scholarly journals Cardiopulmonary Resuscitation: Recent Advances

2020 ◽  
Author(s):  
Abhishek Kumar ◽  
Pratishtha Yadav ◽  
Rakesh Garg
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Time Management ◽  
Life Support ◽  
Point Of Care ◽  
Spontaneous Circulation ◽  
Current Evidence ◽  
Recent Advances ◽  
Cpr Training

Cardiac arrest is the most significant reason for mortality and morbidities worldwide. With a better understanding of the pathophysiology of cardiac arrest, simple adaptations in basic life support to upcoming modifications in post-resuscitation care have been proposed by various resuscitation councils throughout the globe. Role of point of care cardiac ultrasound during cardiopulmonary resuscitation (CPR) has been explored and its contribution for identifying reversible causes and its real time management has been explored. A higher blood and tissue oxygenation levels contributed to an increased rate of return of spontaneous circulation (ROSC) which has to lead us to explore more options to increase the oxygenation. Starting from the CPR training, the use of sensors for spirometric feedback in ventilation maneuvers can help improve the quality of CPR. High flow nasal oxygenation during CPR has shown promising results. Extracorporeal CPR is another entity that has shown survival benefits in a selected group of patients. The aim of the newer advances has always been to decrease the morbidity and improve survival outcomes in terms of neurological deficit as well. These guidelines are reviewed and updated regularly to improve knowledge and training based on the current evidence. This chapter shall focus on recent advances in cardiopulmonary resuscitation.

scholarly journals Role of ultrasound in cardiopulmonary resuscitation: Ultrasound CPR

2021 ◽  
Vol 43 (1-2) ◽  
pp. 31-39
Author(s):  
Isidora Jovanović ◽  
Sanja Ratković ◽  
Adi Hadžibegović ◽  
Tijana Todorčević ◽  
Snežana Komnenović ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
Repeat Test ◽  
Echocardiographic Evaluation ◽  
Focused Echocardiography ◽  
Short Time

Ultrasound has predictive value of identification and management of reversible causes of cardiac arrest on the outcome after applied CPR, in terms of ROSC (return of spontaneous circulation) and the hospital discharge and neurological findings after applied CPR measures. Ultrasound is used in all phases of resuscitation including period before cardiac arrest, during cardiopulmonary resuscitation (CPR), and in the period after that. Ultrasound use during CPR offers numerous advantages including non-invasiveness, easiness, the short time for examination and a safe possibility for a repeat test whenever it is needed. Focused Echocardiography Examination in Life support (FEEL) and Focused Echocardiographic Evaluation in Resuscitation (FEER) protocols are mostly used when we talk about heart examination in cardiopulmonary resuscitation.

Abstract 421: Point of Care Ultrasound Sonography (POCUS) in Cardiac Arrest: Predicting Survivorship

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Ada Wong ◽  
Hassan Patail ◽  
Sahar Ahmad
Keyword(s):  
Cardiac Arrest ◽  
Tricuspid Valve ◽  
Prospective Observational Study ◽  
Thrombus Formation ◽  
Point Of Care ◽  
Spontaneous Circulation ◽  
Point Of Care Ultrasound ◽  
Short Term ◽  
Flow Stasis

Introduction: Survival after in hospital (IH) cardiac arrest (CA) is at 17% suggesting that CA represents an arena of medical practice which deserves more attention. Ultrasound (US) may have a role in both intra-arrest management and peri-arrest prognosis. Very little is known about the role of ultrasound for IH CA. Hypothesis: Intra- arrest POCUS can provide prognostic value. Methods: This was a single center, prospective observational study and we included all IH CA which occurred when a provider was available to perform a standardized POCUS protocol. US and echocardiography imaging was collected during the intra- arrest period and compared with outcome measures of return of spontaneous circulation (ROSC) and survival to 24 hours post-ROSC. Results: Echocardiographic features which may reflect survivorship include cardiac standstill, right ventricle (RV) blood flow stasis, and the appearance of thrombus formation at or around the tricuspid valve. 10 of 16 (62.50%) patients with cardiac standstill alone and 1 of 3 (33.33%) RV stasis alone did not achieve ROSC. Of those that did achieve ROSC in these two groups, none of the patients survived beyond 24 hours of the CA. 11 of 19 (57.89%) patients with RV stasis in combination with cardiac standstill did not achieve ROSC, and of the remaining 8 patients that achieved ROSC, only 1 patient survived past 24 hours. The combination of cardiac standstill, RV stasis, and tricuspid valve thrombus had 2 of 3 (66.67%) patients fail to achieve ROSC, with the remaining 1 patient surviving only to 24 hours. The presence of cardiac standstill alone confers an association with death, with an odds ratio (OR) of 1.212. RV stasis plus cardiac standstill on intra-arrest POCUS confer a markedly higher OR 0.8250 in association with death. Conclusions: Our preliminary work brings to light the role of POCUS for predicting short term survivorship based on echocardiographic patient features. This may have implications for resource utilization in such events.

