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Respiratory Care Jul 2016Extracorporeal membrane oxygenation (ECMO) is a modified form of cardiopulmonary bypass. Although early trials were plagued by severe bleeding and high rates of death,... (Review)
Review
Extracorporeal membrane oxygenation (ECMO) is a modified form of cardiopulmonary bypass. Although early trials were plagued by severe bleeding and high rates of death, subsequent experience with neonates found good survival, and ECMO became an important tool in the care of critically ill infants with respiratory failure. Since the 1980s, expansion to other groups (children, patients with cardiac disease, etc) followed as experience was obtained. Today, there is a rapid growth of ECMO, especially in the adult population. To date, >73,000 patients receiving ECMO have been reported to the international Extracorporeal Life Support Organization registry. This rapid growth in the usage of ECMO has made it possible for it to be included in the management algorithm of certain disease processes, such as ARDS, cardiopulmonary arrest, and septic shock. Significant advances in technology have made it possible to support patients on ECMO for weeks or months with success. Reduction in sedative use and experience with "awake" patients has led to ambulatory and mobile ECMO. Changes in ventilator support while on ECMO, even to the point of extubation, are also occurring. This article will review briefly some of the literature related to criteria for severity of illness before ECMO and related to ECMO care and practice. Issues relating to the use of ECMO as a resuscitative tool in cardiac arrest as well as the controversial topic of volume and outcome will also be presented.
Topics: Adult; Extracorporeal Membrane Oxygenation; Heart Arrest; Humans; Infant; Infant, Newborn; Respiration, Artificial; Respiratory Distress Syndrome; Resuscitation; Severity of Illness Index; Shock, Septic
PubMed: 27381702
DOI: 10.4187/respcare.04985 -
European Journal of Pediatrics Nov 2020We wanted to assess newborn life support (NLS) knowledge and guideline adherence, and provide strategies to improve (neonatal) resuscitation guideline adherence....
We wanted to assess newborn life support (NLS) knowledge and guideline adherence, and provide strategies to improve (neonatal) resuscitation guideline adherence. Pediatricians completed 17 multiple-choice questions (MCQ). They performed a simulated NLS scenario, using a high-fidelity manikin. The literature was systematically searched for publications regarding guideline adherence. Forty-six pediatricians participated: 45 completed the MCQ, 34 performed the scenario. Seventy-one percent (median, IQR 56-82) of the MCQ were answered correctly. Fifty-six percent performed inflation breaths ≤ 60 s, 24% delivered inflation breaths of 2-3 s, and 85% used adequate inspiratory pressures. Airway patency was ensured 83% (IQR 76-92) of the time. Median events/min, compression rate, and percentage of effective compressions were 138/min (IQR 130-145), 120/min (IQR 114-120), and 38% (IQR 24-48), respectively. Other adherence percentages were temperature management 50%, auscultation of initial heart rate 100%, pulse oximeter use 94%, oxygen increase 74%, and correct epinephrine dose 82%. Ten publications were identified and used for our framework. The framework may inspire clinicians, educators, researchers, and guideline developers in their attempt to improve resuscitation guideline adherence. It contains many feasible strategies to enhance professionals' knowledge, skills, self-efficacy, and team performance, as well as recommendations regarding equipment, environment, and guideline development/dissemination.Conclusion: NLS guideline adherence among pediatricians needs improvement. Our framework is meant to promote resuscitation guideline adherence. What is Known: • Inadequate newborn life support (NLS) may contribute to (long-term) pulmonary and cerebral damage. • Video-based assessment of neonatal resuscitations has shown that deviations from the NLS guideline occur frequently; this assessment method has its audiovisual shortcomings. What is New: • The resuscitation quality metrics provided by our high-fidelity manikin suggest that the adherence of Dutch general pediatricians to the NLS guideline is suboptimal. • We constructed a comprehensive framework, containing multiple strategies to improve (neonatal) resuscitation guideline adherence.
Topics: Cardiopulmonary Resuscitation; Computer Simulation; Epinephrine; Guideline Adherence; Humans; Infant, Newborn; Manikins; Resuscitation
PubMed: 32472265
DOI: 10.1007/s00431-020-03693-6 -
Emergency Medicine Journal : EMJ Jun 2019Resuscitation lacks a place in the hospital to call its own. Specialised intensive care units, though excellent at providing longitudinal critical care, often lack the...
