Resuscitation
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Mortality among patients admitted to hospital after out-of-hospital cardiac arrest (OHCA) is high. Based on recent scientific evidence with a main goal of improving survival, we introduced and implemented a standardised post resuscitation protocol focusing on vital organ function including therapeutic hypothermia, percutaneous coronary intervention (PCI), control of haemodynamics, blood glucose, ventilation and seizures. ⋯ Discharge rate from hospital, neurological outcome and 1-year survival improved after standardisation of post resuscitation care. Based on a multivariate logistic analysis, hospital treatment in the intervention period was the most important independent predictor of survival.
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Hyperventilation during cardiopulmonary resuscitation is detrimental to survival. Several clinical studies of ventilation during hospital and out-of-hospital cardiac arrest have demonstrated respiratory rates far in excess of the 10 min(-1) recommended by the ERC. We observed detailed ventilation variables prospectively during manual ventilation of 12 cardiac arrest patients treated in the emergency department of a UK Hospital. ⋯ Hyperventilation was common, mostly through high respiratory rates rather than excessive tidal volumes. This is the first study to document tidal volumes and airway pressures during resuscitation. The persistently high airway pressures are likely to have a detrimental effect on blood flow during CPR. Guidelines on respiratory rates are well known, but it would appear that in practice they are not being observed.
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Randomized Controlled Trial
Comparison of hands-off time during CPR with manual and semi-automatic defibrillation in a manikin model.
Rhythm analysis with current semi-automatic external defibrillators (AEDs) requires mandatory interruptions of chest compressions that may compromise the outcome after cardiopulmonary resuscitation (CPR). We hypothesised that interruptions would be shorter when the defibrillator was operated in manual mode by trained and certified ambulance personnel. ⋯ Paramedics performed CPR with less hands-off time before and after shocks on a manikin with manual compared to semi-automatic defibrillation following the 2000 Guidelines. However, 12% of the shocks given manually were inappropriate.
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"Bystanders" or lay persons are typically the first caregivers to attend to a victim of out-of-hospital cardiopulmonary arrest. Astronaut crew medical officers (CMO) play a similar role to bystanders aboard the International Space Station (ISS). Studies have demonstrated the importance of bystander cardiopulmonary resuscitation (BCPR) for patient survival before the arrival of emergency medical care. ⋯ The M730 also enabled a bystander to meet the recommendation of 4-breath and compression cycles per minute as per Guidelines 2000. Lastly, ease-of-use scores were significantly higher for the M730 compared to the BVM. Overall, the data suggest that the M730 improves the quality of performance for a bystander performing BCPR.
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Clinical Trial
CPR quality improvement during in-hospital cardiac arrest using a real-time audiovisual feedback system.
Cardiopulmonary resuscitation (CPR) quality during actual cardiac arrest has been found to be deficient in several recent investigations. We hypothesized that real-time feedback during CPR would improve the performance of chest compressions and ventilations during in-hospital cardiac arrest. ⋯ Real-time CPR-sensing and feedback technology modestly improved the quality of CPR during in-hospital cardiac arrest, and may serve as a useful adjunct for rescuers during resuscitation efforts. However, feedback specifics should be optimized for maximal benefit and additional studies will be required to assess whether gains in CPR quality translate to improvements in survival.