogalski A. [A brief history of resuscitation - the influence of previous experience on modern techniques and methods]. Pol Merkur Lekarski 2015; 38:123-126. [PMID: 25771524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Cardiopulmonary resuscitation (CPR) is relatively novel branch of medical science, however first descriptions of mouth-to-mouth ventilation are to be found in the Bible and literature is full of descriptions of different resuscitation methods - from flagellation and ventilation with bellows through hanging the victims upside down and compressing the chest in order to stimulate ventilation to rectal fumigation with tobacco smoke. The modern history of CPR starts with Kouwenhoven et al. who in 1960 published a paper regarding heart massage through chest compressions. Shortly after that in 1961Peter Safar presented a paradigm promoting opening the airway, performing rescue breaths and chest compressions. First CPR guidelines were published in 1966. Since that time guidelines were modified and improved numerously by two leading world expert organizations ERC (European Resuscitation Council) and AHA (American Heart Association) and published in a new version every 5 years. Currently 2010 guidelines should be obliged. In this paper authors made an attempt to present history of development of resuscitation techniques and methods and assess the influence of previous lifesaving methods on nowadays technologies, equipment and guidelines which allow to help those women and men whose life is in danger due to sudden cardiac arrest.
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Affiliation(s)
- Tomasz Kucmin
- Chair and Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Poland
| | - Małgorzata Płowaś-Goral
- Chair and Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Poland
| | - Adam Nogalski
- Chair and Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Poland
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Frendl G, Sodickson AC, Chung MK, Waldo AL, Gersh BJ, Tisdale JE, Calkins H, Aranki S, Kaneko T, Cassivi S, Smith SC, Darbar D, Wee JO, Waddell TK, Amar D, Adler D. 2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures. J Thorac Cardiovasc Surg 2014; 148:e153-93. [PMID: 25129609 PMCID: PMC4454633 DOI: 10.1016/j.jtcvs.2014.06.036] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 02/06/2023]
Affiliation(s)
- Gyorgy Frendl
- Department of Anesthesiology, Perioperative Critical Care and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
| | - Alissa C Sodickson
- Department of Anesthesiology, Perioperative Critical Care and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Mina K Chung
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Department of Molecular Cardiology, Lerner Research Institute Cleveland Clinic, Lerner College of Medicine of Case Western Reserve University Cleveland Clinic, Cleveland, Ohio
| | - Albert L Waldo
- Division of Cardiovascular Medicine, Department of Medicine, Case Western Reserve University, Cleveland, Ohio; Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Bernard J Gersh
- Division of Cardiovascular Diseases and Internal Medicine, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minn
| | - James E Tisdale
- Department of Pharmacy Practice, College of Pharmacy, Purdue University and Indiana University School of Medicine, Indianapolis, Ind
| | - Hugh Calkins
- Department of Medicine, Cardiac Arrhythmia Service, Johns Hopkins University, Baltimore, Md
| | - Sary Aranki
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Stephen Cassivi
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minn
| | - Sidney C Smith
- Center for Heart and Vascular Care, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Dawood Darbar
- Division of Cardiovascular Medicine, Department of Medicine, Arrhythmia Service, Vanderbilt University School of Medicine, Nashville, Tenn
| | - Jon O Wee
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Thomas K Waddell
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David Amar
- Memorial Sloan-Kettering Cancer Center, Department of Anesthesiology and Critical Care Medicine, New York, NY
| | - Dale Adler
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
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Vestergård LD, Løfgren B, Krarup NHV, Holm T, Andersen LK. [Data from automated external defibrillators provide important information on the quality of in-hospital resuscitation]. Ugeskr Laeger 2014; 176:V05130275. [PMID: 25293845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
International guidelines recommend monitoring the outcome following in-hospital cardiac arrest. Using data from automatic external defibrillators (AED) prospectively collected during a three-year period in a regional hospital, we evaluated the treatment quality of resuscitation. Time to defibrillation was acceptable, but quality of chest compressions did not comply with current international recommendations. AED use led to a high fraction of time with no chest compressions. Survival to discharge was 11%. Consequently, training in basic and advanced life support of hospital staff has been modified.
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Affiliation(s)
- Lone Due Vestergård
- Hjertemedicinsk Afdeling B, Odense Universitetshospital, Sdr. Boulevard 29, 5000 Odense C.
