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![Schematic diagram of chest compression points. (1) “classic” hand position according to current guidelines [11,32]; (2) a more caudal approach with the hand still on the sternum; (3) a more caudal and left lateral approach in order to provide the maximum compression upon the left ventricle (LV).](profile/Manuel-Obermaier/publication/366153505/figure/fig1/AS:11431281106123118@1670594568100/Schematic-diagram-of-chest-compression-points-1-classic-hand-position-according-to.png)
Schematic diagram of chest compression points. (1) “classic” hand position according to current guidelines [11,32]; (2) a more caudal approach with the hand still on the sternum; (3) a more caudal and left lateral approach in order to provide the maximum compression upon the left ventricle (LV).
Source publication
Background:
Despite numerous promising innovations, the chance of survival from sudden cardiac arrest has remained virtually unchanged for decades. Recently, technological advances have been made, user-friendly portable devices have been developed, and advanced invasive procedures have been described that could improve this unsatisfactory situatio...
Context in source publication
Context 1
... "middle of the chest" has been proven to be an unreliable place when the left ventricle (LV) should be compressed [82][83][84]. One approach would be to continuously assess the capnography waveform and change hand positions based on three pre-defined positions (Figure 1). [11,32]; (2) a more caudal approach with the hand still on the sternum; (3) a more caudal and left lateral approach in order to provide the maximum compression upon the left ventricle (LV). ...
Citations
... Despite well-established protocols and advanced Cardiac Life Support (ACLS) algorithms, determining optimal duration of CPR to optimize the resuscitation process and improve outcomes remains difficult [14,15]. The duration of CPR after CA can be influenced by various demographic and clinical characteristics such as age [16,17], comorbidities [18], initial shockable rhythm [19], response time [20], bystander CPR [21], and cause of cardiac arrest [22]. ...
Background
Extracorporeal cardiopulmonary resuscitation (ECPR) is an alternative method for patients with reversible causes of cardiac arrest (CA) after conventional cardiopulmonary resuscitation (CCPR). However, cardiopulmonary resuscitation (CPR) duration during ECPR can vary due to multiple factors. Healthcare providers need to understand these factors to optimize the resuscitation process and improve outcomes. The aim of this study was to examine the different variables impacting the duration of CPR in patients undergoing ECPR.
Methods
This retrospective, single-center, observational study was conducted on adult patients who underwent ECPR due to in-hospital CA (IHCA) or out-of-hospital CA (OHCA) at Hamad General Hospital (HGH), the tertiary governmental hospital of Qatar, between February 2016 and March 2020. Univariate and multivariate binary logistic regression analyses were performed to identify the prognostic factors associated with CPR duration, including demographic and clinical variables, as well as laboratory tests.
Results
The mean ± standard division age of the 48 participants who underwent ECPR was 41.50 ± 13.15 years, and 75% being male. OHCA and IHCA were reported in 77.1% and 22.9% of the cases, respectively. The multivariate analysis revealed that several factors were significantly associated with an increased CPR duration: higher age (OR: 1.981, 95%CI: 1.021–3.364, P = 0.025), SOFA score (OR: 3.389, 95%CI: 1.289–4.911, P = 0.013), presence of comorbidities (OR: 3.715, 95%CI: 1.907–5.219, P = 0.026), OHCA (OR: 3.715, 95%CI: 1.907–5.219, P = 0.026), and prolonged collapse-to-CPR time (OR: 1.446, 95%CI:1.092–3.014, P = 0.001). Additionally, the study found that the initial shockable rhythm was inversely associated with the duration of CPR (OR: 0.271, 95%CI: 0.161–0.922, P = 0.045). However, no significant associations were found between laboratory tests and CPR duration.
Conclusion
These findings suggest that age, SOFA score, comorbidities, OHCA, collapse-to-CPR time, and initial shockable rhythm are important factors influencing the duration of CPR in patients undergoing ECPR. Understanding these factors can help healthcare providers better predict and manage CPR duration, potentially improving patient outcomes. Further research is warranted to validate these findings and explore additional factors that may impact CPR duration in this population.
