SOSTIENICI
Pubblicazioni recenti - cardiopulmonary resuscitation
-
One-Year Review in Cardiac Arrest: The 2022 Randomized Controlled Trials.
J Clin Med2023 Mar;12(6):. doi: 2235.
Penna Alessio, Magliocca Aurora, Merigo Giulia, Stirparo Giuseppe, Silvestri Ivan, Fumagalli Francesca, Ristagno Giuseppe,
Abstract
Cardiac arrest, one of the leading causes of death, accounts for numerous clinical studies published each year. This review summarizes the findings of all the randomized controlled clinical trials (RCT) on cardiac arrest published in the year 2022. The RCTs are presented according to the following categories: out-of- and in-hospital cardiac arrest (OHCA, IHCA) and post-cardiac arrest care. Interestingly, more than 80% of the RCTs encompassed advanced life support and post-cardiac arrest care, while no studies focused on the treatment of IHCA, except for one that, however, explored the temperature control after resuscitation in this population. Surprisingly, 9 out of 11 RCTs led to neutral results demonstrating equivalency between the newly tested interventions compared to current practice. One trial was negative, showing that oxygen titration in the immediate pre-hospital post-resuscitation period decreased survival compared to a more liberal approach. One RCT was positive and introduced new defibrillation strategies for refractory cardiac arrest. Overall, data from the 2022 RCTs discussed here provide a solid basis to generate new hypotheses to be tested in future clinical studies.
Guarda su PubMed
-
Respiratory Management of the Preterm Infant: Supporting Evidence-Based Practice at the Bedside.
Children (Basel)2023 Mar;10(3):. doi: 535.
Tana Milena, Tirone Chiara, Aurilia Claudia, Lio Alessandra, Paladini Angela, Fattore Simona, Esposito Alice, De Tomaso Davide, Vento Giovanni,
Abstract
Extremely preterm infants frequently require some form of respiratory assistance to facilitate the cardiopulmonary transition that occurs in the first hours of life. Current resuscitation guidelines identify as a primary determinant of overall newborn survival the establishment, immediately after birth, of adequate lung inflation and ventilation to ensure an adequate functional residual capacity. Any respiratory support provided, however, is an important contributing factor to the development of bronchopulmonary dysplasia. The risks correlated to invasive ventilatory techniques increase inversely with gestational age. Preterm infants are born at an early stage of lung development and are more susceptible to lung injury deriving from mechanical ventilation. Any approach aiming to reduce the global burden of preterm lung disease must implement lung-protective ventilation strategies that begin from the newborn's first breaths in the delivery room. Neonatologists today must be able to manage both invasive and noninvasive forms of respiratory assistance to treat a spectrum of lung diseases ranging from acute to chronic conditions. We searched PubMed for articles on preterm infant respiratory assistance. Our narrative review provides an evidence-based overview on the respiratory management of preterm infants, especially in the acute phase of neonatal respiratory distress syndrome, starting from the delivery room and continuing in the neonatal intensive care unit, including a section regarding exogenous surfactant therapy.
Guarda su PubMed
-
The Role of a First Aid Training Program for Young Children: A Systematic Review.
Children (Basel)2023 Feb;10(3):. doi: 431.
Tse Eleana, Plakitsi Katerina, Voulgaris Spyridon, Alexiou George A,
Abstract
BACKGROUND:
Many first aid programs have been conducted in schools, and researchers have identified that interventions improved students' knowledge, skills, and attitude. This study examines the content, practices, and assessment of first aid interventions at primary schools and evaluates their effectiveness.
METHODS:
A systematic review was undertaken. We searched MEDLINE and Cochrane library databases from January 1990 to December 2021 using the search terms: ''first aid'' AND ''primary school children''. School-based first aid training targeting 6 to 10 years old studies in English were eligible for inclusion.
