Resuscitation (RESUSCITATION)

Publications in this journal

• Article: Treatment of Non-Traumatic Out-of-Hospital Cardiac Arrest with Active Compression Decompression Cardiopulmonary Resuscitation plus an Impedance Threshold Device.

  Ralph J Frascone, Marvin A Wayne, Robert A Swor, Brian D Mahoney, Robert M Domeier, Michael L Olinger, David E Tupper, Cindy M Setum, Nathan Burkhart, Lucinda Klann, Joshua G Salzman, Sandi S Wewerka, Demetris Yannopoulos, Keith G Lurie, Brian J O'Neil, Richard G Holcomb, Tom P Aufderheide
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  ABSTRACT: BACKGROUND: A recent out-of-hospital cardiac arrest (OHCA) clinical trial showed improved survival to hospital discharge (HD) with favorable neurologic function for patients with cardiac arrest of cardiac origin treated with active compression decompression cardiopulmonary resuscitation (CPR) plus an impedance threshold device (ACD+ICD) versus standard (S) CPR. The current analysis examined whether treatment with ACD+ITD is more effective than standard (S-CPR) for all cardiac arrests of non-traumatic origin, regardless of the aetiology. METHODS: This is a secondary analysis of data from a randomized, prospective, multicenter, intention-to-treat, OHCA clinical trial. Adults with presumed non-traumatic cardiac arrest were enrolled and followed for one year post arrest. The primary endpoint was survival to hospital discharge (HD) with favorable neurologic function (modified Rankin Scale score ≤3). RESULTS: Between October 2005 to July 2009, 2738 patients were enrolled (S-CPR=1335; ACD+ITD =1403). Survival to HD with favorable neurologic function was greater with ACD+ITD compared with S-CPR: 7.9% versus 5.7%, (OR 1.42, 95% CI 1.04, 1.95, p=0.027). One-year survival was also greater: 7.9% versus 5.7%, (OR 1.43, 95% CI 1.04, 1.96, p=0.026). Nearly all survivors in both groups had returned to their baseline neurological function by one year. Major adverse event rates were similar between groups. CONCLUSIONS: Treatment of out-of-hospital non-traumatic cardiac arrest patients with ACD+ITD resulted in a significant increase in survival to hospital discharge with favorable neurological function when compared with S-CPR. A significant increase survival rates was observed up to one year after arrest in subjects treated with ACD+ITD, regardless of the etiology of the cardiac arrest.
  Resuscitation 05/2013;
• Article: Early Epinephrine in Out-of-Hospital Cardiac Arrest: Is Sooner Better than None at All?

  Peter J Kudenchuk
  Resuscitation 05/2013;
• Article: Real-time feedback during basic life support training: does it prevent skill decay?

  Keith Couper, Judith Finn
  Resuscitation 05/2013;
• Article: Reply letter to: 'Contamination of ambulance staff using the laryngeal mask airway supreme (LMAS) during cardiac arrest'

  Karen Boylan
  Resuscitation 05/2013;
• Article: Pre-training evaluation and feedback improved skills retention of basic life support in medical students.

  Qi Li, Rong-Hua Zhou, Jin Liu, Jing Lin, Er-Li Ma, Peng Liang, Ting-Wei Shi, Li-Qun Fang, Hong Xiao
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  ABSTRACT: BACKGROUND: Pre-training evaluation and feedback have been shown to improve medical students' skills acquisition of basic life support (BLS) immediately following training. The impact of such training on BLS skills retention is unknown. This study was conducted to investigate effects of pre-training evaluation and feedback on BLS skills retention in medical students. METHODS: Three hundred and thirty 3(rd)year medical students were randomized to two groups, the control group (C group) and pre-training evaluation and feedback group (EF group). Each group was subdivided into four subgroups according to the time of retention-test (at 1-, 3-, 6-, 12-month following the initial training). After a 45-minute BLS lecture, BLS skills were assessed (pre-training evaluation) in both groups before training. Following this, the C group received 45minutes training. Fifteen minutes of group feedback corresponding to studentś performance in pre-training evaluation was given only in the EF group that was followed by 30minutes of BLS training. BLS skills were assessed immediately after training (post-test) and at follow up (retention-test). RESULTS: No skills difference was observed between the two groups in pre-training evaluation. Better skills acquisition was observed in the EF group (85.3±7.3 vs. 68.1±12.2 in C group) at post-test (p<0.001). In all retention-test, better skills retention was observed in each EF subgroup, compared with its paired C subgroup. CONCLUSIONS: Pre-training evaluation and feedback improved skills retention in the EF group for 12 months after the initial training, compared with the control group.
  Resuscitation 05/2013;
• Article: Hand-held Ultrasonography to Assess External Chest Compressions on a Fresh Cadaver.

