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Circulation Dec 2019The fundamentals of cardiac resuscitation include the immediate provision of high-quality cardiopulmonary resuscitation combined with rapid defibrillation (as... (Review)
Review
2019 American Heart Association Focused Update on Advanced Cardiovascular Life Support: Use of Advanced Airways, Vasopressors, and Extracorporeal Cardiopulmonary Resuscitation During Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and...
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 interventions such as medications, advanced airways, extracorporeal cardiopulmonary resuscitation, and post-cardiac arrest 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 cardiac arrest. This 2019 focused update to the American Heart Association advanced cardiovascular life support guidelines summarizes the most recent published evidence for and recommendations on the use of advanced airways, vasopressors, and extracorporeal cardiopulmonary resuscitation during cardiac arrest. It includes revised recommendations for all 3 areas, including the choice of advanced airway devices and strategies during cardiac arrest (eg, bag-mask ventilation, supraglottic airway, or endotracheal intubation), the training and retraining required, the administration of standard-dose epinephrine, and the decisions involved in the application of extracorporeal cardiopulmonary resuscitation and its potential impact on cardiac arrest survival.
Topics: American Heart Association; Cardiopulmonary Resuscitation; Emergency Medical Services; Emergency Service, Hospital; Guidelines as Topic; Heart Arrest; Humans; Respiration, Artificial; United States
PubMed: 31722552
DOI: 10.1161/CIR.0000000000000732 -
Critical Care (London, England) Aug 2018After cardiac arrest a combination of basic and advanced airway and ventilation techniques are used during cardiopulmonary resuscitation (CPR) and after a return of... (Review)
Review
After cardiac arrest a combination of basic and advanced airway and ventilation techniques are used during cardiopulmonary resuscitation (CPR) and after a return of spontaneous circulation (ROSC). The optimal combination of airway techniques, oxygenation and ventilation is uncertain. Current guidelines are based predominantly on evidence from observational studies and expert consensus; recent and ongoing randomised controlled trials should provide further information. This narrative review describes the current evidence, including the relative roles of basic and advanced (supraglottic airways and tracheal intubation) airways, oxygenation and ventilation targets during CPR and after ROSC in adults. Current evidence supports a stepwise approach to airway management based on patient factors, rescuer skills and the stage of resuscitation. During CPR, rescuers should provide the maximum feasible inspired oxygen and use waveform capnography once an advanced airway is in place. After ROSC, rescuers should titrate inspired oxygen and ventilation to achieve normal oxygen and carbon dioxide targets.
Topics: Airway Management; Cardiopulmonary Resuscitation; Heart Arrest; Humans; Respiration, Artificial; Resuscitation
PubMed: 30111343
DOI: 10.1186/s13054-018-2121-y -
Schweizer Archiv Fur Tierheilkunde Dec 2020Cardiopulmonary arrest (CPA) is the acute cessation of systemic perfusion and ventilation. It leads to a lack of tissue oxygen delivery and, if not addressed quickly,... (Review)
Review
Cardiopulmonary arrest (CPA) is the acute cessation of systemic perfusion and ventilation. It leads to a lack of tissue oxygen delivery and, if not addressed quickly, will inevitably cause death. Cardiopulmonary resuscitation (CPR) is the only available treatment for CPA and several opportunities exist to improve the veterinary team's resuscitation approach and optimize small animal CPR patient outcomes. In 2012, the Reassessment Campaign on Veterinary Resuscitation (RECOVER) initiative generated evidence-based clinical guidelines to form the basis for training and practice of CPR in dogs and cats. When employing an evidence-based, standardized approach to small animal CPR, return of spontaneous circulation can be achieved in up to 58% of patients and up to 7% of dogs and 19% of cats can be discharged from the veterinary hospital alive. Survival for dogs and cats that suffer CPA is best in patients that suffer a peri-anesthetic arrest, so high quality CPR in the anesthesia patient population is of utmost importance and expected to be the most rewarding. To ensure the best possible outcomes for any patient suffering from CPA and undergoing CPR, a comprehensive resuscitation strategy is necessary, that includes preventive and preparedness measures, basic life support (chest compressions and ventilation), advanced life support (optimization of the patient status by targeted drug therapy, cardiac rhythm monitoring, and defibrillation), and post-cardiac arrest critical care. This article summarizes the most important RECOVER CPR guidelines for the small animal practitioner.
