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Pubblicazioni recenti - cardiac arrest
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Effect of Face-to-Face vs Virtual Reality Training on Cardiopulmonary Resuscitation Quality: A Randomized Clinical Trial.
JAMA Cardiol2019 Nov;():. doi: 10.1001/jamacardio.2019.4992.
Nas Joris, Thannhauser Jos, Vart Priya, van Geuns Robert-Jan, Muijsers Hella E C, Mol Jan-Quinten, Aarts Goaris W A, Konijnenberg Lara S F, Gommans D H Frank, Ahoud-Schoenmakers Sandra G A M, Vos Jacqueline L, van Royen Niels, Bonnes Judith L, Brouwer Marc A,
Abstract
Importance:
Bystander cardiopulmonary resuscitation (CPR) is crucial for survival after cardiac arrest but not performed in most cases. New, low-cost, and easily accessible training methods, such as virtual reality (VR), may reach broader target populations, but data on achieved CPR skills are lacking.
Objective:
To compare CPR quality between VR and face-to-face CPR training.
Design, Setting, and Participants:
Randomized noninferiority trial with a prospective randomized open blinded end point design. Participants were adult attendees from the science section of the Lowlands Music Festival (August 16 to 18, 2019) in the Netherlands. Analysis began September 2019.
Interventions:
Two standardized 20-minute protocols on CPR and automated external defibrillator use: instructor-led face-to-face training or VR training using a smartphone app endorsed by the Resuscitation Council (United Kingdom).
Main Outcomes and Measures:
During a standardized CPR scenario following the training, we assessed the primary outcome CPR quality, measured as chest compression depth and rate using CPR manikins. Overall CPR performance was assessed by examiners, blinded for study groups, using a European Resuscitation Council-endorsed checklist (maximum score, 13). Additional secondary outcomes were chest compression fraction, proportions of participants with mean depth (50 mm-60 mm) or rate (100 min-1-120 min-1) within guideline ranges, and proportions compressions with full release.
Results:
A total of 381 participants were randomized: 216 women (57%); median (interquartile range [IQR]) age, 26 (22-31) years. The VR app (n?=?190 [49.9%]) was inferior to face-to-face training (n?=?191 [50.1%]) for chest compression depth (mean [SD], VR: 49?[10] mm vs face to face: 57?[5] mm; mean [95% CI] difference, -8 [-9 to -6] mm), and noninferior for chest compression rate (mean [SD]: VR: 114 [12] min-1 vs face to face: 109 [12] min-1; mean [95% CI] difference, 6 [3 to 8] min-1). The VR group had lower overall CPR performance scores (median [IQR], 10 [8-12] vs 12 [12-13]; P?
Conclusions and Relevance:
In this randomized noninferiority trial, VR training resulted in comparable chest compression rate but inferior compression depth compared with face-to-face training. Given the potential of VR training to reach a larger target population, further development is needed to achieve the compression depth and overall CPR skills acquired by face-to-face training.
Trial Registration:
ClinicalTrials.gov identifier: NCT04013633.
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Successful cardiopulmonary resuscitation following minimally invasive pectus excavatum repair: A case report.
Int J Surg Case Rep2019 Oct;65():255-258. doi: S2210-2612(19)30601-7.
Glithero Kyle J, Tackett John J, DeMason Kenneth, Burnweit Cathy A,
Abstract
INTRODUCTION:
Pectus excavatum is the most common congenital chest wall deformity. The minimally invasive repair of pectus excavatum (MIRPE) is the most commonly practiced method of surgical treatment and there is concern that the pectus bar will prevent effective CPR. There are no recorded cases of successful cardiopulmonary resuscitation with pectus bars in place.
PRESENTATION OF CASE:
A 17-year-old male with pectus excavatum underwent MIRPE. Two years later, he experienced out-of-hospital cardiac arrest and underwent successful cardiopulmonary resuscitation (CPR) in the field with a pectus bar in place.
DISCUSSION:
Successful CPR is possible after MIRPE. Clear identification of patients who have undergone MIRPE and education of CPR providers in providing effective chest compressions and defibrillation for this patient population is necessary.
CONCLUSION:
This is the first documented case of successful CPR in a patient with a pectus bar in place who experienced out-of-hospital cardiac arrest.
Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.
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Cyclooxygenase inhibition prior to ventricular fibrillation induced ischemia reperfusion injury impairs survival and outcomes.
Med Hypotheses2019 Nov;135():109485. doi: S0306-9877(19)30933-8.
