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Latest & greatest articles for cardiac arrest
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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
Coronary Angiography after CardiacArrest without ST-Segment Elevation. Ischemic heart disease is a major cause of out-of-hospital cardiacarrest. The role of immediate coronary angiography and percutaneous coronary intervention (PCI) in the treatment of patients who have been successfully resuscitated after cardiacarrest in the absence of ST-segment elevation myocardial infarction (STEMI) remains uncertain.In this multicenter trial, we randomly assigned 552 patients who had cardiacarrest (...) angiography group (ratio of geometric means, 1.19; 95% CI, 1.04 to 1.36). No significant differences between the groups were found in the remaining secondary end points.Among patients who had been successfully resuscitated after out-of-hospital cardiacarrest and had no signs of STEMI, a strategy of immediate angiography was not found to be better than a strategy of delayed angiography with respect to overall survival at 90 days. (Funded by the Netherlands Heart Institute and others; COACT Netherlands
Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and CardiacArrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. Catheter ablation is effective in restoring sinus rhythm in atrial fibrillation (AF), but its effects on long-term mortality and stroke risk are uncertain.To determine whether catheter ablation is more effective than conventional medical therapy for improving outcomes in AF.The Catheter Ablation vs (...) at the discretion of site investigators. The drug therapy group (n = 1096) received standard rhythm and/or rate control drugs guided by contemporaneous guidelines.The primary end point was a composite of death, disabling stroke, serious bleeding, or cardiacarrest. Among 13 prespecified secondary end points, 3 are included in this report: all-cause mortality; total mortality or cardiovascular hospitalization; and AF recurrence.Of the 2204 patients randomized (median age, 68 years; 37.2% female; 42.9% had
North American validation of the Bokutoh criteria for withholding professional resuscitation in non-traumatic out-of-hospital cardiacarrest Certain subgroups of patients with out-of-hospital cardiacarrest (OHCA) may not benefit from treatment. Early identification of this cohort in the prehospital (EMS) setting prior to any resuscitative efforts would prevent futile medical therapy and more appropriately allocate EMS and hospital resources. We sought to validate a clinical criteria from (...) Bokutoh, Japan that identified a subgroup of OHCAs for whom withholding resuscitation may be appropriate.We performed a secondary analysis of the "Trial of Continuous or Interrupted Chest Compressions during CPR", which enrolled EMS-treated adult non-traumatic OHCA. We classified patients as per the Bokutoh criteria ("Bokutoh Positive": age ≥ 73, unwitnessed arrest, non-shockable initial rhythm) and calculated test performance for the primary outcome of favourable neurologic outcome (mRS ≤ 3
Pre-hospital advanced airway management for adults with out-of-hospital cardiacarrest: nationwide cohort study. To determine survival associated with advanced airway management (AAM) compared with no AAM for adults with out-of-hospital cardiac arrest.Cohort study between January 2014 and December 2016.Nationwide, population based registry in Japan (All-Japan Utstein Registry).Consecutive adult patients with out-of-hospital cardiacarrest, separated into two sub-cohorts by their first (...) ). In the non-shockable cohort, patients with AAM had better survival than those with no AAM: 2696/118 021 (2.3%) versus 2127/118 021 (1.8%) (adjusted risk ratio 1.27, 1.20 to 1.35).In the time dependent propensity score sequential matching for out-of-hospital cardiacarrest in adults, AAM was not associated with survival among patients with shockable rhythm, whereas AAM was associated with better survival among patients with non-shockable rhythm.Published by the BMJ Publishing Group Limited. For permission
Revised Cardiac Risk Index as a Predictor for Myocardial Infarction and CardiacArrest Following Posterior Lumbar Decompression A retrospective analysis of prospectively collected data.The aim of this study was to determine the ability of Revised Cardiac Risk Index (RCRI) to predict adverse cardiac events following posterior lumbar decompression (PLD).PLD is an increasingly common procedure used to treat a variety of degenerative spinal conditions. The RCRI is used to predict risk for cardiac (...) complications.Membership in the RCRI=1 cohort was a predictor for myocardial infarction (MI) [odds ratio (OR) = 3.3, P = 0.002] and cardiacarrest requiring cardiopulmonary resuscitation (CPR) (OR = 3.4, P = 0.013). Membership in the RCRI = 2 cohort was a predictor for MI (OR = 5.9, P = 0.001) and cardiacarrest requiring CPR (OR = 12.5), Membership in the RCRI = 3 cohort was a predictor for MI (OR = 24.9) and cardiacarrest requiring CPR (OR = 26.9, P = 0.006). RCRI had a good discriminative ability to predict both
Performance of clinical risk scores to predict mortality and neurological outcome in cardiacarrest patients Several scores are available to predict mortality and neurological outcome in cardiacarrest patients admitted to the intensive care unit (ICU). The aim of the study was to externally validate the prognostic value of four previously published risk scores.For this observational, single-center study, we prospectively included 349 consecutive adult cardiacarrest patients upon ICU admission (...) . We calculated two cardiacarrest specific risk scores (OHCA and CAHP) and two general severity of illness scores (APACHE II and SAPS II). The primary endpoint was in-hospital mortality. Secondary endpoints were neurological outcome at hospital discharge and 30-day mortality.170 patients (49%) died until hospital discharge. All scores were independently associated with outcomes in logistic regression analysis and showed acceptable discrimination for in-hospital mortality with highest AUCs