Topics: Animals; Cardiopulmonary Resuscitation; Cats; Dogs; Heart Arrest; Hospitals, Animal
PubMed: 33263542
DOI: 10.17236/sat00280 -
Circulation Oct 2020
Topics: Advanced Cardiac Life Support; Age Factors; American Heart Association; Cardiology; Cardiology Service, Hospital; Cardiopulmonary Resuscitation; Consensus; Emergencies; Emergency Service, Hospital; Evidence-Based Medicine; Heart Arrest; Humans; Infant, Newborn; Neonatology; Risk Factors; Treatment Outcome; United States
PubMed: 33081528
DOI: 10.1161/CIR.0000000000000902 -
Canadian Journal of Rural Medicine :... 2019The purpose of our study was to determine if regular cardiopulmonary resuscitation (CPR) practise improved the quality of nurses' chest compressions in a rural hospital. (Clinical Trial)
Clinical Trial
INTRODUCTION
The purpose of our study was to determine if regular cardiopulmonary resuscitation (CPR) practise improved the quality of nurses' chest compressions in a rural hospital.
METHODS
The study was a prospective interventional trial measuring the effectiveness of brief, monthly CPR practice for rural nurses. The quality of nurses' chest compressions was measured before and after monthly practise with an interactive feedback device at the Golden and District Hospital, a rural facility in BC.
RESULTS
All three components of high-quality CPR (depth, recoil and rate) improved significantly.
CONCLUSION
Monthly practise of chest compressions with an interactive feedback device improved the quality and confidence of nurses' CPR skills. These results suggest that a higher frequency of CPR practice (than the minimum annual recertification) would improve both the quality and retention of CPR skills, specifically for low-volume rural hospitals.
Topics: Adult; Cardiopulmonary Resuscitation; Clinical Competence; Female; Heart Arrest; Humans; Inservice Training; Male; Nursing Staff, Hospital; Prospective Studies; Rural Health Services
PubMed: 30638192
DOI: 10.4103/CJRM.CJRM_13_18 -
Pediatric Critical Care Medicine : a... Feb 2022To determine potential risk factors for severe hemolysis during pediatric cardiopulmonary bypass and examine whether supraphysiologic levels of oxygen and... (Observational Study)
Observational Study
OBJECTIVES
To determine potential risk factors for severe hemolysis during pediatric cardiopulmonary bypass and examine whether supraphysiologic levels of oxygen and cardiopulmonary bypass duration are associated with hemolysis.
DESIGN
Prospective observational study.
SETTING
Cardiac ICU in a university-affiliated children's hospital.
PATIENTS
Greater than 1 month to less than 18 years old patients undergoing cardiopulmonary bypass for cardiac surgery.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Plasma samples from 100 patients to assess cell-free plasma hemoglobin levels were obtained at start cardiopulmonary bypass, at the end of cardiopulmonary bypass, and 2 and 24 hours after reperfusion. Arterial blood gas samples were obtained before and every 30 minutes during cardiopulmonary bypass. Patient demographics and laboratory data were collected from the electronic medical record. Plasma hemoglobin levels peaked at the end of cardiopulmonary bypass and haptoglobin levels continued to fall throughout all time points. There were 44 patients with severe hemolysis (change in cell-free plasma hemoglobin > 50 mg/dL). Younger age (odds ratio/sd 0.45 [95% CI, 0.25-0.81]) and higher mean Pao2 × cardiopulmonary bypass duration (31.11 [1.46-664.64]) were identified as risk factors for severe hemolysis in multivariable analysis. Severe hemolysis was associated with longer hospital and ICU lengths of stay as well as acute kidney injury.
CONCLUSIONS
We observed younger age and the exposure to both oxygen and duration of cardiopulmonary bypass as risk factors for hemolysis. Oxygen delivery through the cardiopulmonary bypass circuit is an easily modifiable risk factor. Its role in the production of reactive oxygen species that could alter the erythrocyte membrane deserves further examination in larger prospective studies.