Adams Jose A, Uryash Arkady, Lopez Jose R,
Abstract
Nonsteroidal anti-inflammatory medications (NSAIDs) are one of the most commonly used analgesics in the world. NSAIDs decrease prostaglandin synthesis through cyclooxygenase inhibition (COX-1 or COX-2). The effects of NSAIDs on survival and outcomes from global ischemia reperfusion events and specifically from cardiac arrest (CA) remain controversial. We hypothesized that NSAIDs prior to global whole-body ischemia reperfusion (I/R) injury impairs survival and outcomes. We explored this hypothesis in our swine model of Cardiac Arrest (CA) which involves global I/R with pretreatment using a predominantly COX-1 inhibitor (Indomethacin [COX-1/min COX-2 Inh], a COX-2 Inhibitor [COX-2-Inh, (Celecoxib)] or placebo control. We determined the effects of each inhibitor on a) survival, b) myocardial injury biomarker (Troponin 1), and c) Autonomic Nervous System (ANS) injury marker (heart rate variability [HRV]) up to 3?h after resuscitation. There were no survivals in COX-1/min COX-2-Inh pretreated animals and, 87% survived in both COX-2 Inhibited and control animals. COX-2 Inh pretreated animals had an 1800 fold increase of Troponin 1 compared to baseline whereas control animals had a 90 fold increase (p?
Copyright © 2019 Elsevier Ltd. All rights reserved.
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2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.
Resuscitation2019 Oct;():. doi: S0300-9572(19)30665-3.
Soar Jasmeet,
Abstract
The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the most recent published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. This summary addresses the role of cardiac arrest centers and dispatcher-assisted cardiopulmonary resuscitation, the role of extracorporeal cardiopulmonary resuscitation in adults and children, vasopressors in adults, advanced airway interventions in adults and children, targeted temperature management in children after cardiac arrest, initial oxygen concentration during resuscitation of newborns, and interventions for presyncope by first aid providers. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the certainty of the evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence to Decision Framework Highlights sections. The task forces also listed priority knowledge gaps for further research.
Copyright © 2019. Published by Elsevier B.V.
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Pediatric In-Hospital CPR Quality at Night and on Weekends.
Resuscitation2019 Nov;():. doi: S0300-9572(19)30693-8.
Esangbedo Ivie, Yu Priscilla, Raymond Tia, Niles Dana E, Hanna Richard, Zhang Xuemei, Wolfe Heather, Griffis Heather, Nadkarni Vinay, ,
Abstract
INTRODUCTION:
Survival after in-hospital cardiac arrest (IHCA) has been reported to be worse for arrests at night or during weekends.This study aimed to determine whether measured cardiopulmonary resuscitation (CPR) quality metrics might explain this difference in outcomes.
METHODS:
IHCA data was collected by the Pediatric Resuscitation Quality (pediRES-Q) collaborative for patients <18 years. Metrics of CPR quality [chest compression rate, depth and fraction] were measured using monitordefibrillator pads, and events were compared by time of day and day of week.
RESULTS:
We evaluated 6915 sixty-second epochs of chest compression (CC) data from 239 subjects between October 2015 and March 2019, across 18 hospitals. There was no significant difference in CPR quality metrics during day (07:00-22:59) versus night (23:00-06:59), or weekdays (Monday 07:00 to Friday 22:59) versus weekends (Friday 23:00 to Monday 06:59).There was also no difference in rate of return of circulation. However, survival to hospital discharge was higher for arrests that occurred during the day (39.1%) vs. nights (22.4%, p?=?0.015), as well as on weekdays (39.9%) vs. weekends (19.1%, p?=?0.003).
CONCLUSIONS:
For pediatric IHCA where CC metrics were obtained, there was no significant difference in CPR quality metrics or rate of return of circulation by time of day or day of week. There was higher survival to hospital discharge when arrests occurred during the day (vs. nights), or on weekdays (vs. weekends), and this difference was not related to disparities in CC quality.
Copyright © 2019. Published by Elsevier B.V.
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Improving Emergency Call Detection of Out-of-Hospital Cardiac Arrests in the Greater Paris Area: Efficiency of a Global System with a New Method of Detection.
Resuscitation2019 Nov;():. doi: S0300-9572(19)30692-6.
