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Use of automated external defibrillators (AEDs) by first arriving emergency medical technicians (EMTs) is advocated to improve the outcome for out-of-hospital ventricular fibrillation (VF). However, adding AEDs to the emergency medical system in Seattle, Wash, did not improve survival. Studies in animals have shown improved outcomes when cardiopulm...
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Citations
... 2 3 Some animal and human trials have shown evidence for delayed defibrillation in favour of an extended period of cardiopulmonary resuscitation (CPR) to improve myocardial perfusion before defibrillation. [4][5][6][7] Other trials, however, have shown no such benefit when compared with early defibrillation. 8 9 The 2020 American Heart Association guidelines recommend immediate initial defibrillation over extended CPR and delayed defibrillation. ...
Background
Predefibrillation end-tidal CO 2 (ETCO 2 ) may predict defibrillation success and could guide defibrillation timing in ventricular fibrillation (VF) cardiac arrest. This relationship has only been studied using advanced airways. Our aim was to evaluate this relationship using both basic (bag–valve–mask (BVM)) and advanced airways (supraglottic airways and endotracheal tubes).
Methods
Prehospital patient records and defibrillator files were abstracted for patients with out-of-hospital cardiac arrest in Ontario, Canada, with initial VF cardiac rhythms between 1 January 2018, and 31 December 2019. Analyses assessed the relationship between each predefibrillation ETCO 2 reading and defibrillation outcomes at the subsequent 2 min pulse check (ie, VF, asystole, pulseless electrical activity (PEA) or return of spontaneous circulation (ROSC)), accounting for airway types used during resuscitation. Multivariable logistic regression evaluated the association between the first documented predefibrillation ETCO 2 and postshock VF termination or ROSC.
Results
Of 269 cases abstracted, 153 had predefibrillation ETCO 2 measurements and were included in the study. Among these cases, 904 shocks were delivered and 44.4% (n=401) had predefibrillation ETCO 2 measured. The first ETCO 2 reading was more often from BVM (n=134) than advanced airways (n=19). ETCO 2 readings were lower when measured through BVM versus advanced airways (30.5 mm Hg (4.06 kPa) (±14.4 mm Hg (1.92 kPa)) vs 42.1 mm Hg (5.61 kPa) (±22.5 mm Hg (3.00 kPa)), adj ANOVA p<0.01). Of all shocks with ETCO 2 reading (n=401), no difference in preshock ETCO 2 was found for subsequent shocks that resulted in persistent VF (32.2 mm Hg (4.29 kPa) (±15.8 mm Hg (2.11 kPa))), PEA (32.8 mm Hg (4.37 kPa) (±17.1 mm Hg (2.30 kPa))), asystole (32.4 mm Hg (4.32 kPa) (±20.6 mm Hg (2.75 kPa))) or ROSC (32.5 mm Hg (4.33 kPa) (±15.3 mm Hg (2.04 kPa))), analysis of variance p=0.99. In the multivariate analysis using the initial predefibrillation ETCO 2 , there was no association with VF termination on the subsequent shock (adjusted OR ( adj OR) 0.99, 95% CI 0.97 to 1.02, p=0.57) or ROSC ( adj OR 1.00, 95% CI 0.97 to 1.03, p=0.94) when evaluated as a continuous or categorical variable.
Conclusion
Predefibrillation ETCO 2 measurement is not associated with VF termination or ROSC when basic and advanced airways are included in the analysis. The role of predefibrillation ETCO 2 requires careful consideration of the type of airway used during resuscitation.
... 31,32 Although perhaps not surprising, the current results help validate experimental research demonstrating CPR mechanisms related to coronary perfusion and oxygen delivery and their influence on myocardial energetics. [33][34][35] The VF waveform measures mediated between a quarter to half of the survival benefit, depending on the specific measure. The observed variability in degree of mediation may be related to the measures' inherent abilities to quantify myocardial physiology. ...
Background
The mechanism by which bystander cardiopulmonary resuscitation (CPR) improves survival following out‐of‐hospital cardiac arrest is unclear. We hypothesized that ventricular fibrillation (VF) waveform measures, as surrogates of myocardial physiology, mediate the relationship between bystander CPR and survival.