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Pedersen CT, Kay GN, Kalman J, Borggrefe M, Della-Bella P, Dickfeld T, Dorian P, Huikuri H, Kim YH, Knight B, Marchlinski F, Ross D, Sacher F, Sapp J, Shivkumar K, Soejima K, Tada H, Alexander ME, Triedman JK, Yamada T, Kirchhof P, Lip GYH, Kuck KH, Mont L, Haines D, Indik J, Dimarco J, Exner D, Iesaka Y, Savelieva I. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. Europace 2014; 16:1257-83. [PMID: 25172618 DOI: 10.1093/europace/euu194] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Doctor NE, Yap S, Gan HN, Leong BSH, Goh ES, Chia MYC, Tham LP, Ng YY, Lim SH, Ong MEH. Recognition and treatment of out-of-hospital cardiac arrests by non-emergency ambulance services in Singapore. Ann Acad Med Singap 2013; 42:445-450. [PMID: 24162319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Prompt recognition of cardiac arrest and initiation of cardiopulmonary resuscitation (CPR) and defibrillation is necessary for good outcomes from out-of-hospital cardiac arrest (OHCA). This study aims to describe the recognition and treatment of OHCA in patients conveyed by non-emergency ambulance services (EAS) in Singapore. MATERIALS AND METHODS This is a multi-centre, retrospective chart review, of cases presenting to public emergency departments (EDs), conveyed by non-EAS and found to be in cardiac arrest upon ED arrival. The study was from October 2002 to August 2009. The following variables were examined: ability to recognise cardiac arrest, whether CPR was carried out by the ambulance crew and whether an automated external defibrillator (AED) was applied. RESULTS Eighty-six patients were conveyed by non-EAS and found to be in cardiac arrest upon ED arrival. Mean age was 63 years (SD 21.8), 70.9% were males. A total of 53.5% of arrests occurred in the ambulance while 70.9% were found to be asystolic upon ED arrival. Seven patients had a known terminal illness. Survival to discharge was 3.5%. Cardiac arrest went unrecognised by the ambulance crew in 38 patients (44.2%). CPR was performed in 35 patients (40.7%) of the 86 patients and AED was applied in only 10 patients (11.6%). CONCLUSION We found inadequate recognition and delayed initiation of treatment for OHCA. Possible reasons include a lack of training in patient monitoring and detection of cardiac arrest, lack of CPR training, lack of confidence in performing CPR, lack of AEDs on ambulances and lack of training in their use.
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Affiliation(s)
- Nausheen E Doctor
- Department of Emergency Medicine, Singapore General Hospital, Singapore
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Morrison LJ, Neumar RW, Zimmerman JL, Link MS, Newby LK, McMullan PW, Hoek TV, Halverson CC, Doering L, Peberdy MA, Edelson DP. Strategies for improving survival after in-hospital cardiac arrest in the United States: 2013 consensus recommendations: a consensus statement from the American Heart Association. Circulation 2013; 127:1538-63. [PMID: 23479672 DOI: 10.1161/cir.0b013e31828b2770] [Citation(s) in RCA: 213] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Food and Drug Administration, HHS. Effective date of requirement for premarket approval for an implantable pacemaker pulse generator. Final rule. Fed Regist 2012; 77:37575-6. [PMID: 22730575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The Food and Drug Administration (FDA) is issuing a final rule to require the filing of a premarket approval application (PMA) or a notice of completion of a product development protocol (PDP) for implantable pacemaker pulse generators. The Agency has summarized its findings regarding the degree of risk of illness or injury designed to be eliminated or reduced by requiring this device to meet the statute's approval requirements and the benefits to the public from the use of the devices. This action implements certain statutory requirements.
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O'Shaughnessy MM, Lappin DW, Reddan DN. Sudden cardiac death in dialysis: do current guidelines for implantable cardioverter defibrillator therapy apply to patients with end-stage kidney disease? Semin Dial 2012; 25:272-6. [PMID: 22452711 DOI: 10.1111/j.1525-139x.2012.01067.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Arrhythmic mechanisms account for one in four deaths in end-stage kidney disease. Large-scale randomized controlled trials have demonstrated a mortality benefit from implantable cardioverter defibrillator therapy in carefully selected patient groups at high risk for sudden cardiac death. Unfortunately, patients with end-stage kidney disease were systematically excluded from these trials. Consequently, the applicability of American College of Cardiology (ACC)/American Heart Association (AHA)/Heart Rhythm Society (HRS) guidelines on implantable cardioverter defibrillator therapy to dialysis patients remains uncertain. Observational data suggest that secondary preventative implantable cardioverter defibrillator therapy following resuscitated cardiac arrest prolongs the lives of dialysis patients. This intervention may also offer a survival advantage as a primary preventative strategy in end-stage kidney disease. However, competing risk from co-morbidity can negate any perceived benefit. Device-related complications also negatively impact outcome. The recommendation that primary preventative device implantation be reserved for patients with severely impaired left ventricular function may be excessively restrictive in this high-risk population. Trials of implantable cardioverter defibrillator therapy that include dialysis patients are required to validate existing device eligibility criteria in this unique population. Novel indications for this intervention in dialysis patients should also be identified.