Resuscitation lacks a place in the hospital to call its own. Specialised intensive care units, though excellent at providing longitudinal critical care, often lack the flexibility to adapt to fluctuating critical care needs. We offer the resuscitative care unit as a potential solution to ensure that patients receive appropriate care during the most critical hours of their illnesses. These units offer an infrastructure for resuscitation and can meet the changing needs of their institutions.
Topics: Academic Medical Centers; Emergency Medicine; Environment Design; Humans; Intensive Care Units; Maryland; Michigan; Pennsylvania; Resuscitation
PubMed: 30940715
DOI: 10.1136/emermed-2019-208455 -
Anales de Pediatria Dec 2022In neonatal resuscitation, it is important to know whether the use of a combination of quality assessment tools has an impact on the preparation of the resuscitation bed...
INTRODUCTION
In neonatal resuscitation, it is important to know whether the use of a combination of quality assessment tools has an impact on the preparation of the resuscitation bed and equipment, the correct performance of the procedure and the clinical outcomes of the most vulnerable neonates.
MATERIAL AND METHODS
Multicentre, prospective, quasi-experimental interventional study in five level III-A neonatal units. In the pre- and post-intervention phases, both of which lasted 1 year, there were weekly random audits of the stabilization beds in the delivery room to assess their preparation. In the post-intervention phase, checklists, briefings and debriefings were used in the resuscitation of neonates delivered before 32 weeks. We compared the performance of the procedure and early post-resuscitation outcomes in the 2 periods.
RESULTS
Total of 852 audits were carried out in the pre-intervention period and 877 in the post-intervention period. There was a greater percentage of audits that did not identify defects in the second phase (63% vs 81%; P < .001). The first phase included 75 resuscitations and the second 48, out of which all the quality assessment tools had been used in 36 (75%). We did not find any differences in the main clinical variables during stabilization, although we observed a trend towards fewer technical problems during the procedure in the second period.
CONCLUSIONS
The use of random audits, checklists, briefings and debriefings in the resuscitation of newborns delivered before 32 weeks is feasible but has no impact on short-term clinical outcomes or correct performance of the procedure. Audits of neonatal resuscitation beds significantly improved their preparation.
Topics: Infant, Newborn; Humans; Resuscitation; Prospective Studies; Checklist
PubMed: 36257893
DOI: 10.1016/j.anpede.2022.10.002 -
Journal of Palliative Medicine Aug 2022Little is known about end-of-life intensive care provided to patients with intellectual disabilities (ID). To identify differences in receipt of end-of-life...
Little is known about end-of-life intensive care provided to patients with intellectual disabilities (ID). To identify differences in receipt of end-of-life cardiopulmonary resuscitation (CPR) and endotracheal intubation among adult patients with and without ID and examine whether do-not-resuscitate orders (DNRs) mediate associations between ID and CPR. Exploratory matched cohort study using medical records of inpatient decedents treated between 2012 and 2018. Patients with ID ( = 37) more frequently received CPR (37.8% vs. 21.6%) and intubation (78.4% vs. 47.8%) than patients without ID ( = 74). In multivariable models, ID was associated with receiving CPR (relative risk [RR] = 2.92, 95% confidence interval = 1.26-6.78, = 0.012), but not intubation. Patients with ID less frequently had a DNR placed (67.6% vs. 91.9%), mediating associations between ID and CPR. In this pilot study, ID was associated with increased likelihood of receiving end-of-life CPR, likely due to lower utilization of DNRs among patients with ID. Further research is needed to confirm these results.
Topics: Adult; Cardiopulmonary Resuscitation; Cohort Studies; Death; Humans; Intellectual Disability; Intubation, Intratracheal; Pilot Projects; Resuscitation Orders
PubMed: 35442779
DOI: 10.1089/jpm.2021.0584 -
GMS Journal For Medical Education 2021The aim of this study was to evaluate resuscitation skills, defined as recognition of resuscitation situations and performance of Basic Life Support (BLS) in students... (Randomized Controlled Trial)
Randomized Controlled Trial
The aim of this study was to evaluate resuscitation skills, defined as recognition of resuscitation situations and performance of Basic Life Support (BLS) in students at the Brandenburg Model Medical School (BMM). Participating students (n=102) were randomized to different simulation scenarios: unconscious person with physiological breathing (15/min), gasping (<10/min) and apnea (resuscitation dummy AmbuMan Wireless with electronic recording). Primary endpoint was the proportion of students with correct decision for or against resuscitation. Secondary endpoint was resuscitation quality, self-assessment, and prior resuscitation experience. The latter two were assessed by questionnaire prior to the simulated situation. Overall, there was a high risk for incorrectly omitted or incorrectly performed resuscitation (OR 3.4 [95% CI 1.4-8.1] p=0.005. The highest probability of error occurred in the unconsciousness and gasping groups. 22.3% of all performed resuscitations where at the same time indicated and reached the European Resuscitation Council recommendations for compression frequency, pressure depth and where as well = 90% relieved. A particularly large discrepancy emerged between participants' self-assessment of being prepared for a resuscitation situation by medical school and their actual documented resuscitation competence. The present data indicate significant uncertainty among students in recognizing a resuscitation situation. Even in curricula with a high proportion of practice and a high degree of students with completed vocational training in health care, resuscitation competence is poor.
