Resuscitation
-
Extracorporeal cardiopulmonary resuscitation (ECPR) is a second line treatment for refractory cardiac arrest (R-OHCA). Timing of ECPR before performing coronary angiography (CAG) is still debated. The aim of the study was to describe the clinical and angiographic characteristics of the largest cohort of out-of-hospital cardiac arrest (OHCA) patients undergoing ECPR. ⋯ In 74 refractory OHCA patients treated with ECPR implanted by a prehospital mobile intensive care unit, the rate of CAD was high (54/74) especially in patients with shockable rhythm. The majority of patients presented with double or triple vessel disease and proximal lesions. The severity and extension of CAD may explain the refractory nature of the cardiac arrest.
-
Observational Study
Ten years of cardiac arrest resuscitation in Irish general practice.
The aim of this study is to establish the role and outcome of general practitioner (GP) involvement in out of hospital cardiac arrest (OHCA) resuscitation in the Republic of Ireland. ⋯ Resuscitation following OHCA is a key task in general practice. Over time a significant number of GPs encounter OHCA, attempt resuscitation and achieve higher survival to hospital discharge rates than occur nationally among OHCAs in Ireland. We conclude that a defibrillator should be routinely available at all general practices and staff should have appropriate resuscitation skills.
-
Comparative Study
Impella support compared to medical treatment for post-cardiac arrest shock after out of hospital cardiac arrest.
To compare survival outcomes of Impella support and medical treatment in patients with post-cardiac arrest cardiogenic shock related to acute myocardial infarction (AMI). ⋯ The results from our study suggest that Impella support is associated with significantly better survival to hospital discharge and at 6 months compared to medical treatment in OHCA patients admitted with post-cardiac arrest cardiogenic shock and AMI.
-
Standardized EEG patterns according to the American Clinical Neurophysiology Society (ACNS) ("highly malignant", "malignant" and "benign") demonstrated good correlation with outcome after cardiac arrest (CA). However, this approach relates to EEGs after target temperature management (TTM), and correlation to other recognized outcome predictors remains unknown. ⋯ Standardized EEG categorization after CA shows strong correlation with other outcome predictors, without marked variation across EEG recording time or TTM targets, underscoring its prognostic role in a multimodal approach.
-
The chain of survival aims to demonstrate the interrelationship between key stages of resuscitation and emphasises the need for all links to be effective in order to optimise the chances of survival. The contribution of each of the four links diminishes rapidly as patients succumb at each stage and the actual attrition rate results in rapidly decreasing numbers of patients progressing along the chain. This revised representation adjusts the area of each link in order to graphically represent the flow of patients through the chain. Greatest benefit in improving outcome will be achieved by focussing on improving care at links in the chain where there is the greatest number of patients.