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Janbavonkij T, Yuksen C, Aramvanitch K, Sanguanwit P, Laksanamapune T, Jenpanitpong C, Seesuklom S. P-ROSC, UB-ROSC, and RACA Scores in Predicting the Return of Spontaneous Circulation in Out-of-hospital Cardiac Arrest: A Retrospective Cohort. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2025; 13:e39. [PMID: 40352101 PMCID: PMC12065029 DOI: 10.22037/aaemj.v13i1.2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/14/2025]
Abstract
Introduction Prehospital Return of Spontaneous Circulation (P-ROSC), Utstein-Based Return of Spontaneous Circulation (UB-ROSC), and Return of Spontaneous Circulation After Cardiac Arrest (RACA) scores have been developed to estimate the likelihood of Return of Spontaneous Circulation (ROSC) in Out-of-hospital cardiac arrest (OHCA). This study aimed to validate and compare these three scoring systems. Methods A retrospective cohort study was conducted using electronic medical records of OHCA patients transported by Ramathibodi Emergency Medical Service (EMS) from January 2021 to October 2024. We included all OHCA patients aged >18 years who transported by Ramathibodi EMS. RACA, UB-ROSC, and P-ROSC scores were calculated, and ROSC was recorded. The area under the ROC curve (AUC) of each score were calculated to assess predictive accuracy. Results Among 336 OHCA cases, 94 (27.97%) patients achieved ROSC. The RACA score demonstrated the highest predictive accuracy, with an AUC of 0.77 (95% CI: 0.71-0.82). The UB-ROSC score followed with an AUC of 0.72 (95% CI: 0.66-0.78), while the P-ROSC score had the lowest predictive value with an AUC of 0.64 (95% CI: 0.58-0.70). Calibration analysis indicated that the RACA score aligned most closely with observed outcomes compared to the UB-ROSC and P-ROSC scores. The RACA score exhibited the best overall performance in terms of both discrimination and calibration. Conclusions Among the three predictive models assessed, the RACA and UB-ROSC scores demonstrated fair predictive accuracy for ROSC in OHCA patients, while the P-ROSC score had poor predictive value.
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Affiliation(s)
- Tanakorn Janbavonkij
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Chaiyaporn Yuksen
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Kasamon Aramvanitch
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Pitsucha Sanguanwit
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Thanakorn Laksanamapune
- Division of Paramedicine, Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Chetsadakon Jenpanitpong
- Division of Paramedicine, Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Suteenun Seesuklom
- Division of Paramedicine, Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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Goh JL, Pek PP, Fook-Chong SMC, Ho AFW, Siddiqui FJ, Leong BSH, Mao DRH, Ng W, Tiah L, Chia MYC, Tham LP, Shahidah N, Arulanandam S, Ong MEH. Impact of time-to-compression on out-of-hospital cardiac arrest survival outcomes: A national registry study. Resuscitation 2023; 190:109917. [PMID: 37506813 DOI: 10.1016/j.resuscitation.2023.109917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/30/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE We aimed to quantify the association of no-flow interval in out-of-hospital cardiac arrests (OHCA) with the odds of neurologically favorable survival and survival to hospital discharge/ 30th day. Our secondary aim was to explore futility thresholds to guide clinical decisions, such as prehospital termination of resuscitation. METHODS All OHCAs from 2012 to 2017 in Singapore were extracted. We examined the association between no-flow interval (continuous variable) and survival outcomes using univariate and multivariable logistic regressions. The primary outcome was survival with favorable cerebral performance (Glasgow-Pittsburgh Cerebral Performance Categories 1/2), the secondary outcome was survival to hospital discharge/ 30th day if not discharged. To determine futility thresholds, we plotted the adjusted probability of good neurological outcomes to no-flow interval. RESULTS 12,771 OHCAs were analyzed. The per-minute adjusted OR when no-flow interval was incorporated as a continuous variable in the multivariable model was: good neurological function- aOR 0.98 (95%CI: 0.97-0.98); survival to discharge- aOR 0.98 (95%CI: 0.98-0.99). Taking the 1% futility of survival line gave a no-flow interval cutoff of 12 mins (NPV 99%, sensitivity 85% and specificity 42%) overall and 7.5 mins for witnessed arrests. CONCLUSION We demonstrated that prolonged no-flow interval had a significant effect on lower odds of favorable neurological outcomes, with medical futility occurring when no-flow interval was >12 mins (>7.5 mins for witnessed arrest). Our study adds to the literature of the importance of early CPR and EMS response and provided a threshold beyond traditional 'down-times', which could aid clinical decisions in TOR or OHCA management.
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Affiliation(s)
- Jia Ling Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Pin Pin Pek
- Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore
| | | | - Andrew F W Ho
- Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Fahad Javaid Siddiqui
- Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore, Singapore
| | | | | | - Weiming Ng
- Emergency Medicine Department, Ng Teng Fong General Hospital, Singapore
| | - Ling Tiah
- Accident & Emergency, Changi General Hospital, Singapore
| | | | - Lai Peng Tham
- Children's Emergency, KK Women's and Children's Hospital, Singapore
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | | | - Marcus Eng Hock Ong
- Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore
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Kim SH, Park JH, Jeong J, Ro YS, Hong KJ, Song KJ, Do Shin S. Bystander cardiopulmonary resuscitation, automated external defibrillator use, and survival after out-of-hospital cardiac arrest. Am J Emerg Med 2023; 66:85-90. [PMID: 36736064 DOI: 10.1016/j.ajem.2023.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/30/2022] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION We aimed to investigate the association between bystander cardiopulmonary resuscitation (CPR) with and without automated external defibrillator (AED) use and neurological outcomes after out-of-hospital cardiac arrest (OHCA) in Korea. METHODS This cross-sectional study used a nationwide Korean OHCA registry between 2015 and 2019. Patients were categorised into no bystander CPR and bystander CPR with and without AED use groups. The primary outcome was good neurological recovery at discharge. We also analysed the interaction effects of place of arrest, response time, and whether the OHCA was witnessed. RESULTS In total, 93,623 patients were included. Among them, 35,486 (37.9%) were in the no bystander CPR group, 56,187 (60.0%) were in the bystander CPR without AED use group, and 1950 (2.1%) were in the bystander CPR with AED use group. Good neurological recovery was demonstrated in 1286 (3.6%), 3877 (6.9%), and 208 (10.7%) patients in the no CPR, bystander CPR without AED use, and bystander CPR with AED use groups, respectively. Compared to the no bystander CPR group, the adjusted odds ratio (95% confidence intervals) for good neurological recovery was 1.54 (1.45-1.65) and 1.37 (1.15-1.63) in the bystander CPR without and with AED use groups, respectively. The effect of bystander CPR with AED use was more apparent in OHCAs with witnessed arrest and prolonged response time (≥8 min). CONCLUSION Bystander CPR was associated with better neurological recovery compared to no bystander CPR; however, the benefits of AED use were not significant. Efforts to disseminate bystander AED availability and ensure proper utilisation are warranted.
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Affiliation(s)
- Sang Hun Kim
- Department of Emergency Medicine, Seoul National University Hospital, South Korea
| | - Jeong Ho Park
- Department of Emergency Medicine, Seoul National University Hospital, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea.
| | - Joo Jeong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea
| | - Young Sun Ro
- Department of Emergency Medicine, Seoul National University Hospital, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University Hospital, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea; Department of Emergency Medicine, Seoul National University Boramae Medical Center, South Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University Hospital, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea
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Matte AE, Vossenberg NE, Akers KG, Paxton JH. Intraosseous Vascular Access in Cardiac Arrest: A Systematic Review of the Literature, with Implications for Future Research. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2023. [DOI: 10.1007/s40138-023-00259-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
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Rea T, Kudenchuk PJ, Sayre MR, Doll A, Eisenberg M. Out of hospital cardiac arrest: Past, present, and future. Resuscitation 2021; 165:101-109. [PMID: 34166740 DOI: 10.1016/j.resuscitation.2021.06.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/09/2021] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
Advances in resuscitation following out-of-hospital cardiac arrest (OHCA) provide an opportunity to improve public health. This review reflects on past developments, present status, and future possibilities using the science-education-implementation framework of the Utstein Formula and the clinical framework of the links in the chain of survival. With the discovery of CPR and defibrillation in the mid 20th century, resuscitation developed a scientific construct for progress. Systems of emergency community response provided operational efficiency to treat OHCA. Contemporary resuscitation involves integrated interventions in the chain of survival: early recognition, early CPR, early defibrillation, expert and timely advanced life support and hospital care, and multidimensional rehabilitation. Implementation of scientific advances is especially challenging given the unexpected nature of OHCA, the need for time-sensitive interventions, and the substantial collective of stakeholders involved in the chain of survival. Systematic measurement provides the foundation to evaluate performance and guide implementation initiatives. For many systems, telecommunicator CPR and high-performance CPR by emergency professionals are accessible, near-term programs to improve OHCA outcome. Smart technologies that activate, coordinate, and/or coach community "volunteers" to accelerate early CPR and defibrillation have conceptual promise, though robust implementation has been achieved by only a handful of systems. Longer-term strategies may leverage technology to develop a high-fidelity "life-detector" or engineer and disseminate a specialized consumer defibrillator designed to bridge care until arrival of professional response.
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Affiliation(s)
- Thomas Rea
- Department of Medicine, University of Washington, United States
| | | | - Michael R Sayre
- Department of Emergency Medicine, University of Washington, United States
| | - Ann Doll
- Resuscitation Academy, United States
| | - Mickey Eisenberg
- Department of Emergency Medicine, University of Washington, United States.
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Time boundaries of the three-phase time-sensitive model for ventricular fibrillation cardiac arrest. Resusc Plus 2021; 6:100095. [PMID: 34223360 PMCID: PMC8244403 DOI: 10.1016/j.resplu.2021.100095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 11/22/2022] Open
Abstract
Aim Ventricular fibrillation (VF) cardiac arrest may consist of three time-sensitive phases: electrical, circulatory, and metabolic. However, the time boundaries of these phases are unclear. We aimed to determine the time boundaries of the three-phase model for VF cardiac arrest. Methods We reviewed 20,741 out-of-hospital cardiac arrest cases with initial VF and presumed cardiac origin from the All-Japan Utstein-style registry between 2013 and 2017. The study endpoint was 1-month neurologically intact survival. The collapse-to-shock interval was defined as the time from collapse to the first shock delivery by emergency medical service personnel. The patients were divided into the bystander cardiopulmonary resuscitation (CPR, n = 11,606) and non-bystander CPR (n = 9135) groups. Results In the bystander CPR group, the collapse-to-shock times that were associated with increased adjusted 1-month neurologically intact survival, compared with those in the non-bystander CPR group, ranged from 7 min (42.9% [244/4999] vs. 26.0% [119/458], adjusted odds ratio [aOR], 1.95; 95% confidence interval [CI], 1.44-2.63; P < 0.0001) to 17 min (17.1% [70/410] vs. 7.3% [21/288], aOR, 2.82; 95% CI, 1.62-4.91; P = 0.0002). However, the neurologically intact survival rate of the bystander CPR group was statistically insignificant compared with that of the non-bystander CPR group when the collapse-to-shock time was outside this range. Conclusions The time boundaries of the three-phase time-sensitive model for VF cardiac arrest may be defined as follows: electrical phase, from collapse to <7 min; circulatory phase, from 7 to 17 min; and metabolic phase, from >17 min onward.