Topics: Cardiopulmonary Resuscitation; Clinical Competence; Curriculum; Humans; Students, Medical; Surveys and Questionnaires
PubMed: 34957321
DOI: 10.3205/zma001512 -
Minerva Anestesiologica Apr 2003Resuscitation from circulatory and respiratory failure represent mainstays of emergency and critical care management. Importantly, no amount of resuscitative effort will... (Review)
Review
Resuscitation from circulatory and respiratory failure represent mainstays of emergency and critical care management. Importantly, no amount of resuscitative effort will be successful in promoting patient survival if the primary reason for the shock state is not identified and treated, independent of resuscitation. Having said that, aggressive resuscitation to normal functional levels of blood flow and organ perfusion pressure during the first 6 hours following the development of shock improves outcome both in patients with trauma or sepsis. However, clinical studies have demonstrated that restoration of total blood flow to supranormal levels in subjects with established shock that has been present for over 6 hours does not improve survival. Still, some defined clinical targets are essential in these patients as well to prevent further organ injury due to ischemia and its associated inflammatory response. Thus, the rapid restoration of normal hemodynamics by conventional means, including fluid resuscitation and surgical repair, results in a better log term outcome than inadequate or delayed resuscitative efforts. Clear initial targets for resuscitation are a mean arterial pressure > 60 mm Hg, and a cardiac output and O(2) transport to the body adequate enough to prevent tissue hypoperfusion. The level of cardiac output needed to achieve this goal is probably different among subjects and within subjects over time. Indirect signposts of adequate perfusion, such as venous O2 saturation, mentation, urine output and local measures of tissue blood flow are useful in monitoring this response.
Topics: Fluid Therapy; Hematocrit; Hemoglobins; Humans; Resuscitation; Shock; Vasoconstrictor Agents
PubMed: 12766714
DOI: No ID Found -
Die Anaesthesiologie Oct 2022The study goals were to analyze the course and compare it with patients who were only resuscitated manually as well as to record the influencing factors in patients in...
STUDY GOAL
The study goals were to analyze the course and compare it with patients who were only resuscitated manually as well as to record the influencing factors in patients in whom the mechanical chest compression aid LUCAS2™ was used as an add-on treatment at the NEF Innsbruck.
MATERIAL AND METHODOLOGY
Retrospective history data analysis of patients in the study period from 01.01.2014 to 31.12.2019 of the NEF Innsbruck from the German Resuscitation Register (GRR), in which LUCAS2™ was used as an add-on treatment according to an emergency doctor's order.
RESULT
A total of 123 add-on LUCAS2™ applications (18.8%) were performed in 653 resuscitations. Of all patients 16.2% survived the first 30 days. By using add-on-LUCAS2 application 7.3% (9/123) of all add-on LUCAS2 resuscitations and 1.4% (n = 9) of all CPR survived. Cardiac arrest was observed in 8/9 add-on LUCAS2™ 30-day survivors and bystander CPR was performed and 8/9 showed ventricular fibrillation as the primary rhythm. Compared to manual CPR alone, add-on LUCAS2™ resuscitation was used highly significantly (p < 0.001) more frequently in younger, male patients, in public, in shockable initial rhythms and during transport, and significantly more frequently in observed cardiac arrest (p < 0.05). The 30-day mortality with additive lysis treatment was 100%.
DISCUSSION
By using add-on LUCAS2™ CPR a percentage increase in survival rate can be achieved and thus appears advantageous (1.4% in our study). This means that high-quality CPR can be carried out on patients with favorable prognostic factors, even with technically complex rescue operations (turntable ladder, staircase, transport in an ambulance) and thus transport can be made possible; however, there is a higher admission rate under CPR and thus the treatment target decision is shifted to the shock room.
