40 results on '"Respiration, artificial"'
Search Results
2. Association of Pediatric Postcardiac Arrest Ventilation and Oxygenation with Survival Outcomes.
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Frazier AH, Topjian AA, Reeder RW, Morgan RW, Fink EL, Franzon D, Graham K, Harding ML, Mourani PM, Nadkarni VM, Wolfe HA, Ahmed T, Bell MJ, Burns C, Carcillo JA, Carpenter TC, Diddle JW, Federman M, Friess SH, Hall M, Hehir DA, Horvat CM, Huard LL, Maa T, Meert KL, Naim MY, Notterman D, Pollack MM, Schneiter C, Sharron MP, Srivastava N, Viteri S, Wessel D, Yates AR, Sutton RM, and Berg RA
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- Humans, Male, Female, Prospective Studies, Child, Child, Preschool, Infant, Hypocapnia, Hyperoxia mortality, Adolescent, Oxygen blood, Survival Rate, Infant, Newborn, Respiration, Artificial, Heart Arrest therapy, Heart Arrest mortality, Hypoxia mortality, Hypercapnia mortality, Hypercapnia therapy, Cardiopulmonary Resuscitation methods
- Abstract
Rationale: Adult and pediatric studies provide conflicting data regarding whether post-cardiac arrest hypoxemia, hyperoxemia, hypercapnia, and/or hypocapnia are associated with worse outcomes. Objectives: We sought to determine whether postarrest hypoxemia or postarrest hyperoxemia is associated with lower rates of survival to hospital discharge, compared with postarrest normoxemia, and whether postarrest hypocapnia or hypercapnia is associated with lower rates of survival, compared with postarrest normocapnia. Methods: An embedded prospective observational study during a multicenter interventional cardiopulmonary resuscitation trial was conducted from 2016 to 2021. Patients ⩽18 years old and with a corrected gestational age of ≥37 weeks who received chest compressions for cardiac arrest in one of the 18 intensive care units were included. Exposures during the first 24 hours postarrest were hypoxemia, hyperoxemia, or normoxemia-defined as lowest arterial oxygen tension/pressure (Pa
O ) <60 mm Hg, highest Pa2 O ⩾200 mm Hg, or every Pa2 O 60-199 mm Hg, respectively-and hypocapnia, hypercapnia, or normocapnia, defined as lowest arterial carbon dioxide tension/pressure (Pa2 CO ) <30 mm Hg, highest Pa2 CO ⩾50 mm Hg, or every Pa2 CO 30-49 mm Hg, respectively. Associations of oxygenation and carbon dioxide group with survival to hospital discharge were assessed using Poisson regression with robust error estimates. Results: The hypoxemia group was less likely to survive to hospital discharge, compared with the normoxemia group (adjusted relative risk [aRR] = 0.71; 95% confidence interval [CI] = 0.58-0.87), whereas survival in the hyperoxemia group did not differ from that in the normoxemia group (aRR = 1.0; 95% CI = 0.87-1.15). The hypercapnia group was less likely to survive to hospital discharge, compared with the normocapnia group (aRR = 0.74; 95% CI = 0.64-0.84), whereas survival in the hypocapnia group did not differ from that in the normocapnia group (aRR = 0.91; 95% CI = 0.74-1.12). Conclusions: Postarrest hypoxemia and hypercapnia were each associated with lower rates of survival to hospital discharge.2 - Published
- 2024
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3. Transthoracic impedance variability to assess quality of chest compression in out-of-hospital cardiac arrest.