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Wenzel V, Russo SG, Arntz HR, Bahr J, Baubin MA, Böttiger BW, Dirks B, Kreimeier U, Fries M, Eich C. [Comments on the 2010 guidelines on cardiopulmonary resuscitation of the European Resuscitation Council]. Anaesthesist 2011; 59:1105-23. [PMID: 21125214 DOI: 10.1007/s00101-010-1820-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
ADULTS Administer chest compressions (minimum 100/min, minimum 5 cm depth) at a ratio of 30:2 with ventilation (tidal volume 500-600 ml, inspiration time 1 s, F(I)O₂ if possible 1.0). Avoid any interruptions in chest compressions. After every single defibrillation attempt (initially biphasic 120-200 J, monophasic 360 J, subsequently with the respective highest energy), chest compressions are initiated again immediately for 2 min independent of the ECG rhythm. Tracheal intubation is the optimal method for securing the airway during resuscitation but should be performed only by experienced airway management providers. Laryngoscopy is performed during ongoing chest compressions; interruption of chest compressions for a maximum of 10 s to pass the tube through the vocal cords. Supraglottic airway devices are alternatives to tracheal intubation. Drug administration routes for adults and children: first choice i.v., second choice intraosseous (i.o.). Vasopressors: 1 mg epinephrine every 3-5 min i.v. After the third unsuccessful defibrillation amiodarone (300 mg i.v.), repetition (150 mg) possible. Sodium bicarbonate (50 ml 8.4%) only for excessive hyperkaliemia, metabolic acidosis, or intoxication with tricyclic antidepressants. Consider aminophylline (5 mg/kgBW). Thrombolysis during spontaneous circulation only for myocardial infarction or massive pulmonary embolism; during on-going cardiopulmonary resuscitation (CPR) only when indications of massive pulmonary embolism. Active compression-decompression (ACD-CPR) and inspiratory threshold valve (ITV-CPR) are not superior to good standard CPR. CHILDREN Most effective improvement of outcome by prevention of full cardiorespiratory arrest. Basic life support: initially five rescue breaths, followed by chest compressions (100-120/min depth about one third of chest diameter), compression-ventilation ratio 15:2. Foreign body airway obstruction with insufficient cough: alternate back blows and chest compressions (infants), or abdominal compressions (children >1 year). Treatment of potentially reversible causes: ("4 Hs and 4 Ts") hypoxia and hypovolaemia, hypokalaemia and hyperkalaemia, hypothermia, and tension pneumothorax, tamponade, toxic/therapeutic disturbances, thrombosis (coronary/pulmonary). Advanced life support: adrenaline (epinephrine) 10 µg/kgBW i.v. or i.o. every 3-5 min. Defibrillation (4 J/kgBW; monophasic or biphasic) followed by 2 min CPR, then ECG and pulse check. NEWBORNS: Initially inflate the lungs with bag-valve mask ventilation (p(AW) 20-40 cmH₂O). If heart rate remains <60/min, start chest compressions (120 chest compressions/min) and ventilation with a ratio 3:1. Maintain normothermia in preterm babies by covering them with foodgrade plastic wrap or similar. POSTRESUSCITATION PHASE: Early protocol-based intensive care stabilization; initiate mild hypothermia early regardless of initial cardiac rhythm [32-34°C for 12-24 h (adults) or 24 h (children); slow rewarming (<0.5°C/h)]. Consider percutaneous coronary intervention (PCI) in patients with presumed cardiac ischemia. Prediction of CPR outcome is not possible at the scene, determine neurological outcome <72 h after cardiac arrest with somatosensory evoked potentials, biochemical tests and neurological examination. ACUTE CORONARY SYNDROME: Even if only a weak suspicion of an acute coronary syndrome is present, record a prehospital 12-lead ECG. In parallel to pain therapy, administer aspirin (160-325 mg p.o. or i.v.) and clopidogrel (75-600 mg depending on strategy); in ST-elevation myocardial infarction (STEMI) and planned PCI also prasugrel (60 mg p.o.). Antithrombins, such as heparin (60 IU/kgBW, max. 4000 IU), enoxaparin, bivalirudin or fondaparinux depending on the diagnosis (STEMI or non-STEMI-ACS) and the planned therapeutic strategy. In STEMI define reperfusion strategy depending on duration of symptoms until PCI, age and location of infarction. TRAUMA: In severe hemorrhagic shock, definitive control of bleeding is the most important goal. For successful CPR of trauma patients a minimal intravascular volume status and management of hypoxia are essential. Aggressive fluid resuscitation, hyperventilation and excessive ventilation pressure may impair outcome in patients with severe hemorrhagic shock. TRAINING Any CPR training is better than nothing; simplification of contents and processes is the main aim.
