Factors That Affect Recovery of Spontaneous Circulation by Patients With Cardiac Arrest Before Arrival at a Hospital in Daegu Metropolitan City, South Korea

BackgroundThis study was conducted to investigate the factors that influence Return of Spontaneous Circulation (ROSC) in patients who suffered cardiac arrest before arriving at the emergency room in DMC, Korea. MethodsThis study considered data for cardiac arrest patients by 119 paramedics from January 1, 2019 to December 31, 2019 in Daegu. Chi-squared analysis was conducted to analyze whether the subjects showed ROSC before arriving at the emergency room. Binary logic regression analysis was conducted to identify the factors that affect ROSC. ResultsROSC when a mechanical compression device was used was reduced to 0.82 of that when it was not used (95% CI = 0.60 ~ 0.92). ROSC was 3.13 times higher when a first-aid defibrillator was used than when it was not used (95% CI = 1.40 ~ 6.99). ROSC was 657 times higher when epinephrine was injected than when it was not injected. Lastly, ROSC was 1.82 (95% CI = 1.04 ~ 3.19) times higher when intubation was used than when it was not used. ConclusionThis study suggests that continuous CPR education, securing financial support, and expansion of emergency rooms for local residents are necessary.

Prolonged cardiopulmonary resuscitation and low flow state are not contraindications for extracorporeal support

Outcomes of out-of-hospital cardiac arrest are poor irrespective of the patient age group and circumstances. Survival to discharge after out-of-hospital arrest in children is less than 10%. Use of extracorporeal cardiopulmonary resuscitation is increasing and has been shown to improve outcomes in some situations. However, the candidacy for such augmentation is based on patient selection, institutional practices, and availability of an extracorporeal membrane oxygenation center. Often, duration of resuscitation, low flow state, presenting pH, and circumstances of arrest dictate candidacy for extracorporeal membrane oxygenation. We present a case of extremely prolonged resuscitation for out-of-hospital arrest in a pediatric patient, and we describe the use of mechanical compression device and transition to extracorporeal membrane oxygenation. We present the case outcome as well as brief discussion about controversies in extracorporeal cardiopulmonary resuscitation. We hope the case provides an opportunity for further discussion regarding opportunities to improve selection, use of extracorporeal cardiopulmonary resuscitation, and impact outcomes.

The Effect of a Mechanical Compression Device and Supraglottic Airway on Flow Time: A Simulation Study of Out-of-Hospital Cardiac Arrest in a High-Rise Building

High-rise buildings present unique challenges to providing high-quality CPR. We investigated the effect of using a mechanical compressor and supraglottic airway on flow time and CPR quality in simulated cardiac arrests occurring within a high-rise building. Twelve teams of EMS providers performed CPR according to 4 scenarios: manual compression and ventilation through bag-valve-mask (MAB) or supraglottic airway (MAS); mechanical compression and ventilation through bag-valve-mask (MEB) or supraglottic airway (MES). Chest compression indices did not differ significantly among the groups. The mechanical compression groups had a higher flow time fraction from exiting the elevator until the manikin was loaded into the ambulance than the manual compression groups. The supraglottic airway groups had higher flow time fractions from entering the elevator until the end of the scenario than the bag-valve-mask groups. The total flow time fraction was lowest in the MAB group and was highest in the MEB group (P < 0.001). In simulated cardiac arrest in a high-rise building, the use of a supraglottic airway maintained flow time at a level similar to that observed with the use of a mechanical compressor. Moreover, the use of a mechanical compressor and a supraglottic airway increased the flow time most effectively.