Journal of the American College of Cardiology
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Historically, cardiac arrest outcomes have been stagnant with few therapies demonstrating clinical benefit. Recent advances in our understanding of cardiac arrest physiology and therapy have led to improved outcomes and renewed interest in defining the "optimal" approach. Cardiocerebral resuscitation (CCR) represents a bundle of specific therapies designed to enhance perfusion during cardiopulmonary arrest by emphasizing chest compressions over ventilations and "priming" the heart with compressions before and after defibrillation attempts. ⋯ Many components of CCR have since been incorporated in the 2005 ILCOR guidelines. Beyond the specific treatment approaches that define CCR, this alternative approach may represent the future of resuscitation science in which each institution and emergency medical services agency will define an optimal approach to treatment and training based on the specific resources available and patient population. This may mandate a paradigm shift away from advanced cardiac life support and basic life support, which emphasize standardization of content and format rather than institution- or agency-specific protocols and training.
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J. Am. Coll. Cardiol. · Jan 2009
ReviewRecent advances in cardiopulmonary resuscitation: cardiocerebral resuscitation.
Cardiocerebral resuscitation (CCR) is a new approach for resuscitation of patients with cardiac arrest. It is composed of 3 components: 1) continuous chest compressions for bystander resuscitation; 2) a new emergency medical services (EMS) algorithm; and 3) aggressive post-resuscitation care. The first 2 components of CCR were first instituted in 2003 in Tucson, Arizona; in 2004 in the Rock and Walworth counties of Wisconsin; and in 2005 in the Phoenix, Arizona, metropolitan area. ⋯ However, EMS personnel most often arrive after the electrical phase -- in the circulatory phase of VF arrest. During the circulatory phase of VF arrest, the fibrillating myocardium has used up much of its energy stores, and chest compressions that perfuse the heart are mandatory prior to and immediately after a defibrillator shock. Endotracheal intubation is delayed, excessive ventilations are avoided, and early-administration epinephrine is advocated.
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J. Am. Coll. Cardiol. · Jan 2009
Comparative StudyUtilization and impact of pre-hospital electrocardiograms for patients with acute ST-segment elevation myocardial infarction: data from the NCDR (National Cardiovascular Data Registry) ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry.
This study sought to determine the association of pre-hospital electrocardiograms (ECGs) and the timing of reperfusion therapy for patients with ST-segment elevation myocardial infarction (STEMI). ⋯ Only one-quarter of these patients transported by EMS receive a pre-hospital ECG. The use of a pre-hospital ECG was associated with a greater use of reperfusion therapy, faster reperfusion times, and a suggested trend for a lower risk of mortality.
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J. Am. Coll. Cardiol. · Jan 2009
Impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: influence of age, obesity, and left ventricular dysfunction.
This study was designed to evaluate the effect of valve prosthesis-patient mismatch (PPM) on late survival after aortic valve replacement (AVR) and to determine if this effect is modulated by patient age, body mass index (BMI), and pre-operative left ventricular (LV) function. ⋯ Moderate PPM is associated with increased late mortality in patients with LV dysfunction, but with normal prognosis in those with preserved LV function. Notwithstanding the previously demonstrated deleterious effect of severe PPM on early mortality, this factor appears to increase late mortality only in patients <70 years old and/or with a BMI <30 kg/m(2) or an LV ejection fraction <50%.
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J. Am. Coll. Cardiol. · Jan 2009
Practice GuidelineACCF 2008 Training Statement on Multimodality Noninvasive Cardiovascular Imaging A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training Developed in Collaboration With the American Society of Echocardiography, the American Society of Nuclear Cardiology, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society for Vascular Medicine.