Topics: Cardiopulmonary Resuscitation; Emergency Medical Services; Humans; Male; Out-of-Hospital Cardiac Arrest; Retrospective Studies; Ventricular Fibrillation; nef Gene Products, Human Immunodeficiency Virus
PubMed: 35389080
DOI: 10.1007/s00101-022-01112-z -
Anales de Pediatria (Barcelona, Spain :... Nov 2006At birth approximately 10 % of term or near-term neonates require initial stabilization maneuvers to establish a cry or regular breathing, maintain a heart rate greater...
At birth approximately 10 % of term or near-term neonates require initial stabilization maneuvers to establish a cry or regular breathing, maintain a heart rate greater than 100 beats per minute (bpm), and good color and muscular tone. About 1 % requires ventilation and very few infants receive chest compressions or medication. However, birth asphyxia is a worldwide problem and can lead to death or serious sequelae. Recently, the European Resuscitation Council (ERC) and the International Liaison Committee on Resuscitation (ILCOR) published new guidelines on resuscitation at birth. These guidelines review specific questions such as the use of air or 100 % oxygen in the delivery room, dose and routes of adrenaline delivery, the peripartum management of meconium-stained amniotic fluid, and temperature control. Assisted ventilation in preterm infants is briefly described. New devices to improve the care of newborn infants, such as the laryngeal mask airway or CO2 detectors to confirm tracheal tube placement, are also discussed. Significant changes have occurred in some practices and are included in this document.
Topics: Algorithms; Asphyxia Neonatorum; Humans; Infant, Newborn; Resuscitation
PubMed: 17195347
DOI: 10.1016/s1695-4033(06)70229-6 -
Systematic Reviews Nov 2023Shock-induced endotheliopathy (SHINE), defined as a profound sympathoadrenal hyperactivation in shock states leading to endothelial activation, glycocalyx damage, and... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Shock-induced endotheliopathy (SHINE), defined as a profound sympathoadrenal hyperactivation in shock states leading to endothelial activation, glycocalyx damage, and eventual compromise of end-organ perfusion, was first described in 2017. The aggressive resuscitation therapies utilised in treating shock states could potentially lead to further worsening endothelial activation and end-organ dysfunction.
OBJECTIVE
This study aimed to systematically review the literature on resuscitation-associated and resuscitation-induced endotheliopathy.
METHODS
A predetermined structured search of literature published over an 11-year and 6-month period (1 January 2011 to 31 July 2023) was performed in two indexed databases (PubMed/MEDLINE and Embase) per PRISMA guidelines. Inclusion was restricted to original studies published in English (or with English translation) reporting on endothelial dysfunction in critically ill human subjects undergoing resuscitation interventions. Reviews or studies conducted in animals were excluded. Qualitative synthesis of studies meeting the inclusion criteria was performed. Studies reporting comparable biomarkers of endothelial dysfunction post-resuscitation were included in the quantitative meta-analysis.
RESULTS
Thirty-two studies met the inclusion criteria and were included in the final qualitative synthesis. Most of these studies (47%) reported on a combination of mediators released from endothelial cells and biomarkers of glycocalyx breakdown, while only 22% reported on microvascular flow changes. Only ten individual studies were included in the quantitative meta-analysis based on the comparability of the parameters assessed. Eight studies measured syndecan-1, with a heterogeneity index, I = 75.85% (pooled effect size, mean = 0.27; 95% CI - 0.07 to 0.60; p = 0.12). Thrombomodulin was measured in four comparable studies (I = 78.93%; mean = 0.41; 95% CI - 0.10 to 0.92; p = 0.12). Three studies measured E-selectin (I = 50.29%; mean = - 0.15; 95% CI - 0.64 to 0.33; p = 0.53), and only two were comparable for the microvascular flow index, MFI (I = 0%; mean = - 0.80; 95% CI - 1.35 to - 0.26; p < 0.01).
CONCLUSION
Resuscitation-associated endotheliopathy (RAsE) refers to worsening endothelial dysfunction resulting from acute resuscitative therapies administered in shock states. In the included studies, syndecan-1 had the highest frequency of assessment in the post-resuscitation period, and changes in concentrations showed a statistically significant effect of the resuscitation. There are inadequate data available in this area, and further research and standardisation of the ideal assessment and panel of biomarkers are urgently needed.
Topics: Animals; Humans; Syndecan-1; Endothelial Cells; Resuscitation; Biomarkers
PubMed: 37990333
DOI: 10.1186/s13643-023-02385-0