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Lee SGW, Park JH, Ro YS, Hong KJ, Song KJ, Shin SD. Time to first defibrillation and survival outcomes of out-of-hospital cardiac arrest with refractory ventricular fibrillation. Am J Emerg Med 2021; 40:96-102. [DOI: 10.1016/j.ajem.2020.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/15/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022] Open
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Coute RA, Nathanson BH, Kurz MC, McNally B, Mader TJ. The association between scene time interval and neurologic outcome following adult bystander witnessed out-of-hospital cardiac arrest. Am J Emerg Med 2020; 46:628-633. [PMID: 33309248 DOI: 10.1016/j.ajem.2020.11.059] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/10/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To analyze the association between Emergency Medical Services (EMS) scene time interval (STI) and survival with functional neurologic recovery following adult out-of-hospital cardiac arrest (OHCA). METHODS A retrospective analysis of prospectively collected data from the national Cardiac Arrest Registry to Enhance Survival from January 2013 to December 2018. All adult non-traumatic, EMS-treated, bystander-witnessed OHCA with complete data were included. Patients with STI times >60 min, defined as the time from EMS arrival at the patient's side to the time the transport vehicle left the scene, unwitnessed OHCA, nursing home events, EMS-witnessed OHCA, or patients with termination of resuscitation in the field were excluded. The primary outcome was survival with functional recovery (Cerebral Performance Category [CPC] = 1 or 2). Multivariable logistic regression was used to quantify the association of STI with the primary. OUTCOME RESULTS 67,237 patients met inclusion criteria with 12,098 (18.0%) surviving with functional recovery. Mean STI (SD) for survivors with CPC 1 or 2 was 19 (8.4) and 22.8 (10.5) for those with poor outcomes (death or CPC 3-4; p < 0.001). For every 1-min increase in STI, the adjusted odds of a poor outcome increased by 3.5%; odds ratio = 1.035; 95% CI (1.027, 1.044); p < 0.001. Restricted cubic spline analysis showed increased risk of poor outcome after approximately 20 min. CONCLUSION Longer STI times are strongly associated with poor neurologic outcome in bystander-witnessed OHCA patients. After a STI duration of approximately 20 min, the associated risk of a poor neurologic outcome increased more rapidly.
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Affiliation(s)
- Ryan A Coute
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, United States of America.
| | | | - Michael C Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, United States of America; Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, AL, United States of America; Center for Injury Science, University of Alabama School of Medicine, Birmingham, AL, United States of America
| | - Bryan McNally
- Department of Emergency Medicine, Emory University, Atlanta, GA, United States of America
| | - Timothy J Mader
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, United States of America
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- Cardiac Arrest Registry to Enhance Survival (CARES) Surveillance Group, Atlanta, GA, United States of America
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Shin J, Chocron R, Rea T, Kudenchuk P, McNally B, Eisenberg M. Merits of expanding the Utstein case definition for out of hospital cardiac arrest. Resuscitation 2020; 158:88-93. [PMID: 33220350 DOI: 10.1016/j.resuscitation.2020.10.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/02/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Utstein population is defined by non-traumatic, bystander-witnessed out-of-hospital cardiac arrest (OHCA) presenting with ventricular fibrillation (VF). It is used to compare resuscitation performance across emergency medical services (EMS) systems. We hypothesized a system-specific survival correlation between the current Utstein population and other VF populations defined by unwitnessed VF OHCA and VF OHCA after EMS arrival (EMS-witnessed). Expanding performance metrics to this more comprehensive population would make the Utstein definition more representative of the actual community burden and response to VF OHCA. METHODS We performed a cohort investigation of all non-traumatic, VF OHCA in the Cardiac Arrest Registry to Enhance Survival from 1/1/2013-12/31/2018 among EMS agencies that treated > = 100 VF OHCA. We evaluated sample size and survival with the addition of the new VF populations. We used Pearson coefficient to assess whether there was a correlation of agency-specific survival outcomes between the current Utstein population and unwitnessed and EMS-witnessed VF OHCA. RESULTS A total of 107 EMS agencies treated 38,836 VF arrests: 22,918 current Utstein, 11,297 unwitnessed VF, and 4621 EMS-witnessed VF OHCA. Overall, survival was 29.8% (11,567/38,836): 33.9% (7774/22,918) among current Utstein, 17.2% (1942/11,297) among unwitnessed VF, and 40.1% (1851/4621) among EMS-witnessed VF. For agency-specific survival outcome, the Pearson correlation was 0.52 between the current Utstein population versus combined unwitnessed and EMS-witnessed groups. For survival with Cerebral Performance Category 1-2, the Pearson correlation was 0.61. CONCLUSION Expanding the Utstein population to include unwitnessed and EMS-witnessed VF OHCA achieves a simpler, more inclusive case definition that minimizes variability in case determination and increases the number of survivors and eligible population by ∼50%, while still achieving a distinguishing metric of system-specific performance.
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Affiliation(s)
- Jenny Shin
- Emergency Medical Services Division of Public Health - Seattle & King County, United States
| | - Richard Chocron
- Paris University, Paris Research Cardiovascular Center, INSERM, F-75015 Paris, France; Emergency Department, Georges Pompidou European Hospital, Paris, France
| | - Thomas Rea
- Emergency Medical Services Division of Public Health - Seattle & King County, United States; University of Washington School of Medicine, United States
| | - Peter Kudenchuk
- Emergency Medical Services Division of Public Health - Seattle & King County, United States; University of Washington School of Medicine, United States
| | - Bryan McNally
- Emory University School of Medicine, Rollins School of Public Health, United States
| | - Mickey Eisenberg
- Emergency Medical Services Division of Public Health - Seattle & King County, United States; University of Washington School of Medicine, United States.
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Shoaib M, Choudhary RC, Choi J, Kim N, Hayashida K, Yagi T, Yin T, Nishikimi M, Stevens JF, Becker LB, Kim J. Plasma metabolomics supports the use of long-duration cardiac arrest rodent model to study human disease by demonstrating similar metabolic alterations. Sci Rep 2020; 10:19707. [PMID: 33184308 PMCID: PMC7665036 DOI: 10.1038/s41598-020-76401-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/20/2020] [Indexed: 12/16/2022] Open
Abstract
Cardiac arrest (CA) is a leading cause of death and there is a necessity for animal models that accurately represent human injury severity. We evaluated a rat model of severe CA injury by comparing plasma metabolic alterations to human patients. Plasma was obtained from adult human control and CA patients post-resuscitation, and from male Sprague–Dawley rats at baseline and after 20 min CA followed by 30 min cardiopulmonary bypass resuscitation. An untargeted metabolomics evaluation using UPLC-QTOF-MS/MS was performed for plasma metabolome comparison. Here we show the metabolic commonality between humans and our severe injury rat model, highlighting significant metabolic dysfunction as seen by similar alterations in (1) TCA cycle metabolites, (2) tryptophan and kynurenic acid metabolites, and (3) acylcarnitine, fatty acid, and phospholipid metabolites. With substantial interspecies metabolic similarity in post-resuscitation plasma, our long duration CA rat model metabolically replicates human disease and is a suitable model for translational CA research.
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Affiliation(s)
- Muhammad Shoaib
- Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA.,Donald and Barbara Zucker School of Medicine At Hofstra/Northwell, Hempstead, NY, USA
| | - Rishabh C Choudhary
- Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
| | - Jaewoo Choi
- Linus Pauling Institute, Oregon State University, Corvallis, OR, USA.,Department of Pharmaceutical Sciences, Oregon State University, Corvallis, OR, USA
| | - Nancy Kim
- Donald and Barbara Zucker School of Medicine At Hofstra/Northwell, Hempstead, NY, USA
| | - Kei Hayashida
- Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
| | - Tsukasa Yagi
- Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
| | - Tai Yin
- Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
| | - Mitsuaki Nishikimi
- Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
| | - Jan F Stevens
- Linus Pauling Institute, Oregon State University, Corvallis, OR, USA.,Department of Pharmaceutical Sciences, Oregon State University, Corvallis, OR, USA
| | - Lance B Becker
- Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA.,Donald and Barbara Zucker School of Medicine At Hofstra/Northwell, Hempstead, NY, USA.,Department of Emergency Medicine, Northwell Health, NY, USA
| | - Junhwan Kim
- Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA. .,Donald and Barbara Zucker School of Medicine At Hofstra/Northwell, Hempstead, NY, USA. .,Department of Emergency Medicine, Northwell Health, NY, USA.
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Shoaib M, Becker LB. A walk through the progression of resuscitation medicine. Ann N Y Acad Sci 2020; 1507:23-36. [PMID: 33040363 DOI: 10.1111/nyas.14507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/03/2020] [Accepted: 09/14/2020] [Indexed: 01/11/2023]
Abstract
Cardiac arrest (CA) is a sudden and devastating disease process resulting in more deaths in the United States than many cancers, metabolic diseases, and even car accidents. Despite such a heavy mortality burden, effective treatments have remained elusive. The past century has been productive in establishing the guidelines for resuscitation, known as cardiopulmonary resuscitation (CPR), as well as developing a scientific field whose aim is to elucidate the underlying mechanisms of CA and develop therapies to save lives. CPR has been successful in reinitiating the heart after arrest, enabling a survival rate of approximately 10% in out-of-hospital CA. Although current advanced resuscitation methods, including hypothermia and extracorporeal membrane oxygenation, have improved survival in some patients, they are unlikely to significantly improve the national survival rate any further without a paradigm shift. Such a change is possible with sustained efforts in the basic and clinical sciences of resuscitation and their implementation. This review seeks to discuss the current landscape in resuscitation medicine-how we got here and where we are going.
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Affiliation(s)
- Muhammad Shoaib
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.,The Feinstein Institutes for Medical Research, Manhasset, New York
| | - Lance B Becker
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.,The Feinstein Institutes for Medical Research, Manhasset, New York.,Department of Emergency Medicine, North Shore University Hospital, Northwell Health, Manhasset, New York
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Delays in Cardiopulmonary Resuscitation, Defibrillation, and Epinephrine Administration All Decrease Survival in In-hospital Cardiac Arrest. Anesthesiology 2020; 130:414-422. [PMID: 30707123 DOI: 10.1097/aln.0000000000002563] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
WHAT WE ALREADY KNOW ABOUT THIS TOPIC Rapid response to witnessed, pulseless cardiac arrest is associated with increased survival. WHAT THIS ARTICLE TELLS US THAT IS NEW Assessment of witnessed, pulseless cardiac arrests occurring at 538 hospitals during a 9-yr period indicates that CPR did not occur immediately at 0 min in 5.7% of patients despite guidelines for instantaneous initiation. Delay in initiation of CPR was associated with significantly decreased survival.Time to initiation of CPR and subsequent time to initiation of administration of defibrillation shock (for shockable arrhythmias) and epinephrine were both associated with reduced patient survival. BACKGROUND Because the extent to which delays in initiating cardiopulmonary resuscitation (CPR) versus the time from CPR to defibrillation or epinephrine treatment affects survival remains unknown, it was hypothesized that all three independently decrease survival in in-hospital cardiac arrest. METHODS Witnessed, index cases of cardiac arrest from the Get With The Guidelines-Resuscitation Database occurring between 2000 and 2008 in 538 hospitals were included in this analysis. Multivariable risk-adjusted logistic regression examined the association of time to initiation of CPR and time from CPR to either epinephrine treatment or defibrillation with survival to discharge. RESULTS In the overall cohort of 57,312 patients, there were 9,802 survivors (17.1%). Times to initiation of CPR greater than 2 min were associated with a survival of 14.7% (91 of 618) as compared with 17.1% (9,711 of 56,694) if CPR was begun in 2 min or less (adjusted odds ratio [95% CI], 0.68 [0.54 to 0.87]; P < 0.002). Times from CPR to either defibrillation or epinephrine treatment of 2 min or less were associated with a survival of 18.0% (7,654 of 42,475), as compared with 15.0% (1,680 of 11,227) for 3 to 5 min (reference, 0 to 2 min; adjusted odds ratios [95% CI], 0.83 [0.78 to 0.88]; P < 0.001), 12.8% (382 of 2,983) for 6 to 8 min (0.67 [0.60 to 0.76], P < 0.001), and 13.7% (86 of 627) for 9 to 11 min (0.54 [0.42 to 0.69], P < 0.001). CONCLUSIONS Delays in the initiation of CPR and from CPR to defibrillation or epinephrine treatment were each associated with lower survival.