RESULTS:
We included 11 studies that were approached by experimental (n = 6) and by observational studies (n = 5). Researchers conducted interventions in Europe (n = 9) and America (n = 2). An essential part of the teaching was hands-on practice. Most studies included in their program cardiopulmonary resuscitation (n = 8) and basic life support (n = 7). The main findings showed that trained children have significantly better knowledge of and skills in first aid than those before or without training. Children under 11 years old were not strong enough to achieve the proper depth of chest compressions. Depth of chest compressions correlates with children's age, weight, height (n = 2), and body mass index (n = 3). Conclusions The effectiveness of resuscitative or non-resuscitative first-aid training for primary school children improved students' knowledge and skills. Subsequent research could investigate children's reactions in actual first aid conditions.
Guarda su PubMed
-
The Influence of Ultra-Low Tidal Volume Ventilation during Cardiopulmonary Resuscitation on Renal and Hepatic End-Organ Damage in a Porcine Model.
Biomedicines2023 Mar;11(3):. doi: 899.
Mohnke Katja, Buschmann Victoria, Baller Thomas, Riedel Julian, Renz Miriam, Rissel René, Ziebart Alexander, Hartmann Erik K, Ruemmler Robert,
Abstract
The optimal ventilation strategy during cardiopulmonary resuscitation (CPR) has eluded scientists for years. This porcine study aims to validate the hypothesis that ultra-low tidal volume ventilation (tidal volume 2-3 mL kg; ULTVV) minimizes renal and hepatic end-organ damage when compared to standard intermittent positive pressure ventilation (tidal volume 8-10 mL kg; IPPV) during CPR. After induced ventricular fibrillation, the animals were ventilated using an established CPR protocol. Upon return of spontaneous circulation (ROSC), the follow-up was 20 h. After sacrifice, kidney and liver samples were harvested and analyzed histopathologically using an Endothelial, Glomerular, Tubular, and Interstitial (EGTI) scoring system for the kidney and a newly developed scoring system for the liver. Of 69 animals, 5 in the IPPV group and 6 in the ULTVV group achieved sustained ROSC and were enlisted, while 4 served as the sham group. Creatinine clearance was significantly lower in the IPPV-group than in the sham group (
Guarda su PubMed
-
The Effect of Early Application of Synthetic Peptides 19-2.5 and 19-4LF to Improve Survival and Neurological Outcome in a Mouse Model of Cardiac Arrest and Resuscitation.
Biomedicines2023 Mar;11(3):. doi: 855.
Bajorat Rika, Danckert Lena, Ebert Florian, Bancken Theresa, Bergt Stefan, Klawitter Felix, Vollmar Brigitte, Reuter Daniel A, Schürholz Tobias, Ehler Johannes,
Abstract
The synthetic antimicrobial peptides (sAMPs) Pep19-2.5 and Pep19-4LF have been shown in vitro and in vivo to reduce the release of pro-inflammatory cytokines, leading to the suppression of inflammation and immunomodulation. We hypothesized that intervention with Pep19-2.5 and Pep19-4LF immediately after cardiac arrest and resuscitation (CA-CPR) might attenuate immediate systemic inflammation, survival, and long-term outcomes in a standardized mouse model of CA-CPR. Long-term outcomes up to 28 days were assessed between a control group (saline) and two peptide intervention groups. Primarily, survival as well as neurological and cognitive parameters were assessed. In addition, systemic inflammatory molecules and specific biomarkers were analyzed in plasma as well as in brain tissue. Treatment with sAMPs did not provide any short- or long-term benefits for either survival or neurological outcomes, and no significant benefit on inflammation in the CA-CPR animal model. While no difference was found in the plasma analysis of early cytokines between the intervention groups four hours after resuscitation, a significant increase in UCH-L1, a biomarker of neuronal damage and blood-brain barrier rupture, was measured in the Pep19-4LF-treated group. The theoretical benefit of both sAMPs tested here for the treatment of post-cardiac arrest syndrome could not be proven.
Guarda su PubMed
-
Effect of location on out-of-hospital cardiac arrests involving older adults in Hong Kong: secondary analysis of a territory-wide cohort.
Hong Kong Med J2023 Mar;():. doi: 10.12809/hkmj209140.