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Magliocca A, Castagna V, Fornari C, Zimei G, Merigo G, Penna A, Carlson J, Fumagalli F, Stirparo G, Migliari M, Coppo A, Sechi GM, Grasselli G, Hardig BM, and Ristagno G
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- Humans, Cardiography, Impedance, Retrospective Studies, Respiration, Artificial, Cardiopulmonary Resuscitation, Out-of-Hospital Cardiac Arrest therapy, Emergency Medical Services
- Abstract
Background: Chest compression is a lifesaving intervention in out-of-hospital cardiac arrest (OHCA), but the optimal metrics to assess its quality have yet to be identified. The objective of this study was to investigate whether a new parameter, that is, the variability of the chest compression-generated transthoracic impedance (TTI), namely Imp
CC , which measures the consistency of the chest compression maneuver, relates to resuscitation outcome., Methods: This multicenter observational, retrospective study included OHCAs with shockable rhythm. ImpCC variability was evaluated with the power spectral density analysis of the TTI. Multivariate regression model was used to examine the impact of ImpCC variability on defibrillation success. Secondary outcome measures were return of spontaneous circulation and survival., Results: Among 835 treated OHCAs, 680 met inclusion criteria and 565 matched long-term outcomes. ImpCC was significantly higher in patients with unsuccessful defibrillation compared to those with successful defibrillation (p = .0002). Lower ImpCC variability was associated with successful defibrillation with an odds ratio (OR) of 0.993 (95% confidence interval [95% CI], 0.989-0.998, p = .003), while the standard chest compression fraction (CCF) was not associated (OR 1.008 [95 % CI, 0.992-1.026, p = .33]). Neither ImpCC nor CCF was associated with long-term outcomes., Conclusions: In this population, consistency of chest compression maneuver, measured by variability in TTI, was an independent predictor of defibrillation outcome. ImpCC may be a useful novel metrics for improving quality of care in OHCA., (© 2024 Acta Anaesthesiologica Scandinavica Foundation.)- Published
- 2024
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4. Post-Cardiac Arrest Care in Adult Patients After Extracorporeal Cardiopulmonary Resuscitation.
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Kang JK, Darby Z, Bleck TP, Whitman GJR, Kim BS, and Cho SM
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- Adult, Humans, Respiration, Artificial, Retrospective Studies, Heart Arrest therapy, Heart Arrest etiology, Cardiopulmonary Resuscitation methods, Extracorporeal Membrane Oxygenation methods, Out-of-Hospital Cardiac Arrest therapy
- Abstract
Objectives: Extracorporeal cardiopulmonary resuscitation (ECPR) serves as a lifesaving intervention for patients experiencing refractory cardiac arrest. With its expanding usage, there is a burgeoning focus on improving patient outcomes through optimal management in the acute phase after cannulation. This review explores systematic post-cardiac arrest management strategies, associated complications, and prognostication in ECPR patients., Data Sources: A PubMed search from inception to 2023 using search terms such as post-cardiac arrest care, ICU management, prognostication, and outcomes in adult ECPR patients was conducted., Study Selection: Selection includes original research, review articles, and guidelines., Data Extraction: Information from relevant publications was reviewed, consolidated, and formulated into a narrative review., Data Synthesis: We found limited data and no established clinical guidelines for post-cardiac arrest care after ECPR. In contrast to non-ECPR patients where systematic post-cardiac arrest care is shown to improve the outcomes, there is no high-quality data on this topic after ECPR. This review outlines a systematic approach, albeit limited, for ECPR care, focusing on airway/breathing and circulation as well as critical aspects of ICU care, including analgesia/sedation, mechanical ventilation, early oxygen/C o2 , and temperature goals, nutrition, fluid, imaging, and neuromonitoring strategy. We summarize common on-extracorporeal membrane oxygenation complications and the complex nature of prognostication and withdrawal of life-sustaining therapy in ECPR. Given conflicting outcomes in ECPR randomized controlled trials focused on pre-cannulation care, a better understanding of hemodynamic, neurologic, and metabolic abnormalities and early management goals may be necessary to improve their outcomes., Conclusions: Effective post-cardiac arrest care during the acute phase of ECPR is paramount in optimizing patient outcomes. However, a dearth of evidence to guide specific management strategies remains, indicating the necessity for future research in this field., Competing Interests: Dr. Bleck received funding from Marinus Pharmaceuticals, SAGE Corporation, iECURE, and Ceribell Corporation. Dr. Whitman received funding from Avania. Dr. Cho is funded by National Heart, Lung, and Blood Institute (1K23HL157610). The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
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- 2024
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5. End-tidal carbon dioxide after sodium bicarbonate infusion during mechanical ventilation or ongoing cardiopulmonary resuscitation.