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Yan S, Gan Y, Jiang N, Wang R, Chen Y, Luo Z, Zong Q, Chen S, Lv C. The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:61. [PMID: 32087741 PMCID: PMC7036236 DOI: 10.1186/s13054-020-2773-2] [Citation(s) in RCA: 506] [Impact Index Per Article: 101.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/11/2020] [Indexed: 12/17/2022]
Abstract
Background To quantitatively summarize the available epidemiological evidence on the survival rate of out-of-hospital cardiac arrest (OHCA) patients who received cardiopulmonary resuscitation (CPR). Methods We systematically searched the PubMed, Embase, and Web of Science databases, and the references of retrieved articles were manually reviewed to identify studies reporting the outcome of OHCA patients who received CPR. The overall incidence and outcome of OHCA were assessed using a random-effects meta-analysis. Results A total of 141 eligible studies were included in this meta-analysis. The pooled incidence of return of spontaneous circulation (ROSC) was 29.7% (95% CI 27.6–31.7%), the rate of survival to hospital admission was 22.0% (95% CI 20.7–23.4%), the rate of survival to hospital discharge was 8.8% (95% CI 8.2–9.4%), the pooled 1-month survival rate was 10.7% (95% CI 9.1–13.3%), and the 1-year survival rate was 7.7% (95% CI 5.8–9.5%). Subgroup analysis showed that survival to hospital discharge was more likely among OHCA patients whose cardiac arrest was witnessed by a bystander or emergency medical services (EMS) (10.5%; 95% CI 9.2–11.7%), who received bystander CPR (11.3%, 95% CI 9.3–13.2%), and who were living in Europe and North America (Europe 11.7%; 95% CI 10.5–13.0%; North America: 7.7%; 95% CI 6.9–8.6%). The survival to discharge (8.6% in 1976–1999 vs. 9.9% in 2010–2019), 1-month survival (8.0% in 2000–2009 vs. 13.3% in 2010–2019), and 1-year survival (8.0% in 2000–2009 vs. 13.3% in 2010–2019) rates of OHCA patients who underwent CPR significantly increased throughout the study period. The Egger’s test did not indicate evidence of publication bias for the outcomes of OHCA patients who underwent CPR. Conclusions The global survival rate of OHCA patients who received CPR has increased in the past 40 years. A higher survival rate post-OHCA is more likely among patients who receive bystander CPR and who live in Western countries. Electronic supplementary material The online version of this article (10.1186/s13054-020-2773-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shijiao Yan
- School of Public Health, Hainan Medical University, Haikou, Hainan, China.,Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Nan Jiang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Rixing Wang
- Department of Emergency, Hainan Clinical Research Center for Acute and Critical Diseases, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Yunqiang Chen
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China.,Emergency and Trauma College, Hainan Medical University, Haikou, Hainan, China
| | - Zhiqian Luo
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China.,Emergency and Trauma College, Hainan Medical University, Haikou, Hainan, China
| | - Qiao Zong
- School of International Education, Hainan Medical University, Haikou, Hainan, China
| | - Song Chen
- Department of Emergency, the First Affiliated Hospital of Hainan Medical University, No.3 Xueyuan Road, Longhua Zone, Haikou, 571199, China
| | - Chuanzhu Lv
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China. .,Department of Emergency, Hainan Clinical Research Center for Acute and Critical Diseases, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China. .,Emergency and Trauma College, Hainan Medical University, Haikou, Hainan, China.
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14
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Affiliation(s)
- William J Brady
- From the Department of Emergency Medicine, University of Virginia Health System, Albemarle County Fire Rescue, Charlottesville (W.J.B.); the Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore (A.M.); and the Department of Emergency Medicine, Vanderbilt University Medical Center, the Metro Nashville Fire Department, and the Nashville International Airport Department of Public Safety - all in Nashville (C.M.S.)
| | - Amal Mattu
- From the Department of Emergency Medicine, University of Virginia Health System, Albemarle County Fire Rescue, Charlottesville (W.J.B.); the Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore (A.M.); and the Department of Emergency Medicine, Vanderbilt University Medical Center, the Metro Nashville Fire Department, and the Nashville International Airport Department of Public Safety - all in Nashville (C.M.S.)
| | - Corey M Slovis
- From the Department of Emergency Medicine, University of Virginia Health System, Albemarle County Fire Rescue, Charlottesville (W.J.B.); the Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore (A.M.); and the Department of Emergency Medicine, Vanderbilt University Medical Center, the Metro Nashville Fire Department, and the Nashville International Airport Department of Public Safety - all in Nashville (C.M.S.)
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15
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Association between shockable rhythm conversion and outcomes in patients with out-of-hospital cardiac arrest and initial non-shockable rhythm, according to the cause of cardiac arrest. Resuscitation 2019; 142:144-152. [DOI: 10.1016/j.resuscitation.2019.07.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 06/29/2019] [Accepted: 07/22/2019] [Indexed: 12/19/2022]
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16
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Choi J, Shoaib M, Yin T, Nayyar G, Shinozaki K, Stevens JF, Becker LB, Kim J. Tissue-Specific Metabolic Profiles After Prolonged Cardiac Arrest Reveal Brain Metabolome Dysfunction Predominantly After Resuscitation. J Am Heart Assoc 2019; 8:e012809. [PMID: 31475603 PMCID: PMC6755859 DOI: 10.1161/jaha.119.012809] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Cardiac arrest (CA) has been a leading cause of death for many decades. Despite years of research, we still do not understand how each organ responds to the reintroduction of blood flow after prolonged CA. Following changes in metabolites of individual organs after CA and resuscitation gives context to the efficiency and limitations of current resuscitation protocols. Methods and Results Adult male Sprague–Dawley rats were arbitrarily assigned into 3 groups: control, 20 minutes of CA, or 20 minutes of CA followed by 30 minutes of cardiopulmonary bypass resuscitation. The rats were euthanized by decapitation to harvest brain, heart, kidney, and liver tissues. The obtained tissue samples were analyzed by ultra‐high‐performance liquid chromatography–high‐accuracy mass spectrometry for comprehensive metabolomics evaluation. After resuscitation, the brain showed decreased glycolysis metabolites and fatty acids and increased amino acids compared with control. Similarly, the heart displayed alterations mostly in amino acids. The kidney showed decreased amino acid and fatty acid pools with severely increased tricarboxylic acid cycle metabolites following resuscitation, while the liver showed minimal alterations with slight changes in the lipid pool. Each tissue has a distinct pattern of metabolite changes after ischemia/reperfusion. Furthermore, resuscitation worsens the metabolic dysregulation in the brain and kidney, while it normalizes metabolism in the heart. Conclusions Developing metabolic profiles using a global metabolome analysis identifies the variable nature of metabolites in individual organs after CA and reperfusion, establishing a stark contrast between the normalized heart and liver and the exacerbated brain and kidney, only after the reestablishment of blood circulation.
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Affiliation(s)
- Jaewoo Choi
- Linus Pauling Institute Oregon State University Corvallis OR
| | - Muhammad Shoaib
- Laboratory for Critical Care Physiology Feinstein Institute for Medical Research Manhasset NY.,Department of Molecular Medicine Zucker School of Medicine at Hofstra/Northwell Hempstead NY
| | - Tai Yin
- Laboratory for Critical Care Physiology Feinstein Institute for Medical Research Manhasset NY
| | | | - Koichiro Shinozaki
- Laboratory for Critical Care Physiology Feinstein Institute for Medical Research Manhasset NY
| | - Jan F Stevens
- Linus Pauling Institute Oregon State University Corvallis OR.,Department of Pharmaceutical Sciences Oregon State University Corvallis OR
| | - Lance B Becker
- Laboratory for Critical Care Physiology Feinstein Institute for Medical Research Manhasset NY.,Department of Molecular Medicine Zucker School of Medicine at Hofstra/Northwell Hempstead NY.,Department of Emergency Medicine North Shore University Hospital Manhasset NY
| | - Junhwan Kim
- Laboratory for Critical Care Physiology Feinstein Institute for Medical Research Manhasset NY.,Department of Molecular Medicine Zucker School of Medicine at Hofstra/Northwell Hempstead NY.,Department of Emergency Medicine North Shore University Hospital Manhasset NY
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17
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Berger C, Brinkrolf P, Ertmer C, Becker J, Friederichs H, Wenk M, Van Aken H, Hahnenkamp K. Combination of problem-based learning with high-fidelity simulation in CPR training improves short and long-term CPR skills: a randomised single blinded trial. BMC MEDICAL EDUCATION 2019; 19:180. [PMID: 31151450 PMCID: PMC6544917 DOI: 10.1186/s12909-019-1626-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 05/22/2019] [Indexed: 05/05/2023]
Abstract
BACKGROUND Performance of sufficient cardiopulmonary resuscitation (CPR) by medical personnel is critical to improve outcomes during cardiac arrest. It has however been shown that even health care professionals possess a lack of knowledge and skills in CPR performance. The optimal method for teaching CPR remains unclear, and data that compares traditional CPR instructional methods with newer modalities of CPR instruction are needed. We therefore conducted a single blinded, randomised study involving medical students in order to evaluate the short- and long-term effects of a classical CPR education compared with a bilateral approach to CPR training, consisting of problem-based learning (PBL) plus high fidelity simulation. METHODS One hundred twelve medical students were randomized during a curricular anaesthesiology course to a control (n = 54) and an intervention (n = 58) group. All participants were blinded to group assignment and partook in a 30-min-lecture on CPR basics. Subsequently, the control group participated in a 90-min tutor-guided CPR hands-on-training. The intervention group took part in a 45-min theoretical PBL module followed by 45 min of high fidelity simulated CPR training. The rate of participants recognizing clinical cardiac arrest followed by sufficiently performed CPR was the primary outcome parameter of this study. CPR performance was evaluated after the intervention. In addition, a follow-up evaluation was conducted after 6 months. RESULTS 51.9% of the intervention group met the criteria of sufficiently performed CPR as compared to only 12.5% in the control group on the day of the intervention (p = 0.007). Hands-off-time as a marker for CPR continuity was significantly less in the intervention group (24.0%) as compared to the control group (28.3%, p = 0.007, Hedges' g = 1.55). At the six-month follow-up, hands-off-time was still significantly lower in the intervention group (23.7% vs. control group: 31.0%, p = 0.006, Hedges' g = 1.88) but no significant difference in sufficiently performed CPR was detected (intervention group: 71.4% vs. control group: 54.5%, p = 0.55). CONCLUSION PBL combined with high fidelity simulation training leads to a measurable short-term increase in initiating sufficient CPR by medical students immediately after training as compared to classical education. At six month post instruction, these differences remained only partially.