scholarly journals Management of EMS on-scene time during advanced life support in out-of-hospital cardiac arrest: a retrospective observational trial

2020 ◽  
Vol 9 (4_suppl) ◽  
pp. S82-S89
Author(s):  
Michael Poppe ◽  
Mario Krammel ◽  
Christian Clodi ◽  
Christoph Schriefl ◽  
Alexandra-Maria Warenits ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Services ◽  
Life Support ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Medical Services ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Emergency Medical ◽  
Hospital Cardiac Arrest

Objective Most western emergency medical services provide advanced life support in out-of-hospital cardiac arrest aiming for a return of spontaneous circulation at the scene. Little attention is given to prehospital time management in the case of out-of-hospital cardiac arrest with regard to early coronary angiography or to the start of extracorporeal cardiopulmonary resuscitation treatment within 60 minutes after out-of-hospital cardiac arrest onset. We investigated the emergency medical services on-scene time, defined as emergency medical services arrival at the scene until departure to the hospital, and its association with 30-day survival with favourable neurological outcome after out-of-hospital cardiac arrest. Methods All patients of over 18 years of age with non-traumatic, non-emergency medical services witnessed out-of-hospital cardiac arrest between July 2013 and August 2015 from the Vienna Cardiac Arrest Registry were included in this retrospective observational study. Results Out of 2149 out-of-hospital cardiac arrest patients, a total of 1687 (79%) patients were eligible for analyses. These patients were stratified into groups according to the on-scene time (<35 minutes, 35–45 minutes, 45–60 minutes, >60 minutes). Within short on-scene time groups, out-of-hospital cardiac arrest occurred more often in public and bystander cardiopulmonary resuscitation was more common (both P<0.001). Patients who did not achieve return of spontaneous circulation at the scene showed higher rates of 30-day survival with favourable neurological outcome with an on-scene time of less than 35 minutes (adjusted odds ratio 5.00, 95% confidence interval 1.39–17.96). Conclusion An emergency medical services on-scene time of less than 35 minutes was associated with higher rates of survival and favourable outcomes. It seems to be reasonable to develop time optimised advance life support protocols to minimise the on-scene time in view of further treatments such as early coronary angiography as part of post-resuscitation care or extracorporeal cardiopulmonary resuscitation in refractory out-of-hospital cardiac arrest.

scholarly journals Out-of-Hospital Cardiac Arrest Response to a Pregnant Woman by the 119 Emergency Medical Service System: A Case Study

2020 ◽  
Vol 34 (1) ◽  
pp. 127-134
Author(s):  
Jae-Min Lee ◽  
Soo-Mi Hong ◽  
Guk-Ki An ◽  
Hyeong-Wan Yun
Keyword(s):  
Cardiac Arrest ◽  
Pregnant Woman ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Pregnant Patient ◽  
Advanced Cardiac Life Support ◽  
Spontaneous Circulation ◽  
Emergency Medical Service System ◽  
Rescue Workers ◽  
System A