Induced hypothermia is associated with reduced circulating subunits of mitochondrial DNA in cardiacarrest patients. Induced hypothermia may protect from ischemia reperfusion injury. The mechanism of protection is not fully understood and may include an effect on mitochondria. Here we describe the effect of hypothermia on circulating mitochondrial (mt) DNA in a substudy of a multicenter randomized trial (the Target Temperature Management trial). Circulating levels of mtDNA were elevated (...) in patients with cardiacarrest at all-time points compared to healthy controls. After 24 h of temperature management, patients kept at 33 °C had significantly lower levels of COX3, NADH1 and NADH2 compared to baseline, in contrast to those kept at 36 °C. After regain of temperature, cytochrome - B was significantly reduced in patients kept at 33 °C with cardiacarrest. Cardiacarrest results in circulating mtDNA levels, which reduced during a temperature management protocol in patients with a target
2018 American Heart Association Focused Update on Advanced Cardiovascular Life Support Use of Antiarrhythmic Drugs During and Immediately After CardiacArrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Em Antiarrhythmic medications are commonly administered during and immediately after a ventricular fibrillation/pulseless ventricular tachycardia cardiacarrest. However, it is unclear whether these medications improve patient outcomes. This 2018 (...) American Heart Association focused update on advanced cardiovascular life support guidelines summarizes the most recent published evidence for and recommendations on the use of antiarrhythmic drugs during and immediately after shock-refractory ventricular fibrillation/pulseless ventricular tachycardia cardiacarrest. This article includes the revised recommendation that providers may consider either amiodarone or lidocaine to treat shock-refractory ventricular fibrillation/pulseless ventricular
Traumatic CardiacArrest in Adults Traumatic cardiacarrest in adults (September 2019) Page 1/8 The Royal College of Emergency Medicine Best Practice Guideline Traumatic CardiacArrest in Adults September 2019 Traumatic cardiacarrest in adults (September 2019) Page 2/8 Contents Considerations 3 Emergency departments (EDs) that are not designated Major Trauma Centres 3 Causes of Traumatic CardiacArrest (TCA) 3 Withholding resuscitation 3 Favourable prognostic signs 3 Initial presenting rhythm (...) 3 Initial management priorities 4 Point of care ultrasonography 4 Clear protocols for resuscitative thoracotomy 4 Successful resuscitation and return of spontaneous circulation (ROSC) 4 Indications to stop resuscitation in TCA 4 TCA in children 4 About this document 5 Authors 5 Acknowledgements 5 Review 5 Conflicts of Interest 5 Disclaimers 5 Research Recommendations 5 Audit standards 5 Key words for search 5 References 6 Appendix 1 7 Traumatic cardiacarrest in adults (September 2019) Page 3/8
Incidence, outcomes and guideline compliance of out-of-hospital maternal cardiacarrest resuscitations: A population-based cohort study Incidence and survival rates after cardiacarrest among pregnant women are reported for in-hospital cardiacarrests; the incidence and outcomes of maternal out-of-hospital cardiacarrest (OHCA) are unknown. Current cardiopulmonary resuscitation guidelines contain recommendations specific to this population; compliance with these has not been investigated.To (...) report maternal OHCA incidence, outcomes, and compliance with recommended treatment guidelines.A population-based cohort study of consecutive maternal OHCAs from 2010 to 2014. Census data of all women of childbearing age provided the comparison. Resuscitation performance was measured against the 2010 American Heart Association (AHA) Guidelines.Six maternal OHCAs were identified among 1085 OHCAs occurring in females of child bearing age (15-49) years; Incidence 1.71 per 100,000 pregnant women (95% CI
?brillation out-of- hospital cardiacarrest. Circulation. 2015;132:1030-1037. 3. Kleinman ME, Brennan EE, Goldberger ZD, et al. Part 5: adult basic life support and cardiopulmonary resuscitation quality: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132:S414-S435. 4. Aufderheide TP, Sigurdsson G, Pirrallo RG, et al. Hyperventilation-induced hypotension during cardiopulmonary resuscitation. Circulation. 2004;109:1960 (...) Which Compression-to-Ventilation Ratio Yields Better CardiacArrest Outcomes? (SRS therapy) TAKE-HOME MESSAGE Continuous compressions with asynchronous ventilations and a compression-to- ventilation ratio of 30:2 resulted in improved outcomes in adults in cardiopulmonary arrest, whereas either 30:2 or 15:2 improved outcomes in children. Which Compression-to-Ventilation Ratio Yields Better CardiacArrest Outcomes? EBEM Commentators Dhimitri A. Nikolla, DO Jestin N. Carlson, MD, MS Department
Does Spontaneous Cardiac Motion, Identified With Point-of-Care Echocardiography During CardiacArrest, Predict Survival? (SRS prognosis) TAKE-HOME MESSAGE Point-of-care echocardiography demonstrating no spontaneous cardiac motion is associated with lower likelihood of return of spontaneous circulation and survival to hospital admission. This may be used to assist with decisionmaking about resuscitation termination. Does Spontaneous Cardiac Motion, Identi?ed With Point-of-Care Echocardiography (...) During CardiacArrest, Predict Survival? EBEM Commentators Michael D. April, MD, DPhil Brit Long, MD Department of Emergency Medicine SAUSHEC Fort Sam Houston, TX Results Summary of meta-analysis outcomes for 1,695 patients and 15 studies. Outcome No. Studies No. Patients* Sensitivity (95% CI) Speci?city (95% CI) LRD (95% CI) LR– (95% CI) AUROC (95% CI) I 2 (95% CI) ROSC 8 543 95 (72–99) 80 (63–91) 4.8 (2.5–9.4) 0.06 (0.01–0.39) 0.93 (0.91–0.95) 98 (97–99) Survival to hospital admission 10 1,018 90