Wong R T M,
Abstract
INTRODUCTION:
Most out-of-hospital cardiac arrests in Hong Kong involve older adults. The likelihood of survival varies among locations. This study investigated patient and bystander characteristics, as well as the timing of interventions, that affect the prevalences of shockable rhythm and survival outcomes among cardiac arrests involving older adults in homes, on streets, and in other public places.
METHODS:
This secondary analysis of a territory-wide historical cohort used data collected by the Fire Services Department of Hong Kong from 1 August 2012 to 31 July 2013.
RESULTS:
Bystander cardiopulmonary resuscitation was primarily performed by relatives in homes but not in non-residential locations. The intervals in terms of receipt of emergency medical services (EMS) call, initiation of bystander cardiopulmonary resuscitation, and receipt of defibrillation were longer for cardiac arrests that occurred in homes. The median interval for EMS to reach patients was 3 minutes longer in homes than on streets (P
CONCLUSION:
There were significant location-related differences in patient and bystander characteristics, interventions, and outcomes among cardiac arrests involving older adults. A large proportion of patients had a shockable rhythm in the early period after cardiac arrest. Good survival outcomes in out-of-hospital cardiac arrests involving older adults can be achieved through early bystander defibrillation and intervention.
Guarda su PubMed
-
Sedation Strategies in Patients Undergoing Extracorporeal Cardiopulmonary Resuscitation.
Eur Heart J Acute Cardiovasc Care -
Amplitude Spectrum Area of ventricular fibrillation to guide defibrillation: a small open-label, pseudo-randomized controlled multicenter trial.
EBioMedicine2023 Mar;90():104544. doi: 10.1016/j.ebiom.2023.104544.
Ruggeri Laura, Fumagalli Francesca, Bernasconi Filippo, Semeraro Federico, Meessen Jennifer M T A, Blanda Adriana, Migliari Maurizio, Magliocca Aurora, Gordini Giovanni, Fumagalli Roberto, Sechi Giuseppe, Pesenti Antonio, Skrifvars Markus B, Li Yongqin, Latini Roberto, Wik Lars, Ristagno Giuseppe,
Abstract
BACKGROUND:
Ventricular fibrillation (VF) waveform analysis has been proposed as a potential non-invasive guide to optimize timing of defibrillation.
METHODS:
The AMplitude Spectrum Area (AMSA) trial is an open-label, multicenter randomized controlled study reporting the first in-human use of AMSA analysis in out-of-hospital cardiac arrest (OHCA). The primary efficacy endpoint was the termination of VF for an AMSA ? 15.5 mV-Hz. Adult shockable OHCAs randomly received either an AMSA-guided cardiopulmonary resuscitation (CPR) or a standard-CPR. Randomization and allocation to trial group were carried out centrally. In the AMSA-guided CPR, an initial AMSA ? 15.5 mV-Hz prompted for immediate defibrillation, while lower values favored chest compression (CC). After completion of the first 2-min CPR cycle, an AMSA
FINDINGS:
The trial was early discontinued for low recruitment due to the COVID-19 pandemics. A total of 31 patients were recruited in 3 Italian cities, 19 in AMSA-CPR and 12 in standard-CPR, and included in the data analysis. No difference in primary outcome was observed between the two groups. Termination of VF occurred in 74% of patients in the AMSA-CPR compared to 75% in the standard CPR (OR 0.93 [95% CI 0.18-4.90]). No adverse events were reported.
INTERPRETATION:
AMSA was used prospectively in human patients during ongoing CPR. In this small trial, an AMSA-guided defibrillation provided no evidence of an improvement in termination of VF.
TRIAL REGISTRATION:
NCT03237910.
FUNDING:
European Commission - Horizon 2020; ZOLL Medical Corp., Chelmsford, USA (unrestricted grant); Italian Ministry of Health - Current research IRCCS.
Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.
Guarda su PubMed
-
Impact of COVID-19 on Out-of-Hospital Cardiac Arrest in Korea.
J Korean Med Sci2023 Mar;38(12):e92. doi: 10.3346/jkms.2023.38.e92.