Derkenne Clément, Jost Daniel, Thabouillot Oscar, Briche Frédérique, Travers Stéphane, Frattini Benoit, Lesaffre Xavier, Kedzierewicz Romain, Roquet Florian, de Charry Félicité, Prunet Bertrand, ,
Abstract
AIM:
The detection of cardiac arrests by dispatchers allows telephone-assisted cardiopulmonary resuscitation (t-CPR) and improves Out-of-Hospital Cardiac Arrest (OHCA) survival. To enhance the OHCA detection rate, in 2012, the Paris Fire Brigade dispatch center created an original technique called "Hand On Belly" (HoB). The new algorithm that resulted has become a central point in a broader program for dispatch-assisted cardiac arrests.
METHODS:
This is a repeated cross-sectional study with retrospective data of four 15-day call samples recorded from 2012 to 2018. We included all calls from OHCAs cared for by Basic Life Support (BLS) teams and excluded calls where the dispatcher wasn't in contact directly with a witness. The primary endpoint was the successful detection of an OHCA by the dispatcher; the secondary endpoints were successful t-CPR and measurements of the different time intervals related to the call. Logistic regressions were performed to assess parameters associated with detecting OHCAs and initiating t-CPR.
RESULTS:
From 2012 to 2018, among the detectable OCHAs, the proportion correctly identified increased from 54% to 93% ; the rate of t-CPRs from 51% to 84%. OHCA detection and t-CPR initiation were both associated with HoB breathing assessments (adjustedOR:89, 95%CI:31-299, and adjustedOR:11.2, 95%CI:1.4-149, respectively). Over the study period, the times to answering calls and the time to sending BLS teams were shorter than those recommended by international guidelines; however, the times to OHCA recognition and starting t-CPR delivery were longer.
CONCLUSIONS:
The HoB effectively facilitated OHCA detection in our system, which has achieved very high performance levels.
Copyright © 2019. Published by Elsevier B.V.
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An audio-visual review model enhanced one-year retention of cardiopulmonary resuscitation skills and knowledge: A randomized controlled trial.
Int J Nurs Stud2019 Oct;102():103451. doi: S0020-7489(19)30258-5.
Xu Yimin, Li Jia, Wu Ying, Yue Peng, Wu Fangqin, Xu Yahong,
Abstract
BACKGROUND:
As the majority of out-of-hospital cardiac arrest occur at patients' homes, implementing high-quality cardiopulmonary resuscitation by family members is critical in improving patient outcomes. However, the survival rate remains low due to low bystander cardiopulmonary resuscitation rate and rapid skill deterioration in individuals who complete the training.
OBJECTIVES:
To evaluate the effectiveness of audio-visual review model and audio-visual-practice review model on cardiopulmonary resuscitation skill retention 12 months after training.
DESIGN:
A randomized, double-blind, placebo controlled, and three-arm parallel study.
PARTICIPANTS:
A total of 641 family members of patients at high risk of out-of-hospital cardiac arrest enrolled in the study and 448 participants completed the follow-up.
METHODS:
Family members from Beijing, China were recruited. All families underwent initial cardiopulmonary resuscitation training. Their cardiopulmonary resuscitation skill and knowledge were assessed immediately after training. Trainees who were rated "adequate skill and knowledge" were assigned randomly into one of three groups. The control group was given a cardiopulmonary resuscitation instruction booklet and a placebo-DVD without any reminders. Both audio-visual and audio-visual-practice groups were reinforced by a telephone reminder every 3 months. The audio-visual-practice group was also asked to simultaneously practice the skills while watching the instructional-DVD. The trainees' cardiopulmonary resuscitation skills and knowledge were re-assessed 12 months after training.
RESULTS:
The retention rates of cardiopulmonary resuscitation skills in both audio-visual-practice (N?=?177) and audio-visual (N?=?157) groups were higher than that in control group (N?=?114) 12 months after training (all P-values < 0.001). The cardiopulmonary resuscitation skill retention rate in audio-visual-practice group was higher than that in audio-visual group (49.7% vs 36.9%, P?=?0.019), but no difference was found in intention-to-treat analysis (32.1% vs 27.1%, P?=?0.230). Both audio-visual-practice and audio-visual groups had higher correct rates on all skill elements than that in control group (all P-values < 0.05). The cardiopulmonary resuscitation knowledge scores in both audio-visual-practice and audio-visual groups were higher than that in control group (all P-values < 0.001). However, no significant difference was found between audio-visual-practice and audio-visual groups (P?=?0.243).