  Richard A Hoppmann, Floyd E Bell, Nicholas A Hoppmann, Stephen A Clarkson, James M Kreiner
  Resuscitation 05/2013;
• Article: Use of Rapid Sequence Intubation Predicts Improved Survival Among Patients Intubated after Out-of-Hospital Cardiac Arrest.

  Heemun Kwok, Matthew Prekker, Andreas Grabinsky, David Carlbom, Thomas D Rea
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  ABSTRACT: OBJECTIVE: Some observational studies indicate that endotracheal intubation is associated with a worse outcome compared to bag-mask ventilation after out-of-hospital cardiac arrest in emergency medical services (EMS) systems without rapid sequence intubation (RSI). We evaluated the role of RSI in airway management following cardiac arrest. METHODS: We conducted a cohort study of all non-traumatic arrest patients treated by a metropolitan EMS system from 2007-2011. Advanced airway management information was obtained from a prospective airway registry and linked to a cardiac arrest registry. We used multivariate logistic regression to estimate the association between attempted intubation status and survival to hospital discharge. RESULTS: Of 3,133 patients, 82% underwent attempted intubation without RSI, 15% underwent attempted RSI, and 3% experienced no intubation attempt. Survival to hospital discharge differed by attempted intubation status: 11% (n=291/2576) for intubation without RSI, 48% (n=226/471) for RSI, and 71% (n=61/86) for "no intubation." Compared to the intubation without RSI group, the adjusted odds ratios of survival were 5.6 (95% CI 4.3, 7.2) for the RSI group and 15 (95% CI 9, 27) for the "no intubation" group. CONCLUSION: In this population-based cohort of out-of-hospital cardiac arrest, RSI was used in 15% of patients and associated with a better prognosis than intubation attempted without paralytics. Because this subset with a favorable prognosis may not be readily intubated in systems without paralytics, these findings could help to explain the adverse relationship between intubation and survival observed in prior studies.
  Resuscitation 05/2013;
• Article: An unexplained cardiac arrest, always re-check the "A" after resuscitation.

  Myrthe M Pastoors, M H van Leuken, Cornelis P C de Jager
  Resuscitation 05/2013;
• Article: Performance of the i-gel™ during pre-hospital cardiopulmonary resuscitation.

  David Häske, Benjamin Schempf, Gernot Gaier, Christoph Niederberger
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  ABSTRACT: BACKGROUND: Current cardiopulmonary resuscitation (CPR) guidelines recommend airway and ventilation whilt minimising interruptions to chest compressions. We have assessed i-gel use during CPR. METHODS: In an observational study of i-gel™ use during CPR we assessed the ease of igel™ insertion, adequacy of ventilation, the presence of a leak during ventilation, and whether ventilation was possible without interrupting chest compressions. RESULTS: We analysed i-gel insertion by paramedics (n=63) and emergency physicians (n=7) in 70 pre-hospital CPR attempts. There was a 90% first attempt insertion success rate, 7% on the second attempt, and 3% on the third attempt. Insertion was reported as easy in 80% (n=56), moderately difficult in 16% (n=11), and difficult in 4% (n=3). Providers reported no leak on ventilation in 80% (n=56), a moderate leak in 17% (n=12), and a major leak with no chest rise in 3% (n=2). There was a significant association between ease of insertion and the quality of the seal (r=0.99, p=0.02). The i-gel enabled continuous chest compressions without pauses for ventilation in 74% (n=52) of CPR attempts. There was no difference in the incidence of leaks on ventilation between patients having continuous chest compressions and patients who had pauses in chest compressions for ventilation (83% versus 72%, p=0.33, 95% CI [-0.1282, 0.4037]). Ventilation during CPR was adequate during 96% of all CPR attempts. CONCLUSIONS: The i-gel is an easy supraglottic airway device to insert and enables adequate ventilation during CPR.
  Resuscitation 05/2013;
• Article: Effect of Valproic acid on Survival and Neurologic Outcomes in an Asphyxial Cardiac Arrest Model of Rats.