Kim Young Su, Lee Seung Hyo, Lim Hyouk Jae, Hong Won Pyo,
Abstract
BACKGROUND:
Coronavirus disease 2019 (COVID-19) is a global public health crisis that has had a significant impact on emergency medical services (EMS). Several studies have reported an increase in the incidence of out-of-hospital cardiac arrest (OHCA) and a decreased survival due to COVID-19, which has been limited to a short period or has been reported in some regions. This study aimed to investigate the effect of COVID-19 on OHCA patients using a nationwide database.
METHODS:
We included adult OHCA patients treated by EMS providers from January 19, 2019 to January 20, 2021. The years before and after the first confirmed case in Korea were set as the non-COVID-19 and COVID-19 periods, respectively. The main exposure of interest was the COVID-19 period, and the primary outcome was prehospital return of spontaneous circulation (ROSC). Other OHCA variables were compared before and after the COVID-19 pandemic and analyzed. We performed a multivariable logistic regression analysis to understand the independent effect of the COVID-19 period on prehospital ROSC.
RESULTS:
The final analysis included 51,921 eligible patients, including 25,355 (48.8%) during the non-COVID-19 period and 26,566 (51.2%) during the COVID-19 period. Prehospital ROSC deteriorated during the COVID-19 period (10.2% vs. 11.1%, = 0.001). In the main analysis, the adjusted odds ratios (AORs) for prehospital ROSC showed no significant differences between the COVID-19 and non-COVID-19 periods (AOR [95% confidence interval], 1.02 [0.96-1.09]).
CONCLUSION:
This study found that the proportion of prehospital ROSC was lower during the COVID-19 period than during the non-COVID-19 period; however, there was no statistical significance when adjusting for potential confounders. Continuous efforts are needed to restore the broken chain of survival in the prehospital phase and increase the survival rate of OHCA patients.
© 2023 The Korean Academy of Medical Sciences.
Guarda su PubMed
-
Outcome of Non-invasive Respiratory Support in Pediatric High Dependency Units for acute respiratory distress.
Respir Care2023 Mar;():. doi: respcare.10603.
Al-Mukhaini Khaloud S, Shaikh Samiuddin, Al-Kharusi Ahmed K, Thani Saif S A, Al-Abdwani Raghad M, Al-Senaidi Omar A, Elkhamisy Ahmed, Birru Florence, Al-Fahdi Amna A,
Abstract
Noninvasive respiratory support (NRS) is widely used in pediatric intensive care units (PICUs). However, there is limited experience regarding the utilization of NRS in non-PICU settings. We aimed to evaluate the success rate of NRS in pediatric high-dependency units (PHDU), identify predictors of NRS failure, quantify adverse events and assess outcomes. We included infants and children (older than 7 days to less than 13 years old) admitted to PHDU in two tertiary hospitals in Oman for acute respiratory distress over a 19-month period. Collected data included diagnosis, type and duration of NRS, adverse events, and the need for PICU transfer or invasive ventilation. 299 children were included, with a median age of 7 months (IQR:3-25 months) and a median weight of 6.1 kg (IQR: 4.3-10.5 kg). Bronchiolitis (37.5%), pneumonia (34.1%), and asthma (12.7%) were the most frequent diagnoses. Median NRS duration was two days (IQR: 1-3 days). At baseline, median S was 96% (IQR: 90-99%), median pH was 7.36 (IQR: 7.31-7.41), and median P was 44 mmHg (IQR: 36-53 mmHg). Overall, 234(78.3%) children were successfully managed in PHDU while 65 (21.7%) required transfer to PICU. 38(12.7%) needed invasive ventilation on a median time of 43.5 hours (IQR: 13.5-108 hours). On multivariate analysis, maximum F of > 0.5 (odds ratio [OR]: 4.494, 95% confidence interval [CI]: 1.357-14.886; = 0.02) and PEEP of >7 cm HO (OR: 3.368, 95% CI: 1.490-7.612; = 0.004) were predictors for NRS failure. Significant apnea, cardiopulmonary resuscitation, and air leak syndrome were reported in 0.4%, 0.9%, and 0.9% of children, respectively. In our cohort, we found NRS in PHDU safe and effective; however, maximum F of > 0.5 post treatment and PEEP of >7 cm HO were associated with NRS failure.
