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Latest & greatest articles for cardiac arrest
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2019 American Heart Association Focused Update on Systems of Care: Dispatcher-Assisted Cardiopulmonary Resuscitation and CardiacArrest Centers: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiov Survival after out-of-hospital cardiacarrest requires an integrated system of care (chain of survival) between the community elements responding to an event and the healthcare professionals who continue to care for and transport the patient (...) for appropriate interventions. As a result of the dynamic nature of the prehospital setting, coordination and communication can be challenging, and identification of methods to optimize care is essential. This 2019 focused update to the American Heart Association systems of care guidelines summarizes the most recent published evidence for and recommendations on the use of dispatcher-assisted cardiopulmonary resuscitation and cardiacarrest centers. This article includes the revised recommendations
COVID-19 infection risk to rescuers from patients in cardiacarrest COVID-19 infection risk to rescuers from patients in cardiacarrest Toggle navigation Remember me Forgot password Consensus on Science with Treatment Recommendations (CoSTR) COVID-19 infection risk to rescuers from patients in cardiacarrest ILCOR staff Created: · Updated: Final draft This Review is a draft version prepared by ILCOR and is labelled “draft” to comply with copyright rules of journals. The final Review (...) in cardiacarrest. Consensus on Science with Treatment Recommendations [Internet] Brussels, Belgium: International Liaison Committee on Resuscitation (ILCOR), 2020 March 30. Available from: Methodological Preamble and Link to Published Systematic Review The continuous evidence evaluation process for the production of Consensus on Science with Treatment Recommendations (CoSTR) started with a systematic review (CRD42020175594) conducted by Warwick Evidence at the University of Warwick with involvement
interventions such as medications, advanced airways, extracorporeal cardiopulmonary resuscitation, and post-cardiacarrest care, including targeted temperature management, cardiorespiratory support, and percutaneous coronary intervention. Since 2015, an increased number of studies have been published evaluating some of these interventions, requiring a reassessment of their use and impact on survival from cardiacarrest. This 2019 focused update to the American Heart Association advanced cardiovascular life (...) 2019 American Heart Association Focused Update on Advanced Cardiovascular Life Support: Use of Advanced Airways, Vasopressors, and Extracorporeal Cardiopulmonary Resuscitation During CardiacArrest: An Update to the American Heart Association Guidelines f The fundamentals of cardiac resuscitation include the immediate provision of high-quality cardiopulmonary resuscitation combined with rapid defibrillation (as appropriate). These mainstays of therapy set the groundwork for other possible
Prevention of Early Ventilator-Associated Pneumonia after CardiacArrest. Patients who are treated with targeted temperature management after out-of-hospital cardiacarrest with shockable rhythm are at increased risk for ventilator-associated pneumonia. The benefit of preventive short-term antibiotic therapy has not been shown.We conducted a multicenter, double-blind, randomized, placebo-controlled trial involving adult patients (>18 years of age) in intensive care units (ICUs) who were being (...) mechanically ventilated after out-of-hospital cardiacarrest related to initial shockable rhythm and treated with targeted temperature management at 32 to 34°C. Patients with ongoing antibiotic therapy, chronic colonization with multidrug-resistant bacteria, or moribund status were excluded. Either intravenous amoxicillin-clavulanate (at doses of 1 g and 200 mg, respectively) or placebo was administered three times a day for 2 days, starting less than 6 hours after the cardiacarrest. The primary outcome
Targeted Temperature Management for CardiacArrest with Nonshockable Rhythm. Moderate therapeutic hypothermia is currently recommended to improve neurologic outcomes in adults with persistent coma after resuscitated out-of-hospital cardiacarrest. However, the effectiveness of moderate therapeutic hypothermia in patients with nonshockable rhythms (asystole or pulseless electrical activity) is debated.We performed an open-label, randomized, controlled trial comparing moderate therapeutic (...) hypothermia (33°C during the first 24 hours) with targeted normothermia (37°C) in patients with coma who had been admitted to the intensive care unit (ICU) after resuscitation from cardiacarrest with nonshockable rhythm. The primary outcome was survival with a favorable neurologic outcome, assessed on day 90 after randomization with the use of the Cerebral Performance Category (CPC) scale (which ranges from 1 to 5, with higher scores indicating greater disability). We defined a favorable neurologic
Sodium Bicarbonate Administration in CardiacArrest Sodium Bicarbonate Administration in CardiacArrest | Emergency Medicine | Washington University in St. Louis Open Menu Back Close Menu Search for: Loading... Welcome Our Team Sections Education Alumni Research ECRC Journal Club Events Jermyn Lectures Open Search Vignette You’re working a busy shift in TCC one Sunday afternoon when you get a page that EMS is bringing in a patient in cardiacarrest. The patient is a 57-year-old male (...) a laryngeal airway device with a good waveform on capnography. You defibrillate the patient, which results in PEA. he has now been in cardiacarrest for twenty minutes, and you begin to wonder what other management options you have. you consider whether you should give sodium bicarbonate or calcium chloride given his prolonged cardiacarrest, but your attending tells you that neither treatment is beneficial (though , and you keep giving that). After a total of thirty minutes of downtime, the patient
