Resuscitation
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Observational Study
Repeated adrenaline doses and survival from an out-of-hospital cardiac arrest.
Adrenaline is the primary drug of choice for resuscitation from out-of-hospital cardiac arrest (OHCA). Although adrenaline may increase the chance of achieving return of spontaneous circulation (ROSC), there is limited evidence that repeated doses of adrenaline improves overall survival, and increasing evidence of a detrimental effect on neurological function in survivors. This paper reports the relationship between repeated doses of adrenaline and survival in a cohort of patients attended by the London Ambulance Service in the United Kingdom. ⋯ Our study indicates that repeated doses of adrenaline are associated with decreasing odds of survival. There were no survivors amongst patients requiring more than 10 doses of adrenaline.
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Survival from out-of-hospital cardiac arrest (OHCA) is improved when public access defibrillators are used. Areas of socioeconomic deprivation may have higher rates of OHCA and thus a greater demand for public access defibrillators. We aimed to determine if there was a relationship between socioeconomic factors, the geographic distribution of public access defibrillators (PADs) and incidence of OHCA. ⋯ The most socioeconomically deprived communities had the highest incidence of OHCA and the least availability of PADs. This provides impetus for targeted PAD placement in areas of higher deprivation.
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Extracorporeal cardiopulmonaryresuscitation (ECPR) is emerging as a viable rescue strategy for refractory out-of-hospital cardiac arrest. In the U.S., limited training of emergency medicine providers is a barrier to widespread implementation. ⋯ High fidelity simulation training is effective in preparing emergency medicine physicians and nurses to rapidly and safely initiate ECPR in a simulated cardiac arrest scenario, and should be considered when implementing an ED-based ECPR program.
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Unsuccessful defibrillation shocks adversely affect survival from out-of-hospital cardiac arrest (OHCA). Ventricular fibrillation (VF) waveform analysis is the tool-of-choice for the non-invasive prediction of shock success, but surrogate markers of perfusion like end-tidal CO2 (EtCO2) could improve the prediction. The aim of this study was to evaluate EtCO2 as predictor of shock success, both individually and in combination with VF-waveform analysis. ⋯ MEtCO2 predicted defibrillation success only for first shocks. Adding MEtCO2 to VF-waveform analysis in first shocks improved prediction of shock success. VF-waveform features and MEtCO2 were automatically calculated from the device files, so these methods could be introduced in current defibrillators adding only new software.
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Despite a consistent association with improved outcomes, public automated external defibrillators (AEDs) are rarely used in out-of-hospital cardiac arrest. One of the barriers towards increased use might be cost-effectiveness. ⋯ Public AEDs are a cost-effective public health intervention in the United States. These findings support widespread dissemination of public AEDs.