Copyright © 2023 by Daedalus Enterprises.
Guarda su PubMed
-
Value Placed on Comfort vs Life Prolongation Among Patients Treated With Maintenance Dialysis.
JAMA Intern Med2023 Mar;():. doi: e230265.
Wong Susan P Y, Prince David K, Kurella Tamura Manjula, Hall Yoshio N, Butler Catherine R, Engelberg Ruth A, Vig Elizabeth K, Curtis J Randall, O'Hare Ann M,
Abstract
IMPORTANCE:
Patients receiving maintenance dialysis experience intensive patterns of end-of-life care that might not be consistent with their values.
OBJECTIVE:
To evaluate the association of patients' health care values with engagement in advance care planning and end-of-life care.
DESIGN, SETTING, AND PARTICIPANTS:
Survey study of patients who received maintenance dialysis between 2015 and 2018 at dialysis centers in the greater metropolitan areas of Seattle, Washington, and Nashville, Tennessee, with longitudinal follow-up of decedents. Logistic regression models were used to estimate probabilities. Data analysis was conducted between May and October 2022.
EXPOSURES:
A survey question about the value that the participant would place on longevity-focused vs comfort-focused care if they were to become seriously ill.
MAIN OUTCOMES AND MEASURES:
Self-reported engagement in advance care planning and care received near the end of life through 2020 using linked kidney registry data and Medicare claims.
RESULTS:
Of 933 patients (mean [SD] age, 62.6 [14.0] years; 525 male patients [56.3%]; 254 [27.2%] identified as Black) who responded to the question about values and could be linked to registry data (65.2% response rate [933 of 1431 eligible patients]), 452 (48.4%) indicated that they would value comfort-focused care, 179 (19.2%) that they would value longevity-focused care, and 302 (32.4%) that they were unsure about the intensity of care they would value. Many had not completed an advance directive (estimated probability, 47.5% [95% CI, 42.9%-52.1%] of those who would value comfort-focused care vs 28.1% [95% CI, 24.0%-32.3%] of those who would value longevity-focused care or were unsure; P?.001), had not discussed hospice (estimated probability, 28.6% [95% CI, 24.6%-32.9%] comfort focused vs 18.2% [95% CI, 14.7%-21.7%] longevity focused or unsure; P?.001), or had not discussed stopping dialysis (estimated probability, 33.3% [95% CI, 29.0%-37.7%] comfort focused vs 21.9% [95% CI, 18.2%-25.8%] longevity focused or unsure; P?.001). Most respondents wanted to receive cardiopulmonary resuscitation (estimated probability, 78.0% [95% CI, 74.2%-81.7%] comfort focused vs 93.9% [95% CI, 91.4%-96.1%] longevity focused or unsure; P?.001) and mechanical ventilation (estimated probability, 52.0% [95% CI, 47.4%-56.6%] comfort focused vs 77.9% [95% CI, 74.0%-81.7%] longevity focused or unsure; P?.001). Among decedents, the percentages of participants who received an intensive procedure during the final month of life (estimated probability, 23.5% [95% CI, 16.5%-31.0%] comfort focused vs 26.1% [95% CI, 18.0%-34.5%] longevity focused or unsure; P?=?.64), discontinued dialysis (estimated probability, 38.3% [95% CI, 32.0%-44.8%] comfort focused vs 30.2% [95% CI, 23.0%-37.8%] longevity focused or unsure; P?=?.09), and enrolled in hospice (estimated probability, 32.2% [95% CI, 25.7%-38.7%] comfort focused vs 23.3% [95% CI, 16.4%-30.5%] longevity focused or unsure; P?=?.07) were not statistically different.
CONCLUSIONS AND RELEVANCE:
This survey study found that there appeared to be a disconnect between patients' expressed values, which were largely comfort focused, and their engagement in advance care planning and end-of-life care, which reflected a focus on longevity. These findings suggest important opportunities to improve the quality of care for patients receiving dialysis.