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Affiliation(s)
- V Wenzel
- Univ.-Klinik für Anaesthesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
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Sandroni C, Nolan J. ERC 2010 guidelines for adult and pediatric resuscitation: summary of major changes. Minerva Anestesiol 2011; 77:220-226. [PMID: 21368728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The new European Resuscitation Council (ERC) guidelines for cardiopulmonary resuscitation (CPR) published on October 18th, 2010, replace those published in 2005 and are based on the latest International Consensus on CPR Science with Treatment Recommendations (CoSTR). For both adult and pediatric resuscitation, the most important general changes include: the introduction of chest compression-only CPR in primary cardiac arrest as an option for rescuers who are unable or unwilling to perform expired-air ventilation; increased emphasis on uninterrupted, good-quality CPR and minimisation of both pre- and post-shock pauses during defibrillation. For adult resuscitation, the recommended chest compression depth and rate are 5-6 cm and 100-120 compressions per minute, respectively. Both a specific period of CPR before defibrillation during out-of-hospital resuscitation and use of endotracheal route for drug delivery during advanced life support are no longer recommended. During postresuscitation care, inspired oxygen should be titrated to obtain an arterial oxygen saturation of 94-98%, to avoid possible damage from hyperoxemia. In pediatric resuscitation, the role of pulse palpation for the diagnosis of cardiac arrest has been de-emphasised. The compression-to-ventilation ratio depends on the number of rescuers available, and a 30:2 ratio is acceptable even for rescuers with a duty to respond if they are alone. Chest compression depth should be at least 1/3 of the anterior-posterior chest diameter. The use of automated external defibrillators for children under one year of age should be considered.
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Affiliation(s)
- C Sandroni
- Department of Anesthesiology and Intensive Care, Catholic University School of Medicine, Policlinico Universitario "Agostino Gemelli", Rome, Italy.
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Page RL. The AED in resuscitation: it's not just about the shock. Trans Am Clin Climatol Assoc 2011; 122:347-355. [PMID: 21686237 PMCID: PMC3116356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The automated external defibrillator (AED), in combination with effective cardiopulmonary resuscitation (CPR), is a critical part of the American Heart Association's "Chain of survival." Newer guidelines have simplified resuscitation and emphasized the importance of CPR in providing rapid and deep compressions with minimal interruptions; in fact, CPR should resume immediately after the shock given by the AED, without the delay entailed in checking for pulse or rhythm conversion. Our experience with the AED aboard aircraft, showing 40% long-term survival with the AED in ventricular fibrillation, demonstrated the safety and efficacy of the device. Despite this and other reports of successful AED deployment, AEDs are not yet available at all public locations. Prospective research, as undertaken by the Resuscitation Outcomes Consortium, will be the key to future refinements of the guidelines and enhanced survival with use of the AED in sudden cardiac arrest.
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Affiliation(s)
- Richard L Page
- University of Wisconsin School of Medicine and Public Health, Suite 5000, 1685 Highland Ave., Madison, WI 53705-2281, USA.
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Ruda MI. [Acute coronary syndrome: the system of organization of treatment]. Kardiologiia 2011; 51:4-9. [PMID: 21627606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Carrero Cardenal EJ, Bueno Rodríguez A, Fontanals Dotras J, Tercero Machín FJ, Gomar Sancho C. [First-year medical residents' self-assessment of skill in basic life support and automatic external defibrillation]. Rev Esp Anestesiol Reanim 2010; 57:201-208. [PMID: 20499797 DOI: 10.1016/s0034-9356(10)70205-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To determine first-year medical residents' perception of their competence in basic life support (BLS) and the use of automatic external defibrillation (AED). MATERIAL AND METHODS Course in BLS and AED accredited by the European Resuscitation Council with pre- and post-course self-assessment. The post-training questionnaire was administered immediately after the course and 8 months later. The data recorded covered (a) prior training and experience, (b) self-assessment of BLS and AED skills (9 items, scored 1-5), (c) the skill considered most difficult, and (d) satisfaction (13 items, scored 0-10). RESULTS The questionnaire was initially completed by 71 residents; 31 also responded 8 months later. Self-assessment scores improved immediately after the course (P = .0001). Scores had fallen 8 months later (P = .0001) but were still significantly higher than pre-course perception of skill (P = .017). More than 95% of the residents considered themselves to be competent after the course and more than 80% felt competent 8 months later, with the exception of skills in bag-mask ventilation (74.2%) and removal of a foreign body (61.3%). The skill considered most difficult was bag-mask ventilation. Mean (SD) BLS and AED scores for real-life situations were 8.48 (1.33) and 9.19 (0.94), respectively, after the course and 7.32 (1.4) and 7.29 (1.32) at 8 months (P = .0001). Overall satisfaction was high. CONCLUSIONS The residents perceived themselves as competent to give BLS and AED immediately after the course and 8 months after training, although fewer felt as competent at the second assessment. Bag-mask ventilation was considered the most difficult skill.
