Figure 1 - uploaded by Demetris Yannopoulos
Content may be subject to copyright.
After 6 min of untreated ventricular fibrillation, 6 min of either 15:2 or 30:2 compression to ventilation ratio CPR was performed. At the end, the inspiratory ITD was added for another 4 min. There was a significant increase in cardiac output, common carotid artery flow, end tidal CO 2 in the animals that received 30:2 C/V ratio. There was a further increase with the addition of an ITD, although it was applied late. PaCO 2-EtCO 2 is a marker of pulmonary ventilation/perfusion matching. Asterisk means statistical significant difference compared with the ratio of 15:2 (P , 0.05).
Source publication
Purpose of the review The aim of this article is to provide a comprehensive description of interventions that can improve outcomes in adults with sudden cardiac death. The new American Heart Association 2005 Guidelines introduced a number of changes for the initial management of cardiorespiratory arrest based on new data that accumulated over the l...
Context in source publication
Context 1
... change in the guidelines was based upon a consensus of experts in CPR. However, it has been recently shown in pigs that with the shift from a 15:2 to 30:2 compression:ven- tilation ratio, there is doubling of the common carotid blood flow and a 25% increase in cardiac output without any com- promise in oxygenation and acid-base balance 19 (Figure ...
Similar publications
The patient with difficult airways is a common challenge for emergency physicians.
Our goal was to study the reasons for difficult airways in the emergency department.
We performed a prospective observational study of patients requiring advanced airway management from 1 January 2000 to 31 December 2006.
There were 2,343 patients who received advanc...
Airway epithelial cells (AECs) are important in asthma as they are the first cells to encounter pathogens/allergens. In children, AECs can be obtained using a "blind" nonbronchoscopic technique through an endotracheal tube. However, due to the increasing use of laryngeal masks the number of children in whom this technique is applicable has become l...
Any health care professional can be faced with a medical emergency in which the patient needs ventilatory support. Bag-valve-mask ventilation with the assistance of an oropharyngeal airway that uses 100% oxygen is currently the preferred method for artificial ventilation. This procedure is generally performed ineffectively by most dentists inexperi...
Citations
... A third review outlines interventions for adults with sudden cardiac death, emphasizing early defibrillation and uninterrupted compressions [9]. Additionally, a cross-sectional study in Melaka reveals that BLS training and longer professional experience correlate with higher CPR knowledge levels among general practitioners, despite low possession of AEDs in clinics [10]. ...
... 7. Further validation of ML algorithms for predictive modeling in heart disease is required for their successful integration into clinical practice ([21],[22],[23],[24],[25]).8. Investigating the potential negative effects of advanced CPR devices, such as the LUCAS device, on survival rates in OHCA patients is essential for informed decision-making ([14]).9. Research on the integration of AI and IoMT for smart healthcare delivery could lead to more efficient disease forecasting and personalized treatment strategies ([26],[29]).10. ...
This review explores the pivotal role of cardiopulmonary resuscitation (CPR) in the chain of survival during cardiac events and delves into the challenges and advancements in CPR techniques and technologies. While manual interventions and automated devices have improved survival rates, they present limitations such as rescuer fatigue and lack of real-time feedback. The emergence of the Internet of Medical Things (IoMT) and machine learning (ML) algorithms offers transformative opportunities to enhance CPR rescue efforts by facilitating real-time data acquisition, remote monitoring, and adaptive feedback. However, challenges including interoperability and data security must be addressed for effective integration. The study discusses major findings from related literature, gaps in research, and future directions, highlighting the potential of integrating IoMT and ML to improve CPR outcomes and revolutionize healthcare delivery. Finally, it concludes with recommendations for optimizing CPR strategies and advancing technology for better patient outcomes.
... Endotracheal intubation performed during CPR is not associated with an improved outcome with regard to ROSC, and has been shown to increase HOT significantly (Don Michael, 1985;Wang, Simeone, Weaver, & Callaway, 2009). Today, airway devices such as SAD are viewed as acceptable alternatives to ETI during CPR, as they provide easy and rapid insertion with good seal pressures (Don Michael, 1985;Hazinski et al. 2010;Ruetzler et al. 2011;Yannopoulos & Aufderheide, 2007). ...