CONCLUSIONS:
Both audio-visual-practice and audio-visual review models demonstrated better long-term retention of cardiopulmonary resuscitation skills for families of people at higher risk of out-of-hospital cardiac arrest. (Registration number: chiCTR-TRC-12002149).
Copyright © 2019. Published by Elsevier Ltd.
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Family presence during resuscitation: Updated review and clinical pearls.
Geriatr Nurs2019 Nov;():. doi: S0197-4572(19)30541-5.
Tennyson Carolina D,
Abstract
There is mounting evidence that Family Presence During Resuscitation (FPDR) can benefit family members who wish to observe the resuscitation efforts of a loved one. Given that older patients have poor resuscitation outcomes, presence of a family advocate could add value to the process of end of life decision making. A review of the current literature from the perspectives of patients, families, and health-care providers will help in reassessing family involvement during resuscitation and developing best practices for health care facilities.
Copyright © 2019 Elsevier Inc. All rights reserved.
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Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction.
N Engl J Med2019 Nov;():. doi: 10.1056/NEJMoa1912388.
Tardif Jean-Claude, Kouz Simon, Waters David D, Bertrand Olivier F, Diaz Rafael, Maggioni Aldo P, Pinto Fausto J, Ibrahim Reda, Gamra Habib, Kiwan Ghassan S, Berry Colin, López-Sendón José, Ostadal Petr, Koenig Wolfgang, Angoulvant Denis, Grégoire Jean C, Lavoie Marc-André, Dubé Marie-Pierre, Rhainds David, Provencher Mylène, Blondeau Lucie, Orfanos Andreas, L'Allier Philippe L, Guertin Marie-Claude, Roubille François,
Abstract
BACKGROUND:
Experimental and clinical evidence support the role of inflammation in atherosclerosis and its complications. Colchicine is an orally administered, potent antiinflammatory medication that is indicated for the treatment of gout and pericarditis.
METHODS:
We performed a randomized, double-blind trial involving patients recruited within 30 days after a myocardial infarction. The patients were randomly assigned to receive either low-dose colchicine (0.5 mg once daily) or placebo. The primary efficacy end point was a composite of death from cardiovascular causes, resuscitated cardiac arrest, myocardial infarction, stroke, or urgent hospitalization for angina leading to coronary revascularization. The components of the primary end point and safety were also assessed.
RESULTS:
A total of 4745 patients were enrolled; 2366 patients were assigned to the colchicine group, and 2379 to the placebo group. Patients were followed for a median of 22.6 months. The primary end point occurred in 5.5% of the patients in the colchicine group, as compared with 7.1% of those in the placebo group (hazard ratio, 0.77; 95% confidence interval [CI], 0.61 to 0.96; P?=?0.02). The hazard ratios were 0.84 (95% CI, 0.46 to 1.52) for death from cardiovascular causes, 0.83 (95% CI, 0.25 to 2.73) for resuscitated cardiac arrest, 0.91 (95% CI, 0.68 to 1.21) for myocardial infarction, 0.26 (95% CI, 0.10 to 0.70) for stroke, and 0.50 (95% CI, 0.31 to 0.81) for urgent hospitalization for angina leading to coronary revascularization. Diarrhea was reported in 9.7% of the patients in the colchicine group and in 8.9% of those in the placebo group (P?=?0.35). Pneumonia was reported as a serious adverse event in 0.9% of the patients in the colchicine group and in 0.4% of those in the placebo group (P?=?0.03).
CONCLUSIONS:
Among patients with a recent myocardial infarction, colchicine at a dose of 0.5 mg daily led to a significantly lower risk of ischemic cardiovascular events than placebo. (Funded by the Government of Quebec and others; COLCOT ClinicalTrials.gov number, NCT02551094.).
Copyright © 2019 Massachusetts Medical Society.
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Developmental toxicity of fipronil in early development of zebrafish (Danio rerio) larvae: Disrupted vascular formation with angiogenic failure and inhibited neurogenesis.
J Hazard Mater2019 Oct;():121531. doi: S0304-3894(19)31485-2.