Methods and Results
We performed a retrospective cohort study of adult, bystander‐witnessed patients with out‐of‐hospital cardiac arrest with an initial rhythm of VF who were treated by a metropolitan emergency medical services system from 2005 to 2018. Patient, resuscitation, and outcome variables were extracted from emergency medical services and hospital records. A total of 3 VF waveform measures (amplitude spectrum area, peak frequency, and median peak amplitude) were computed from a 3‐second ECG segment before the initial shock. Multivariable logistic regression estimated the association between bystander CPR and survival to hospital discharge adjusted for Utstein elements. Causal mediation analysis quantified the proportion of survival benefit that was mediated by each VF waveform measure. Of 1069 patients, survival to hospital discharge was significantly higher among the 814 patients who received bystander CPR than those who did not (0.52 versus 0.43, respectively; P <0.01). The multivariable‐adjusted odds ratio for bystander CPR and survival was 1.6 (95% CI, 1.2, 2.1), and each VF waveform measure attenuated this association. Depending on the specific waveform measure, the proportion of mediation varied: 53% for amplitude spectrum area, 31% for peak frequency, and 29% for median peak amplitude.
Conclusions
Bystander CPR correlated with more robust initial VF waveform measures, which in turn mediated up to one‐half of the survival benefit associated with bystander CPR. These results provide insight into the biological mechanism of bystander CPR in VF out‐of‐hospital cardiac arrest.
... The number of investigations that indicated the importance of early defibrillation is prevalent [36][37][38][39][40]. Wik et al. [38] found that the patients with ventricular fibrillation and ambulance response intervals of longer than 5 min had better outcomes with CPR before defibrillation was attempted. ...
... The number of investigations that indicated the importance of early defibrillation is prevalent [36][37][38][39][40]. Wik et al. [38] found that the patients with ventricular fibrillation and ambulance response intervals of longer than 5 min had better outcomes with CPR before defibrillation was attempted. Additionally, it was observed that the routine provision of approximately 90 s of CPR prior to the use of the automatic external defibrillator was associated with an increased survival when response intervals were 4 min or longer [39]. Finally, the quality of CPR prior to defibrillation directly affected clinical outcomes [40]. ...
The evaluation of scientific content by researchers, as well as the knowledge networks and working groups of cardiopulmonary resuscitation, can help to improve and expand new scientific evidence in this field. The aim of this study was to identify the global scientific publications on cardiopulmonary resuscitation research using a novel method. The method used was based on obtaining bibliographic data automatically from scientific publications through the use of the Scopus Database API Interface. A total of 17,917 results were obtained, with a total of 60,226 reports and 53,634 authors. Six categories were detected with 38.56% corresponding to cardiac arrest, 21.8% to cardiopulmonary resuscitation, 17.16% to life-support training and education, 12.45% to ethics and decision-making in cardiac arrest, 4.77% to therapeutic treatment, and 3.72% to life-support techniques. Analyzing and identifying the main scientific contributions to this field of study can make it possible to establish collaboration networks and propose new lines of research, as well as to unify criteria for action. Future research should delve into the analyses of the other elements involved in this area.
... • При остановке кровообращения (ЖТ с отсутствием пульса или ФЖ) рекомендуется незамедлительное проведение комплекса сердечно-легочных реанимационных мероприятий (СЛР) [150][151][152]165]. ...
... • Ведение пациента после реанимации рекомендуется в специализированных центрах с мультидисциплинарным подходом к интенсивной терапии и возможностью выполнения первичных коронарных вмешательств, ЭФИ, имплантации вспомогательных желудочковых систем для механической КЛИНИЧЕСКИЕ РЕКОМЕНДАЦИИ поддержки кровообращения, хирургических вмешательств на сердце и сосудах и терапевтической гипотермии [65,153,165,193,195,320,537]. ...
Russian Society of Cardiology (RSC).
With the participation of Russian Scientific Society of Clinical Electrophysiology, Arrhythmology and Cardiac Pacing, Russian Association of Pediatric Cardiologists, Society for Holter Monitoring and Noninvasive Electrocardiology.
Approved by the Scientific and Practical Council of the Russian Ministry of Health.
