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Circulation Dec 2024This is the eighth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency... (Review)
Review
2024 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task...
This is the eighth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recent published resuscitation evidence reviewed by the International Liaison Committee on Resuscitation task force science experts. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research.
Topics: Humans; Cardiopulmonary Resuscitation; Consensus; Emergency Medical Services; Infant, Newborn; Advisory Committees; First Aid
PubMed: 39540293
DOI: 10.1161/CIR.0000000000001288 -
Journal of the American College of... Jun 2011Despite substantial efforts to make cardiopulmonary resuscitation (CPR) algorithms known to healthcare workers, the outcome of CPR has remained poor during the past... (Review)
Review
Despite substantial efforts to make cardiopulmonary resuscitation (CPR) algorithms known to healthcare workers, the outcome of CPR has remained poor during the past decades. Resuscitation teams often deviate from algorithms of CPR. Emerging evidence suggests that in addition to technical skills of individual rescuers, human factors such as teamwork and leadership affect adherence to algorithms and hence the outcome of CPR. This review describes the state of the science linking team interactions to the performance of CPR. Because logistical barriers make controlled measurement of team interaction in the earliest moments of real-life resuscitations challenging, our review focuses mainly on high-fidelity human simulator studies. This technique allows in-depth investigation of complex human interactions using precise and reproducible methods. It also removes variability in the clinical parameters of resuscitation, thus letting researchers study human factors and team interactions without confounding by clinical variability from resuscitation to resuscitation. Research has shown that a prolonged process of team building and poor leadership behavior are associated with significant shortcomings in CPR. Teamwork and leadership training have been shown to improve subsequent team performance during resuscitation and have recently been included in guidelines for advanced life support courses. We propose that further studies on the effects of team interactions on performance of complex medical emergency interventions such as resuscitation are needed. Future efforts to better understand the influence of team factors (e.g., team member status, team hierarchy, handling of human errors), individual factors (e.g., sex differences, perceived stress), and external factors (e.g., equipment, algorithms, institutional characteristics) on team performance in resuscitation situations are critical to improve CPR performance and medical outcomes of patients.
Topics: Cardiopulmonary Resuscitation; Clinical Competence; Communication; Female; Humans; Interprofessional Relations; Leadership; Patient Care Team; Prognosis; Switzerland; Total Quality Management; Treatment Outcome
PubMed: 21658557
DOI: 10.1016/j.jacc.2011.03.017 -
Circulation Oct 2020This (CPR) on basic life support summarizes evidence evaluations performed for 22 topics that were prioritized by the Basic Life Support Task Force of the... (Review)
Review
This (CPR) on basic life support summarizes evidence evaluations performed for 22 topics that were prioritized by the Basic Life Support Task Force of the International Liaison Committee on Resuscitation. The evidence reviews include 16 systematic reviews, 5 scoping reviews, and 1 evidence update. Per agreement within the International Liaison Committee on Resuscitation, new or revised treatment recommendations were only made after a systematic review. Systematic reviews were performed for the following topics: dispatch diagnosis of cardiac arrest, use of a firm surface for CPR, sequence for starting CPR (compressions-airway-breaths versus airway-breaths-compressions), CPR before calling for help, duration of CPR cycles, hand position during compressions, rhythm check timing, feedback for CPR quality, alternative techniques, public access automated external defibrillator programs, analysis of rhythm during chest compressions, CPR before defibrillation, removal of foreign-body airway obstruction, resuscitation care for suspected opioid-associated emergencies, drowning, and harm from CPR to victims not in cardiac arrest. The topics that resulted in the most extensive task force discussions included CPR during transport, CPR before calling for help, resuscitation care for suspected opioid-associated emergencies, feedback for CPR quality, and analysis of rhythm during chest compressions. After discussion of the scoping reviews and the evidence update, the task force prioritized several topics for new systematic reviews.
Topics: Adult; Cardiopulmonary Resuscitation; Cardiovascular Diseases; Defibrillators; Emergency Medical Services; Evidence-Based Practice; Humans; Life Support Care; Out-of-Hospital Cardiac Arrest
PubMed: 33084391
DOI: 10.1161/CIR.0000000000000892 -
JAMA Pediatrics Mar 2021Pediatric in-hospital cardiac arrest (IHCA) occurs frequently and is associated with high morbidity and mortality. The objective of this narrative review is to summarize... (Review)
Review
IMPORTANCE
Pediatric in-hospital cardiac arrest (IHCA) occurs frequently and is associated with high morbidity and mortality. The objective of this narrative review is to summarize the current knowledge and recommendations regarding pediatric IHCA and cardiopulmonary resuscitation (CPR).