... The incidence of DMV has been reported to be as high 5% in the general population undergoing routine anaesthesia in a controlled environment (Langeron, Masso, Huraux, & Guggiari, 2000). DMV is more likely in the case of a single person resuscitation, as it becomes increasingly difficult to achieve an adequate seal between the mask and the patient's face with one hand and squeeze the bag with the other (D€ orges, Wenzel, Neubert, & Schmucker, 2000) (Yannopoulos & Aufderheide, 2007). ...
... The use of SADs during CPR provides an alternative form of airway management to BVM, as BVM is known to be associated with many complications such as DMV (D€ orges et al., 2000;Hazinski et al., 2010;Stone et al., 1998;Wiese et al., 2008;Yannopoulos & Aufderheide, 2007). Some of these SADs include the laryngeal mask airway (LMA) and the laryngeal tube (D€ orges et al., 2000). ...
Background: Recent recommendations made by ILCOR have de-emphasised the role of advanced airway management such as “endotracheal intubation” (ETI) during cardiac arrest in favour of maximising the number of chest compressions performed by rescuers. Maximising time available for compressions is achieved by minimising hands-off time (HOT). This has led to first responders and paramedics performing single rescuer CPR using a bag-valve-mask (BVM) device as opposed to the historical practice of intubating and ventilating via an endotracheal tube. Bag-valve-mask ventilations, especially during single rescuer CPR, are however associated with complications potentially resulting in increased ventilation times. More time spent on ventilations in the single rescuer scenario naturally leads to an increase in HOT and less time being available for compressions. It is postulated that the use of an appropriate supraglottic airway device (SAD) may decrease the time spent on the ventilation component of CPR and result in a decrease in HOT.
Objectives: This pilot study evaluated how interruptions to chest compressions or hands-off time (HOT) are affected by the placement of an i-gel® airway vs. simple BVM ventilation during single rescuer CPR.
Method: 16 participants performed two, ten-minute single rescuer CPR simulations, firstly using the BVM and later the i-gel® airway for ventilation. Data pertaining to ventilations and HOT in each scenario was statistically analysed and compared.
Results: The i-gel® airway demonstrated a superior ease of ventilation compared to BVM alone and resulted in a reduction of time spent on ventilations overall. The i-gel® however took a mean of 29 s, ± 10 s, to secure which contributes considerably to HOT.
Conclusion: The use of the i-gel® airway resulted in a considerable decrease in the amount of time spent on ventilations and in more compressions being performed. The overall reduction in HOT was, however, offset by the time it took to secure the device. Further investigation into the use and securing of the i-gel® airway in single rescuer CPR is recommended.
... Pored toga, ukoliko se akutni zastoj srca desi na javnom mestu, učestalost reanimacije od strane spasilaca je veća 10 a time i šanse za preživljavanje značajno rastu. Čak iako EKG oblik akutnog zastoja srca nije VF/VT, održanje koronarnog perfuzionog pritiska zahvaljujući kompresiji grudnog koša značajno povećava šanse za uspešan ishod [11]. Većina pacijenata koji su pre dolaska ekipe HMP reanimirani od strane spasilaca bili su u momentu dolaska stručnog osoblja i dalje u VF, što je značajno povećalo šanse tih pacijenata da prežive 12. Studija objavljena 2008. ...
The aim was to define factors associated with an improved outcome among patients suffering out-of-hospital cardiac arrest (OHCA) using the Utstain style data collection. We examined 200 patients suffering from OHCA in a prospective study in a two years period. We determined survival from cardiac arrest (CA) to discharge from hospital and the factors associated with survival. 78% of CA patients had a cardiac aetiology, 65% occurred at home, 3.7% received bystander CPR. 36% were found in VF/VT, 64% in asystole/PEA. 52% of patients were intubated in the field, survival to discharge from hospital was significantly higher among patients who were intubated in the field. The mean response time was 6.6 minutes. 66.7% of patients were given the shock after 4 minutes. 131 (65.5%) were pronounced dead in the field, 69 patients were transported to the hospital. 53 (76.8%) patients of them died during the transport or in the ED, 7 died after hospital admission and 9 survived to hospital discharge. Multivariate logistic regression analysis showed that variables significantly associated with survival to hospital discharge were: age, endotracheal intubation in the field and mean response time. The outcome of CPR was better in patients who were younger, who were intubated in the field and when the response time was shorter.