... [2,8] It is known that hospital staff who are inexperienced in emergency situations may have anxiety and reluctance to initiate resuscitation for fear they may perform a wrong action, cause undue harm or trauma to the patient, or are unsure of their roles and responsibilities in relation to a medical emergency code response team. [4,5,9] With immediate and effective CPR as the key component of BLS for favorable patient outcomes, [2,3,28] this course achieved the goals of improving staff confidence for performing CPR from 35% pre-course to 100% post-course and improving medical knowledge on how to perform CPR correctly from 5% to 100%. The low baseline of CPR confidence and knowledge were consistent with prior studies that showed skills and confidence degrade over time after receiving training -more so for personnel working outside of critical care areas due to the lack of exposure to real-world experience and infrequent intermittent training. ...
... [41] The exact amount of time delay of resuscitation before it causes irreversible patient harm is unknown and may depend on the underlying cause of the arrest, but the research is clear that earlier access to treatment and initiation of resuscitation, i.e. direct current cardioversion within 4 minutes or less or CPR within 4 to 10 minutes or less of the arrest, improves patient outcomes. [1,2,28,42,43] If resuscitation is started beyond 10 minutes of the onset of the arrest, a metabolic phase entailing a cascade of biochemical pathways are triggered resulting in multi-system organ failure with poor neurologic or functional outcomes or even poor survival. [44] We hope that the confidence gained by the staff would transfer to decreased hesitation and time in activating a Code Team and initating CPR and other necessary BLS resuscitation steps. ...
Background: Recognition and timely management of medical emergencies in non-critical care units are essential in initiating and delivering high quality care. Simulation training is a constructive tool that can be utilized to refresh and maintain knowledge and skills for staff that may not encounter medical emergencies frequently. This study examined staff that work at the John D. Dingell VA Medical Center Community Living Center (CLC), a subacute and inpatient rehabilitation unit, on their critical thinking skills, knowledge, role responsibilities and confidence levels prior to and after implementation of a mixed intervention of a one-hour webinar didactic and one-hour case-based simulation with debriefing. The purpose of the study was to improve non-critical care staff critical thinking, knowledge and confidence when working with a deteriorating patient.Methods: A pretest-posttest study design was used to conduct the study. Pre and post surveys were given to 42 health professionals which included registered nurses (RN), licensed practical nurses (LPN) and nursing aides after participating in a case scenario using a high-fidelity mannequin to simulate a medical emergency. Analyses were performed using the two-tailed t-test with p-value significance of less than .05 using Excel and JMP by SAS.Results: Among the 42 participants, there was a significant improvement in confidence for recognizing signs of patient deterioration for timely activation of code team (p < .001). Critical thinking skills and knowledge on appropriate activation of the type of response team based on patients’ speed of deterioration also improved after the intervention (p < .001). Overall, the staff felt more comfortable, confident and knowledgeable concerning their roles and local policy of emergent situations.Conclusions: A team-based case scenario simulation course may improve non-critical care nursing staff confidence, knowledge and critical thinking as it pertains to activation of code teams and willingness to actively participate in medical emergencies.
... Recently, awareness and utilization of AEDs have unambiguously increased, but even so, the overall survival from CA remains low. Ample animal experiments and clinical trials support previous findings that showed improved survival to hospital discharge when CPR was provided for a prescribed time period before defibrillation rather than an immediate shock approach in patients with OHCA due to VF [13,20,21]. Moreover, as mentioned in a section of recent guidelines of the European Resuscitation Council, patients failing to receive early defibrillation can still benefit from effective chest compression provided by bystanders than those without CPR, although averaging 3% to 4% decline in survival per minute delay to defibrillation [16]. ...
Background
Cardiopulmonary resuscitation (CPR) is a topic of great scientific and clinical interest that has received much attention in the past decade. Our study aimed to predict the trends in CPR research activities and evaluate hot topics via bibliometric means, quantitatively and qualitatively.
Material/Methods
All data were collected from a search of the Web of Science Core Collection on May 12, 2020. Retrieved information was investigated with bibliometric analysis by CiteSpace and VOSviewer software and the Online Analysis Platform of Literature Metrology to analyze and predict the trends and hotspots in this field.
