Resuscitation
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Supraglottic airway devices such as the laryngeal tube (LT) are recommended in current guidelines for simplified airway management in patients during and immediately after out-of-hospital cardiac arrest (OHCA). Trials evaluating LTs included predominantly OHCA patients with non-shockable rhythms and low survival rates. Hence, LTs are widely used, but their impact on preventing hypoxic brain damage during resuscitation has not been evaluated yet. ⋯ While the original prehospital pragmatic trials comparing LT to ETI mostly included patients with non-shockable rhythm in settings with high mortality, our analysis is based on a real-world registry and focuses on successfully resuscitated patients, whose cause of arrest was most probably not due to hypoxia. In this cohort, use of LT was associated with a higher rate of anoxic brain damage and worse functional neurological outcome compared to use of ETI.
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This is the eighth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recent published resuscitation evidence reviewed by the International Liaison Committee on Resuscitation task force science experts. ⋯ Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research.
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Observational Study
Survival in relation to number of defibrillation attempts in out-of-hospital cardiac arrest.
Out-of-hospital cardiac arrest (OHCA) with shockable pulseless ventricular tachycardia or fibrillation not responding to defibrillation is a medical challenge. Novel treatment strategies have emerged for so-called refractory ventricular fibrillation not responding to three or more defibrillations but the evidence for optimal timing for these strategies is sparse. The primary aim of this observational study was to assess survival in relation to total numbers of defibrillations in OHCA. ⋯ In this registry-based retrospective cohort study, additional defibrillations were associated with a lower survival. This association persisted after adjustments for patient and resuscitation characteristics.
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The impact of personal protective equipment (PPE) on resuscitation quality is largely unknown. We sought to examine the effect of PPE requirements on CPR quality and resuscitation interventions during the COVID-19 pandemic in Victoria, Australia. ⋯ Several CPR quality metrics declined during the COVID-19 period and some remain below pre-pandemic levels. Further research is needed to understand these impacts on OHCA outcomes.
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Observational Study
The association between intra-arrest arterial blood pressure and return of spontaneous circulation in out-of-hospital cardiac arrest.
The optimal haemodynamic parameter for goal-directed resuscitation in out-of-hospital cardiac arrest (OHCA) remains uncertain. This study aimed to characterise the association between invasive blood pressure (IBP) measurements and return of spontaneous circulation (ROSC) in adult OHCA patients, to identify this parameter. ⋯ This study supports the use of arterial DBP as an important haemodynamic parameter for goal-directed resuscitation in adult OHCA. Maximising DBP may increase the chances of ROSC. These data suggest that a DBP threshold of 35 mmHg is optimal for identifying patients who may achieve ROSC with continued resuscitation.