J E Smith, S Le Clerc, P A F Hunt
Attempts to resuscitate patients in traumatic cardiac arrest (TCA) have, in the past, been viewed as futile. However, reported outcomes from TCA in the past five years, particularly from military series, are improving. The pathophysiology of TCA is different to medical causes of cardiac arrest, and therefore, treatment priorities may also need to be different. This article reviews recent literature describing the pathophysiology of TCA and describes how the military has challenged the assumption that outcome is universally poor in these patients...
December 2015: Emergency Medicine Journal: EMJ
Jestin N Carlson, Henry E Wang
No abstract text is available yet for this article.
March 2016: Annals of Emergency Medicine
Tanveer Rab, Karl B Kern, Jacqueline E Tamis-Holland, Timothy D Henry, Michael McDaniel, Neal W Dickert, Joaquin E Cigarroa, Matthew Keadey, Stephen Ramee
Patients who are comatose after cardiac arrest continue to be a challenge, with high mortality. Although there is an American College of Cardiology Foundation/American Heart Association Class I recommendation for performing immediate angiography and percutaneous coronary intervention (when indicated) in patients with ST-segment elevation myocardial infarction, no guidelines exist for patients without ST-segment elevation. Early introduction of mild therapeutic hypothermia is an established treatment goal. However, there are no established guidelines for risk stratification of patients for cardiac catheterization and possible percutaneous coronary intervention, particularly in patients who have unfavorable clinical features in whom procedures may be futile and affect public reporting of mortality...
July 7, 2015: Journal of the American College of Cardiology
Joo Yeong Kim, Sang Do Shin, Young Sun Ro, Kyoung Jun Song, Eui Jung Lee, Chang Bae Park, Seung Sik Hwang
OBJECTIVE: This study aimed to determine whether active post-resuscitation care (APRC) was associated with improved out-of-hospital cardiac arrest (OHCA) outcomes on a nationwide level. METHODS AND RESULTS: We used a national OHCA cohort database consisting of hospital and ambulance data. We included all survivors of OHCA, excluding patients with non-cardiac etiology, younger than 15 years, and with unknown outcomes, from (2008 to 2010). The APRC was defined when the OHCA patients received mild therapeutic hypothermia (MTH) or active cardiac care (ACC), such as intravenous thrombolysis, percutaneous coronary intervention, coronary artery bypass surgery, and pacemaker/implantable cardioverter defibrillator insertion, as well as routine intensive care; patients receiving conservative post-resuscitation care (CPRC) served as the other group...
August 2013: Resuscitation
Wulfran Bougouin, Hazrije Mustafic, Eloi Marijon, Mohammad Hassan Murad, Florence Dumas, Anna Barbouttis, Patricia Jabre, Frankie Beganton, Jean-Philippe Empana, David S Celermajer, Alain Cariou, Xavier Jouven
BACKGROUND: Conflicting results exist regarding the impact of gender on early survival after sudden cardiac arrest (SCA). We aimed to assess the association between female gender and early SCA survival. METHODS: We searched Embase, MEDLINE, EBM Reviews, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (between 1948 and January 2014) for studies evaluating the association between gender and survival after SCA. Two independent reviewers selected studies of any design or language...
September 2015: Resuscitation
Gordon A Ewy, Karl B Kern
Cardiocerebral resuscitation (CCR) is a new approach for resuscitation of patients with cardiac arrest. It is composed of 3 components: 1) continuous chest compressions for bystander resuscitation; 2) a new emergency medical services (EMS) algorithm; and 3) aggressive post-resuscitation care. The first 2 components of CCR were first instituted in 2003 in Tucson, Arizona; in 2004 in the Rock and Walworth counties of Wisconsin; and in 2005 in the Phoenix, Arizona, metropolitan area. The CCR method has been shown to dramatically improve survival in the subset of patients most likely to survive: those with witnessed arrest and shockable rhythm on arrival of EMS...