  Jae Hyuk Lee, Kyuseok Kim, You Hwan Jo, Soo Hoon Lee, Changwoo Kang, Joonghee Kim, Chan Jong Park, Min A Kim, Min Ji Lee, Joong Eui Rhee
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  ABSTRACT: AIM OF THE STUDY: Valproic acid (VPA) has been known to reduce neuronal injury, have anti-inflammatory and anti-apoptotic effects as a histone deacetylase (HDAC) inhibitor. Thus, this study was performed to investigate the effects of VPA on survival and neurological outcomes in an asphyxial cardiac arrest model of rats. METHODS: Male Sprague-Dawley rats were subjected to asphyxial cardiac arrest. For survival study, rats were subjected to 450seconds of asphyxial cardiac arrest. Cardiopulmonary resuscitation (CPR) was performed and then rats were blindly allocated to one of two groups (control group, n=10; VPA group, n=10). Valproic acid (300mg/Kg) or vehicle (normal saline) was administered via tail vein immediately after return of spontaneous circulation (ROSC) and observed for 72hours. For neurological outcome study, rats (n=7 for each group) were subjected to same experimental procedures except duration of cardiac arrest of 360seconds. Neurological deficit scale (NDS) score was measured every 24hours after ROSC for 72hours and was ranged from 0 (brain dead) to 80 (normal). Brain tissues were harvested at 72hours for evaluation of apoptotic injury and acetylation status of histone H3. RESULTS: In survival study, 2 rats in VPA group were excluded because cardiac arrest was not achieved in predetermined time. Thus, 10 rats were allocated to control group and 8 rats were allocated to VPA group. The survival rates at 72hours after cardiac arrest were significantly higher in VPA group than in control group (6/8 in VPA group, 3/10 rats in control group; log rank test, p<0.05). In neurological outcome study, all rats survived for 72hours and NDS at 72hour were significantly higher in VPA group than in control group (p<0.05). In brain tissues, expressions of acetylated histone H3 were not significantly different. However, expressions of cleaved caspase-3 were significantly lower in VPA group than in control group (p <0.05). CONCLUSION: VPA increased survival rates and improved neurologic outcome in asphyxial cardiac arrest model of rats while decreasing expressions of cleaved caspase-3.
  Resuscitation 05/2013;
• Article: PROGNOSTICATION OF COMA AFTER CARDIAC ARREST: THINK POSITIVE!

  Mauro Oddo
  Resuscitation 05/2013;
• Article: Police AED Programs: A Systematic Review and Meta-Analysis.

  Sofia Husain, Mickey Eisenberg
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  ABSTRACT: BACKGROUND: Approximately 359,400 out-of-hospital cardiac arrests occur in the United States every year, and around 60% of them are treated by emergency medical services (EMS) personnel. In order to alleviate the impact of this public health burden, some communities have trained police officers as first responders so that they can provide cardiopulmonary resuscitation and defibrillation to cardiac arrest patients. This paper is a review of the current literature on the impact of police automated external defibrillators (AEDs) programs in these communities. METHODS AND RESULTS: A literature search of electronic journal databases was conducted to identify articles that evaluated police AED programs and quantified survival rates. The 10 articles that met the inclusion criteria were very heterogeneous in terms of study design, controlling for confounders, outcome definitions, and comparison groups. Two communities found a statistically significant difference in survival and 6 studies reported a statistically significant difference in time to defibrillation after the implementation of these programs. The weighted mean survival rate of the study groups was higher than that of the control groups (p<0.001), as was the weighted mean survival rate of the group first shocked by police compared to those first shocked by EMS (39.4% vs. 28.6%, p<0.001). The pooled relative risk of survival was 1.4 (95% CI: 1.3-1.6). CONCLUSIONS: Though there are many challenges in initiating these programs, this literature review shows that time to defibrillation decreased and survival from out-of-hospital cardiac arrests increased with the implementation of police AED programs.
  Resuscitation 05/2013;
• Article: Arterial Carbon Dioxide Tension after Cardiac Arrest: Too little, too much, or just right?