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Roh YI, Kim HI, Kim SJ, Cha KC, Jung WJ, Park YJ, and Hwang SO
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- Adult, Humans, Carbon Dioxide, Sodium Bicarbonate, Respiration, Artificial, Cardiopulmonary Resuscitation, Heart Arrest drug therapy
- Abstract
Purpose: End-tidal CO
2 is used to monitor the ventilation status or hemodynamic efficacy during mechanical ventilation or cardiopulmonary resuscitation (CPR), and it may be affected by various factors including sodium bicarbonate administration. This study investigated changes in end-tidal CO2 after sodium bicarbonate administration., Materials and Methods: This single-center, prospective observational study included adult patients who received sodium bicarbonate during mechanical ventilation or CPR. End-tidal CO2 elevation was defined as an increase of ≥20% from the baseline end-tidal CO2 value. The time to initial increase (lag time, Tlag ), time to peak (Tpeak ), and duration of the end-tidal CO2 rise (Tduration ) were compared between the patients with spontaneous circulation (SC group) and those with ongoing resuscitation (CPR group)., Results: Thirty-three patients, (SC group, n = 25; CPR group, n = 8), were included. Compared with the baseline value, the median values of peak end-tidal CO2 after sodium bicarbonate injection increased by 100% (from 21 to 41 mmHg) in all patients, 89.5% (from 21 to 39 mmHg) in the SC group, and 160.2% (from 15 to 41 mmHg) in the CPR group. The median Tlag was 17 s (IQR: 12-21) and the median Tpeak was 35 s (IQR: 27-52). The median Tduration was 420 s (IQR: 90-639). The median Tlag , Tpeak , and Tduration were not significantly different between the groups. Tduration was associated with the amount of sodium bicarbonate for SC group (correlation coefficient: 0.531, p = 0.006)., Conclusion: The administration of sodium bicarbonate may lead to a substantial increase in end-tidal CO2 for several minutes in patients with spontaneous circulation and in patients with ongoing CPR. After intravenous administration of sodium bicarbonate, the use of end-tidal CO2 pressure as a physiological indicator may be limited., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)- Published
- 2024
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6. Manual resuscitator valve malfunction causing severe hypotension and a simple test to ensure safe function.
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Chen YA, Po YJ, Wang ML, and Huang HH
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- Humans, Respiration, Artificial, Cardiopulmonary Resuscitation, Hypotension etiology
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- 2024
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7. 2023 American Heart Association and American Academy of Pediatrics Focused Update on Neonatal Resuscitation: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
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Yamada NK, Szyld E, Strand ML, Finan E, Illuzzi JL, Kamath-Rayne BD, Kapadia VS, Niermeyer S, Schmölzer GM, Williams A, Weiner GM, Wyckoff MH, and Lee HC
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- Infant, Child, Infant, Newborn, Humans, United States, Resuscitation, American Heart Association, Emergency Treatment, Cardiopulmonary Resuscitation, Emergency Medical Services
- Abstract
This 2023 focused update to the neonatal resuscitation guidelines is based on 4 systematic reviews recently completed under the direction of the International Liaison Committee on Resuscitation Neonatal Life Support Task Force. Systematic reviewers and content experts from this task force performed comprehensive reviews of the scientific literature on umbilical cord management in preterm, late preterm, and term newborn infants, and the optimal devices and interfaces used for administering positive-pressure ventilation during resuscitation of newborn infants. These recommendations provide new guidance on the use of intact umbilical cord milking, device selection for administering positive-pressure ventilation, and an additional primary interface for administering positive-pressure ventilation.
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- 2024
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8. Small ventilation bags and cardiac arrest outcomes - Not so fast.
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Becker TK, Lykens D, Jones JM, Justice BT, and Carr CT
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- Humans, Respiration, Artificial, Heart Arrest therapy, Cardiopulmonary Resuscitation
- Abstract
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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- 2024
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9. Neonatal resuscitation with continuous chest compressions and high frequency percussive ventilation in preterm lambs.