Guarda su PubMed
-
[Out-of-hospital cardiac arrest: University of Trieste students' skills on resuscitative maneuvers and automated external defibrillator].
G Ital Cardiol (Rome)2023 Apr;24(4):310-317. doi: 10.1714/4004.39822.
Marcori Sara, Pezzato Andrea, Hinojosa Ana Karina, Gant Alessia, Uliana Andrea, Koni Miranda, Rakar Serena, Aleksova Aneta, Sinagra Gianfranco, Merlo Marco,
Abstract
BACKGROUND:
Out-of-hospital cardiac arrest is the third leading cause of death in industrialized countries. Although most cardiac arrests are witnessed, survival is only 2-10%, since bystanders are often unable to correctly perform cardiopulmonary resuscitation (CPR). This study aims to assess the theoretical and practical knowledge of CPR and the use of the automatic external defibrillator in university students.
METHODS:
The study involved a total of 1686 students from 21 different faculties of the University of Trieste, 662 students from healthcare faculties and 1024 from non-healthcare faculties. Basic life support and early defibrillation (BLS-D) courses and retrainings after 2 years are mandatory for students in their final 2-year healthcare faculties at the University of Trieste. Through the platform "EUSurvey" from March to June 2021, they were given an online questionnaire of 25 multiple choice questions to investigate the performance of BLS-D.
RESULTS:
In the overall population, 68.7% knew how to diagnose a cardiac arrest and 47.5% knew the time frame after which irreversible brain damage occurs. Practical knowledge was analyzed by evaluating the correct answers to all four questions on performing CPR (i.e. hand position during compressions, frequency of compressions, depth of compressions, and ventilation-compression ratio). Health faculties students have better theoretical and practical knowledge of CPR than their colleagues of non-healthcare faculties, with better overall knowledge on the all four practical questions (11.2% vs 4.3%; p
CONCLUSION:
Mandatory BLS-D training and retraining leads to a better knowledge of cardiac arrest management and consequently a better patient outcome. In order to improve patient survival, heartsaver (BLS-D for laics) training should be extended as obligatory in all university courses.
Guarda su PubMed
-
Guidance for Cardiopulmonary Resuscitation of Children With Suspected or Confirmed COVID-19.
Pediatrics -
Cardiopulmonary Arrest During Pregnancy: A Review Article.
Cureus2023 Feb;15(2):e35219. doi: e35219.
Pawar Sujeet J, Anjankar Vaibhav P, Anjankar Ashish, Adnan Mohammad,
Abstract
Massive pulmonary embolism (PE) is an uncommon but severe complication of pregnancy or during the first few weeks after giving birth. Our intention was to thoroughly analyze the information available to its management methods. Significant bleeding of mother survival and early deliveries in fetal survivals were having hemorrhage and were having key outcomes. We found 127 severe PE cases that have had at least one form of treatment (at least 83% big; 23% with cardiac arrest). The 83 women who received thrombolysis had a 94% (95%) survival rate. Cardiac arrest in pregnancy is uncommon, although maintaining current competency can be challenging. While maternal mortality rates have decreased globally over the past 25 years, they have increased in the United States. The intricacy of the maternal mortality issue is a result of a number of clinical and socioeconomic problems such as unequal healthcare access, racial and ethnic disparities, maternal comorbidities, and bias in epidemiologic ascertainment. The importance of doctors being prepared to react to a potential maternal cardiac arrest in any situation where they are providing treatment for pregnant women is highlighted by the rise in maternal mortality. For the treatment of maternal cardiac arrest, an interdisciplinary team with expertise in both the maternal resuscitation procedure and the physiological changes that take place during pregnancy is necessary. Additionally offered are basic and advanced cardiac life support protocols. Techniques to remove obstacles like aortocaval compression that could impair the effectiveness of resuscitation should be used.
Copyright © 2023, Pawar et al.
Guarda su PubMed
-
[Basics and novelties of neonatal resuscitation].