... This study was initially designed to study the effect of early use of the KA and ITD in out-of-hospital cardiac arrest on end-tidal carbon dioxide (ETCO 2 ) as a surrogate measure of circulation, survival, and cerebral performance category (CPC) scores. Our hypothesis was that the combination of uninterrupted compressions and early use of an ITD would increase neurologically intact survival in adult out-of-hospital cardiac arrest patients [1]- [4]. After the first 9 month post (active) study period the KA was relegated to rescue airway status and outcomes were compared vs. actual airway management. ...
... Maximizing OHCA survival is a complex process. Current experience suggests that a multifaceted systematic approach to the treatment of OHCA victims offers the best chance of substantially improving survival statistics (Table 2). 1, 21,22 Success demands that the strategy begin immediately at the ...
Approximately 330 000 out-of-hospital cardiac arrests (OHCAs) occur annually in the United States; in essence, there are nearly 1000 OHCA events each day.1 However, despite the presence of extensive emergency medical response systems (especially in heavily populated regions) and aggressive steps by both professional organizations and private industry to enhance public awareness of the magnitude of the problem and the need for cardiopulmonary resuscitation (CPR) training,1,2 overall OHCA survival rates generally remain dismal and highly variable from location to location. On average, only ≈5% of OHCA victims leave the hospital.3–6
Article see p 91
Improving OHCA survival should be a healthcare priority, but effecting substantial improvement is complex. Experience suggests that altering current outcomes requires a well-organized, multifaceted treatment strategy. It is unlikely that introduction of any single intervention, no matter how novel, will do the trick. In fact, as the course of events that followed the introduction of portable automatic external defibrillators (AEDs) illustrates, excessive reliance on any single innovative technology might be detrimental. In that case, AED availability was initially accompanied by a seemingly paradoxical decline in resuscitation success.7 Only later did it become evident that failure to initiate basic CPR while waiting for an AED to arrive undermined patient viability. Thus, although early defibrillation is now advocated if available quickly after a witnessed OHCA event, in most cases, CPR should be initiated first to “prime” the pump with oxygenated blood and increase the chances for a successful defibrillation.1,2,7
That prompt initiation of CPR in OHCA victims has a positive impact on survival is well established. In one of the earliest reports to emphasize the value of early CPR, Cummins et al8 examined survival outcomes in 1297 OHCA events; 579 cases received bystander CPR, whereas CPR was delayed until paramedics arrived in …
The phospholipid bilayer membrane that surrounds each cell in the body represents the first and last line of defense for preserving overall cell viability. In several forms of cardiac and skeletal muscle disease, deficits in the integrity of the muscle membrane play a central role in disease pathogenesis. In Duchenne muscular dystrophy, an inherited and uniformly fatal disease of progressive muscle deterioration, muscle membrane instability is the primary cause of disease, including significant heart disease, for which there is no cure or highly effective treatment. Further, in multiple clinical forms of myocardial ischemia-reperfusion injury, the cardiac sarcolemma is damaged and this plays a key role in disease etiology. In this review, cardiac muscle membrane stability is addressed, with a focus on synthetic block copolymers as a unique chemical-based approach to stabilize damaged muscle membranes. Recent advances using clinically relevant small and large animal models of heart disease are discussed. In addition, mechanistic insights into the copolymer-muscle membrane interface, featuring atomistic, molecular, and physiological structure-function approaches are highlighted. Collectively, muscle membrane instability contributes significantly to morbidity and mortality in prominent acquired and inherited heart diseases. In this context, chemical-based muscle membrane stabilizers provide a novel therapeutic approach for a myriad of heart diseases wherein the integrity of the cardiac muscle membrane is at risk.