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Affiliation(s)
- Christian Berger
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Peter Brinkrolf
- Department of Anesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Cristian Ertmer
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Jan Becker
- Institute for Education and Students Affairs-IFAS, Medical Faculty, University of Münster, Münster, Germany
| | - Hendrik Friederichs
- Institute for Education and Students Affairs-IFAS, Medical Faculty, University of Münster, Münster, Germany
| | - Manuel Wenk
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Hugo Van Aken
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Klaus Hahnenkamp
- Department of Anesthesiology, University Medicine Greifswald, Greifswald, Germany
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18
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Lupton JR, Schmicker R, Daya MR, Aufderheide TP, Stephens S, Le N, May S, Puyana JC, Idris A, Nichol G, Wang H, Hansen M. Effect of initial airway strategy on time to epinephrine administration in patients with out-of-hospital cardiac arrest. Resuscitation 2019; 139:314-320. [PMID: 30902690 DOI: 10.1016/j.resuscitation.2019.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/05/2019] [Accepted: 03/11/2019] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Epinephrine and advanced airway management are commonly used during treatment of out-of-hospital cardiac arrest (OHCA). Recent studies suggest that early but not late administration of epinephrine is associated with improved survival. The purpose of this study was to evaluate the effect of initial airway strategy on timing to the first epinephrine dose in OHCA. METHODS This is a secondary analysis of patients enrolled in the Pragmatic Airway Resuscitation Trial who had an advanced airway attempted. We examined differences in time to epinephrine administration by randomly assigned airway strategy, laryngeal tube (LT) or endotracheal tube (ETI); by the duration of airway attempt; and by number of attempts. We used survival methods to account for interval censoring due to unknown administration time. We also examined the association of epinephrine administration timing with survival to hospital discharge. RESULTS Among 2652 subjects (1299 ETI and 1353 LT), 2579 received epinephrine.There were no significant differences between ETI and LT in median time to initial epinephrine administration (min) (ETI - 9.0 vs. LT - 8.6, p = 0.55). There was no significant association between the duration of airway attempt or number of attempts and time to initial epinephrine administration (p = 0.12 and 0.66, respectively). Early administration of epinephrine (<10 min from EMS arrival) was significantly associated with survival compared to administration ≥10 min (OR 1.36, 95% CI: 1.05, 1.77). CONCLUSIONS There was no significant association between airway strategy and time to initial epinephrine administration. Earlier administration of epinephrine (< 10 min from EMS arrival) was associated with improved survival.
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Affiliation(s)
| | | | | | | | | | - Nancy Le
- Oregon Health and Science University United States.
| | | | | | | | | | - Henry Wang
- University of Texas Health Science Center United States.
| | - Matt Hansen
- Oregon Health and Science University United States.
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19
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Coute RA, Nathanson BH, Panchal AR, Kurz MC, Haas NL, McNally B, Neumar RW, Mader TJ. Disability-Adjusted Life Years Following Adult Out-of-Hospital Cardiac Arrest in the United States. Circ Cardiovasc Qual Outcomes 2019; 12:e004677. [DOI: 10.1161/circoutcomes.118.004677] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Ryan A. Coute
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham (R.A.C., M.C.K.)
| | | | - Ashish R. Panchal
- Department of Emergency Medicine, Ohio State University Wexner Medical Center, Columbus (A.R.P.)
| | - Michael C. Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham (R.A.C., M.C.K.)
| | - Nathan L. Haas
- Department of Emergency Medicine, University of Michigan, Ann Arbor (N.L.H., R.W.N.)
| | - Bryan McNally
- Department of Emergency Medicine, Emory University, Atlanta, GA (B.M.)
| | - Robert W. Neumar
- Department of Emergency Medicine, University of Michigan, Ann Arbor (N.L.H., R.W.N.)
- Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor (R.W.N.)
| | - Timothy J. Mader
- Department of Emergency Medicine, University of Massachusetts Medical School—Baystate, Springfield (T.J.M.)
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20
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Michaelis P, Leone RJ. Cardiac Arrest After Cardiac Surgery: An Evidence-Based Resuscitation Protocol. Crit Care Nurse 2019; 39:15-25. [DOI: 10.4037/ccn2019309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
More than 250 000 cardiac surgical procedures are performed annually in the United States. Postoperative cardiac arrest rates range from 0.7% to 5.2%. This article reviews current evidence for cardiac arrest resuscitation after cardiac surgery. The evaluation included resuscitation guidelines and 22 studies identified through a MEDLINE search. Evidence-based resuscitation differs from advanced cardiovascular life support guidelines. European Resuscitation Council guidelines include correcting reversible causes of arrest, applying defibrillation/pacing before external cardiopulmonary resuscitation, resternotomy within 5 minutes if electrical therapies fail, and restricting epinephrine use to avoid rebound hypertension. A 2017 Society of Thoracic Surgeons protocol derived from European Resuscitation Council guidelines is now standard of care in the United States. Evidence-based practices can improve survival and reduce resternotomy rates. This article describes the clinical implementation of the Society of Thoracic Surgeons guidelines.
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Affiliation(s)
| | - Richard J. Leone
- Richard Leone is a cardiothoracic surgeon, Skagit Regional Health, Mount Vernon, and Kadlec Regional Medical Center, Richland, Washington
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21
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Song J, Guo W, Lu X, Kang X, Song Y, Gong D. The effect of bystander cardiopulmonary resuscitation on the survival of out-of-hospital cardiac arrests: a systematic review and meta-analysis. Scand J Trauma Resusc Emerg Med 2018; 26:86. [PMID: 30309373 PMCID: PMC6182861 DOI: 10.1186/s13049-018-0552-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/24/2018] [Indexed: 11/16/2022] Open
Abstract
Background For many years, bystander cardiopulmonary resuscitation (BCPR) has been considered as a favorable factor to improve survival of out-of-hospital cardiac arrests (OHCAs). To examine the effect of BCPR on the survival of OHCAs and whether BCPR might also improve survival when the initial rhythm of OHCAs is limited, we performed a meta-analysis on published observational studies. Methods We did a systematic review to identify all studies published up to March, 2018, in any language, that reported the relation between BCPR and the survival of OHCAs. Using standard forms, two authors independently identified studies for inclusion and extracted information. The outcome was survival. Meta-regression was done to ascertain weighted factors for the outcomes. Results Data were extracted from 19 studies involving 232,703 patients. Firstly, pooled odds ratio (OR) from 16 cohort studies showed that BCPR was associated with improved chance of survival of OHCAs compared with NO-BCPR (OR 1.95, 95% confidence interval [CI]: 1.66–2.30). Secondly, from 8 cohort studies of OHCAs whose initial rhythm is limited, the pooled OR was 2.10 (95% CI, 1.68–2.63) of 6 articles for shockable rhythm and 1.07 (95% CI, 0.37–3.13) of 2 articles for non-shockable rhythm. Meta-regression showed a relation between the survival of OHCAs and BCPR was influenced by area (p < 0.05). Conclusions Based on currently available evidence, the findings of this meta-analysis suggest that BCPR increases the survival of OHCAs, and it also help OHCAs whose initial rhythm is shockable. That is to say BCPR is also helpful when emergency department response time is short. Therefore global priority should be given to increasing the incidence of BCPR by evidence-based best practice.
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Affiliation(s)
- Jianting Song
- Dalian Medical University, No. 9, west section, Lushun South road, Dalian city, Liaoning Province, China
| | - Wenxiu Guo
- Liaoning university of Traditional Chinese Medicine, No. 79, Chongshan road, Huanggu District, Shenyang city, Liaoning province, China
| | - Xiaoguang Lu
- Department of Emergency Medicine, Affiliated Zhongshan Hospital of Dalian University, No. 6th Jiefang Street, ZhongShan District, Dalian city, Liaoning Province, China.
| | - Xin Kang
- Department of Emergency Medicine, Affiliated Zhongshan Hospital of Dalian University, No. 6th Jiefang Street, ZhongShan District, Dalian city, Liaoning Province, China
| | - Yi Song
- Department of Emergency Medicine, Affiliated Zhongshan Hospital of Dalian University, No. 6th Jiefang Street, ZhongShan District, Dalian city, Liaoning Province, China
| | - Dianbo Gong
- Department of Emergency Medicine, Affiliated Zhongshan Hospital of Dalian University, No. 6th Jiefang Street, ZhongShan District, Dalian city, Liaoning Province, China
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22
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Del Rios Rivera M. Eliminating Disparities in Out-of-Hospital Cardiac Arrest Survival. Circ Cardiovasc Qual Outcomes 2018; 11:e004989. [DOI: 10.1161/circoutcomes.118.004989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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23
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Abbas F, Sawaf B, Hanafi I, Hajeer MY, Zakaria MI, Abbas W, Alabdeh F, Ibrahim N. Peers versus professional training of basic life support in Syria: a randomized controlled trial. BMC MEDICAL EDUCATION 2018; 18:142. [PMID: 29914441 PMCID: PMC6006697 DOI: 10.1186/s12909-018-1241-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 05/25/2018] [Indexed: 05/06/2023]
Abstract
BACKGROUND Peer training has been identified as a useful tool for delivering undergraduate training in basic life support (BLS) which is fundamental as an initial response in cases of emergency. This study aimed to (1) Evaluate the efficacy of peer-led model in basic life support training among medical students in their first three years of study, compared to professional-led training and (2) To assess the efficacy of the course program and students' satisfaction of peer-led training. METHODS A randomized controlled trial with blinded assessors was conducted on 72 medical students from the pre-clinical years (1st to 3rd years in Syria) at Syrian Private University. Students were randomly assigned to peer-led or to professional-led training group for one-day-course of basic life support skills. Sixty-four students who underwent checklist based assessment using objective structured clinical examination design (OSCE) (practical assessment of BLS skills) and answered BLS knowledge checkpoint-questionnaire were included in the analysis. RESULTS There was no statistically significant difference between the two groups in delivering BLS skills to medical students in practical (P = 0.850) and BLS knowledge questionnaire outcomes (P = 0.900). Both groups showed statistically significant improvement from pre- to post-course assessment with significant statistical difference in both practical skills and theoretical knowledge (P-Value < 0.001). Students were satisfied with the peer model of training. CONCLUSION Peer-led training of basic life support for medical students was beneficial and it provided a quality of education which was as effective as training conducted by professionals. This method is applicable and desirable especially in poor-resource countries and in crisis situation.
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Affiliation(s)
- Fatima Abbas
- Faculty of Medicine, Damascus University, Fayez Mansour St. Al-Mezzeh, Damascus, Syria
| | - Bisher Sawaf
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Ibrahem Hanafi
- Faculty of Medicine, Damascus University, Fayez Mansour St. Al-Mezzeh, Damascus, Syria
| | | | | | - Wafaa Abbas
- Faculty of Medicine, Damascus University, Fayez Mansour St. Al-Mezzeh, Damascus, Syria
| | - Fadi Alabdeh
- Emergency Department, Damascus Hospital, Damascus, Syria
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24
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Tanguay-Rioux X, Grunau B, Neumar R, Tallon J, Boone R, Christenson J. Is initial rhythm in OHCA a predictor of preceding no flow time? Implications for bystander response and ECPR candidacy evaluation. Resuscitation 2018; 128:88-92. [PMID: 29738800 DOI: 10.1016/j.resuscitation.2018.05.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/11/2018] [Accepted: 05/04/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Shockable cardiac rhythms are associated with improved outcomes among out-of-hospital cardiac arrests (OHCA). Initial cardiac rhythm may also be predictive of a short preceding no-flow duration. We examined the relationship between no-flow duration and initial cardiac rhythm, which may demonstrate the urgency in rescuer response and assist with candidacy evaluation for extracorporeal-cardiopulmonary resuscitation (ECPR). METHODS We examined consecutive adult OHCA's identified by a prospective registry in British Columbia (2005-2016). We included those with witnessed OHCA but no bystander CPR. The variable of interest was no-flow duration, defined as time from 9-1-1 call to EMS arrival. We fit an adjusted logistic regression model to estimate the association of no-flow duration and initial cardiac rhythm. Among those with shockable initial rhythms, we calculated the cumulative proportion with no-flow durations under incremental time cut-offs. RESULTS Of 26 621 EMS-treated OHCA's, 2532 were included. Overall survival was 13.8%, and 34% had initial shockable rhythms. The probability of having an initial shockable rhythm decreased with increasing no-flow durations (adjusted OR 0.88 per minute, 95% CI 0.85-0.91). Among those found with initial shockable rhythms, 94% (95% CI 92-96%) had a no-flow time under 10 min. CONCLUSION The odds of a shockable initial rhythm declined with each additional minute of no-flow time, highlighting the importance of early access to defibrillation. Among those with initial shockable rhythms, the preceding no-flow duration was highly likely to be under 10 min, which may inform decisions about ECPR candidacy among select patients with unwitnessed arrests.
