Successful resuscitation using nitroglycerin for refractory pulseless electrical activity in intensive care unit

2000 ◽  
Vol 26 (2) ◽  
pp. 255-255 ◽  
Author(s):  
M. Osada ◽  
Y. Tanaka ◽  
T. Komai ◽  
Y. Maeda ◽  
M. Kitano ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Electrical Activity ◽  
Pulseless Electrical Activity ◽  
Successful Resuscitation

Abstract 120: Epidemiology and Outcomes of Cardiopulmonary Resuscitation Events in the Neonatal Intensive Care Unit

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Kaashif A Ahmad ◽  
Steven G Velasquez ◽  
Cody L Henderson ◽  
Katy L Kohlleppel ◽  
Jaclyn M LeVan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Pulseless Electrical Activity ◽  
Chest Compressions ◽  
Term Infants ◽  
Level Ii ◽  
High Acuity

Introduction: Limited data exists regarding cardiopulmonary resuscitation (CPR) in infants in the Neonatal Intensive Care Unit (NICU). Objectives included determining the incidence, demographics, diagnoses, and outcomes of infants who require CPR across 10 NICUs in San Antonio, Texas. Methods: We conducted a retrospective review of in-NICU CPR events requiring chest compressions for 1 minute from 2012 - 2017. Included NICUs provided the following levels of care: two level IV, two high acuity level III, four low acuity level III, and two level II. Case identification occurred by reviewing death summaries and CPR coding in the electronic medical record. Results: In total, 139 infants (81 or 58% male) required 211 episodes of CPR. CPR incidence per 1000 patient days was 0.68, 0.37, 0.02 and 0 among level IV, high acuity level III, low acuity level III, and level II NICUs, respectively. Median birth weight was 945 (IQR 630, 2243) grams, gestational age at birth 27 (IQR 24, 34) weeks and age at CPR 11 (IQR 1, 42) days. Only 27 events (13%) occurred in term infants. Ninety-three CPR events (44%) had a primary respiratory etiology, 38 (18%) circulatory, 36 (17%) infectious, and 24 (11%) metabolic. Term and preterm infants had significantly different CPR etiologies (p=0.036). Circulatory etiologies were more common in term infants (37% vs 15%) with respiratory etiologies being less common (33.3% vs 46.2%). The most common rhythm documented leading to initiation of CPR was bradycardia (63%), followed by asystole (19%), and pulseless electrical activity (14%). The median duration of CPR was 10 (IQR 4, 25.5) minutes and chest compressions 8 (IQR 3, 18) minutes. While 135 of 211 CPR events (64%) had ROSC, only 22 of 139 patients (16%) survived to hospital discharge. The rate of ROSC among Level IV NICUs was significantly higher than in high acuity level III NICUs (68.2% vs 51.9%, p = 0.034). Conclusions: NICU CPR events occur most commonly in premature infants and are respiratory in origin. Bradycardia is the most common initial rhythm requiring CPR in the NICU. The incidence of CPR and the rate of ROSC are higher in level IV than level III NICUs. Further investigation is needed into factors associated with ROSC for in-NICU CPR.

Neonatal Resuscitation

2017 ◽  
Author(s):  
Megan Litzau ◽  
Sheryl E Allen
Keyword(s):  
Intensive Care Unit ◽  
Heart Rate ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Neonatal Resuscitation ◽  
Chest Compressions ◽  
Compression Technique ◽  
Apgar Scores ◽  
Successful Resuscitation

The resuscitation of a neonate in the emergency department is an infrequent occurrence. As such, it is imperative that emergency physicians are aware of the resources available at their institution in the event that resuscitation arises. The two mainstays of neonatal resuscitation are respiration and temperature. When resuscitation is required, it is due to a respiratory cause in the majority of neonates. Therefore, if the airway and breathing are managed properly, the heart rate and overall neonatal status will follow suit. Should the neonate’s heart rate continue to be below 60 beats per minute, then he or she will need chest compressions in addition to respiratory support. During the transition from intrauterine life to extrauterine life, neonates stand to lose substantial amounts of heat. Therefore, the temperature of the neonate also needs to be actively managed to prevent the loss of heat. The resuscitation will eventually end in one of two pathways: the termination of efforts or the successful resuscitation of the neonate. If the resuscitation is successful, the proper admission or transfer will need to be arranged for definitive care for the neonate. Figures include the review of fetal and neonatal circulation, proper use of equipment, and proper chest compression technique. Tables include equipment needed, Apgar scores, normal neonatal vital signs, disposition, and neonatal intensive care unit levels. Key words: Apgar scores, fetal circulation, neonatal chest compressions, neonatal circulation, neonatal resuscitation, neonatal intensive care unit levels

scholarly journals P003: Which factors predict resuscitation outcomes in patients arriving to the emergency department in cardiac arrest? A SHoC series study