Park Hahyun, Lee Jin-Young, Park Sunwoo, Song Gwonhwa, Lim Whasun,
Abstract
Fipronil has been widely used in agriculture to prevent aggressive insects from damaging agricultural products. Fipronil residues circulate in the environment and they have been detected in non-targeted organisms in aquatic environments. To study the effect of fipronil toxicity on environmental health, 6?h post fertilization (hpf) zebrafish embryos were treated with fipronil for 72?h. LC value was obtained by applying varying concentrations of fipronil to zebrafish embryos for 72?h. As zebrafish embryos are useful vertebrate models for studying developmental and genetic findings in toxicology research, they were exposed to fipronil to study detailed elucidating mechanisms with hazardous end points of toxicity. Cell cycle arrest-related apoptosis supported pathological alterations, such as increased mortality, shortened body length, and reduced hatchability. Furthermore, observed heart defects, including edema and irregular heartbeat were caused due to abnormal blood circulation. In transgenic zebrafish models (fli1:eGFP and olig2:dsRED), disrupted blood vessel formations were indicated by eGFP endothelial cells. Moreover, neurogenic defects were observed by studying dsRED motor neurons and oligodendrocytes. This study demonstrates fipronil accumulation in aquatic environment and its ability to impair essential processes, such as angiogenesis and neurogenesis during early developmental stage of zebrafish, along with general developmental toxicity.
Copyright © 2019 Elsevier B.V. All rights reserved.
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Medical Event Management for Future Deep Space Exploration Missions to Mars.
J Surg Res2019 Nov;246():305-314. doi: S0022-4804(19)30710-3.
Robertson Jamie M, Dias Roger D, Gupta Avni, Marshburn Thomas, Lipsitz Stuart R, Pozner Charles N, Doyle Thomas E, Smink Douglas S, Musson David M, Yule Steven,
Abstract
BACKGROUND:
Long-duration exploration missions (LDEMs), such as voyages to Mars, will present unique medical challenges for astronaut crews, including communication delays and the inability to return to Earth early. Medical events threaten crewmember lives and increase the risk of mission failure. Managing a range of potential medical events will require excellent technical and nontechnical skills (NTSs). We sought to identify medical events with potential for rescue, range them according to the potential impact on crew health and mission success during LDEMs, and develop a list of NTSs to train for management of in-flight medical events.
MATERIALS AND METHODS:
Twenty-eight subject matter experts with specializations in surgery, medicine, trauma, spaceflight operations, NTS training, simulation, human factors, and organizational psychology completed online surveys followed by a 2-d in-person workshop. They identified and rated medical events for survivability, mission impact, and impact of crewmember NTSs on outcomes in space.
RESULTS:
Sudden cardiac arrest, smoke inhalation, toxic exposure, seizure, and penetrating eye injury emerged as events with the highest potential mission impact, greatest potential for survival, and that required excellent NTS for successful management. Key NTS identified to target in training included information exchange, supporting behavior, communication delivery, and team leadership/followership.
CONCLUSIONS:
With a planned Mars mission on the horizon, training countermeasures need to be developed in the next 3-5 y. These results may inform policy, selection, medical system design, and training scenarios for astronauts to manage in-flight medical events on LDEMs. Findings may extend to surgical and medical care in any rural and remote location.
Copyright © 2019. Published by Elsevier Inc.
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CaRdiac Arrest Survival Score (CRASS) - a tool to predict good neurological outcome after out-of-hospital cardiac arrest.
Resuscitation2019 Nov;():. doi: S0300-9572(19)30689-6.
Seewald S, Wnent J, Lefering R, Fischer M, Bohn A, Jantzen T, Brenner S, Masterson S, Bein B, Scholz J, Gräsner J T,
Abstract
AIM:
The aim of this study was to develop a score to predict the outcome for patients brought to hospital following OHCA.
METHODS:
All patients recorded in the German Resuscitation Registry who suffered OHCA 2010-2017, who had ROSC or ongoing CPR at hospital admission were included. The study population was divided into development (2010-2016: 7,985) and validation dataset (2017: 1,806). Binary logistic regression analysis was used to derive the score. The probability of hospital discharge with good neurological outcome was defined as 1/ (1 + e), where X is the weighted sum of independent variables.
RESULTS:
The following variables were found to have a significant positive (+) or negative (-) impact: age 61-70 years (-0·5), 71-80 (-0·9), 81-90 (-1·3) and >?=?91 (-2·3); initial PEA (-0·9) and asystole (-1·4); presumable trauma (-1·1); mechanical CPR (-0·3); application of adrenalin >0-<2?mg (-1·1), 2-<4?mg (-1·6), 4-<6?mg (-2·1), 6-<8?mg (-2·5) and >?=?8?mg (-2·8); pre emergency status without previous disease (+0·5) or minor disease (+0·2); location at nursing home (-0·6), working place/school (+0·7), doctor's office (+0·7) and public place (+0·3); application of amiodarone (+0·4); hospital admission with ongoing CPR (-1·9) or normotension (+0·4); witnessed arrest (+0·6); time from collapse until start CPR 2-<10?min (-0·3) and >?=?10?min (-0·5); duration of CPR <5?min (+0·6). The AUC in the development dataset was 0·88 (95% CI 0·87-0·89) and in the validation dataset 0·88 (95% CI 0·86-0·90).