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Affiliation(s)
| | - Brian Grunau
- Department of Emergency Medicine, University of British Columbia, Canada; St. Paul's Hospital, Vancouver, B.C., Canada
| | - Robert Neumar
- Department of Emergency Medicine and Michigan Center for Integrative Research in Critical Care (MCIRCC), University of Michigan, Ann Arbor, MI, United States
| | - John Tallon
- Department of Emergency Medicine, University of British Columbia, Canada; British Columbia Emergency Health Services, Vancouver, B.C., Canada
| | - Robert Boone
- St. Paul's Hospital, Vancouver, B.C., Canada; Division of Cardiology, University of British Columbia, Canada
| | - Jim Christenson
- Department of Emergency Medicine, University of British Columbia, Canada; St. Paul's Hospital, Vancouver, B.C., Canada
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25
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Luo S, Zhang Y, Zhang W, Zheng R, Tao J, Xiong Y. Prognostic significance of spontaneous shockable rhythm conversion in adult out-of-hospital cardiac arrest patients with initial non-shockable heart rhythms: A systematic review and meta-analysis. Resuscitation 2017; 121:1-8. [DOI: 10.1016/j.resuscitation.2017.09.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/08/2017] [Accepted: 09/20/2017] [Indexed: 01/28/2023]
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26
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Yamaguchi Y, Woodin JA, Gibo K, Zive DM, Daya MR. Improvements in Out-of-Hospital Cardiac Arrest Survival from 1998 to 2013. PREHOSP EMERG CARE 2017; 21:616-627. [PMID: 28426258 DOI: 10.1080/10903127.2017.1308604] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Out-of-hospital cardiac arrest (OHCA) remains a major public health burden. Aggregate OHCA survival to hospital discharge has reportedly remained unchanged at 7.6% for almost 30 years from 1970 to 2008. We examined the trends in adult OHCA survival over a 16-year period from 1998 to 2013 within a single EMS agency. METHODS Observational cohort study of adult OHCA patients treated by Tualatin Valley Fire & Rescue (TVF&R) from 1998 to 2013. This is an ALS first response fire agency that maintains an active Utstein style cardiac arrest registry and serves a population of approximately 450,000 in 9 incorporated cities in Oregon. Primary outcomes were survival to hospital discharge in all patients and in the subgroup with witnessed ventricular fibrillation/pulseless ventricular tachycardia (VF/VT). The impact of key covariates on survival was assessed using univariate logistic regression. These included patient factors (age and sex), event factors (location of arrest, witnessed status, and first recorded cardiac arrest rhythm), and EMS system factors (response time interval, bystander CPR, and non-EMS AED shock). We used multivariate logistic regression to examine the impact of year increment on survival after multiple imputation for missing data. Sensitivity analysis was performed with complete cases. RESULTS During the study period, 2,528 adult OHCA had attempted field resuscitation. The survival rate for treated cases increased from 6.7% to 18.2%, with witnessed VF/VT cases increasing from 14.3% to 31.4% from 1998 to 2013. Univariate analysis showed that younger age, male sex, public location of arrest, bystander or EMS witnessed event, initial rhythm of pulseless electrical activity (PEA) or VF/VT, bystander CPR, non-EMS AED shock, and a shorter EMS response time were independently associated with survival. After adjustment for covariates, the odds of survival increased by 9% (OR 1.09, 95%CI: 1.05-1.12) per year in all treated cases, and by 6% (OR 1.06, 95% 1.01-1.10) per year in witnessed VF/VT subgroups. Findings remained consistent on sensitivity analysis. CONCLUSIONS Overall survival from treated OHCA has increased over the last 16 years in this community. These survival increases demonstrate that OHCA is a treatable condition that warrants further investigation and investment of resources.
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Wah W, Wai KL, Pek PP, Ho AFW, Alsakaf O, Chia MYC, Noor JM, Kajino K, De Souza NNA, Ong MEH. Conversion to shockable rhythms during resuscitation and survival for out-of hospital cardiac arrest. Am J Emerg Med 2016; 35:206-213. [PMID: 27810251 DOI: 10.1016/j.ajem.2016.10.042] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 10/19/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In out of hospital cardiac arrest (OHCA), the prognostic influence of conversion to shockable rhythms during resuscitation for initially non-shockable rhythms remains unknown. This study aimed to assess the relationship between initial and subsequent shockable rhythm and post-arrest survival and neurological outcomes after OHCA. METHODOLOGY This was a retrospective analysis of all OHCA cases collected from the Pan-Asian Resuscitation Outcomes Study (PAROS) registry in 7 countries in Asia between 2009 and 2012. We included OHCA cases of presumed cardiac etiology, aged 18-years and above and resuscitation attempted by EMS. We performed multivariate logistic regression analyses to assess the relationship between initial and subsequent shockable rhythm and survival and neurological outcomes. 2-stage seemingly unrelated bivariate probit models were developed to jointly model the survival and neurological outcomes. We adjusted for the clustering effects of country variance in all models. RESULTS 40,160 OHCA cases met the inclusion criteria. There were 5356 OHCA cases (13.3%) with initial shockable rhythm and 33,974 (84.7%) with initial non-shockable rhythm. After adjustment of baseline and prehospital characteristics, OHCA with initial shockable rhythm (odds ratio/OR=6.10, 95% confidence interval/CI=5.06-7.34) and subsequent conversion to shockable rhythm (OR=2.00,95%CI=1.10-3.65) independently predicted better survival-to-hospital-discharge outcomes. Subsequent shockable rhythm conversion significantly improved survival-to-admission, discharge and post-arrest overall and cerebral performance outcomes in the multivariate logistic regression and 2-stage analyses. CONCLUSION Initial shockable rhythm was the strongest predictor for survival. However, conversion to subsequent shockable rhythm significantly improved post-arrest survival and neurological outcomes. This study suggests the importance of early resuscitation efforts even for initially non-shockable rhythms which has prognostic implications and selection of subsequent post-resuscitation therapy.
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Affiliation(s)
- Win Wah
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
| | - Khin Lay Wai
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, A*STAR, Singapore
| | - Pin Pin Pek
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Andrew Fu Wah Ho
- Emergency Medicine Residency Program, SingHealth Services, Singapore
| | - Omer Alsakaf
- Dubai Corporation for Ambulance Services, Dubai, United Arab Emirates
| | | | - Julina Md Noor
- Department of Emergency and Trauma, Hospital Sungai Buloh, Selangor, Malaysia
| | - Kentaro Kajino
- Critical Care Medical Center, Osaka National Hospital, Osaka, Japan
| | | | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
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Hidano D, Coult J, Blackwood J, Fahrenbruch C, Kwok H, Kudenchuk P, Rea T. Ventricular fibrillation waveform measures and the etiology of cardiac arrest. Resuscitation 2016; 109:71-75. [PMID: 27784613 DOI: 10.1016/j.resuscitation.2016.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/27/2016] [Accepted: 10/06/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Early determination of the acute etiology of cardiac arrest could help guide resuscitation or post-resuscitation care. In experimental studies, quantitative measures of the ventricular fibrillation waveform distinguish ischemic from non-ischemic etiology. METHODS We investigated whether waveform measures distinguished arrest etiology among adults treated by EMS for out-of-hospital ventricular fibrillation between January 1, 2006-December 31, 2014. Etiology was classified using hospital information into three exclusive groups: acute coronary syndrome (ACS) with ST elevation myocardial infarction (STEMI), ACS without ST elevation (non-STEMI), or non-ischemic arrest. Waveform measures included amplitude spectrum area (AMSA), centroid frequency (CF), mean frequency (MF), and median slope (MS) assessed during CPR-free epochs immediately prior to the initial and second shock. Waveform measures prior to the initial shock and the changes between first and second shock were compared by etiology group. We a priori chose a significance level of 0.01 due to multiple comparisons. RESULTS Of the 430 patients, 35% (n=150) were classified as STEMI, 29% (n=123) as non-STEMI, and 37% (n=157) with non-ischemic arrest. We did not observe differences by etiology in any of the waveform measures prior to shock 1 (Kruskal-Wallis Test) (p=0.28 for AMSA, p=0.07 for CF, p=0.63 for MF, and p=0.39 for MS). We also did not observe differences for change in waveform between shock 1 and 2, or when the two acute ischemia groups (STEMI and non-STEMI) were combined and compared to the non-ischemic group. CONCLUSION This clinical investigation suggests that waveform measures may not be useful in distinguishing cardiac arrest etiology.
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Affiliation(s)
- Danelle Hidano
- Department of Medicine, University of Washington, Emergency Medical Services Division of Public Health Seattle & King County, United States
| | - Jason Coult
- Department of Bioengineering, University of Washington, Emergency Medical Services Division of Public Health Seattle & King County, United States
| | - Jennifer Blackwood
- Department of Public Health, Emergency Medical Services Division of Public Health Seattle & King County, United States
| | - Carol Fahrenbruch
- Department of Public Health, Emergency Medical Services Division of Public Health Seattle & King County, United States
| | - Heemun Kwok
- Department of Medicine, University of Washington, Emergency Medical Services Division of Public Health Seattle & King County, United States
| | - Peter Kudenchuk
- Department of Medicine, University of Washington, Emergency Medical Services Division of Public Health Seattle & King County, United States; Department of Public Health, Emergency Medical Services Division of Public Health Seattle & King County, United States
| | - Thomas Rea
- Department of Medicine, University of Washington, Emergency Medical Services Division of Public Health Seattle & King County, United States; Department of Public Health, Emergency Medical Services Division of Public Health Seattle & King County, United States.
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Karlis G, Iacovidou N, Lelovas P, Niforopoulou P, Papalois A, Siafaka I, Mentzelopoulos S, Xanthos T. Nifekalant Versus Amiodarone in the Treatment of Cardiac Arrest: an Experimental Study in a Swine Model of Prolonged Ventricular Fibrillation. Cardiovasc Drugs Ther 2016; 29:425-31. [PMID: 26145169 DOI: 10.1007/s10557-015-6604-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of the experiment was to compare the effects of nifekalant and amiodarone on the return of spontaneous circulation (ROSC), survival, as well as on the hemodynamic parameters in a swine model of prolonged ventricular fibrillation (VF). METHODS After 8 min of untreated VF, bolus doses of epinephrine (adrenaline) and either nifekalant, or amiodarone, or saline (n = 10 per group), were administered after randomization. Cardiopulmonary resuscitation (CPR) was commenced immediately after drug administration and defibrillation was attempted 2 min later. CPR was resumed for another 2 min after each defibrillation attempt and the same dose of adrenaline was given every 4th minute during CPR. RESULTS Forty-eight hour survival was significantly higher with nifekalant compared to amiodarone (p < 0.001) and saline (p = 0.02), (9/10 vs. 0/10 vs. 3/10, respectively). Systolic aortic pressure, diastolic aortic pressure and coronary perfusion pressure were significantly higher with nifekalant during CPR and immediate post-resuscitation period (p < 0.05). The animals in the amiodarone group had a slower heart rate at the 1st and 45th min post-ROSC (p < 0.001 and p = 0.006, respectively). The number of electric shocks required for terminating VF, time to ROSC and adrenaline dose were significantly higher with amiodarone compared to nifekalant (p < 0.001). CONCLUSIONS Nifekalant showed a more favorable hemodynamic profile and improved survival compared to amiodarone and saline in this swine model.