January 13, 2009: Journal of the American College of Cardiology
Prachi Sanghavi, Anupam B Jena, Joseph P Newhouse, Alan M Zaslavsky
IMPORTANCE: Most out-of-hospital cardiac arrests receiving emergency medical services in the United States are treated by ambulance service providers trained in advanced life support (ALS), but supporting evidence for the use of ALS over basic life support (BLS) is limited. OBJECTIVE: To compare the effects of BLS and ALS on outcomes after out-of-hospital cardiac arrest. DESIGN, SETTING, AND PARTICIPANTS: Observational cohort study of a nationally representative sample of traditional Medicare beneficiaries from nonrural counties who experienced out-of-hospital cardiac arrest between January 1, 2009, and October 2, 2011, and for whom ALS or BLS ambulance services were billed to Medicare (31,292 ALS cases and 1643 BLS cases)...
February 2015: JAMA Internal Medicine
Marios Georgiou, Elizabeth Papathanassoglou, Theodoros Xanthos
BACKGROUND: High quality chest compressions is the most significant factor related to improved short-term and long-term outcome in cardiac arrest. However, considerable controversy exists over the mechanisms involved in driving blood flow. OBJECTIVES: The aim of this systematic review is to elucidate major mechanisms involved in effective compression-mediated blood flow during adult cardiopulmonary resuscitation (CPR). DESIGN AND SETTING: Systematic review of studies identified from the bibliographic databases of PubMed/Medline, Cochrane, and Scopus...
November 2014: Resuscitation
Jarrod Mosier, Ajit Itty, Arthur Sanders, Jane Mohler, Christopher Wendel, Jacob Poulsen, Jeff Shellenberger, Lani Clark, Bentley Bobrow
BACKGROUND: Recent studies have shown that a new emergency medical services (EMS) protocol for treating patients who suffer out-of-hospital cardiac arrest (OHCA), cardiocerebral resuscitation (CCR), significantly improves survival compared to standard advanced life support (ALS). However, due to their different physiology, it is unclear if all elders, or any subsets of elders who are OHCA victims, would benefit from the CCR protocol. OBJECTIVES: The objectives of this analysis were to compare survival by age group for patients receiving CCR and ALS, to evaluate their neurologic outcome, and to determine what other factors affect survival in the subset of patients who do receive CCR...
March 2010: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Gordon A Ewy, Bentley J Bobrow
Out-of-hospital cardiac arrest (OHCA) is a major public health problem. In the United States, OHCA accounts for more premature deaths than any other cause. For over a half-century, the national "Guidelines" for resuscitation have recommended the same initial treatment of primary and secondary cardiac arrests. Using this approach, the overall survival of patients with OHCA, while quite variable, was generally very poor. One reason is that the etiologies of cardiac arrests are not all the same. The vast majority of nontraumatic OHCA in adults are due to a "primary" cardiac arrest, rather than secondary to respiratory arrest...
January 2016: Journal of Intensive Care Medicine
Adaira Landry, Mark Foran, Alex Koyfman
No abstract text is available yet for this article.
August 2014: Annals of Emergency Medicine
Frank W Moler, Amy E Donaldson, Kathleen Meert, Richard J Brilli, Vinay Nadkarni, Donald H Shaffner, Charles L Schleien, Robert S B Clark, Heidi J Dalton, Kimberly Statler, Kelly S Tieves, Richard Hackbarth, Robert Pretzlaff, Elise W van der Jagt, Jose Pineda, Lynn Hernan, J Michael Dean
OBJECTIVES: To describe a large cohort of children with out-of-hospital cardiac arrest with return of circulation and to identify factors in the early postarrest period associated with survival. These objectives were for planning an interventional trial of therapeutic hypothermia after pediatric cardiac arrest. METHODS: A retrospective cohort study was conducted at 15 Pediatric Emergency Care Applied Research Network clinical sites over an 18-month study period...
January 2011: Critical Care Medicine
Robert J Myerburg, Henry Halperin, Debra A Egan, Robin Boineau, Sumeet S Chugh, Anne M Gillis, Joshua I Goldhaber, David A Lathrop, Peter Liu, James T Niemann, Joseph P Ornato, George Sopko, Jennifer E Van Eyk, Gregory P Walcott, Myron L Weisfeldt, Jacqueline D Wright, Douglas P Zipes
No abstract text is available yet for this article.