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Affiliation(s)
- E J Carrero Cardenal
- Servicio de Anestesiologia, Reanimación y Terapéutica del Dolor, Hospital Clinic, Universidad de Barcelona.
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Herlitz J, Aune S, Lindqvist J, Svensson CJ, Svensson L, Oddby E. [Development work can yield better results after cardiac arrest in the hospital. Defibrillation in 3 minutes a goal]. Lakartidningen 2010; 107:506-509. [PMID: 20384060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Johan Herlitz
- Sahlgrenska universitetssjukhuset och Högskolan i Boris.
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Liu Q, Zhou S, Qi S, Zeng G, Ma X, Huang H. [Efficacy and safety of implantable cardioverter defibrillator avoiding routine defibrillation threshold testing]. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2009; 34:1132-1135. [PMID: 19952404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy-defibrillators (CRT-D) avoiding defibrillation threshold (DFT) testing when treating ventricular tachycardia (VT) or ventricular fibrillation (VF). METHODS We analyzed a continuous database of the 21 patients who had avoided DFT during ICD implantation from Oct. 1999 to Aug. 2008. Follow-up data were completed and analyzed in the 21 patients with ICD implantation. RESULTS ICDs were implanted successfully in 17 patients with VT or VF, and CRT-D were implanted successfully in 4 myocardiopathy patients with severe heart failure who avoided DFT during ICD or CRT-D implantation. Eight patients accepted DFT 1 week later, VT or VF was not induced in 3 patients (37.5%). During the mean follow-up of 1 approximately 7 (4.2+/-1.9) years, malignant ventricular arrythmia was recorded in 16 patients. Among them, 89 episodes were successfully terminated by defbrillation (100%), 120 VT events were terminated by the first run of antitachycardia pacing (51.1%) and 22 by low energy cardioversion (59.2%). All patients took antiarrhycardia drugs after ICD or CRT-D implantation. No patient died from malignant ventricular arrythmia during the follow-up. CONCLUSION No application of routine DFT may avoid complications associated with DFT during ICD or CRT-D implantation. ICD or CRT-D implantation may effectively treat fatal ventricular tachyarrhythmias and prevent sudden cardiac death.
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Affiliation(s)
- Qiming Liu
- Department of Cardiology, Central South University, Changsha 410011, China.
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Ho PM, Bradley SM. In a heartbeat: decreasing in-hospital time to defibrillation. Arch Intern Med 2009; 169:1260-1261. [PMID: 19636025 DOI: 10.1001/archinternmed.2009.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Breckwoldt J. [Resuscitation measures often not guideline adherent. What should improve in emergency care? (interview by Dr. Thomas Meissner)]. MMW Fortschr Med 2008; 150:6. [PMID: 18605050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Cairns KJ, Hamilton AJ, Marshall AH, Moore MJ, Adgey AAJ, Kee F. The obstacles to maximising the impact of public access defibrillation: an assessment of the dispatch mechanism for out-of-hospital cardiac arrest. Heart 2008; 94:349-53. [PMID: 17540690 DOI: 10.1136/hrt.2006.109785] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To determine the diagnostic accuracy of advanced medical priority dispatch system (AMPDS) software used to dispatch public access defibrillation first responders to out-of-hospital cardiac arrests (OHCA). DESIGN All true OHCA events in North and West Belfast in 2004 were prospectively collated. This was achieved by a comprehensive search of all manually completed Patient Report Forms compiled by paramedics, together with autopsy reports, death certificates and medical records. The dispatch coding of all emergency calls by AMPDS software was also obtained for the same time period and region, and a comparison was made between these two datasets. SETTING A single urban ambulance control centre in Northern Ireland. POPULATION All 238 individuals with a presumed or actual OHCA in the North and West Belfast Health and Social Services Trust population of 138 591 (2001 Census), as defined by the Utstein Criteria. MAIN OUTCOME MEASURES The accurate dispatch of an emergency ambulance to a true OHCA. RESULTS The sensitivity of the dispatch mechanism for detecting OHCA was 68.9% (115/167, 95% confidence interval (CI) 61.3% to 75.8%). However, the sensitivity for arrests with ventricular fibrillation (VF) was 44.4% (12/27) with sensitivity for witnessed VF of 47.1% (8/17). The positive predictive value was 63.5% (115/181, 95% CI 56.1% to 70.6%). CONCLUSIONS The sensitivity of this dispatch process for cardiac arrest is moderate and will constrain the effectiveness of Public Access Defibrillation (PAD) schemes which utilise it. TRIAL REGISTRATION controlled-trials.com ISRCTN07286796.