When a pregnant woman experiences cardiac arrest, resuscitation is of the utmost importance. Cardiac arrest in pregnant women differs from cardiac arrest in the general population since both mother and fetus need to be taken into consideration. In the event of cardiac arrest, determining whether to deliver the baby is significant. Cardiopulmonary resuscitation is not always successful, and the survival rate depends on the speed and precision of the procedure. In this study, we focus on the case of a 30-year-old pregnant woman who experienced cardiac arrest and whose family was quick to perceive her condition and call the hospital. A witness performed initial cardiopulmonary resuscitation, while rescue workers performed the advanced procedure. In this case, the patient and baby received proper treatment and left the hospital after six days. It is extremely rare for a pregnant patient to achieve return of spontaneous circulation (ROSC) or receive advanced cardiac life support before reaching the hospital. However, the woman in question in this study achieved ROSC and received both cardiopulmonary resuscitation before reaching the hospital and advanced cardiac life support at the hospital. The specifics of the case are reported in the context of a literature review.

scholarly journals Return of spontaneous circulation in patients with out-of-hospital cardiac arrest caused by pulmonary embolism using early point-of-care ultrasound and timely thrombolytic agent application: Two case reports

2020 ◽  
pp. 102490792096413
Author(s):  
Su Yeong Pyo ◽  
Gwan Jin Park ◽  
Sang Chul Kim ◽  
Hoon Kim ◽  
Suk Woo Lee ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Acute Pulmonary Embolism ◽  
Thrombolytic Agent ◽  
Point Of Care ◽  
Fibrinolytic Therapy ◽  
Spontaneous Circulation ◽  
Point Of Care Ultrasound ◽  
Hospital Cardiac Arrest

Introduction: Acute pulmonary embolism is a confirmed cause of up to 5% of out-of-hospital cardiac arrest and 5%–13% of unexplained cardiac arrest in patients. However, the true incidence may be much higher, as pulmonary embolism is often clinically underdiagnosed. Thrombolytic therapy is a recognized therapy for pulmonary embolism–associated cardiac arrest but is not routinely recommended during cardiopulmonary resuscitation. Therefore, clinicians should attempt to identify patients with suspected pulmonary embolism. Many point-of care ultrasound protocols suggest diagnosis of pulmonary embolism for cardiac arrest patients. Case presentation: We describe two male patients (60 years and 66 years, respectively) who presented to the emergency department with cardiac arrest within a period of 1 week. With administration of point-of care ultrasound during the ongoing cardiopulmonary resuscitation in both patients, fibrinolytic therapy was initiated under suspicion of cardiac arrest caused by pulmonary embolism. Both patients had return of spontaneous circulation; however, only the second patient, who received fibrinolytic therapy relatively early, was discharged with a good outcome. In this report, we discussed how to diagnose and manage patients with cardiac arrest–associated pulmonary embolism with the help of point-of care ultrasound. We also discuss the different clinical outcomes of the two patients based on the experience of the clinicians and the timing of thrombolytic agent application. Conclusions: If acute pulmonary embolism is suspected in patients with out-of-hospital cardiac arrest, we recommend prompt point-of care ultrasound examination. Point-of care ultrasound may help identify patients with pulmonary embolism during cardiopulmonary resuscitation, leading to immediate treatment, although the clinical outcomes may vary.

scholarly journals Mode of Death after Extracorporeal Cardiopulmonary Resuscitation

Membranes ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 270
Author(s):  
Viviane Zotzmann ◽  
Corinna N. Lang ◽  
Xavier Bemtgen ◽  
Markus Jaeckel ◽  
Annabelle Fluegler ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Cerebral Damage ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Refractory Shock ◽  
Lactate Levels ◽  
Mode Of Death