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Affiliation(s)
- George Karlis
- 2nd Department of Internal Medicine, Sismanoglio General Hospital, Athens, Greece. .,Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.
| | - Nicoletta Iacovidou
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.,2nd Department of Obstetrics and Gynecology, Neonatal Division, Aretaieio Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Pavlos Lelovas
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | | | | | - Ioanna Siafaka
- 1st Anesthesiology Clinic, Pain Relief and Palliative Care Unit, Aretaieio Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Spyros Mentzelopoulos
- 1st Department of Intensive Care Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Theodoros Xanthos
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.,MSc "Cardiopulmonary Resuscitation", National and Kapodistrian University of Athens, Medical School, Athens, Greece.,Midwestern University of Chicago, Chicago, IL, USA
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Mendelson J, Berg MD. Getting the right bystander to the right place at the right time. Resuscitation 2016; 107:A11-2. [PMID: 27496258 DOI: 10.1016/j.resuscitation.2016.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 07/10/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Jenny Mendelson
- Banner/University of Arizona College of Medicine, Department of Pediatrics, Tucson, AZ, USA
| | - Marc D Berg
- Banner/University of Arizona College of Medicine, Department of Pediatrics, Tucson, AZ, USA.
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Ha TS, Yang JH, Cho YH, Chung CR, Park CM, Jeon K, Suh GY. Clinical outcomes after rescue extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest. Emerg Med J 2016; 34:107-111. [DOI: 10.1136/emermed-2015-204817] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 03/25/2016] [Accepted: 06/11/2016] [Indexed: 11/03/2022]
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Hansen CM, Kragholm K, Granger CB, Pearson DA, Tyson C, Monk L, Corbett C, Nelson RD, Dupre ME, Fosbøl EL, Strauss B, Fordyce CB, McNally B, Jollis JG. The role of bystanders, first responders, and emergency medical service providers in timely defibrillation and related outcomes after out-of-hospital cardiac arrest: Results from a statewide registry. Resuscitation 2015; 96:303-9. [DOI: 10.1016/j.resuscitation.2015.09.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 08/17/2015] [Accepted: 09/08/2015] [Indexed: 10/23/2022]
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Müller MP, Poenicke C, Kurth M, Richter T, Koch T, Eisold C, Pfältzer A, Heller AR. Quality of basic life support when using different commercially available public access defibrillators. Scand J Trauma Resusc Emerg Med 2015; 23:48. [PMID: 26094032 PMCID: PMC4475613 DOI: 10.1186/s13049-015-0123-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 05/14/2015] [Indexed: 01/14/2023] Open
Abstract
Background Basic life support (BLS) guidelines focus on chest compressions with a minimal no-flow fraction (NFF), early defibrillation, and a short perishock pause. By using an automated external defibrillator (AED) lay persons are guided through the process of attaching electrodes and initiating defibrillation. It is unclear, however, to what extent the voice instructions given by the AED might influence the quality of initial resuscitation. Methods Using a patient simulator, 8 different commercially available AEDs were evaluated within two different BLS scenarios (ventricular fibrillation vs. asystole). A BLS certified instructor acted according to the current European Resuscitation Council 2010 Guidelines and followed all of the AED voice prompts. In a second set of scenarios, the rescuer anticipated the appropriate actions and started already before the AED stopped speaking. A BLS scenario without AED served as the control. All scenarios were run three times. Results The time until the first chest compression was 25 ± 2 seconds without the AED and ranged from 50 ± 3 to 148 ± 13 seconds with the AED depending on the model used. The NFF was .26 ± .01 without the AED and between .37 ± .01 and .72 ± .01 when an AED was used. The perishock pause ranged from 12 ± 0 to 46 ± 0 seconds. The optimized sequence of actions reduced the NFF, which ranged now from .32 ± .01 to .41 ± .01, and the perishock pause ranging from 1 ± 1 to 19 ± 1 seconds. Conclusions Voice prompts given by commercially available AED merely meet the requirements of current evidence in basic life support. Furthermore, there is a significant difference between devices with regard to time until the first chest compression, perishock pause, no-flow fraction and other objective measures of the quality of BLS. However, the BLS quality may be improved with optimized handling of the AED. Thus, rescuers should be trained on the respective AED devices, and manufacturers should expend more effort in improving user guidance to shorten the NFF and perishock pause. Electronic supplementary material The online version of this article (doi:10.1186/s13049-015-0123-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael P Müller
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Technische Universität Dresden, Dresden, Germany.
| | - Cynthia Poenicke
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Technische Universität Dresden, Dresden, Germany.
| | - Maxi Kurth
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Technische Universität Dresden, Dresden, Germany.
| | - Torsten Richter
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Technische Universität Dresden, Dresden, Germany.
| | - Thea Koch
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Technische Universität Dresden, Dresden, Germany.
| | - Carolin Eisold
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Technische Universität Dresden, Dresden, Germany.
| | - Adrian Pfältzer
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Technische Universität Dresden, Dresden, Germany.
| | - Axel R Heller
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Technische Universität Dresden, Dresden, Germany.
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Warren SA, Prince DK, Huszti E, Rea TD, Fitzpatrick AL, Andrusiek DL, Darling S, Morrison LJ, Vilke GM, Nichol G. Volume versus outcome: More emergency medical services personnel on-scene and increased survival after out-of-hospital cardiac arrest. Resuscitation 2015; 94:40-8. [PMID: 25724356 DOI: 10.1016/j.resuscitation.2015.02.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 02/06/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIM The large regional variation in survival after treatment of out-of-hospital cardiac arrest (OHCA) is incompletely explained. Communities respond to OHCA with differing number of emergency medical services (EMS) personnel who respond to the scene. The effect of different numbers of EMS personnel on-scene upon outcomes is unclear. We sought to evaluate the association between number of EMS personnel on-scene and survival after OHCA. METHODS We performed a retrospective review of prospectively collected data on 16,122 EMS-treated OHCA events from December 1, 2005 to May 31, 2007 from a combined population over 21 million people residing in an area of over 33,000 square miles in Canada and the United States. Number of EMS personnel on-scene was defined as the number of EMS personnel who responded to the scene of OHCA within 15 min after 9-1-1 call receipt and prior to patient death or transport away from the scene. Associations with survival to hospital discharge were assessed by using generalized estimating equations to construct multivariable logistic regression models. RESULTS Compared to a reference number of EMS personnel on-scene of 5 or 6, 7 or 8 EMS personnel on-scene was associated with a higher rate of survival to hospital discharge, adjusted odds ratio [OR], 1.35 (95% CI: 1.05, 1.73). There was no significant difference in survival between 5 or 6 personnel on-scene versus fewer. CONCLUSION More EMS personnel on-scene within 15 min of 9-1-1 call was associated with improved survival of out-of-hospital cardiac arrest. It is unlikely that this finding was mediated solely by earlier CPR or earlier defibrillation.
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Affiliation(s)
- Sam A Warren
- University of Washington, Harborview Center for Prehospital Emergency Care, Seattle, WA, United States; University of Washington, Department of Medicine, Seattle, WA, United States.
| | - David K Prince
- University of Washington, Department of Biostatistics, Seattle, WA, United States; University of Washington, Clinical Trial Center, Department of Biostatistics, Seattle, WA, United States
| | - Ella Huszti
- University of Washington, Harborview Center for Prehospital Emergency Care, Seattle, WA, United States; University of Washington, Department of Medicine, Seattle, WA, United States
| | - Tom D Rea
- University of Washington, Department of Medicine, Seattle, WA, United States
| | - Annette L Fitzpatrick
- University of Washington, Department of Epidemiology, Seattle, WA, United States; University of Washington, Collaborative Health Studies Coordinating Center, Seattle, WA, United States; University of Washington, Department of Global Health, Seattle, WA, United States
| | | | - Steve Darling
- York Regional Emergency Medical Services, Sharon, Ontario, Canada
| | - Laurie J Morrison
- Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gary M Vilke
- University of California San Diego Health System, United States
| | - Graham Nichol
- University of Washington, Harborview Center for Prehospital Emergency Care, Seattle, WA, United States; University of Washington, Department of Medicine, Seattle, WA, United States; University of Washington, Clinical Trial Center, Department of Biostatistics, Seattle, WA, United States
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Cherry BH, Nguyen AQ, Hollrah RA, Olivencia-Yurvati AH, Mallet RT. Modeling cardiac arrest and resuscitation in the domestic pig. World J Crit Care Med 2015; 4:1-12. [PMID: 25685718 PMCID: PMC4326759 DOI: 10.5492/wjccm.v4.i1.1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/03/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023] Open
Abstract
Cardiac arrest remains a leading cause of death and permanent disability worldwide. Although many victims are initially resuscitated, they often succumb to the extensive ischemia-reperfusion injury inflicted on the internal organs, especially the brain. Cardiac arrest initiates a complex cellular injury cascade encompassing reactive oxygen and nitrogen species, Ca2+ overload, ATP depletion, pro- and anti-apoptotic proteins, mitochondrial dysfunction, and neuronal glutamate excitotoxity, which injures and kills cells, compromises function of internal organs and ignites a destructive systemic inflammatory response. The sheer complexity and scope of this cascade challenges the development of experimental models of and effective treatments for cardiac arrest. Many experimental animal preparations have been developed to decipher the mechanisms of damage to vital internal organs following cardiac arrest and cardiopulmonary resuscitation (CPR), and to develop treatments to interrupt the lethal injury cascades. Porcine models of cardiac arrest and resuscitation offer several important advantages over other species, and outcomes in this large animal are readily translated to the clinical setting. This review summarizes porcine cardiac arrest-CPR models reported in the literature, describes clinically relevant phenomena observed during cardiac arrest and resuscitation in pigs, and discusses numerous methodological considerations in modeling cardiac arrest/CPR. Collectively, published reports show the domestic pig to be a suitable large animal model of cardiac arrest which is responsive to CPR, defibrillatory countershocks and medications, and yields extensive information to foster advances in clinical treatment of cardiac arrest.
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Drennan IR, Lin S, Thorpe KE, Morrison LJ. The effect of time to defibrillation and targeted temperature management on functional survival after out-of-hospital cardiac arrest. Resuscitation 2014; 85:1623-8. [PMID: 25107539 DOI: 10.1016/j.resuscitation.2014.07.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 06/24/2014] [Accepted: 07/15/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cardiac arrest physiology has been proposed to occur in three distinct phases: electrical, circulatory and metabolic. There is limited research evaluating the relationship of the 3-phase model of cardiac arrest to functional survival at hospital discharge. Furthermore, the effect of post-cardiac arrest targeted temperature management (TTM) on functional survival during each phase is unknown. OBJECTIVE To determine the effect of TTM on the relationship between the time of initial defibrillation during each phase of cardiac arrest and functional survival at hospital discharge. METHODS This was a retrospective observational study of consecutive adult (≥18 years) out-of-hospital cardiac arrest (OHCA) patients with initial shockable rhythms. Included patients obtained a return of spontaneous circulation (ROSC) and were eligible for TTM. Multivariable logistic regression was used to determine predictors of functional survival at hospital discharge. RESULTS There were 20,165 OHCA treated by EMS and 871 patients were eligible for TTM. Of these patients, 622 (71.4%) survived to hospital discharge and 487 (55.9%) had good functional survival. Good functional survival was associated with younger age (OR 0.94; 95% CI 0.93-0.95), shorter times from collapse to initial defibrillation (OR 0.73; 95% CI 0.65-0.82), and use of post-cardiac arrest TTM (OR 1.49; 95% CI 1.07-2.30). Functional survival decreased during each phase of the model (65.3% vs. 61.7% vs. 50.2%, P<0.001). CONCLUSION Functional survival at hospital discharge was associated with shorter times to initial defibrillation and was decreased during each successive phase of the 3-phase model. Post-cardiac arrest TTM was associated with improved functional survival.