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Affiliation(s)
- K J Cairns
- Centre for Statistical Science and Operational Research (CenSSOR), Sir David Bates Building, Queen's University Belfast, UK.
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Haskell SE, Kenney MA, Patel S, Sanddal TL, Altenhofen KL, Sanddal ND, Atkins DL. Awareness of guidelines for use of automated external defibrillators in children within emergency medical services. Resuscitation 2007; 76:354-9. [PMID: 17936491 DOI: 10.1016/j.resuscitation.2007.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2007] [Revised: 08/01/2007] [Accepted: 08/02/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ventricular fibrillation occurs in 10-20% of pediatric cardiac arrests. Survival rates in children with ventricular fibrillation can be as high as 30% when the rhythm is identified and treated promptly. In the last 5 years, recommendations have been made for the use of automated external defibrillators in children between 1 and 8 years of age. OBJECTIVE The goal of this study was to determine the awareness of the ILCOR guidelines and statewide protocols concerning AED use in children ages 1-8 among emergency medical providers after new guideline release. Availability of pediatric capable AED equipment was also assessed. METHODS Surveys were distributed to EMS providers in Iowa and Montana within 1 year of the ILCOR advisory statement in 2003 recommending use of AEDs in children ages 1-8, and again approximately 1 year after the 2005 ILCOR guidelines on cardiopulmonary resuscitation were published. In Iowa, there were concentrated efforts to disseminate information about AED use in children, while there were minimal efforts in Montana. RESULTS Awareness of ILCOR guidelines for use of AEDs in children was low in both states in 2003 (29% in Iowa vs. 9% in Montana, p<0.001). After release of the 2005 guidelines, awareness improved significantly in both states but was still significantly greater in Iowa (83% vs. 60%, p<0.002). In 2003, less than 20% of respondents in both states reported access to pediatric capable AEDs. Availability of pediatric pads and cables increased significantly in 2006 but remained low in Montana (74% in Iowa vs. 37% in Montana, p<0.001). CONCLUSIONS At the present time, publication of new or interim guidelines in the scientific literature alone is insufficient to ensure that new protocols are implemented. An effective and efficient method to disseminate new pediatric out-of-hospital protocols emergency care to become standard of care in a timely matter must be developed.
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Affiliation(s)
- Sarah E Haskell
- University of Iowa Children's Hospital, Department of Pediatrics, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, United States
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Singh S. PALS update 2005. Indian Pediatr 2007; 44:691-693. [PMID: 17921559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Many of the changes in BLS recommended in 2005 Guidelines are designed to simplify CPR recommendations, increase the number and quality of chest compressions delivered, and increase the number of uninterrupted chest compressions. The recommendations for compressions have been summarized as, "Push harder, push faster, allow the chest to fully recoil, and stop only to use a bag mask to ventilate the patient, analyze the rhythm, deliver a shock or intubate. When such an interruption to compressions occurs, keep the length of that interruption to an absolute minimum. For lay rescuers, a single compression-ventilation ratio (30:2) for all age groups greatly simplifies the instructions for performing CPR. Recommendation of 1 Shock plus Immediate CPR for Attempted Defibrillation for cardiac arrest associated with VF or pulseless VT. Rescuers should not interrupt chest compressions to check circulation until about 5 cycles or approximately 2 minutes of CPR have been provided after the shock. The changes are designed to minimize interruptions in chest compressions. For Neonatal resuscitation, additional evidence was available about the use of oxygen versus room air for resuscitation, the need for clearing the airway of meconium, methods of assisting ventilation, techniques for confirming endotracheal tube placement, and use of the laryngeal mask airway (LMA).
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Mols P, Claessens B. [Adult cardio-respiratory arrest: guidelines 2005-2010]. Rev Med Brux 2007; 28:227-231. [PMID: 17958014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
At the end of 2005 the new guidelines for the treatment of cardiac arrest were published. The diagnostic criteria of cardiac arrest were simplified and priority is given to thoracic compressions. The ratio of thoracic compressions to insufflations is 30/2. The frequency of thoracic compression is 100/min. In ventricular tachycardia (VT) without pulse or in ventricle fibrillation (VF), defibrillation is attempted with a single external electric shock per cycle. The reanimation cycles are divided in periods of 2 minutes. The two drugs, used to treat VF and VT without pulse, are amiodarone and adrenaline. Adrenaline is not given before the fourth minute into the reanimation and it is administered before the third electrical external shock. In case of asystole or pulse less electrical activity adrenaline is administered as early as possible. Atropine is used in case of pulse less electrical activity with a ventricular response lower than 60/min. In advanced life support a priority is given to whether or not there are treatable secondary causes (4H, 4T), furthermore controlled hypothermia is installed when systemic circulation is restored and optimal support to all vital functions is given.