... A quarter of patients affected by this disease have an initial ventricular fibrillation, which evolves into asystole before extra-hospital rescuers arrive (6). Thus, shortening the time before resuscitative manoeuvres is crucial to improve outcomes in cardiac arrest cases (7)(8)(9)(10)(11). Indeed, if the resuscitation actions are performed within the first minute, the chances of success are up to 98%, while from the fifth minute on, the chances drop to 25%, and survival rates drop to 1% if the resuscitation manoeuvres are performed after ten minutes (12). ...
Introduction:
Cardiopulmonary resuscitation is fundamental to improve the outcomes of a life-threatening event. The correct knowledge of first aid actions to provide may guarantee the victim's survival. This study was aimed at evaluating the competence about cardiopulmonary resuscitation and its predictors in a sample of Italian undergraduate students.
Methods:
Information on socio-demographic characteristics, first aid training, knowledge of stroke and heart attack symptoms and perceived ability to provide first aid, were collected through a web-based questionnaire.
Results:
On a total of 744 respondents (mean age 23.9±5.4 years, 62.5% female), 71.4% identified correctly first aid actions, 59.9% and 60.8% showed a good knowledge of stroke and heart attack symptoms, respectively. However, only 39.0% of them declared their ability to intervene in case of emergency. Attending a healthcare degree course and having had first aid training were associated with knowledge of symptoms and perceived ability to provide first aid. Female gender was negatively related with perceived ability to intervene.
Conclusions:
In spite of the satisfactory level of knowledge, these findings highlight the need to enhance the competence about cardiopulmonary resuscitation in the lay population, especially among females.
... Neben der genannten Indikation bei NCTH ergibt REBOA jedoch auch im Rahmen der CPR Sinn. Besonders vor dem Hintergrund tierexperimenteller Daten und einigen kleineren klinischen Untersuchungen bewirkt die proximale endovaskuläre Aortenokklusion, wie sie bei REBOA in Zone I Anwendung findet, eine Zunahme des koronaren und zerebralen Perfusionsdrucks, was sich positiv auf die Rate an Return Of Spontaneous Circulation (ROSC) und eventuell auf das neurologische Behandlungsergebnis auswirken kann [10,11,12,13,14,15,16,17]. Vor dem Hintergrund potenziell positiver Effekte der endovaskulären Aortenokklusion bei Blutungen und im Rahmen des Out of Hospital Cardiac Arrest (OHCA) wird REBOA als optionale Therapiemaßnahme auf den Luftrettungsmitteln Christoph (CHX) 84 und CHX 85 der DRF Luftrettungsstation Halle vorgehalten. ...
... Die genannte verbesserte Myokardperfusion mit Zunahme des koronaren Perfusionsdrucks sowie die verbesserte zerebrale Perfusion sind die Grundlagen der Anwendung der aortalen Okklusion beim therapierefraktären Herz-Kreislauf-Stillstand. Wie bereits oben erwähnt zeigen hier tierexperimentelle Daten und einige kleinere klinische Untersuchungen am Menschen potenziell positive Ergebnisse beim OHCA [10,11,12,13,14,15,16,17]. In den vorliegenden Fallserien hatten 35% der Patienten eine Asystolie, 40% einen schockbaren Rhythmus, 11% eine pulslose elektrische Aktivität (PEA) und der Rest einen nicht genauer definierten "nicht schockbaren" Rhythmus. ...
Zusammenfassung
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) ist ein wenig invasives Verfahren, um ein „internes“ Cross-Clamping der Aorta durchzuführen. Hierdurch ist es entweder möglich, den Blutverlust bei nicht komprimierbaren Körperstammblutungen zu reduzieren und den Patienten vor dem Verbluten zu retten oder im Rahmen der Herz-Lungen-Wiederbelebung (CPR) den koronaren und zerebralen Perfusionsdruck zu erhöhen und damit eventuell die ROSC-Rate und das neurologische Outcome zu verbessern. Aktuell findet REBOA in Deutschland nur in einigen Traumazentren im Schockraum Anwendung und der prähospitale Einsatz ist eher eine extrem seltene Ausnahme. Wir berichten über 2 Fälle, in denen das Verfahren im Rahmen des RIBCAP-HEMS-Projektes (REBOA In Bleeding and Cardiac Arrest in the Pre-hospital care by Helicopter Emergency Medical Service) prähospital durch das Team eines Rettungshubschraubers der DRF Luftrettung jeweils bei der CPR sowie beim Trauma angewendet wurde.