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) might be a lifesaving therapy for patients with cardiac arrest and no return of spontaneous circulation during advanced life support. However, even with ECPR, mortality of these severely sick patients is high. Little is known on the exact mode of death in these patients. Methods: Retrospective registry analysis of all consecutive patients undergoing ECPR between May 2011 and May 2020 at a single center. Mode of death was judged by two researchers. Results: A total of 274 ECPR cases were included (age 60.0 years, 47.1% shockable initial rhythm, median time-to-extracorporeal membrane oxygenation (ECMO) 53.8min, hospital survival 25.9%). The 71 survivors had shorter time-to-ECMO durations (46.0 ± 27.9 vs. 56.6 ± 28.8min, p < 0.01), lower initial lactate levels (7.9 ± 4.5 vs. 11.6 ± 8.4 mg/dL, p < 0.01), higher PREDICT-6h (41.7 ± 17.0% vs. 25.3 ± 19.0%, p < 0.01), and SAVE (0.4 ± 4.8 vs. −0.8 ± 4.4, p < 0.01) scores. Most common mode of death in 203 deceased patients was therapy resistant shock in 105/203 (51.7%) and anoxic brain injury in 69/203 (34.0%). Comparing patients deceased with shock to those with cerebral damage, patients with shock were significantly older (63.2 ± 11.5 vs. 54.3 ± 16.5 years, p < 0.01), more frequently resuscitated in-hospital (64.4% vs. 29.9%, p < 0.01) and had shorter time-to-ECMO durations (52.3 ± 26.8 vs. 69.3 ± 29.1min p < 0.01). Conclusions: Most patients after ECPR decease due to refractory shock. Older patients with in-hospital cardiac arrest might be prone to development of refractory shock. Only a minority die from cerebral damage. Research should focus on preventing post-CPR shock and treating the shock in these patients.

scholarly journals European Resuscitation Council guidelines 2021: Adult advanced life support changes related to the guidelines 2015

2021 ◽  
Vol 7 (18) ◽  
pp. 298-303
Author(s):  
Srđan Nikolovski ◽  
Lovćenka Čizmović
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Point Of Care ◽  
Advanced Life Support ◽  
High Heart Rate ◽  
Point Of Care Ultrasound ◽  
European Resuscitation Council ◽  
Skilled Operator ◽  
New Guidelines

Adult advanced life support guidelines 2021 provided by the European Resuscitation Council in its largest extent do not differ significantly from equivalent guidelines published six years ago. However, some important points were further emphasized, and some protocols show new additions and structural changes. According to the new guidelines, there is a greater recognition that patients with both in-hospital and out-of-hospital cardiac arrest have premonitory signs, and that many of these arrests may be preventable. High-quality chest compressions with minimal interruption, early defibrillation, and treatment of reversible causes remained high priority steps in resuscitation process. New guidelines also recommend that, if an advanced airway is required, rescuers with a high tracheal intubation success rate should use this technique. With regard to using diagnostic procedures, medications, and special methods of cardiopulmonary resuscitation, newest guidelines also made new suggestions. According to these guidelines, when adrenaline is used, it should be used as soon as possible when the cardiac arrest rhythm is non-shockable, and after three defibrillation attempts for a shockable cardiac arrest rhythm. The guidelines recognise the increasing role of point-of-care ultrasound in peri-arrest care for diagnosis, but emphasis that it requires a skilled operator, and the need to minimise interruptions during chest compression. Additionally, 2015 guidelines suggested use of point-of-care ultrasound in diagnosing several various conditions with potential of causing cardiac arrest. However, 2021 guidelines limited indications in diagnosing only cardiac causes, such as tamponade or pneumothorax. The guidelines also reflect the increasing evidence for extracorporeal cardiopulmonary resuscitation as a rescue therapy for selected patients with cardiac arrest when conventional advanced life support measures are failing or to facilitate specific interventions. Additionally, newest guidelines made significant changes in the order of steps used in the In/hospital resuscitation algorithm, as well as changes in several very important steps of treating tachycardias and high heart rate associated arrhythmias.

scholarly journals Initial capnography values and resuscitation outcomes of patients assisted by basic life support units in first instance; descriptive prospective study

2021 ◽  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Work Experience ◽  
Basic Life Support ◽  
Life Support ◽  
Survival Rates ◽  
Spontaneous Circulation ◽  
Patient Treatment ◽  
Mean Values ◽  
Hospital Cardiac Arrest