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Affiliation(s)
- P Mols
- Service des Urgences et du SMUR, C.H.U. Saint-Pierre, Bruxelles
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Fus AM, Kim MH, Haw JM, Trohman RG, Stephan E. A written policy increases compliance with guidelines for therapeutic anticoagulation prior to elective direct current cardioversion of atrial fibrillation. J Cardiovasc Nurs 2007; 22:417-21. [PMID: 17724424 DOI: 10.1097/01.jcn.0000287039.30810.2e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Therapeutic anticoagulation before elective direct current cardioversion (DCC) of atrial fibrillation reduces the risk of embolic stroke. Direct current cardioversion is performed by a variety of practitioners, and variable adherence to preprocedural anticoagulation guidelines is common. OBJECTIVE We assessed the impact of a written policy on guideline compliance. METHODS : Anticoagulation status and transesophageal echocardiogram (TEE) results were reviewed in 55 patients (32 men/23 women; ages 18-83 years) who underwent elective DCC during the 6-month period before a written anticoagulation policy was sent to physicians who perform, prepare, or refer patients for this procedure. The nurse assigned to each DCC was responsible for documenting anticoagulation status. In accordance with guidelines, therapeutic anticoagulation was defined as a normalized ratio range > or = 2.0 for at least 3 weeks or a negative TEE with a normalized ratio range > or = 2.0 or a partial thromboplastin time > 50 seconds at the time of DCC. Immediately after policy implementation, anticoagulation status and TEE results were reviewed in 53 patients (42 men/11 women; ages 21-84 years) and 1 year post-policy implementation. RESULTS Before policy implementation, 14 of 52 patients (27%) had DCC performed without adequate anticoagulation or a negative TEE. Immediately postimplementation, only 2 of 50 patients (4%) had DCC performed without adequate anticoagulation or a negative TEE (P = .002). One year post-policy implementation, only 4 of 48 patients (8%) had DCC performed without adequate anticoagulation or a negative TEE (P = .03). CONCLUSIONS Implementing a written policy greatly reduces the number of patients undergoing DCC without adequate anticoagulation or a negative TEE. The impact of this intervention was quickly demonstrable and persisted during follow-up. Supplementing published recommendations with guideline-driven policies may reduce variations in clinical practice and improve quality of care.
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Affiliation(s)
- Allison M Fus
- Rush University Medical Center, Chicago, IL 60612, USA.
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Bird S, Petley GW, Deakin CD, Clewlow F. Defibrillation during renal dialysis: A survey of UK practice and procedural recommendations. Resuscitation 2007; 73:347-53. [PMID: 17291670 DOI: 10.1016/j.resuscitation.2006.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Revised: 10/08/2006] [Accepted: 10/20/2006] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Defibrillation of patients connected to medical equipment that is not defibrillation proof risks ineffective defibrillation and harm to the operator as a result of aberrant electrical pathways taken by the defibrillation current. Many renal dialysis systems are not currently defibrillation proof. Although national and international safety standards caution against defibrillating under this circumstance, it appears to be an area of confusion that we have investigated in more detail. METHODS Thirty renal dialysis units across the UK were invited to participate in a telephone survey of current practice from 1 October 2004 to 1 October 2005. The Medical Healthcare Regulatory Agency and renal dialysis machine manufacturers were contacted for advice, and current safety standards were reviewed. RESULTS Twenty-eight renal dialysis units completed the survey. Seven (25%) units would not disconnect patients from dialysis equipment during defibrillation, collectively reporting 14 patients who had required defibrillation during dialysis. Eighteen (64.3%) units would disconnect patients from dialysis equipment during defibrillation, collectively reporting 29 patients who had required defibrillation during dialysis. No complications were identified by this survey, through the MHRA or through a literature search. CONCLUSION Defibrillation of patients while undergoing renal dialysis is common practice in the UK. Although no adverse events have been reported, this practice risks injury to the patient and clinical staff, and equipment damage if the dialysis equipment is not defibrillation proof. It is in breach of national and international safety standards and should not be practiced.
