Resuscitation
-
Targeted defibrillation therapy is needed to optimise survival chances of ventricular fibrillation (VF) patients, but at present VF analysis strategies to optimise defibrillation timing have insufficient predictive power. From 197 patients with in-hospital and out-of-hospital cardiac arrest, 770 electrocardiogram (ECG) recordings of countershock attempts were analysed. Preshock VF ECG features in the time and frequency domain were tested retrospectively for outcome prediction. ⋯ Using frequency band segmentation of human VF ECG, several single predictive features with high ROC AUC>0.840 were identified. Combining these single predictive features using neural networks did not further improve outcome prediction in human VF data. This may indicate that various simple VF features, such as median slope already reach the maximum prediction power extractable from VF ECG.
-
Extracorporeal life support has been used as an extension of conventional cardiopulmonary resuscitation (CPR). However, the appropriate indications for extracorporeal CPR (ECPR) including the duration of CPR are unknown. We present a case of a male, 37-year-old out-of-hospital cardiac arrest patient who received prolonged CPR followed by ECPR. ⋯ Ultimately, the patient was discharged without neurological complications. Although cardiac arrest occurred out-of-hospital and CPR was performed for a long time, a patient might be a candidate for ECPR if perfusing rhythms are restored transiently but not successfully maintained due to recurrent VF. ECPR may be used for VF unresponsive to standard CPR techniques.
-
The quality of education, CPR guidelines and the chain of survival all contribute to patient outcome following cardiac arrest. Increasing concerns about patient safety have focused attention on the methods used to train and prepare doctors for clinical practice. Reductions in clinical exposure at both undergraduate and postgraduate level have been implicated in junior doctors inability to recognise and manage critically ill patients. ⋯ Simulation provides a learning opportunity for controlled clinical practice without putting patients or others at risk. This review examines the history and rationale for simulation training in resuscitation and provides some background to the learning theories that underpin it. The role of task trainers, high and low fidelity patient simulators and computer assisted simulation as teaching tools are discussed.
-
Although early care in out-of-hospital cardiac arrest has been improved over the past decades, survival remains poor and neurological performance after survival is often impaired. Consequently, new therapies are needed to improve outcome. ⋯ Both therapies can restore coronary and pulmonary perfusion in cardiac arrest patients and, additionally, fibrinolysis might prevent microthrombi to the brain. In this review, the rationale, safety and efficacy of reperfusion therapy in patients with out-of-hospital cardiac arrest will be discussed.
-
Semi-automatic defibrillation requires pauses in chest compressions during ECG analysis and charging, and prolonged pre-shock compression pauses reduce the chance of a return of spontaneous circulation (ROSC). We hypothesised that pauses are shorter for manual defibrillation by trained rescuers, but with an increased number of inappropriate shocks given for a non-VF/VT rhythm. ⋯ Manual defibrillation resulted in shorter pauses in chest compressions, but a higher frequency of inappropriate shocks. A higher formal level of education did not prevent inappropriate shocks. Trial registrationhttp://www.clinicaltrials.gov/ (NCT00138996 and NCT00228293).