OBSERVATIONS
Each year, more than 15 000 children receive CPR for cardiac arrest during hospitalization in the United States. As many as 80% to 90% survive the event, but most patients do not survive to hospital discharge. Most IHCAs occur in intensive care units and other monitored settings and are associated with respiratory failure or shock. Bradycardia with poor perfusion is the initial rhythm in half of CPR events, and only about 10% of events have an initial shockable rhythm. Pre-cardiac arrest systems focus on identifying at-risk patients and ensuring that they are in monitored settings. Important components of CPR include high-quality chest compressions, timely defibrillation when indicated, appropriate ventilation and airway management, administration of epinephrine to increase coronary perfusion pressure, and treatment of the underlying cause of cardiac arrest. Extracorporeal CPR and measurement of physiological parameters are evolving areas in improving outcomes. Structured post-cardiac arrest care focused on targeted temperature management, optimization of hemodynamics, and careful intensive care unit management is associated with improved survival and neurological outcomes.
CONCLUSIONS AND RELEVANCE
Pediatric IHCA occurs frequently and has a high mortality rate. Early identification of risk, prevention, delivery of high-quality CPR, and post-cardiac arrest care can maximize the chances of achieving favorable outcomes. More research in this field is warranted.
Topics: Cardiopulmonary Resuscitation; Heart Arrest; Hospitalization; Humans; Pediatrics; United States
PubMed: 33226408
DOI: 10.1001/jamapediatrics.2020.5039 -
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 -
Critical Care (London, England) May 2018In cardiac arrest, high quality cardiopulmonary resuscitation (CPR) is a key determinant of patient survival. However, delivery of effective chest compressions is often... (Review)
Review
In cardiac arrest, high quality cardiopulmonary resuscitation (CPR) is a key determinant of patient survival. However, delivery of effective chest compressions is often inconsistent, subject to fatigue and practically challenging.Mechanical CPR devices provide an automated way to deliver high-quality CPR. However, large randomised controlled trials of the routine use of mechanical devices in the out-of-hospital setting have found no evidence of improved patient outcome in patients treated with mechanical CPR, compared with manual CPR. The limited data on use during in-hospital cardiac arrest provides preliminary data supporting use of mechanical devices, but this needs to be robustly tested in randomised controlled trials.In situations where high-quality manual chest compressions cannot be safely delivered, the use of a mechanical device may be a reasonable clinical approach. Examples of such situations include ambulance transportation, primary percutaneous coronary intervention, as a bridge to extracorporeal CPR and to facilitate uncontrolled organ donation after circulatory death.The precise time point during a cardiac arrest at which to deploy a mechanical device is uncertain, particularly in patients presenting in a shockable rhythm. The deployment process requires interruptions in chest compression, which may be harmful if the pause is prolonged. It is recommended that use of mechanical devices should occur only in systems where quality assurance mechanisms are in place to monitor and manage pauses associated with deployment.In summary, mechanical CPR devices may provide a useful adjunct to standard treatment in specific situations, but current evidence does not support their routine use.
Topics: Cardiopulmonary Resuscitation; Equipment Design; Humans; Out-of-Hospital Cardiac Arrest; Tissue and Organ Procurement
PubMed: 29843753
DOI: 10.1186/s13054-018-2059-0 -
Journal of Veterinary Emergency and... 2024
Topics: Cardiopulmonary Resuscitation; Animals; Practice Guidelines as Topic; Veterinary Medicine; Heart Arrest
PubMed: 38728061
DOI: 10.1111/vec.13382 -
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 -
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 -
Medicina (Kaunas, Lithuania) Nov 2023Heart failure remains a major global burden regarding patients' morbidity and mortality and health system organization, logistics, and costs. Despite continual advances... (Review)
Review
Heart failure remains a major global burden regarding patients' morbidity and mortality and health system organization, logistics, and costs. Despite continual advances in pharmacological and resynchronization device therapy, it is currently well accepted that heart transplantation and mechanical circulatory support represent a cornerstone in the management of advanced forms of this disease, with the latter becoming an increasingly accepted treatment modality due to the ongoing shortage of available donor hearts in an ever-increasing pool of patients. Mechanical circulatory support strategies have seen tremendous advances in recent years, especially in terms of pump technology improvements, indication for use, surgical techniques for device implantation, exchange and explantation, and postoperative patient management, but not in the field of treatment of critically ill patients and those undergoing cardiac arrest. This contemporary review aims to summarize the collected knowledge of this topic with an emphasis on complications in patients with left ventricular assist devices, their treatment, and establishing a clear-cut algorithm and the latest recommendations regarding out-of-hospital or emergency department management of cardiac arrest in this patient population.
Topics: Humans; Heart Transplantation; Tissue Donors; Heart Failure; Cardiopulmonary Resuscitation; Heart-Assist Devices; Heart Arrest
PubMed: 38004030
DOI: 10.3390/medicina59111981