Results
Our search returned a total of 9563 articles and reviews on CPR published from 2010 through 2019. The number of original research studies on CPR has been increasing annually. The journal Resuscitation published the greatest number of manuscripts involved CPR, and the leading country and institution with regard to contributions on CPR were the United States and the University of Pennsylvania. Keyword co-occurrence/co-citation-cluster analysis showed that the most popular terms associated with CPR occurred in the manner of cluster labels, such as therapeutic hypothermia and treatment recommendation, among others. In addition, palliative care, sepsis, extracorporeal membrane oxygenation, and brain injury were identified as new foci through burst detection analysis.
Conclusions
Our study showed that the scientific research focus on CPR is switching from traditional therapeutic treatments to a public health practice, with in-depth understanding and development of CPR-related techniques expanding over the past decade. These results demonstrate trends in the CPR research and detected the possible neo-foci for ensuing research.
... Patients with prolonged VF may respond more favorably to defibrillation following a period of CPR that has augmented the cellular status of the myocardium. Clinically, some prior investigations have demonstrated that survival is improved by a period of chest compressions prior to defibrillation when EMS response time was greater than 4 or 5 minutes (14,15). However, two other studies found no improvement in outcomes when CPR was performed 1.5-3 minutes prior to defibrillation regardless of response time (16,17). ...
Introduction
The likelihood of survival from ventricular fibrillation (VF) declines 7%-10% per minute until successful defibrillation. When VF duration is prolonged, immediate defibrillation of the ischemic myocardium is less likely to result in ROSC, and repeated unsuccessful defibrillations are associated with post-resuscitation myocardial dysfunction. Thus, the timing of defibrillation should be based upon the probability of shock success—a function of VF duration. Unfortunately, VF duration is often unknown in out-of-hospital cardiac arrest (OHCA) and a better predictor of shock success is needed.
Objective
To assess the ability of end-tidal carbon dioxide (EtCO2) to predict successful defibrillation in OHCA.
Methods
This retrospective study included adult patients among four EMS systems who experienced non-traumatic OHCA from August, 2015-July, 2017 and received one or more defibrillations. First and succedent shocks were analyzed separately. First shocks represented EMS-attempted defibrillation of patients who had not received a prior AED shock, whereas succedent shocks included all shocks subsequent to the first. Logistic regression provided odds ratios (OR) for first shocks resulting in ROSC, while a generalized estimating equation was used to analyze succedent shocks.
Results
Among 324 patients, 869 shocks were delivered by EMS (153 first and 716 succedent shocks). Layperson CPR was performed in 48.1% of cases and 21.6% received an AED shock before EMS arrival. First defibrillation ROSC was more likely with layperson CPR (OR = 4.41;p = 0.01) and increasing EtCO2 (OR = 1.03/mmHg;p = 0.01). No other variables were statistically significant. Notably, only one patient with EtCO2 < 20 mmHg was successfully defibrillated on the first shock. The probability of ROSC was higher with increasing values of EtCO2 when layperson CPR was provided, yet remained relatively unchanged across all values of EtCO2 ≥ 20 mmHg without layperson CPR. The optimal threshold first shock EtCO2 was 27 and 32 mmHg for those with/without layperson CPR, respectively. EtCO2 was not a predictor of ROSC for succedent shocks.
Conclusions
An optimal defibrillation threshold EtCO2 of 27 and 32 mmHg was observed for patients with and without layperson CPR, respectively. Further studies are warranted to verify these results and to evaluate the clinical effect of delaying defibrillation in favor of chest compressions until these values are attained.
... Some measures including defibrillation, CPR, or inotropic agents should be implemented as soon as possible for the purpose of relieving shock and restoring brain recovery. 16) If the shock was not timely corrected, the chance to develop unfavorable neurologic outcomes will be greatly increased. ...
To investigate the association of shock on admission with predicting intensive care unit (ICU) mortality, hospital mortality, and neurological outcomes of post cardiac arrest patients.
This was a retrospective study of cardiac arrest (CA) patients admitted to ICU. Student's t test and Chi-square test were performed to compare the difference of non-shock and shock group. Multivariable regression analysis was performed to investigate shock and its association with ICU mortality, hospital mortality, and neurologic outcomes and linear regression analysis to explore its correlation with length of stay in hospital.