Introduction: Understanding the key factors which affect out hospital cardiac arrest (OHCA) outcomes is essential in order to promote patient treatment. The main objective of this research was to describe the correlations between the capnographic values obtained during the first minute of monitoring on cardiopulmonary resuscitation, assisted by basic life-support units, with the results as return of spontaneous circulation (ROSC) and alive hospital admission. The secondary objectives were to describe the sociodemographic characteristics of the patients assisted, and to analyze any correlations between receiving basic life-support units and/or defibrillation prior to the arrival of basic life-support units, and the results of the cardiopulmonary resuscitation maneuvers. Methods: A prospective, descriptive, observational study of adult non-traumatic out hospital cardiac arrest patients was conducted. The patients were initially assisted by basic life-support units on the island of Mallorca, with one minute of initial capnography monitoring. Results: From July 2018 to March 2020, fifty-nine patients meeting the inclusion criteria were assisted, 76% were men and their mean age was 64.45 (±15.07) years old. The number of emergency lifesaving technicians who participated in the study was 58, they had a mean work experience of 14.05 (±6.7) years. Thirty-seven (63.7%) patients underwent basic life-support by bystanders and in 91.5% of cases the semi-automatic external defibrillator was used. Capnometry values during the first minute were obtained in 34 (58.6%) patients, their mean values were 22 (±19.07) mmHg, 35.5% of patients had values <10 mmHg. In 25.4% of the patients, spontaneous circulation returned during cardiopulmonary resuscitation, and 18.6% were admitted to hospital alive. Conclusion: No correlations were found between initial capnography values scoring above or below 10 mmHg and survival, however, basic life-support maneuvers, and defibrillation by bystanders and first responders, did correlate with survival rates. The average patient assisted in out of hospital cardiac arrest by the basic life-support units sampled was an adult male aged over 65 years.

Point-of-care Ultrasound in Cardiac Arrest

2021 ◽  
Author(s):  
Jonathan A. Paul ◽  
Oliver P. F. Panzer
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Point Of Care ◽  
Advanced Cardiac Life Support ◽  
Point Of Care Ultrasound

This review explains the role of point-of-care ultrasound in cardiac arrest rhythm classification and the diagnosis of reversible causes, discusses available protocols for the application of ultrasound to Advanced Cardiac Life Support, and summarizes principles for its safe implementation.

Healthcare professionals’ knowledge on cardiopulmonary resuscitation correlated with return of spontaneous circulation rates after in-hospital cardiac arrests: A multicentric study between university hospitals in 12 European countries

2020 ◽  
Vol 19 (5) ◽  
pp. 401-410
Author(s):  
Christos Kourek ◽  
Robert Greif ◽  
Georgios Georgiopoulos ◽  
Maaret Castrén ◽  
Bernd Böttiger ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Healthcare Professionals ◽  
Life Support ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
European Countries ◽  
University Hospitals ◽  
Return Of Spontaneous Circulation ◽  
Hospital Cardiac Arrest

Background: In-hospital cardiac arrest is a major cause of death in European countries, and survival of patients remains low ranging from 20% to 25%. Aims: The purpose of this study was to assess healthcare professionals’ knowledge on cardiopulmonary resuscitation among university hospitals in 12 European countries and correlate it with the return of spontaneous circulation rates of their patients after in-hospital cardiac arrest. Methods and results: A total of 570 healthcare professionals from cardiology, anaesthesiology and intensive care medicine departments of European university hospitals in Italy, Poland, Hungary, Belgium, Spain, Slovakia, Germany, Finland, The Netherlands, Switzerland, France and Greece completed a questionnaire. The questionnaire consisted of 12 questions based on epidemiology data and cardiopulmonary resuscitation training and 26 multiple choice questions on cardiopulmonary resuscitation knowledge. Hospitals in Switzerland scored highest on basic life support ( P=0.005) while Belgium hospitals scored highest on advanced life support ( P<0.001) and total score in cardiopulmonary resuscitation knowledge ( P=0.01). The Swiss hospitals scored highest in cardiopulmonary resuscitation training ( P<0.001). Correlation between cardiopulmonary resuscitation knowledge and return of spontaneous circulation rates of patients with in-hospital cardiac arrest demonstrated that each additional correct answer on the advanced life support score results in a further increase in return of spontaneous circulation rates (odds ratio 3.94; 95% confidence interval 2.78 to 5.57; P<0.001). Conclusion: Differences in knowledge about resuscitation and course attendance were found between university hospitals in 12 European countries. Education in cardiopulmonary resuscitation is considered to be vital for patients’ return of spontaneous circulation rates after in-hospital cardiac arrest. A higher level of knowledge in advanced life support results in higher return of spontaneous circulation rates.

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