  Mioara D Manole, Ericka L Fink
  Resuscitation 04/2013;
• Article: Reply letter to: Association of serum lactate and survival outcomes after cardiac arrest.

  David F Gaieski, Anne V Grossestreuer, Benjamin S Abella
  Resuscitation 04/2013;
• Article: BLEEDING EVENTS IN REFRACTORY CARDIAC ARREST TREATED WITH EXTRACORPOREAL MEMBRANE OXYGENATION - A single centre experience.

  Serafina Valente, Chiara Lazzeri, Pasquale Bernardo, Andrea Sori, Marco Chiostri, Lisa Innocenti, Pierluigi Stefano, Adriano Peris, Gian Franco Gensini
  Resuscitation 04/2013;
• Article: Predictive Value of Electrocardiogram in Diagnosing Acute Coronary Artery Lesions Among Patients with Out-Of-Hospital-Cardiac-Arrest.

  Davide Zanuttini, Ilaria Armellini, Gaetano Nucifora, Maria Teresa Grillo, Giorgio Morocutti, Elio Carchietti, Giulio Trillò, Leonardo Spedicato, Guglielmo Bernardi, Alessandro Proclemer
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  ABSTRACT: AIMS: Acute coronary lesions are known to be the most common trigger of out of hospital cardiac arrest (OHCA). Aim of the present study was to assess the predictive value of ST-segment changes in diagnosing the presence of acute coronary lesions among OHCA patients METHODS: Findings of coronary angiography (CA) performed in patients resuscitated from OCHA were retrospectively reviewed and related to ST-segment changes on post-ROSC electrocardiogram (ECG) RESULTS: Ninety-one patients underwent CA after OHCA; 44% of patients had ST-segment elevation and 56% of patients had other ECG patterns on post-ROSC ECG. Significant coronary artery disease (CAD) was found in 86% of patients; CAD was observed in 98% of patients with ST-segment elevation and in 77% of patients with other ECG patterns on post-ROSC ECG (p=0.004). Acute or presumed recent coronary artery lesions were diagnosed in 56% of patients, respectively in 85% of patients with ST-segment elevation and in 33% of patients with other ECG patterns (p <0.001). ST-segment analysis on post-ROSC ECG has a good positive predictive value but a low negative predictive value in diagnosing the presence of acute or presumed recent coronary artery lesions (85% and 67%, respectively) CONCLUSIONS: Electrocardiographic findings after OHCA should not be considered as strict selection criteria for performing emergent CA in patients resuscitated from OHCA without obvious extra-cardiac cause; even in the absence of ST-segment elevation on post-ROSC ECG, acute culprit coronary lesions may be present and considered the trigger of cardiac arrest.
  Resuscitation 04/2013;
• Article: Association of serum lactate and survival outcomes after cardiac arrest.

  Ingrid Meex, Cathy De Deyne, Cornelia Genbrugge, Frank Jans, Jo Dens
  Resuscitation 04/2013;
• Article: Reference: - "Contamination of ambulance staff using the laryngeal mask airway supreme (LMAS) during cardiac arrest"

  Megan Rhys, Sarah Voss, Jonathan Benger
  Resuscitation 04/2013;
• Article: Title of editorial: It Takes a System to Save a Victim.

  Mickey Eisenberg
  Resuscitation 04/2013;
• Article: The cost of health care resources in cardiovascular disease.

  Claire Hulme
  Resuscitation 04/2013;