This article focuses on important advances in the science of cardiopulmonary resuscitation (CPR) in the last decade that have led to a significant improvement in understanding the complex physiology of cardiac arrest and critical interventions for the initial management of cardiac arrest and postresuscitation treatment. Special emphasis is given to the basic simple ways to improve circulation, vital organ perfusion pressures, and the grave prognosis of sudden cardiac death.
Background: Recent recommendations made by ILCOR have de-emphasised the role of advanced airway management such as “endotracheal intubation” (ETI) during cardiac arrest in favour of maximising the number of chest compressions performed by rescuers. Maximising time available for compressions is achieved by minimising hands-off time (HOT). This has led to first responders and paramedics performing single rescuer CPR using a bag-valve-mask (BVM) device as opposed to the historical practice of intubating and ventilating via an endotracheal tube. Bag-valve-mask ventilations, especially during single rescuer CPR, are however associated with complications potentially resulting in increased ventilation times. More time spent on ventilations in the single rescuer scenario naturally leads to an increase in HOT and less time being available for compressions. It is postulated that the use of an appropriate supraglottic airway device (SAD) may decrease the time spent on the ventilation component of CPR and result in a decrease in HOT.
Objectives: This pilot study evaluated how interruptions to chest compressions or hands-off time (HOT) are affected by the placement of an i-gel® airway vs. simple BVM ventilation during single rescuer CPR.
Method: 16 participants performed two, ten-minute single rescuer CPR simulations, firstly using the BVM and later the i-gel® airway for ventilation. Data pertaining to ventilations and HOT in each scenario was statistically analysed and compared.
Results: The i-gel® airway demonstrated a superior ease of ventilation compared to BVM alone and resulted in a reduction of time spent on ventilations overall. The i-gel® however took a mean of 29 s, ± 10 s, to secure which contributes considerably to HOT.
Conclusion: The use of the i-gel® airway resulted in a considerable decrease in the amount of time spent on ventilations and in more compressions being performed. The overall reduction in HOT was, however, offset by the time it took to secure the device. Further investigation into the use and securing of the i-gel® airway in single rescuer CPR is recommended.
Introduction
Over-ventilation can compromise coronary perfusion pressures during cardiopulmonary resuscitation (CPR) and should be minimised. We compared ventilations during manual and mechanical (load-distributing band - LDB) CPR, which gives ventilation prompts. Our primary objective was to compare the ventilation rate between manual CPR and LDB-CPR.
Method
This was a phased, non-randomised study at a tertiary hospital emergency department. All out-of-hospital, non-traumatic cardiac arrest adult patients during the study period from February 2007 till July 2008 were eligible. Pregnant females and patients aged less than 18 years of age were excluded. Ventilation rates in the first and second 5 minutes segments were recorded. Over-ventilation was defined as ventilation rate above 12 breaths per minute. All data analyses were performed with SPSS, version 17.0. Mean differences with 95% confidence interval (CI) were compared between the 2 treatment groups.
Results
From February 2007 till August 2007, there were 29 patients with manual CPR; and from September 2007 till July 2008, there were 62 with LDB-CPR. In the first 5 minutes of CPR, the proportion of patients that were over-ventilated, was 27.6% (manual) and 4.8% (LDB) (difference = 22.7%; 95% CI: 3.5-46.4%). In the next 5 minutes, the proportion of patients that were over-ventilated was 37.9% and 1.6% for manual and mechanical CPR respectively (difference = 36.3%; 95% CI: 16.5-58.9%).
Conclusion
Over-ventilation is reduced significantly in LDB-CPR compared to manual CPR during the first and second 5 minutes of resuscitation.
A new emphasis on high-quality CPR was one of many new recommendations made by the AHA and ILCOR in 2005 regarding pediatric CPR and ALS. The respiratory etiology for most cardiac arrests is unique in pediatrics and influences priorities in resuscitation. ALS recommendations aim to improve survival outcomes for children presenting with tachycardia, bradycardia, and pulseless arrest. New recommendations are expected in 2010. Family presence during a pediatric arrest is a new and controversial topic that requires further research.