CONCLUSION:
The CaRdiac Arrest Survival Score (CRASS) represents a tool for calculating the probability of survival with good neurological function for patients brought to hospital following OHCA.
Copyright © 2019. Published by Elsevier B.V.
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Low Dose- High Frequency, Case Based Psychomotor CPR Training Improves Compression Fraction for Patients with In-Hospital Cardiac Arrest.
Resuscitation2019 Nov;():. doi: S0300-9572(19)30687-2.
Panchal Ashish R, Norton Gregory, Gibbons Emily, Buehler Jeri, Kurz Michael C,
Abstract
BACKGROUND:
High quality cardiopulmonary resuscitation (CPR) is critical to improve survival from cardiac arrest. While low dose- high frequency case-based training enhances CPR skill retention, it is unclear if this training method is feasible in a clinical environment and if it yields improved clinical CPR quality during in-hospital cardiac arrest. We evaluated the implementation of a novel platform providing low dose- high frequency psychomotor CPR training and its impact upon CPR quality.
METHODS:
The described training platform was launched on two nursing units (60 beds) in a university teaching hospital. Quarterly utilization of the platform was integrated into normal clinical duties of hospital staff. Simulated CPR performance and staff compliance were evaluated pre- and post-intervention. In addition, clinical CPR performance was evaluated for periods of six months before and after four quarters of implementation (median, IQR).
RESULTS:
The low dose, high frequency CPR training led to retention of simulated CPR skills (compression rate, depth and fraction) during each quarter exceeding high-quality guideline thresholds. Clinical CPR quality, measured by compression fraction (Pre: 83% (73, 95) to Post: 93% (88 to 98), P?
CONCLUSIONS:
Low dose-high frequency case based psychomotor CPR training is feasible in a clinical setting with high compliance. In two nursing units, this method of training resulted in enhanced CPR skill retention and improved in-hospital clinical CPR quality.
Copyright © 2019. Published by Elsevier B.V.
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Systematic Review and Meta-Analysis of INTRAvascular Temperature Management versus Surface Cooling in COMATose Patients Resuscitated from Cardiac Arrest.
Resuscitation2019 Nov;():. doi: S0300-9572(19)30688-4.
Bartlett Emily, Valenzuela Terence, Idris Ahamed, Deye Nicolas, Glover Guy, Gillies Michael, Taccone Fabio Silvio, Sunde Kjetil, Flint Alexander, Thiele Holger, Arrich Jasmin, Hemphill Claude, Holzer Michael, Skrifvars Markus B, Pittl Undine, Polderman Kees, Ong Marcus Eh, Kim Ki Hong, Oh Sang Hoon, Shin Sang, Kirkegaard Hans, Nichol Graham,
Abstract
OBJECTIVE:
To systematically review the effectiveness and safety of intravascular temperature management (IVTM) versus surface cooling methods (SCM) for induced hypothermia (IH).
METHODS:
Systematic review and meta-analysis. English-language PubMed, Embase and the Cochrane Database of Systematic Reviews were searched on May 27, 2019. The quality of included observational studies was graded using the Newcastle-Ottawa Quality Assessment tool. The quality of included randomized trials was evaluated using the Cochrane Collaboration's risk of bias tool. Random effects modeling was used to calculate risk differences for each outcome. Statistical heterogeneity and publication bias were assessed using standard methods.
ELIGIBILITY:
Observational or randomized studies comparing survival and/or neurologic outcomes in adults aged 18 years or greater resuscitated from out-of-hospital cardiac arrest receiving IH via IVTM versus SCM were eligible for inclusion.
RESULTS:
In total, 12 studies met inclusion criteria. These enrolled 1,573 patients who received IVTM; and 4,008 who received SCM. Survival was 55.0% in the IVTM group and 51.2% in the SCM group [pooled risk difference 2% (95% CI -1%, 5%)]. Good neurological outcome was achieved in 40.9% in the IVTM and 29.5% in the surface group [pooled risk difference 5% (95% CI 2%, 8%)]. There was a 6% (95% CI 11%, 2%) lower risk of arrhythmia with use of IVTM and 15% (95% CI 22%, 7%) decreased risk of overcooling with use of IVTM versus SCM. There was no significant difference in other evaluated adverse events between groups.