Orv Hetil2023 Mar;164(12):474-480. doi: 10.1556/650.2023.32733.
Széll András,
Abstract
This recommendation summarizes the recent neonatal resuscitation guidelines of the European Resuscitation Council (ERC), but it takes into account the guidelines of the American Heart Association (AHA) and the statements of the International Liaison Committee on Resuscitation (ILCOR) Consensus on Science with Treatment Recommendations (CoSTR) for neonatal life support. The goal of the management of the newly born infants is to support the cardiorespiratory transition. Personnel and equipment should be prepared for neonatal life support before every delivery. After birth, the heat loss of the newborn must be prevented and, if possible, the clamping of the cord should be delayed. Initially the newborn must be assessed and, if possible, the baby should be kept with the mother in skin-to-skin contact. The infant must be placed under radiant warmer and the airways must be opened, if respiratory or circulatory support is needed. Decisions about the further steps of resuscitation are based on the evaluation of breathing, heart rate and oxygen saturation. If the baby is apnoeic or has a low heart rate, positive pressure ventilation must be started. The effectiveness of the ventilation must be checked, and failures are to be corrected if necessary. If the heart rate is
Guarda su PubMed
-
[Pediatric cardiopulmonary resuscitation].
Orv Hetil2023 Mar;164(12):463-473. doi: 10.1556/650.2023.32728.
Tövisházi Gyula, Csordás Katalin, Hauser Balázs,
Abstract
Our aim is to summarize the new European Resuscitation Council (ERC) 2021 guidelines on paediatric life support. In children, exhaustion of compensatory mechanisms in respiratory or circulatory failure leads to cardiac arrest. Recognition and treatment of children in critical condition are the most important element of its prevention. With the ABCDE approach, life-threatening problems can be identified and treated using simple interventions (bag-mask ventilation, intraosseous access, fluid bolus, etc.). Important new recommendations: 4-hand ventilation during bag-mask ventilation, target saturation of 94-98% during oxygen therapy, and fluid bolus of 10 ml/kg. In pediatric basic life support, if there is no normal breathing after 5 initial rescue breaths in absence of signs of life, chest compression should be initiated immediately using primarily two-thumb encircling method for infants. Recommended rate is 100-120/min, ratio of compression to ventilation is 15 : 2. Pediatric advanced life support is a teamwork. The structure of the algorithm is unchanged, high-quality chest compression is still a paramount. Recognition and treatment of potential reversible causes (4H-4T) and the decisive role of focused ultrasound are emphasized. New features: recommendation of 4-hand technique bag-mask ventilation, role of capnography, and age-dependent ventilatory rate in the case of continuous chest compression after endotracheal intubation. Drug therapy is unchanged, the fastest way to administer adrenaline during resuscitation is via intraosseous access. Treatment after return of spontaneous circulation decisively influences neurological outcome. Patient care is further based on the ABCDE scheme. Important goals are maintaining normoxia, normocapnia, avoiding hypotension, hypoglycemia, fever and use of targeted temperature management. Orv Hetil. 2023; 164(12): 463-473.
Guarda su PubMed
-
[In-hospital cardiac arrest and basic life support].
Orv Hetil2023 Mar;164(12):449-453. doi: 10.1556/650.2023.32724.
Kiss Domonkos, Fritúz Gábor, Kovács Enik?, Diószeghy Csaba,
Abstract
Survival of in-hospital cardiac arrests is still as low as 15-35%. Healthcare workers should closely monitor patients' vital signs, notice any deterioration, and initiate the necessary actions to prevent cardiac arrest. The introduction of early warning sign protocols (including the monitoring of respiratory rate, oxygen saturation, pulse, blood pressure, consciousness, etc.) can improve the recognition of periarrest patients during hospital stay. However, when a cardiac arrest occurs, healthcare workers should also be able to work in team and follow the relevant protocols delivering good quality chest compressions and early defibrillation. To achieve this goal, regular trainings, appropriate infrastructure and system-wide teamwork are needed. In this paper, we discuss the challenges of the first phase of in-hospital resuscitation and its integration into the hospital-wide medical emergency response system. Orv Hetil. 2023; 164(12): 449-453.