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Affiliation(s)
- Scott Bird
- Shackleton Department of Anaesthetics, Southampton University Hospital N.H.S. Trust, Tremona Road, Southampton SO16 6YD, UK
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Er F, Erdmann E. Die Elektrokardioversion. Dtsch Med Wochenschr 2007; 132:759-61. [PMID: 17393351 DOI: 10.1055/s-2007-973616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- F Er
- Klinik III für Innere Medizin der Universität zu Köln, 50937 Köln.
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Abstract
INTRODUCTION A failed near-threshold defibrillation shock is followed by an isoelectric window (IEW) and rapid repetitive responses that reinitiate ventricular fibrillation (VF). We hypothesized that properly timed (synchronized) postshock pacing stimuli (SyncP) may capture the recovered tissues during the repetitive responses and prevent postshock reinitiation of VF, resulting in improved defibrillation efficacy. METHODS AND RESULTS We explored the effect of postshock SyncP on defibrillation efficacy in isolated rabbit hearts (n = 12). Optical recording-guided real-time detection and electrical stimulation (5 mA) of recovered tissues in anterior/posterior left ventricle (LV) were performed following IEW. The IEW duration was found to be 69 +/- 13 ms. With the same shock strength, successful and failed defibrillation episodes were associated with 50% and 15% of the myocardium, respectively, captured by the SyncP (P < 0.001). Electrical stimulation from the posterior LV resulted in 75% of episodes capturing myocardium, as compared with anterior LV stimulation (55%; P < 0.01) and higher successful defibrillation rate (14%, posterior vs. 3%, anterior LV). The overall success in terminating VF by postshock SyncP was approximately 10%. The causes for failed myocardium capture by postshock SyncP included lack of IEW after low-strength shock (42.9%), incorrect locations of reference site (25.7%) and pacing electrodes (17.9%), and others, such as wave breakthroughs (13.5%). CONCLUSION Postshock SyncP was feasible and the larger the myocardium captured area, the more likely was the successful defibrillation. Postshock SyncP delivered to the posterior LV was more effective than anterior LV to terminate VF.
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Affiliation(s)
- Liang Tang
- Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center and David Geffen School of Medicine, UCLA, Los Angeles, California 90048, USA
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Beckers SK, Fries M, Bickenbach J, Skorning MH, Derwall M, Kuhlen R, Rossaint R. Retention of skills in medical students following minimal theoretical instructions on semi and fully automated external defibrillators. Resuscitation 2007; 72:444-50. [PMID: 17188417 DOI: 10.1016/j.resuscitation.2006.08.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2006] [Revised: 07/21/2006] [Accepted: 08/01/2006] [Indexed: 11/29/2022]
Abstract
AIM OF THE STUDY There is consent that the use of automated external defibrillators (AED) by laypersons improves survival rates in case of cardiac arrest, but no evident consensus exists on the content and duration of training for this purpose. Acceptance of the implementation of Public Access Defibrillation programmes will depend on practical and target-oriented training concepts. The aim of this prospective randomised interventional study was to evaluate long-term effects of a specific, minimal training programme on using semiautomatic and fully automatic AEDs in simulated cardiac arrest. MATERIALS AND METHODS In a mock cardiac arrest scenario 59 medical students with no specific previous medical education were tested during their first semester at medical school. Students who passed any medical emergency training were excluded. The subjects were evaluated before and after attending specified instructions of 15 min duration and after a period of 6 months. Main end points were time to first shock, electrode-positioning and safety throughout the procedure. RESULTS Mean time to first shock without prior instructions was 77.7+/-17.05 s. After instruction there was a significant improvement to 56.5+/-9.5 s (p<or=0.01) and after 6 months this time had only slightly elongated (59.9+/-8.9 s; p<or=0.01). Initially, correct electrode placement was observed in 84.4%. No difference was found immediately and 6 months after instructions (93.2% and 98.3%). All individuals performed safely. CONCLUSION First year medical students with minimal instruction are able to use semiautomatic as well as fully automatic AED sufficiently fast and safe without prior training. A significant improvement in time to first shock can be detected up to 6 months after receiving non-specific instructions of 15 min duration.
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Affiliation(s)
- Stefan K Beckers
- Department of Anaesthesiology, University Hospital Aachen, Germany.
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Lexow K, Sunde K. Why Norwegian 2005 guidelines differs slightly from the ERC guidelines. Resuscitation 2007; 72:490-2. [PMID: 17161898 DOI: 10.1016/j.resuscitation.2006.07.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Revised: 07/28/2006] [Accepted: 07/28/2006] [Indexed: 11/29/2022]
Affiliation(s)
- Kristian Lexow
- Division of Acute Care Medicine, Stavanger University Hospital, Stavanger, Norway
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