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Affiliation(s)
- Ian R Drennan
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, Department of Medicine, University of Toronto, Toronto, ON, Canada; School of Health and Wellness, Georgian College, Barrie, ON, Canada.
| | - Steve Lin
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Applied Health Research Centre, St. Michael's Hospital, Toronto, ON, Canada.
| | - Laurie J Morrison
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Howe A, Escalona OJ, Di Maio R, Massot B, Cromie NA, Darragh KM, Adgey J, McEneaney DJ. A support vector machine for predicting defibrillation outcomes from waveform metrics. Resuscitation 2013; 85:343-9. [PMID: 24291591 DOI: 10.1016/j.resuscitation.2013.11.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 11/12/2013] [Accepted: 11/24/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Algorithms to predict shock success based on VF waveform metrics could significantly enhance resuscitation by optimising the timing of defibrillation. OBJECTIVE To investigate robust methods of predicting defibrillation success in VF cardiac arrest patients, by using a support vector machine (SVM) optimisation approach. METHODS Frequency-domain (AMSA, dominant frequency and median frequency) and time-domain (slope and RMS amplitude) VF waveform metrics were calculated in a 4.1Y window prior to defibrillation. Conventional prediction test validity of each waveform parameter was conducted and used AUC>0.6 as the criterion for inclusion as a corroborative attribute processed by the SVM classification model. The latter used a Gaussian radial-basis-function (RBF) kernel and the error penalty factor C was fixed to 1. A two-fold cross-validation resampling technique was employed. RESULTS A total of 41 patients had 115 defibrillation instances. AMSA, slope and RMS waveform metrics performed test validation with AUC>0.6 for predicting termination of VF and return-to-organised rhythm. Predictive accuracy of the optimised SVM design for termination of VF was 81.9% (± 1.24 SD); positive and negative predictivity were respectively 84.3% (± 1.98 SD) and 77.4% (± 1.24 SD); sensitivity and specificity were 87.6% (± 2.69 SD) and 71.6% (± 9.38 SD) respectively. CONCLUSIONS AMSA, slope and RMS were the best VF waveform frequency-time parameters predictors of termination of VF according to test validity assessment. This a priori can be used for a simplified SVM optimised design that combines the predictive attributes of these VF waveform metrics for improved prediction accuracy and generalisation performance without requiring the definition of any threshold value on waveform metrics.
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Affiliation(s)
- Andrew Howe
- Cardiovascular Research Unit, Craigavon Area Hospital, Portadown, UK
| | - Omar J Escalona
- Centre for Advanced Cardiovascular Research (CACR), University of Ulster, Newtownabbey, UK.
| | | | - Bertrand Massot
- Institut des Nanotechnologies de Lyon, INSA-Lyon, Villeurbanne, France
| | - Nick A Cromie
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, UK
| | | | - Jennifer Adgey
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, UK
| | - David J McEneaney
- Cardiovascular Research Unit, Craigavon Area Hospital, Portadown, UK
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A composite model of survival from out-of-hospital cardiac arrest using the Cardiac Arrest Registry to Enhance Survival (CARES). Resuscitation 2013; 84:1093-8. [DOI: 10.1016/j.resuscitation.2013.03.030] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 02/28/2013] [Accepted: 03/25/2013] [Indexed: 11/24/2022]
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Abstract
AbstractIntroductionImmediate resuscitation is necessary in order to achieve conscious survival for persons who have lost airways or pulses. However, current literature suggests that even in medically-trained personnel, CPR skills are forgotten shortly after certification.Hypothesis/ProblemThe purpose of this study was to determine the CPR skill and knowledge decay in those who are paid to respond to emergency situations within the workplace.MethodsUsing an unconscious victim scenario, the sequence and accuracy of CPR events were observed and recorded in 244 participants paid to act as first responders in large industrial or service industry settings.ResultsA significant negative correlation was observed between days since training and a pre-CPR safety check variable, periodic checks for breathing and positioning. Many of the knowledge-related assessment skills (e.g., scene safety, emergency medical system (EMS) activation) appeared to deteriorate with time, although they could be contaminated by the repetition of training in those who had recertified one or more times. Skill-based components such as landmarking for chest compressions and controlling the airway declined in a more predictable fashion.ConclusionThe results of this study suggest that repetition may be more important than days since last trained for skill and knowledge retention, and methods of “refreshing” skills should be examined. While skills deteriorate rapidly, changing frequency of certification is not necessarily the best way to increase retention of skill and knowledge.Anderson GS, Gaetz M, Statz C. CPR skill retention of first aid attendants within the workplace. Prehosp Disaster Med. 2012;27(4):1-7.
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Testori C, Sterz F, Holzer M, Losert H, Arrich J, Herkner H, Krizanac D, Wallmüller C, Stratil P, Schober A, Hörburger D, Stöckl M, Weiser C, Uray T. The beneficial effect of mild therapeutic hypothermia depends on the time of complete circulatory standstill in patients with cardiac arrest. Resuscitation 2011; 83:596-601. [PMID: 22138057 DOI: 10.1016/j.resuscitation.2011.11.019] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 10/26/2011] [Accepted: 11/12/2011] [Indexed: 11/17/2022]
Abstract
AIM Mild therapeutic hypothermia has shown to improve long-time survival as well as favorable functional outcome after cardiac arrest. Animal models suggest that ischemic durations beyond 8 min results in progressively worse neurologic deficits. Based on these considerations, it would be obvious that cardiac arrest survivors would benefit most from mild therapeutic hypothermia if they have reached a complete circulatory standstill of more than 8 min. METHODS In this retrospective cohort study we included cardiac arrest survivors of 18 years of age or older suffering a witnessed out-of-hospital cardiac arrest, which remain comatose after restoration of spontaneous circulation. Data were collected from 1992 to 2010. We investigated the interaction of 'no-flow' time on the association between post arrest mild therapeutic hypothermia and good neurological outcome. 'No-flow' time was categorized into time quartiles (0, 1-2, 3-8, >8 min). RESULTS One thousand-two-hundred patients were analyzed. Hypothermia was induced in 598 patients. In spite of showing a statistically significant improvement in favorable neurologic outcome in all patients treated with mild therapeutic hypothermia (odds ratio [OR]: 1.49; 95% confidence interval [CI]: 1.14-1.93) this effect varies with 'no-flow' time. The effect is significant in patients with 'no-flow' times of more than 2 min (OR: 2.72; CI: 1.35-5.48) with the maximum benefit in those with 'no-flow' times beyond 8 min (OR: 6.15; CI: 2.23-16.99). CONCLUSION The beneficial effect of mild therapeutic hypothermia increases with cumulative time of complete circulatory standstill in patients with witnessed out-of-hospital cardiac arrest.
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Affiliation(s)
- Christoph Testori
- Department of Emergency Medicine, Medical University of Vienna, Austria
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Abstract
Solutions to improve care provided during cardiac arrest resuscitation attempts must be multifaceted and targeted to the diverse number of care providers to be successful. In this article, new approaches to improving cardiac arrest resuscitation performance are reviewed. The focus is on a continuous quality improvement paradigm highlighting improving training methods before actual cardiac arrest events, monitoring quality during resuscitation attempts, and using quantitative debriefing programs after events to educate frontline care providers.
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Abstract
PURPOSE OF REVIEW Summary estimates indicate that bystander cardiopulmonary resuscitation (CPR) can improve the chances of out-of-hospital cardiac arrest survival two-fold to three-fold. And yet, only a minority of arrest victims receive bystander CPR. This summary will review the challenges and approaches to achieve early and effective bystander CPR. RECENT FINDINGS Given the host of barriers, a successful strategy to improve bystander CPR must enable more timely and comprehensive arrest identification, encourage and empower bystanders to act, and help assure effective CPR. Arrest identification can be simplified so that bystanders should start CPR when a person is unconscious and not breathing normally. Evidence from observational studies and interventional trials supports the effectiveness of chest compression-only CPR for bystanders. As a consequence, the emphasis of bystander CPR training has been modified to feature and assure chest compressions. Bystanders should initiate CPR with compressions and consider the addition of rescue breathing based on their CPR training and skills as well as special circumstances of the victim. Bystander CPR training has evolved to incorporate this emphasis. Although general community-level CPR training remains a cornerstone strategy, training directed to those most likely to witness an arrest also has a useful role. In particular, 'just-in-time' dispatcher-assisted CPR instruction can increase bystander CPR and improve the likelihood of survival. SUMMARY Recent developments in bystander CPR have simplified arrest recognition and improved CPR training, while retaining CPR effectiveness. The goal of these developments is to increase and improve bystander CPR and in turn improve resuscitation.
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Blewer AL, Leary M, Decker CS, Andersen JC, Fredericks AC, Bobrow BJ, Abella BS. Cardiopulmonary resuscitation training of family members before hospital discharge using video self-instruction: a feasibility trial. J Hosp Med 2011; 6:428-32. [PMID: 21916007 PMCID: PMC4091628 DOI: 10.1002/jhm.847] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 06/14/2010] [Accepted: 08/14/2010] [Indexed: 12/30/2022]
Abstract
BACKGROUND Bystander cardiopulmonary resuscitation (CPR) is a crucial therapy for sudden cardiac arrest (SCA), yet rates of bystander CPR are low. This is especially the case for SCA occurring in the home setting, as family members of at-risk patients are often not CPR trained. OBJECTIVE To evaluate the feasibility of a novel hospital-based CPR education program targeted to family members of patients at increased risk for SCA. DESIGN Prospective, multicenter, cohort study. SETTING Inpatient wards at 3 hospitals. SUBJECTS Family members of inpatients admitted with cardiac-related diagnoses. MEASUREMENTS AND RESULTS Family members were offered CPR training via a proctored video-self instruction (VSI) program. After training, CPR skills and participant perspectives regarding their training experience were assessed. Surveys were conducted one month postdischarge to measure the rate of "secondary training" of other individuals by enrolled family members. At the 3 study sites, 756 subjects were offered CPR instruction; 280 agreed to training and 136 underwent instruction using the VSI program. Of these, 78 of 136 (57%) had no previous CPR training. After training, chest compression performance was generally adequate (mean compression rate 90 ± 26/minute, mean depth 37 ± 12 mm). At 1 month, 57 of 122 (47%) of subjects performed secondary training for friends or family members, with a calculated mean of 2.1 persons trained per kit distributed. CONCLUSIONS The hospital setting offers a unique "point of capture" to provide CPR instruction to an important, undertrained population in contact with at-risk individuals.