CONCLUSIONS:
IVTM was associated with improved neurological outcomes vs. SCM among survivors resuscitated following cardiac arrest. These results may have implications for care of patients in the emergency department and intensive care settings after resuscitation from cardiac arrest.
Copyright © 2019. Published by Elsevier B.V.
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2019 American Heart Association Focused Update on Pediatric Basic Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
Pediatrics2019 Nov;():. doi: e20191358.
Duff Jonathan P, Topjian Alexis A, Berg Marc D, Chan Melissa, Haskell Sarah E, Joyner Benny L, Lasa Javier J, Ley S Jill, Raymond Tia T, Sutton Robert Michael, Hazinski Mary Fran, Atkins Dianne L,
Abstract
This 2019 focused update to the American Heart Association pediatric basic life support guidelines follows the 2019 systematic review of the effects of dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) on survival of infants and children with out-of-hospital cardiac arrest. This systematic review and the primary studies identified were analyzed by the Pediatric Task Force of the International Liaison Committee on Resuscitation. It aligns with the International Liaison Committee on Resuscitation's continuous evidence review process, with updates published when the International Liaison Committee on Resuscitation completes a literature review based on new published evidence. This update summarizes the available pediatric evidence supporting DA-CPR and provides treatment recommendations for DA-CPR for pediatric out-of-hospital cardiac arrest. Four new pediatric studies were reviewed. A systematic review of this data identified the association of a significant improvement in the rates of bystander CPR and in survival 1 month after cardiac arrest with DA-CPR. The writing group recommends that emergency medical dispatch centers offer DA-CPR for presumed pediatric cardiac arrest, especially when no bystander CPR is in progress. No recommendation could be made for or against DA-CPR instructions when bystander CPR is already in progress.
© 2019 American Heart Association, Inc. Reprinted with permission of the American Heart Association, Inc. This article has been published in Circulation.
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2019 American Heart Association Focused Update on Pediatric Advanced Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
Pediatrics2019 Nov;():. doi: e20191361.
Duff Jonathan P, Topjian Alexis A, Berg Marc D, Chan Melissa, Haskell Sarah E, Joyner Benny L, Lasa Javier J, Ley S Jill, Raymond Tia T, Sutton Robert Michael, Hazinski Mary Fran, Atkins Dianne L,
Abstract
This 2019 focused update to the American Heart Association pediatric advanced life support guidelines follows the 2018 and 2019 systematic reviews performed by the Pediatric Life Support Task Force of the International Liaison Committee on Resuscitation. It aligns with the continuous evidence review process of the International Liaison Committee on Resuscitation, with updates published when the International Liaison Committee on Resuscitation completes a literature review based on new published evidence. This update provides the evidence review and treatment recommendations for advanced airway management in pediatric cardiac arrest, extracorporeal cardiopulmonary resuscitation in pediatric cardiac arrest, and pediatric targeted temperature management during post-cardiac arrest care. The writing group analyzed the systematic reviews and the original research published for each of these topics. For airway management, the writing group concluded that it is reasonable to continue bag-mask ventilation (versus attempting an advanced airway such as endotracheal intubation) in patients with out-of-hospital cardiac arrest. When extracorporeal membrane oxygenation protocols and teams are readily available, extracorporeal cardiopulmonary resuscitation should be considered for patients with cardiac diagnoses and in-hospital cardiac arrest. Finally, it is reasonable to use targeted temperature management of 32°C to 34°C followed by 36°C to 37.5°C, or to use targeted temperature management of 36°C to 37.5°C, for pediatric patients who remain comatose after resuscitation from out-of-hospital cardiac arrest or in-hospital cardiac arrest.
© 2019 American Heart Association, Inc. Reprinted with permission of the American Heart Association, Inc. This article has been published in Circulation.
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Family presence in the trauma setting: A case study.
Indian J Med Ethics;4(3):221-224. doi: 10.20529/IJME.2019.049.
