Resuscitation
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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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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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We investigated the mechanism and extent of myocardial injury associated with out-of-hospital cardiac arrest (OHCA). ⋯ Significant myocardial injury associated with OHCA occurs in the presence of acute culprit lesion while extent of myocardial injury in stable or absent coronary disease is significantly smaller and correlates with the duration and intensity of cardiac resuscitation. Admission cTnI, although combined with post-resuscitation ECG, have insufficient accuracy to securely predict presence of acute culprit lesion.
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Observational Study
Association of sudden in-hospital cardiac arrest with emergency department crowding.
In Taiwan, emergency department (ED) crowding is inevitable; many studies have investigated the various negative effects of ER crowding on patients. In general, ED crowding reduces patient satisfaction, delays treatment, and increases mortality. However, most studies have focused on the relationship between ED crowding and delay mortality rather than sudden mortality. This study investigates the association of ED crowding with sudden unexpected in-hospital cardiac arrest (IHCA). ⋯ This first study investigating the relationship between ED crowding and sudden IHCA found EDBORs and prolonged boarding to general wards or ICUs were associated with increased sudden IHCA incidence.
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In terms of treatment options, the underlying cause of out-of-hospital cardiac arrest (OHCA) has an impact on survival. This study aimed to examine the frequencies of different causes of OHCA and their outcomes using data from a national resuscitation registry. ⋯ The most common causes of OHCA are cardiac events and hypoxia. Depending on the underlying cause, outcome after pre-hospital CPR varies widely with a survival rate with good neurological outcome ranging from 0.9 to 14%.