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S57-S58
Author(s):  
P. Atkinson ◽  
N. Beckett ◽  
D. Lewis ◽  
J. Fraser ◽  
A. Banerjee ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Electrical Activity ◽  
Odds Ratio ◽  
Cardiac Rhythm ◽  
Point Of Care ◽  
Pulseless Electrical Activity ◽  
Spontaneous Circulation ◽  
Point Of Care Ultrasound ◽  
Successful Resuscitation

Introduction: The decision as to whether to end resuscitation for pre-hospital cardiac arrest (CA) patients in the field or in the emergency department (ED) is commonly made based upon standard criteria. We studied the reliability of several easily determined criteria as predictors of resuscitation outcomes in a population of adults in CA transported to the ED. Methods: A retrospective database and chart analysis was completed for patients arriving to a tertiary ED in cardiac arrest, between 2010 and 2014. Patients were excluded if aged under 19. Multiple data were abstracted from charts using a standardized form. Regression analysis was used to compare criteria that predicted return of spontaneous circulation (ROSC) and survival to hospital admission (SHA). Results: 264 patients met the study inclusion criteria. Logistic regression was used to identify predictors of ROSC and SHA. The criteria that emerged as significant predictors for ROSC included; longer ED resuscitation time (Odds ratio 1.11 (1.06- 1.18)), witnessed arrest (Odds ratio 9.43 (2.58- 53.0)) and having an initial cardiac rhythm of Pulseless Electrical Activity (Odds Ratio 3.23 (1.07-9.811)) over Asystole. Receiving point of care ultrasound (PoCUS; Odds ratio 0.22 (0.07-0.69)); and having an initial cardiac rhythm of Pulseless Electrical Activity (Odds Ratio 4.10 (1.43-11.88)) were the significant predictors for SHA. Longer times for ED resuscitation was close to reaching significance for predicting SHA Conclusion: Our results suggest that both fixed and adaptable factors, including increasing resuscitation time, and PoCUS use in the ED were important independent predictors of successful resuscitation. Several commonly used criteria were unreliable predictors.

scholarly journals Characteristics and Risk Factors for Intensive Care Unit Cardiac Arrest in Critically Ill Patients with COVID-19—A Retrospective Study

2021 ◽  
Vol 10 (10) ◽  
pp. 2195
Author(s):  
Kevin Roedl ◽  
Gerold Söffker ◽  
Dominic Wichmann ◽  
Olaf Boenisch ◽  
Geraldine de Heer ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Pulseless Electrical Activity ◽  
Severity Of Illness ◽  
Spontaneous Circulation ◽  
Saps Ii ◽  
Initial Rhythm

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causing the coronavirus disease 2019 (COVID-19) led to an ongoing pandemic with a surge of critically ill patients. Very little is known about the occurrence and characteristic of cardiac arrest in critically ill patients with COVID-19 treated at the intensive care unit (ICU). The aim was to investigate the incidence and outcome of intensive care unit cardiac arrest (ICU-CA) in critically ill patients with COVID-19. This was a retrospective analysis of prospectively recorded data of all consecutive adult patients with COVID-19 admitted (27 February 2020–14 January 2021) at the University Medical Centre Hamburg-Eppendorf (Germany). Of 183 critically ill patients with COVID-19, 18% (n = 33) had ICU-CA. The median age of the study population was 63 (55–73) years and 66% (n = 120) were male. Demographic characteristics and comorbidities did not differ significantly between patients with and without ICU-CA. Simplified Acute Physiological Score II (SAPS II) (ICU-CA: median 44 points vs. no ICU-CA: 39 points) and Sequential Organ Failure Assessment (SOFA) score (median 12 points vs. 7 points) on admission were significantly higher in patients with ICU-CA. Acute respiratory distress syndrome (ARDS) was present in 91% (n = 30) with and in 63% (n = 94) without ICU-CA (p = 0.002). Mechanical ventilation was more common in patients with ICU-CA (97% vs. 67%). The median stay in ICU before CA was 6 (1–17) days. A total of 33% (n = 11) of ICU-CAs occurred during the first 24 h of ICU stay. The initial rhythm was non-shockable (pulseless electrical activity (PEA)/asystole) in 91% (n = 30); 94% (n = 31) had sustained return of spontaneous circulation (ROSC). The median time to ROSC was 3 (1–5) minutes. Patients with ICU-CA had significantly higher ICU mortality (61% vs. 37%). Multivariable logistic regression showed that the presence of ARDS (odds ratio (OR) 4.268, 95% confidence interval (CI) 1.211–15.036; p = 0.024) and high SAPS II (OR 1.031, 95% CI 0.997–1.065; p = 0.077) were independently associated with the occurrence of ICU-CA. A total of 18% of critically ill patients with COVID-19 suffered from a cardiac arrest within the intensive care unit. The occurrence of ICU-CA was associated with presence of ARDS and severity of illness.