A total of 374 CA patients were analyzed, with 200 (53.5%) patients in the presence of shock on admission. Shock was significantly associated with higher ICU mortality (OR 2.42, 95% CI 1.60 to 3.68; P < 0.001), hospital mortality (OR 2.33, 95% CI 1.54 to 3.54; P < 0.001), and more unfavorable neurological outcomes (OR 1.98, 95% CI 1.30 to 3.02; P = 0.001). After adjusting for confounding factors, shock was still an independent predictor of ICU mortality (OR 2.40, 95% CI 1.30 to 4.43; P = 0.005).
Shock on admission of CA patients was significantly associated with ICU mortality.
... This study site was Seattle, Washington, a U.S. city with 725,000 residents. The Seattle Fire Department's tiered emergency medical services (EMS) system staffed by emergency medical technicians and Mobile Intensive Care Paramedics, Seattle Medic One (SMO), has been described previously (11). ...
... This was a retrospective cohort study of adult patients (≥ 18 yr) who suffered nontraumatic OHCA in the City of Seattle between January 1, 2010, and April 30, 2017, and were transported to HMC. Qualifying OHCA patients were identified in the SMO cardiac arrest registry, which has existed since the 1970s and has been previously described and includes detailed pre-hospital and in-hospital variables collected by a trained nurse abstractor (11). A single nurse abstracted all data during the entire 7-year study period. ...
Objectives:
To determine the association between targeted temperature management goal temperature of 33°C versus 36°C and neurologic outcome after out-of-hospital cardiac arrest.
Design:
This was a retrospective, before-and-after, cohort study.
Setting:
Urban, academic, level 1 trauma center from 2010 to 2017.
Patients:
Adults with nontraumatic out-of-hospital cardiac arrest who received targeted temperature management.
Interventions:
Our primary exposure was targeted temperature management goal temperature, which was changed from 33°C to 36°C in April of 2014 at the study hospital. Primary outcome was neurologically intact survival to discharge. Secondary outcomes included hospital mortality and care processes.
Measurements and main results:
Of 782 out-of-hospital cardiac arrest patients transported to the study hospital, 453 (58%) received targeted temperature management. Of these, 258 (57%) were treated during the 33°C period (targeted temperature management 33°C) and 195 (43%) were treated during the 36°C period (targeted temperature management 36°C). Patients treated during targeted temperature management 33°C were older (57 vs 52 yr; p < 0.05) and had more arrests of cardiac etiology (45% vs 35%; p < 0.05), but otherwise had similar baseline characteristics, including initial cardiac rhythm. A total of 40% of patients treated during targeted temperature management 33°C survived with favorable neurologic outcome, compared with 30% in the targeted temperature management 36°C group (p < 0.05). After adjustment for demographic and cardiac arrest characteristics, targeted temperature management 33°C was associated with increased odds of neurologically intact survival to discharge (odds ratio, 1.79; 95% CI, 1.09-2.94). Targeted temperature management 33°C was not associated with significantly improved hospital mortality. Targeted temperature management was implemented faster (1.9 vs 3.5 hr from 911 call; p < 0.001) and more frequently in the emergency department during the targeted temperature management 33°C period (87% vs 55%; p < 0.001).
Conclusions:
Comatose, adult out-of-hospital cardiac arrest patients treated during the targeted temperature management 33°C period had higher odds of neurologically intact survival to hospital discharge compared with those treated during the targeted temperature management 36°C period. There was no significant difference in hospital mortality.
... American Heart Association guidelines advise rapid that the goal is delivery of a shock within 3 minutes of victim collapse [14]. However chest compressions prior to defibrillation have also been shown to facilitate return of spontaneous circulation with defibrillation [15,16].It is therefore recommended that CPR should be initiated during AED retrieval and setup if more than 1 rescuer is present, but early defibrillation should be the priority if the defibrillator is available [14]. Hypothermia has been shown to facilitate resuscitation from VF both in animal studies as well as in humans and has therefore become a standard part of post-resuscitation care [17,18,19]. ...
Ventricular fibrillation is associated with onset of heart failure. Timely detection and proper real time analysis and monitoring of ventricular function is the catch in successful management. Western clinical practices are highlighted for treatment with other clinical trials.