- Author
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Giusto E, Sankaran D, Lesneski A, Joudi H, Hardie M, Hammitt V, Zeinali L, Lakshminrusimha S, and Vali P
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- Animals, Sheep, Respiration, Artificial, Hemodynamics, Sheep, Domestic, Oxygen, Cardiopulmonary Resuscitation, Heart Arrest therapy
- Abstract
Background: Cerebral oxygen delivery (cDO
2 ) is low during chest compressions (CC). We hypothesized that gas exchange and cDO2 are better with continuous CC with high frequency percussive ventilation (CCC + HFPV) compared to conventional 3:1 compressions-to-ventilation (C:V) resuscitation during neonatal resuscitation in preterm lambs with cardiac arrest induced by umbilical cord compression., Methods: Fourteen lambs in cardiac arrest were randomized to 3:1 C:V resuscitation (90CC + 30 breaths/min) per the Neonatal Resuscitation Program guidelines or CCC + HFPV (120CC + HFPV continuously). Intravenous epinephrine was given every 3 min until return of spontaneous circulation (ROSC)., Results: There was no difference in the incidence and time to ROSC between both groups. Median (IQR) PaCO2 was significantly lower with CCC + HFPV during CC, at ROSC and 15 min post-ROSC-[104 (99-112), 83 (77-99), and 43 (40-64)], respectively compared to 3:1 C:V-[149 (139-167), 153 (143-168), and 153 (138-178) mmHg. PaO2 and cDO2 were higher with CCC + HFPV during CC and at ROSC. PaO2 was similar 15 min post-ROSC with a lower FiO2 in the CCC + HFPV group 0.4 (0.4-0.5) vs. 1 (0.6-1)., Conclusion: In preterm lambs with perinatal cardiac-arrest, continuous chest compressions with HFPV does not improve ROSC but enhances gas exchange and increases cerebral oxygen delivery compared to 3:1 C:V during neonatal resuscitation., Impact Statement: Ventilation is the most important intervention in newborn resuscitation. Currently recommended 3:1 compression-to-ventilation ratio is associated with hypercarbia and poor oxygen delivery to the brain. Providing uninterrupted continuous chest compressions during high frequency percussive ventilation is feasible in a lamb model of perinatal cardiac arrest, and demonstrates improved gas exchange and oxygen delivery to the brain. This is the first study in premature lambs evaluating high frequency percussive ventilation with asynchronous chest compressions and lays the groundwork for future clinical studies to optimize gas exchange and hemodynamics during chest compressions in newborns., (© 2023. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)- Published
- 2024
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10. Association of small adult ventilation bags with return of spontaneous circulation in out of hospital cardiac arrest.
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Snyder BD, Van Dyke MR, Walker RG, Latimer AJ, Grabman BC, Maynard C, Rea TD, Johnson NJ, Sayre MR, and Counts CR
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- Adult, Humans, Retrospective Studies, Return of Spontaneous Circulation, Respiration, Artificial, Out-of-Hospital Cardiac Arrest therapy, Cardiopulmonary Resuscitation, Emergency Medical Services
- Abstract
Introduction: Little is known about the impact of tidal volumes delivered by emergency medical services (EMS) to adult patients with out-of-hospital cardiac arrest (OHCA). A large urban EMS system changed from standard adult ventilation bags to small adult bags. We hypothesized that the incidence of return of spontaneous circulation (ROSC) at the end of EMS care would increase after this change., Methods: We performed a retrospective analysis evaluating adults treated with advanced airway placement for nontraumatic OHCA between January 1, 2015 and December 31, 2021. We compared rates of ROSC, ventilation rate, and mean end tidal carbon dioxide (ETCO
2 ) by minute before and after the smaller ventilation bag implementation using linear and logistic regression., Results: Of the 1,994 patients included, 1,331 (67%) were treated with a small adult bag. ROSC at the end of EMS care was lower in the small bag cohort than the large bag cohort, 33% vs 40% (p = 0.003). After adjustment, small bag use was associated with lower odds of ROSC at the end of EMS care [OR 0.74, 95% CI 0.61 - 0.91]. Ventilation rates did not differ between cohorts. ETCO2 values were lower in the large bag cohort (33.2 ± 17.2 mmHg vs. 36.9 ± 19.2 mmHg, p < 0.01)., Conclusion: Use of a small adult bag during OHCA was associated with lower odds of ROSC at the end of EMS care. The effects on acid base status, hemodynamics, and delivered minute ventilation remain unclear and warrant additional study., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: This research did not receive any external funding. Robert Walker is a biomedical engineer employed by Stryker Emergency Care. Nicholas Johnson receives research funding from National Institutes of Health, Centers for Disease Control and Prevention, and University of Washington Royalty Research Fund for unrelated work and serves on a Scientific Advisory Board for Neuroptics, Inc. Thomas Rea has received support from Philips. Michael Sayre has received consulting fees from Stryker Emergency Care. The remaining authors have no conflicts of interest to report., (Copyright © 2023 Elsevier B.V. All rights reserved.)- Published
- 2023
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11. The effects of mechanical versus bag-valve ventilation on gas exchange during cardiopulmonary resuscitation in emergency department patients: A randomized controlled trial (CPR-VENT).