December 3, 2013: Circulation
Farida M Jeejeebhoy, Laurie J Morrison
Cardiac arrest during pregnancy is a dedicated chapter in the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care; however, a robust maternal cardiac arrest knowledge translation strategy and emergency response plan is not usually the focus of institutional emergency preparedness programs. Although maternal cardiac arrest is rare, the emergency department is a high-risk area for receiving pregnant women in either prearrest or full cardiac arrest. It is imperative that institutions review and update emergency response plans for a maternal arrest...
2013: Emergency Medicine International
Alan C Heffner, Douglas S Swords, Marcy N Neale, Alan E Jones
OBJECTIVE: Cardiac arrest (CA) is a rare but recognized complication of emergency airway management. Our aim was to measure the incidence of peri-intubation CA during emergency intubation and identify factors associated with this complication. METHODS: Retrospective cohort study of emergency endotracheal intubations performed in a large, urban emergency department over a one-year period. Patients were included if they were >18 years old and not in CA prior to intubation...
November 2013: Resuscitation
Mark Westfall, Steve Krantz, Christopher Mullin, Christopher Kaufman
OBJECTIVE: The objective of this study was to conduct a meta-analysis of literature examining rates of return of spontaneous circulation from load-distributing band and piston-driven chest compression devices as compared with manual cardiopulmonary resuscitation. DATA SOURCES: Searches were conducted in MEDLINE, the registry, and bibliographies on manufacturer websites for studies written in English. STUDY SELECTION: Selection criteria for the meta-analysis required that studies must be human controlled (randomized, historical, or case-control) investigations with confirmed out-of-hospital cases...
July 2013: Critical Care Medicine
Jerry P Nolan, Gavin D Perkins
PURPOSE OF REVIEW: To critically evaluate the recent data on the influence adrenaline has on outcome from cardiopulmonary resuscitation. RECENT FINDINGS: Two prospective controlled trials in out-of-hospital cardiac arrest (OHCA) have indicated that adrenaline increases the rate of return of spontaneous circulation (ROSC), but neither was sufficiently powered to determine the long-term outcomes. Several observational studies document higher ROSC rates in patients receiving adrenaline after OHCA, but these also document an association between receiving adrenaline and worse long-term outcomes...
June 2013: Current Opinion in Critical Care
Eric Qvigstad, Jo Kramer-Johansen, Øystein Tømte, Tore Skålhegg, Øyvar Sørensen, Kjetil Sunde, Theresa M Olasveengen
PURPOSE OF THE STUDY: Optimal hand position for chest compressions during cardiopulmonary resuscitation is unknown. Recent imaging studies indicate significant inter-individual anatomical variations, which might cause varying haemodynamic responses with standard chest compressions. This prospective clinical pilot study intended to assess the feasibility of utilizing capnography to optimize chest compressions and identify the optimal hand position. MATERIALS AND METHODS: Intubated cardiac arrest patients treated by the physician manned ambulance between February and December 2011 monitored with continuous end-tidal CO2 (EtCO2) measurements were included...
September 2013: Resuscitation
Andrew J Thomas, Craig D Newgard, Rongwei Fu, Dana M Zive, Mohamud R Daya
BACKGROUND: Non-shockable arrest rhythms (pulseless electrical activity and asystole) represent an increasing proportion of reported cases of out-of-hospital cardiac arrest (OHCA). The prognostic significance of conversion from non-shockable to shockable rhythms during the course of resuscitation remains unclear. OBJECTIVE: To evaluate whether out-of-hospital cardiac arrest survival with initially non-shockable arrest rhythms is improved with subsequent conversion to shockable rhythms...
September 2013: Resuscitation
Prokopis Papadimitriou, Athanasios Chalkias, Antonis Mastrokostopoulos, Irene Kapniari, Theodoros Xanthos
OBJECTIVE: Chest compressions are pivotal determinants of successful resuscitation. The aim of our study was to identify the variations of the anatomical structures underneath the sternum and to investigate possible implications for chest compressions. METHODS: A retrospective study of all patients who underwent a routine chest computed tomography from January 2009 to January 2010 in a tertiary teaching general hospital was performed. The sternum and the area underneath were divided in 2 regions, one consisting of the second and third intercostal spaces, referred to as 2-3 segment, and one consisting of the fourth and fifth intercostal spaces, referred to as 4-6 segment...
March 2013: American Journal of Emergency Medicine
2014-04-16 18:09:27
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