Topics: Adolescent; Cardiopulmonary Bypass; Child; Female; Hemoglobins; Hemolysis; Humans; Infant; Male; Oxygen; Prospective Studies
PubMed: 34560775
DOI: 10.1097/PCC.0000000000002814 -
Singapore Medical Journal Aug 2011Defibrillation may be needed in witnessed and unwitnessed cardiac arrests. Cardiopulmonary resuscitation (CPR) must be initiated and defibrillation administered without... (Review)
Review
Defibrillation may be needed in witnessed and unwitnessed cardiac arrests. Cardiopulmonary resuscitation (CPR) must be initiated and defibrillation administered without delay. Every shock cycle includes 1-2 minutes of CPR followed by rhythm analysis. The energy level for biphasic defibrillation of ventricular fibrillation is 150 J with possible step-wise escalation to 360 J. All healthcare workers need to learn and be authorised to use an automated external defibrillator (AED). In addition, all ambulances must be equipped with AEDs when transporting patients. Self-adhesive pads/paddles must be applied firmly to the skin for best effect. Monitoring electrodes and pacemaker locations should be considered during paddle/pad placement. AED skills should be imparted to a wide variety of community groups. More efforts will be made to increase the availability of AEDs in public, residential, commercial and industrial facilities.
Topics: Ambulances; Cardiopulmonary Resuscitation; Defibrillators; Emergency Medical Services; Humans; Out-of-Hospital Cardiac Arrest; Practice Guidelines as Topic; Singapore; Societies, Medical
PubMed: 21879210
DOI: No ID Found -
Jornal de Pediatria 2020To analyze the main epidemiological aspects of prehospital and hospital pediatric cardiopulmonary resuscitation and the impact of scientific evidence on survival. (Review)
Review
OBJECTIVE
To analyze the main epidemiological aspects of prehospital and hospital pediatric cardiopulmonary resuscitation and the impact of scientific evidence on survival.
SOURCE OF DATA
This was a narrative review of the literature published at PubMed/MEDLINE until January 2019 including original and review articles, systematic reviews, meta-analyses, annals of congresses, and manual search of selected articles.
SYNTHESIS OF DATA
The prehospital and hospital settings have different characteristics and prognoses. Pediatric prehospital cardiopulmonary arrest has a three-fold lower survival rate than cardiopulmonary arrest in the hospital setting, occurring mostly at home and in children under 1year. Higher survival appears to be associated with age progression, shockable rhythm, emergency medical care, use of automatic external defibrillator, high-quality early life support, telephone dispatcher-assisted cardiopulmonary resuscitation, and is strongly associated with witnessed cardiopulmonary arrest. In the hospital setting, a higher incidence was observed in children under 1year of age, and mortality increased with age. Higher survival was observed with shorter cardiopulmonary resuscitation duration, occurrence on weekdays and during daytime, initial shockable rhythm, and previous monitoring. Despite the poor prognosis of pediatric cardiopulmonary resuscitation, an increase in survival has been observed in recent years, with good neurological prognosis in the hospital setting.
CONCLUSIONS
A great progress in the science of pediatric cardiopulmonary resuscitation has been observed, especially in developed countries. The recognition of the epidemiological aspects that influence cardiopulmonary resuscitation survival may direct efforts towards more effective actions; thus, studies in emerging and less favored countries remains a priority regarding the knowledge of local factors.
Topics: Cardiopulmonary Resuscitation; Child; Emergency Medical Services; Heart Arrest; Humans; Survival Rate; Time Factors
PubMed: 31580845
DOI: 10.1016/j.jped.2019.08.004 -
Ugeskrift For Laeger Oct 2017
Topics: Cardiopulmonary Resuscitation; Heart Arrest; Humans; Respiration, Artificial
PubMed: 29429471
DOI: No ID Found -
Respiratory Care May 2018
Topics: Cardiopulmonary Resuscitation; Gastric Dilatation; Heart Arrest; Humans; Pressure
PubMed: 29703796
DOI: 10.4187/respcare.06239