Guarda su PubMed
-
[Out-of-hospital adult basic life support: new guidelines and the involvement of bystanders].
Orv Hetil2023 Mar;164(12):443-448. doi: 10.1556/650.2023.32723.
Molnár Noémi, Nagy Ferenc, Fritúz Gábor, Kovács Enik?, Diószeghy Csaba,
Abstract
Survival rate for out-of-hospital cardiac arrest remains low across Europe. In the last decade, involving bystanders turned out to be one of the most important key factors in improving the outcome of out-of-hospital cardiac arrest. Beside recognizing cardiac arrest and initiate chest compressions, bystanders could be also involved in delivering early defibrillation. Although adult basic life support is a sequence of simple interventions that can be easily learnt even by schoolchildren, non-technical skills and emotional components can complicate real-life situations. This recognition combined with modern technology brings a new point of view in teaching and implementation. We review the latest practice guidelines and new advances in the education (including the importance of non-technical skills) of out-of-hospital adult basic life support, also considering the effects of COVID-19 pandemic. We briefly present the Szív City application developed to support the involvement of lay rescuers. Orv Hetil. 2023; 164(12): 443-448.
Guarda su PubMed
-
[The novelties of adult advanced life support and post-resuscitation therapy].
Orv Hetil2023 Mar;164(12):454-462. doi: 10.1556/650.2023.32725.
Szabó Némedi Noémi, Lóczi Gerda, Kovács Enik?, Zima Endre,
Abstract
The fourth element of chain-of-survival contains advanced life support and post-resuscitation treatment. Both treatment options influence the outcome of patients suffering cardiac arrest. Advanced life support includes all interventions that require special medical equipment and expertise. High-quality chest compressions and early defibrillation (if indicated) compose the main elements of advanced life support. Clarifying and treating the cause of cardiac arrest have also high priority, in which point-of-care ultrasound plays an important role. In addition, securing higher level of airway and capnography, securing intravenous or intraosseous line, and the parenteral administration of drugs - such as epinephrine or amiodarone - are the most important steps of advanced life support. If conventional therapy is unsuccessful, extracorporeal circulatory support can be used in special patient populations. The protection of vital organs that are sensitive to hypoxia (brain and heart) has a high priority after the return of spontaneous circulation beside the causative treatment of cardiac arrest. The most important parts of the supportive post-resuscitation treatment are: targeting normoxia, normocapnia, normotension, normoglycemia, and the application of target temperature management. Orv Hetil. 2023; 164(12): 454-462.
Guarda su PubMed
-
[The role of extracorporeal life support in cardiopulmonary resuscitation].
Orv Hetil2023 Apr;164(13):510-514. doi: 10.1556/650.2023.32727.
Kovács Enik?, Németh Endre, Prigya Jutas, Szvath Petra, Édes István, Hartyánszky István, Soltész Ádám, Csikós Gergely Richárd, Fazekas Levente, Gál János, Becker Dávid, Merkely Béla, Zima Endre,
Abstract
The frequency of the administration of extracorporeal cardiopulmonary resuscitation is increasing both in the treatment of in-hospital and out-of-hospital cardiac arrest. The latest resuscitation guidelines support the use of mechanical circulatory support devices in the cases of prolonged cardiopulmonary resuscitation in certain selected patient groups. However, only little evidence is available regarding the effectiveness of extracorporeal cardiopulmonary resuscitation, and many open questions remained unanswered regarding the adequate conditions of this modality. The timing and location of extracorporeal cardiopulmonary resuscitation are important factors, as well as the appropriate training of the personnel using extracorporeal techniques. Our review briefly summarizes, according to the current literature and recommendations, in which cases extracorporeal resuscitation may be beneficial, which type of mechanical circulatory support is the first choice of extracorporeal cardiopulmonary resuscitation, which factors influence the efficacy of this supportive treatment, and which complications may be expected during mechanical circulatory support during resuscitation. Orv Hetil. 2023; 164(13): 510-514.
Guarda su PubMed