... These innovations have significantly influenced the outcomes of both adult and pediatric resuscitation efforts. Key developments include improvements in cardiopulmonary resuscitation (CPR) techniques, the widespread availability of automated external defibrillators (AEDs), and the incorporation of evidence-based guidelines into clinical practice [4]. In the context of pediatric resuscitation, specialized considerations such as age-appropriate defibrillation energy levels, medication dosages, and airway management techniques have evolved to address the unique needs of children. ...
This comprehensive review thoroughly examines post-resuscitation care in pediatric ICUs (PICUs) following cardiac arrest. The analysis encompasses adherence to resuscitation guidelines, advances in therapeutic interventions, and the nuanced management of neurological, cardiovascular, and respiratory considerations during the immediate post-resuscitation phase. Delving into the complexities of long-term outcomes, cognitive and developmental considerations, and rehabilitation strategies, the review emphasizes the importance of family-centered care for pediatric survivors. A call to action is presented, urging continuous education, research initiatives, and quality improvement efforts alongside strengthened multidisciplinary collaboration and advocacy for public awareness. Through implementing these principles, healthcare providers and systems can collectively contribute to ongoing advancements in pediatric post-resuscitation care, ultimately improving outcomes and fostering a culture of excellence in pediatric critical care.
... The addition of the VTL, like with other previously trialled CPR adjuncts, is consistent with strategies that attempt to enhance the constant achievement of HPCPR quality performance targets. 13 The ventilation timing light (VTL) ...
Unlabelled:
A ventilation timing light (VTL) is a small commercially available single-use device that is programmed to light up at six-second intervals prompting rescuers to provide a single controlled breath during manual ventilation. The device also indicates the duration of the breath by remaining illuminated for the duration of the inspiratory time. The aim of this study was to evaluate the impact of the VTL on a selection of CPR quality metrics.
Methods:
A total of 71 paramedic students who were already proficient in performing high-performance CPR (HPCPR) were required to perform HPCPR with and without a VTL. The quality of the HPCPR delivered, reflected by the selected quality metrics; chest compression fraction (CCF), chest compression rate (CCR), and ventilation rate (VR), was then evaluated.
Results:
While HPCPR with and without a VTL were both able to achieve guideline-based performance targets of CCF, CCR, and VR, the group who had used the VTL to deliver HPCPR were able to consistently provide 10 ventilations for every minute of asynchronous compressions (10 breath/min vs 8.7 breath/min p < 0.001).
Conclusion:
The use of a VTL allows for a VR target of 10 ventilations per minute to be consistently achieved without compromising guideline-based compression fraction targets (>80%), and chest compression rates when used during the delivery of HPCPR in a simulated OHCA event.
Objetivo: Avaliar os benefícios do uso do POCUS na emergência. Métodos: Trata-se de uma revisão bibliográfica que avaliou os benefícios do POCUS na emergência. Foram utilizados como base de pesquisa PubMed, Scielo e LILACS, sendo escolhido 7 artigos analisados. Foram incluídas as publicações dos últimos seis anos relacionadas ao impacto do uso do POCUS em emergências. Resultados: O uso do POCUS mostrou-se útil no manejo e prognóstico do paciente, no entanto, em alguns casos não implicou significativamente nisso e em um estudo mostrou danos, durante avaliação do pulso na Parada Cardiorrespiratória (PCR). Conclusão: Seu uso tem se mostrado eficaz e seguro quando aplicado de forma complementar ou alternativa aos protocolos já utilizados em urgências e emergências hospitalares. É importante incorporar o POCUS em uma abordagem multidisciplinar para aumentar os resultados favoráveis. Para que isso aconteça, a ampliação da formação de seus operadores deve ser vista como fundamental para a formação básica dos médicos generalistas.