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Affiliation(s)
- Audrey L. Blewer
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marion Leary
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher S. Decker
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James C. Andersen
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amanda C. Fredericks
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bentley J. Bobrow
- Emergency Medicine Department, Maricopa Medical Center, Phoenix, Arizona
| | - Benjamin S. Abella
- Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania
- Address for correspondence and reprint requests: Benjamin S. Abella, MD, MPhil, 3400 Spruce Street, Ground Ravdin, Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA 19104; Telephone: 215-279-3452; Fax: 215-662-3953;
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Del Rossi G, Bodkin D, Dhanani A, Courson RW, Konin JG. Protective athletic equipment slows initiation of CPR in simulated cardiac arrest. Resuscitation 2011; 82:908-12. [PMID: 21458135 DOI: 10.1016/j.resuscitation.2011.02.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 02/16/2011] [Accepted: 02/21/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Standard protective athletic equipment used in collision sports such as American football poses a unique challenge to rescuers because they block access to both the airway and chest. The main objective of this investigation was to determine the effect of athletic equipment on the initiation of CPR. The feasibility of performing compressions over the chest protector as a potential time-saving step was also evaluated. METHODS Thirty-four certified athletic trainers performed CPR on a manikin wearing protective equipment during a simulated episode of cardiac arrest. For one trial the protective equipment was removed or unfastened prior to initiating CPR, and for another, chest compressions were initiated over the protective equipment. The following were recorded for comparison purposes: time until first breath and first compression; percentage of compressions delivered to the recommended depth; compression rate; accuracy of hand placement; percentage of compressions without full chest recoil. RESULTS Although chest compressions began sooner when compressions were delivered over the chest protector, this improvement was not statistically significant. A more notable positive outcome resulting from keeping the chest protector on was an increase in the number of compressions that were delivered to the recommended depth. Unfortunately, one of the significant negative outcomes of performing chest compression over the chest pad was the increased percentage of compressions that did not obtain full chest recoil. CONCLUSIONS Although removal of the chest protector delays the initiation of chest compressions, keeping the chest protector on during CPR does not appear to be a feasible option.
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Shimpuku G, Morimura N, Sakamoto T, Isshiki T, Nagata S, Goto T. Diagnostic performance of a new multifunctional electrocardiograph during uninterrupted chest compressions in cardiac arrest patients. Circ J 2010; 74:1339-45. [PMID: 20508381 DOI: 10.1253/circj.cj-09-0928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND External chest compression is considered to play a significant role in cardiopulmonary resuscitation (CPR), but during a rhythm check, chest compressions must be discontinued to avoid artifacts. A new multifunctional electrocardiograph (ECG; Radarcirc) has been developed for use in clinical settings. METHODS AND RESULTS The performance of the Radarcirc and conventional ECG (CoECG) during CPR was compared in a single-center, non-randomized, sequential self-controlled study. CPR was performed on 41 out-of-hospital cardiac arrest patients. Cardiac rhythm with and without chest compressions during a rhythm check was measured using leads I and II. When the rhythm changed during CPR, it was measured as another waveform. Fifty ECG recordings were obtained, of which 27 were asystole, 18 pulseless electrical activity, and 5 ventricular fibrillation (VF). The area under the receiver-operating characteristic curve (AUC) for VF was 0.448 (95% confidence interval (CI) 0.274-0.622) for lead II of the CoECG, and 0.797 (95%CI 0.684-0.910) for lead II of the Radarcirc. The AUC for VF was 0.422 (95%CI 0.219-0.626) for lead I of the CoECG, and 0.987 (95%CI 0.975-1.00) for lead I of the Radarcirc. CONCLUSIONS Diagnoses based on the data from Radarcirc were more accurate in predicting rhythm during chest compressions than those based on data from the CoECG.
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Affiliation(s)
- Genji Shimpuku
- Department of Emergency Medicine, Trauma and Critical Care Center, Teikyo University School of Medicine, Tokyo, Japan.
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Jo IJ, Shin TG, Sim MS, Song HG, Jeong YK, Song YB, Hahn JY, Choi SH, Gwon HC, Jeon ES, Kim WS, Lee YT, Sung K, Choi JH. Outcome of in-hospital adult cardiopulmonary resuscitation assisted with portable auto-priming percutaneous cardiopulmonary support. Int J Cardiol 2010; 151:12-7. [PMID: 20471704 DOI: 10.1016/j.ijcard.2010.04.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 11/17/2009] [Accepted: 04/17/2010] [Indexed: 11/15/2022]
Abstract
BACKGROUND Outcome from in-hospital cardiopulmonary resuscitation (CPR) is still unsatisfactory. CPR assisted with percutaneous cardiopulmonary support (PCPS) is expected to improve the outcome of in-hospital CPR. METHODS We retrospectively analyzed 83 consecutive cases of adult in-hospital CPR assisted by a portable pre-assembled auto-priming PCPS system (EBS, Terumo, Japan) from January 2004 to December 2007. RESULTS PCPS was successfully performed in 97.6% of the patients and could be weaned in 57.8% of the patients. The survival-to-discharge rate was 41.0% with an acceptable neurological status in 85.3% of the patients. The 6-month survival was 38.6%. Survival-to-discharge decreased about 1% for each 1 min increase in the duration of CPR. The probability of survival was about 65%, 45%, and 19% when the duration of CPR was 10, 30, or 60 min, respectively. Multivariate analysis adjusted with clinical factors including organ dysfunction severity scores revealed that defibrillation and CPR duration less than 35 min were independent predictors for both survival-to-discharge (odds ratio=8.0, 95% CI=2.8-23.0, p<0.001) and 6-month survival (hazard ratio=3.3, 95% CI=1.9-5.9, p<0.001). CONCLUSIONS Our results showed that CPR assisted with PCPS results in an acceptable survival-to-discharge rate and mid-term prognosis.
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Affiliation(s)
- Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Eschmann NM, Pirrallo RG, Aufderheide TP, Lerner EB. The association between emergency medical services staffing patterns and out-of-hospital cardiac arrest survival. PREHOSP EMERG CARE 2010; 14:71-7. [PMID: 19947870 DOI: 10.3109/10903120903349820] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine whether the number of advanced life support-trained personnel at the scene of an out-of-hospital cardiac arrest (OHCA) was associated with return of spontaneous circulation (ROSC) or survival to hospital discharge. METHODS A retrospective database review using Utstein-style reporting definitions was conducted in Milwaukee County. All adult (>or= 18 years of age) OHCA cases of presumed cardiac etiology from January 1993 through December 2005 were eligible for inclusion in the study. Cardiac arrests resulting from a drug overdose, suicide, drowning, hypoxia, exsanguination, stroke, or trauma were excluded from the study. Also excluded were cases in which no crew configuration or responding unit was available, cases in which no resuscitation effort was attempted, and cases in which no time data were available. Return of spontaneous circulation and survival to hospital discharge for OHCA patients treated by a crew with two paramedics were compared to those patients treated by crews with three or more paramedics. Multivariable logistic regression was used for the analysis and the results are reported as odds ratios (ORs). RESULTS During the study period, there were 10,298 OHCAs of cardiac etiology. Of those, 10,057 (98%) cases had sufficient data to be included in the analysis. There were 4,229 patients treated by two paramedics (9% survived to discharge), 4,459 patients treated by three paramedics (9% survived to discharge), and 1,369 patients treated by four or more paramedics (8% survived to discharge). In the multivariable analysis, when referenced against crews with two paramedics and controlled for factors that have a known correlation with cardiac arrest survival, patients treated by crews with three paramedics (0.83, 95% confidence interval [CI] 0.70 to 0.97, p = 0.02) and crews with four or more paramedics (0.66, 95% CI 0.52 to 0.83, p < 0.01) were associated with reduced survival to hospital discharge. Return of spontaneous circulation was not influenced by the number of paramedics present. CONCLUSIONS The presence of three or more paramedics at the scene of OHCA was not associated with improved survival to hospital discharge when compared to crews with two paramedics. Additional research is needed to determine the potential cause of this finding.
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Affiliation(s)
- Nicholas M Eschmann
- Department of Epidemiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
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Rea TD, Cook AJ, Stiell IG, Powell J, Bigham B, Callaway CW, Chugh S, Aufderheide TP, Morrison L, Terndrup TE, Beaudoin T, Wittwer L, Davis D, Idris A, Nichol G. Predicting Survival After Out-of-Hospital Cardiac Arrest: Role of the Utstein Data Elements. Ann Emerg Med 2010; 55:249-57. [DOI: 10.1016/j.annemergmed.2009.09.018] [Citation(s) in RCA: 164] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Revised: 09/02/2009] [Accepted: 09/18/2009] [Indexed: 11/29/2022]
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Initial defibrillation versus initial chest compression in a 4-minute ventricular fibrillation canine model of cardiac arrest. Crit Care Med 2009; 37:2250-2. [PMID: 19455026 DOI: 10.1097/ccm.0b013e31819ffc6a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Previous laboratory and clinical studies have demonstrated that chest compression preceding defibrillation in prolonged ventricular fibrillation (VF) increases the likelihood of successful cardiac resuscitation. The lower limit of VF duration when preshock chest compression provides no benefit has not been specifically studied. We aimed to study the effect of order of defibrillation and chest compression on defibrillation and cardiac resuscitation in a 4-minute VF canine model of cardiac arrest. DESIGN Prospective, randomized animal study. SETTING Key Laboratory of Cardiovascular Remodeling and Function Research and Department of Cardiology, QiLu Hospital. SUBJECTS Twenty-four domestic dogs. INTERVENTIONS VF was induced in anesthetized and ventilated canines. After 4 minutes of untreated VF, animals were randomly assigned to receive shock first or chest compression first. Animals in the shock-first group received an immediate single countershock of 360 J for <10 seconds, then 200 immediate compressions before pulse check or rhythm reanalysis. The ratio of compression to ventilation was 30:2. Interruptions to deliver rescue breaths were eliminated in this study. Animals in the chest compression-first group received 200 chest compressions before a single countershock; the other interventions were the same as for the shock-first group. End points were restoration of spontaneous circulation (ROSC), defined as spontaneous systolic arterial pressure >50 mm Hg, when epinephrine (0.02 mg/kg intravenously) was given, and resuscitation, defined as maintaining systolic arterial pressure >50 mm Hg at the 24-hour study end point. MEASUREMENTS AND MAIN RESULTS In the shock-first group, all animals achieved ROSC, and ten of 12 survived at the 24-hour study end point. In the chest compression-first group, 11 of 12 animals achieved ROSC, and nine of 12 survived at the 24-hour study end point. CONCLUSIONS In this 4-minute VF canine model of cardiac arrest, the order of initial defibrillation or initial chest compression does not affect cardiac resuscitation.
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Indik JH, Hilwig RW, Zuercher M, Kern KB, Berg MD, Berg RA. Preshock cardiopulmonary resuscitation worsens outcome from circulatory phase ventricular fibrillation with acute coronary artery obstruction in swine. Circ Arrhythm Electrophysiol 2009; 2:179-84. [PMID: 19808463 DOI: 10.1161/circep.108.824862] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Some clinical studies have suggested that chest compressions before defibrillation improve survival in cardiac arrest because of prolonged ventricular fibrillation (VF; ie, within the circulatory phase). Animal data have also supported this conclusion, and we have previously demonstrated that preshock chest compressions increase the VF median frequency and improve the likelihood of a return of spontaneous circulation in normal swine. We hypothesized that chest compressions before defibrillation in a swine model of acute myocardial ischemia would also increase VF median frequency and improve resuscitation outcome. METHODS AND RESULTS Twenty-six swine were subjected to balloon occlusion of the left anterior descending coronary artery for 2 hours. The balloon was removed and VF was induced and untreated for 8 minutes. Swine were then treated with up to 3 stacked defibrillation shocks (n=13, shock-first group) or 3 minutes of chest compressions before shock (n=13, preshock cardiopulmonary resuscitation group). In the preshock cardiopulmonary resuscitation group, median frequency was increased from 7.0+/-0.8 to 13.9+/-1.6 Hz after chest compressions (P=0.002). Despite the improved median frequency in the preshock cardiopulmonary resuscitation group, 24-hour survival with favorable neurological status was significantly worse in the preshock cardiopulmonary resuscitation group (1/13) compared with the shock-first group (8/13, P=0.01). CONCLUSIONS In a swine model of prolonged VF in acute myocardial ischemia, 24-hour survival with favorable neurological status was more likely when defibrillation was performed first without preceding chest compressions. Myocardial substrate is an important factor in determining the optimal resuscitation strategy.
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Affiliation(s)
- Julia H Indik
- Sarver Heart Center, Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona 85724-5037, USA.
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