Abstract 221: Bradycardia at the Onset of Pulseless Electrical Activity Arrests in Hospitalized Patients is Associated With Improved Survival to Discharge

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Dan Nguyen ◽  
Patricia A Kritek ◽  
Sheryl A Greco ◽  
Jordan M Prutkin
Keyword(s):  
Electrical Activity ◽  
Hospital Discharge ◽  
Electronic Device ◽  
Medical Center ◽  
Academic Medical Center ◽  
Significant Proportion ◽  
Vital Signs ◽  
Pulseless Electrical Activity ◽  
Hospitalized Patients ◽  
Successful Resuscitation

Background: Recent studies have suggested that the incidence of in-hospital pulseless electrical activity (PEA) arrests is increasing. Bradycardia in patients with in-hospital PEA is common but it is unknown if it is associated with patient outcomes. Objective: To determine risk factors and outcomes associated with bradycardic-PEA arrests. Methods: This was a retrospective study of all inpatient cardiac arrests at an academic medical center. Patient demographics, comorbidities, vital signs, arrest event data, and outcomes were abstracted from the medical record. PEA arrest was defined as a non-shockable rhythm with loss of pulse requiring cardiopulmonary resuscitation and having organized electrocardiographic activity. Bradycardia was classified as a HR < 60 bpm at the time of pulse loss. Obvious vasovagal events were excluded. The primary outcomes were survival of arrest and survival to hospital discharge. Results: Between July 2013 and August 2017, there were 176 in-hospital PEA arrests. While 105 (59.7%) survived the arrest, only 38 (21.6%) survived to discharge. A total of 65 (36.9%) were bradycardic-PEA arrests. Bradycardia was associated with improved survival to hospital discharge (χ2 8.60, p=0.003), but not survival of arrest (χ2 2.15, p=0.14). Hypoxemia increased (OR 2.72, 95% CI: 1.26-5.87, p=0.01) and a cardiac implanted electronic device decreased (OR 0.17, 95% CI: 0.04-0.78, p = 0.02) the odds of an arrest being preceded by bradycardia. On multivariate analysis, bradycardia remained a predictor of survival to discharge (OR 2.46, 95% CI 1.14-5.32, p=0.02). Other predictors of survival to discharge included hypoxemia (OR 3.38, 95% CI 1.45-7.89, p=0.005) and coronary artery disease (OR 2.29, 95% CI 1.03-5.09, p=0.04). Conclusion: While a significant proportion of hospitalized patients survive a PEA arrest, many fewer survive to discharge. Bradycardia at the time of PEA arrest was associated with improved survival to discharge but not survival of arrest. Bradycardia was associated with hypoxemic arrests, in which rapid airway management should be a priority to improve the chance of successful resuscitation.

The Psychosocial Aspects of Feeding in the Neonatal Intensive Care Unit and Beyond

2019 ◽  
Vol 4 (6) ◽  
pp. 1507-1515
Author(s):  
Lauren L. Madhoun ◽  
Robert Dempster
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Hospital Discharge ◽  
Neonatal Intensive Care ◽  
Oral Feeding ◽  
Medical Attention ◽  
Primary Role ◽  
Speech Language Pathologists ◽  
The Family

Purpose Feeding challenges are common for infants in the neonatal intensive care unit (NICU). While sufficient oral feeding is typically a goal during NICU admission, this can be a long and complicated process for both the infant and the family. Many of the stressors related to feeding persist long after hospital discharge, which results in the parents taking the primary role of navigating the infant's course to ensure continued feeding success. This is in addition to dealing with the psychological impact of having a child requiring increased medical attention and the need to continue to fulfill the demands at home. In this clinical focus article, we examine 3 main areas that impact psychosocial stress among parents with infants in the NICU and following discharge: parenting, feeding, and supports. Implications for speech-language pathologists working with these infants and their families are discussed. A case example is also included to describe the treatment course of an infant and her parents in the NICU and after graduation to demonstrate these points further. Conclusion Speech-language pathologists working with infants in the NICU and following hospital discharge must realize the family context and psychosocial considerations that impact feeding progression. Understanding these factors may improve parental engagement to more effectively tailor treatment approaches to meet the needs of the child and family.

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