Cardiopulmonary resuscitation (CPR) is an essential procedure used to treat patients who are in cardiac arrest, particularly in the Critical Care Unit (CCU). Objective: To assess the success rate of CPR admitted to the CCU, revealing insight on the effectiveness of current resuscitation techniques. Methods: This retrospective study was conducted at Department of Cardiology Ayub Medical Teaching Institute, Abbottabad, between 13th April 2023 to 30th November 2023, 110 patients had cardiac arrest while in the intensive care unit. Data were gathered and examined on patient demographics, pre-existing comorbidities, time to start CPR, duration of CPR, and results. CPR success was defined as a sustained restoration of spontaneous circulation (ROSC) for at least 20 minutes. Results: This study included 110 cardiac patients. Most patients (68.18%) were male. Hypertension was the most common comorbidity at 72.7%. CPR started on average 4.8 minutes late, with a 1.2-minute standard deviation. The average CPR time was 18.2 minutes, with a 5.6-minute SD. After cardiac arrest, 60 (54.5%) patients began CPR within 5 minutes. Another subgroup found 96.0% CPR success in 25 (22.7%) ventricular fibrillation patients. Then occurred ventricular tachycardia (80.0%), pulseless electrical activity (76.0%), and asystole (68.9%). These data suggest that CPR works better in ventricular fibrillation patients. Conclusions: This research sheds light on cardiac arrest CCU patients' demographics, care, and outcomes. The data show that early CPR and ventricular fibrillation detection and treatment improve outcomes for these individuals.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) represents an endovascular procedure for aortic occlusion. The procedure can be used for temporary hemorrhage control as a bridge until surgical treatment for noncompressible abdominal or pelvic bleeding and to improve coronary and cerebral perfusion pressure during cardiopulmonary resuscitation. The prehospital administration is challenging and currently hardly possible in Germany. In the REBOA in bleeding and cardiac arrest in the prehospital care by helicopter emergency medical service (RIBCAP-HEMS) project, the prehospital use of REBOA will be tested in a feasibility study. This article describes the training course on the procedure in preparation for prehospital use, which was conducted before the start of the aforementioned feasibility study for the emergency physicians and paramedics (HEMS-TC) of the DRF Air Rescue Base in Halle (Saale). The course provided the necessary theoretical and practical skills to apply REBOA in the prehospital setting to patients in extremis in a safe, indications-conform and time-critical manner. The fact that all emergency physicians of the two air ambulances Christoph 84 and Christoph 85 in Halle are specialists in anesthesiology with corresponding experience in the placement of invasive arterial catheters proved to be advantageous. The training course was able to significantly improve the theoretical and practical abilities of the participants. The results of the currently ongoing study must show whether the procedure can be usefully integrated into the prehospital care of patients in extremis.
Modern thoracic surgery encompasses a multitude of different and specific surgical approaches. This article aims to give an overview of contemporary surgical techniques for access to the thoracic cavity and mediastinum, their indications and implementation. Thoracotomy is the classical approach in emergency situations and for the resection of large tumors or in cases of pleural adhesions due to previous surgery. Despite the successful implementation of minimally invasive techniques, thoracotomy remains an essential part of thoracic surgery especially as it serves as a safe technique in cases of major bleeding and probably necessary conversion from minimally invasive surgery to open procedures. Nowadays, video-assisted thoracoscopy is the procedure of first choice especially in oncology because of its small access-related trauma and low perioperative and postoperative morbidity and rapid recovery. Robotic-assisted thoracoscopy is the superior procedure, particularly for mediastinal tumors and gains increasingly more importance for thoracic operations as well. Resection of tumors infiltrating the anterior mediastinum or upper thoracic aperture requires sophisticated techniques. Today, these techniques are often combined with minimally invasive procedures.