Zaidi Danish,
Abstract
The topic of family presence during resuscitation (FPDR) has been in the medical literature for several decades. However, these discussions have largely failed to delineate a difference between resuscitation of patients in cardiac arrest and the resuscitation and stabilisation of trauma victims before a necessary procedure. Through a case-based scenario, this primer aims to explore the ethical considerations of FPDR in emergent trauma care - particularly in the case of a motor vehicle collision. In doing so, consideration is given to the relevant aspects of patient dignity and privacy; as well as to the benefits of exposing family to clinician efforts, including how FPDR can aid in the grieving process.
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Left ventricular wall findings in non-electrocardiography-gated contrast-enhanced computed tomography after extracorporeal cardiopulmonary resuscitation.
Crit Care2019 Nov;23(1):357. doi: 10.1186/s13054-019-2624-1.
Sugiyama Kazuhiro, Takahashi Masamichi, Miyazaki Kazuki, Ishida Takuto, Kobayashi Mioko, Hamabe Yuichi,
Abstract
BACKGROUND:
Few studies have reported left ventricular wall findings in contrast-enhanced computed tomography (CE-CT) after extracorporeal cardiopulmonary resuscitation (ECPR). This study examined left ventricular wall CE-CT findings after ECPR and evaluated the association between these findings and the results of coronary angiography and prognosis.
METHODS:
We evaluated out-of-hospital cardiac arrest patients who were treated with ECPR and subsequently underwent both non-electrocardiography-gated CE-CT and coronary angiography at our center between January 2011 and April 2018. Left ventricular wall CE-CT findings were classified as follows: (1) homogeneously enhanced (HE; the left ventricular wall was homogeneously enhanced), (2) segmental defect (SD; the left ventricular wall was not segmentally enhanced according to the coronary artery territory), (3) total defect (TD; the entire left ventricular wall was not enhanced), and (4) others. Successful weaning from extracorporeal membrane oxygenation, survival to hospital discharge, and predictive ability of significant stenosis on coronary angiography were compared among patients with HE, SD, and TD patterns.
RESULTS:
A total of 74 patients (median age, 59?years) were eligible, 50 (68%) of whom had initial shockable rhythm. Twenty-three (31%) patients survived to hospital discharge. HE, SD, TD, and other patterns were observed in 19, 33, 11, and 11 patients, respectively. The rates of successful weaning from extracorporeal membrane oxygenation (84% vs. 39% vs. 9%, p?
CONCLUSIONS:
Homogenously enhanced left ventricular wall might be a predictor of good left ventricular function recovery. In contrast, total enhancement defect in the entire left ventricular wall was associated with poor outcomes. Contrast defect matching the coronary artery territory could predict significant coronary artery stenosis with good specificity. The left ventricular wall findings in non-electrocardiography-gated CE-CT after ECPR might be useful for diagnosis and prognostic prediction.
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Corrigendum to "Highly malignant routine EEG predicts poor prognosis after cardiac arrest in the Target Temperature Management trial" [Resuscitation 131 (2019) 24-28].
Resuscitation2019 Nov;145():82. doi: S0300-9572(19)30672-0.
Backman S, Cronberg T, Friberg H, Ullén S, Horn J, Kjaergaard J, Hassager C, Wanscher M, Nielsen N, Westhall E,
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Biomechanical properties of the hypoxic and dying brain quantified by magnetic resonance elastography.
Acta Biomater2019 Nov;():. doi: S1742-7061(19)30751-2.
Bertalan Gergely, Klein Charlotte, Schreyer Stefanie, Steiner Barbara, Kreft Bernhard, Tzschätzsch Heiko, de Schellenberger Angela Ariza, Nieminen-Kelhä Melina, Braun Jürgen, Guo Jing, Sack Ingolf,
Abstract
Respiratory arrest is a major life-threatening condition leading to cessation of vital functions and hypoxic-anoxic injury of the brain. The progressive structural tissue changes characterizing the dying brain biophysically are unknown. Here we use noninvasive magnetic resonance elastography to show that biomechanical tissue properties are highly sensitive to alterations in the brain in the critical period before death. Our findings demonstrate that brain stiffness increases after respiratory arrest even when cardiac function is still preserved. Within 5 minutes of cardiac arrest, cerebral stiffness further increases by up to 30%. This early mechanical signature of the dying brain can be explained by water accumulation and redistribution from extracellular spaces into cells. These processes, together, increase interstitial and intracellular pressure as revealed by magnetic resonance spectroscopy and diffusion-weighted imaging. Our data suggest that the fast response of cerebral stiffness to respiratory arrest enables the monitoring of life-threatening brain pathology using noninvasive in vivo imaging.
Copyright © 2019 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.
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