Community first responders for out-of-hospital cardiacarrest in adults and children. Mobilization of community first responders (CFRs) to the scene of an out-of-hospital cardiacarrest (OHCA) event has been proposed as a means of shortening the interval from occurrence of cardiacarrest to performance of cardiopulmonary resuscitation (CPR) and defibrillation, thereby increasing patient survival.To assess the effect of mobilizing community first responders (CFRs) to out-of-hospital cardiac (...) arrest events in adults and children older than four weeks of age, in terms of survival and neurological function.We searched the following databases for relevant trials in January 2019: CENTRAL, MEDLINE (Ovid SP), Embase (Ovid SP), and Web of Science. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov, and we scanned the abstracts of conference proceedings of the American Heart Association and the European Resuscitation
The effects of adrenaline in out of hospital cardiacarrest with shockable and non-shockable rhythms: Findings from the PACA and PARAMEDIC-2 randomised controlled trials Previous research suggests there may be differences in the effects of adrenaline related to the initial cardiacarrest rhythm. The aim of this study was to assess the effect of adrenaline compared with placebo according to whether the initial cardiacarrest rhythm was shockable or non-shockable.Return of spontaneous circulation (...) (ROSC), survival and neurological outcomes according to the initial arrest rhythm were compared amongst patients enrolled in the PARAMEDIC-2 randomised, placebo controlled trial. The results of the PARAMEDIC-2 and PACA out of hospital cardiacarrest trials were combined and meta-analysed.The initial rhythm was known for 3929 (98.2%) in the placebo arm and 3919 (97.6%) in the adrenaline arm. The effect on the rate of ROSC of adrenaline relative to placebo was greater in patients with non-shockable
Prospective validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) score for in-hospital cardiacarrest prognosis We aimed to prospectively validate the Good Outcome Following Attempted Resuscitation (GO-FAR) score, which predicts the likelihood of survival to discharge neurologically intact or with minimal deficits (conscious, alert, and able to work) after in-hospital cardiacarrest (IHCA).Inpatients experiencing an index episode of IHCA between 2010 and 2016 in hospitals
Chiefs’ inquiry corner: monoclonal antibodies and clostridium difficile infection, outcomes after in-hospital cardiacarrest v out-of-hospital, dermatomyositis and malignancy, malignancy work up in unprovoked VTE. Chiefs’ Inquiry Corner – Clinical Correlations Search Chiefs’ Inquiry Corner June 10, 2019 3 min read Clostridium difficile (C diff) is the most common pathogen implicated in infectious diarrhea among hospitalized patients. Several antimicrobials, chief among them an oral formulation (...) was discontinued after interim analysis). Patients receiving bezlotoxumab-containing regimens demonstrated significantly reduced rates of recurrence within 12 weeks compared to placebo, suggesting a possible role for this monoclonal antibody in the prevention of recurrence when added to standard antimicrobial therapy. References: The epidemiology, etiology, and outcomes of in-hospital cardiacarrest (IHCA) are quite different from those of out-of-hospital cardiacarrest (OHCA). In contrast to OHCA, survival
Accuracy of nature of call screening tool in identifying patients requiring treatment for out of hospital cardiacarrest A new pre-triage screening tool, Nature of Call (NoC), has been introduced into the telephone triage system of UK ambulance services which employ National Health Service Pathways (NHSP). Its function is to provide rapid recognition of patients who may need immediate ambulance dispatch for out-of-hospital cardiacarrest (OHCA) and withholding dispatch for other calls while
Effect of Trans-Nasal Evaporative Intra-arrest Cooling on Functional Neurologic Outcome in Out-of-Hospital CardiacArrest: The PRINCESS Randomized Clinical Trial. Therapeutic hypothermia may increase survival with good neurologic outcome after cardiacarrest. Trans-nasal evaporative cooling is a method used to induce cooling, primarily of the brain, during cardiopulmonary resuscitation (ie, intra-arrest).To determine whether prehospital trans-nasal evaporative intra-arrest cooling improves (...) survival with good neurologic outcome compared with cooling initiated after hospital arrival.The PRINCESS trial was an investigator-initiated, randomized, clinical, international multicenter study with blinded assessment of the outcome, performed by emergency medical services in 7 European countries from July 2010 to January 2018, with final follow-up on April 29, 2018. In total, 677 patients with bystander-witnessed out-of-hospital cardiacarrest were enrolled.Patients were randomly assigned
Early goal-directed haemodynamic optimization of cerebral oxygenation in comatose survivors after cardiacarrest: the Neuroprotect post-cardiacarrest trial During the first 6-12 h of intensive care unit (ICU) stay, post-cardiacarrest (CA) patients treated with a mean arterial pressure (MAP) 65 mmHg target experience a drop of the cerebral oxygenation that may cause additional cerebral damage. Therefore, we investigated whether an early goal directed haemodynamic optimization strategy (EGDHO
In-Hospital CardiacArrest: A Review. In-hospital cardiacarrest is common and associated with a high mortality rate. Despite this, in-hospital cardiacarrest has received little attention compared with other high-risk cardiovascular conditions, such as stroke, myocardial infarction, and out-of-hospital cardiac arrest.In-hospital cardiacarrest occurs in over 290 000 adults each year in the United States. Cohort data from the United States indicate that the mean age of patients with in-hospital (...) cardiacarrest is 66 years, 58% are men, and the presenting rhythm is most often (81%) nonshockable (ie, asystole or pulseless electrical activity). The cause of the cardiacarrest is most often cardiac (50%-60%), followed by respiratory insufficiency (15%-40%). Efforts to prevent in-hospital cardiacarrest require both a system for identifying deteriorating patients and an appropriate interventional response (eg, rapid response teams). The key elements of treatment during cardiacarrest include chest