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Tangpaisarn T, Tosibphanom J, Sata R, Kotruchin P, Drumheller B, and Phungoen P
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- Adult, Humans, Male, Middle Aged, Female, Respiration, Artificial, Oxygen, Emergency Service, Hospital, Cardiopulmonary Resuscitation, Heart Arrest therapy
- Abstract
Introduction: Effective ventilation is crucial for successful cardiopulmonary resuscitation (CPR). Previous studies indicate that higher arterial oxygen levels (PaO
2 ) during CPR increase the chances of successful resuscitation. However, the advantages of mechanical ventilators over bag-valve ventilation for achieving optimal PaO2 during CPR remain uncertain., Method: We conducted a randomized trial involving non-traumatic adult cardiac arrest patients who received CPR in the ED. After intubation, patients were randomly assigned to ventilate with a mechanical ventilator (MV) or bag valve ventilation (BV). In MV group, ventilation settings were: breath rate 10/minute, tidal volume 6-7 ml/kg, inspiratory time 1 second, positive end-expiratory pressure 0 cm water, inspiratory oxygen fraction (FiO2 ) 100%. The primary outcome was to compare the difference in PaO2 from arterial blood gases (ABG) obtained 4-10 minutes later during CPR between both groups., Results: Sixty patients were randomized (30 in each group). The study population consisted of: 57% male, median age 62 years, 37% received bystander CPR, and 20% had an initial shockable rhythm. Median time from arrest to intubation was 24 minutes. The median PaO2 was not significantly different in the BV compared to MV [36.5 mmHg (14.0-70.0) vs. 29.0 mmHg (15.0-70.0), P = 0.879]. Other ABG parameters and rates of return of spontaneous circulation and survival were not different., Conclusions: In ED patients with refractory cardiac arrest, arterial oxygen levels during CPR were comparable between patients ventilated with MV and BV. Mechanical ventilation is at least feasible and safe during CPR in intubated cardiac arrest patients., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)- Published
- 2023
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12. Ventilation assisted feedback in out of hospital cardiac arrest.
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Gerber S, Pourmand A, Sullivan N, Shapovalov V, and Pourmand A
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- Humans, Feedback, Respiration, Artificial, Out-of-Hospital Cardiac Arrest therapy, Cardiopulmonary Resuscitation, Emergency Medical Services
- Abstract
Excessive ventilatory volumes and rates during cardiopulmonary resuscitation (CPR) can lead to adverse effects, such as elevated intrathoracic pressure and decreased coronary blood flow. The 2020 American Heart Association (AHA) guidelines acknowledge the value of real-time feedback devices in improving CPR performance. In this case series, three out-of-hospital cardiac arrest cases received ventilation feedback during prehospital resuscitation and the initial in-hospital care phase. In each case, a notable increase in ventilation rate and volume was observed following the transfer of care from emergency medical services to hospital staff. This deviation from established ventilation guidelines emphasizes the importance of monitoring and addressing ventilation strategy during the transition to hospital care. Existing evidence supports the importance of maintaining specific ventilation rates and tidal volumes during cardiac arrest to improve outcomes. We believe further research is essential to establish a definitive link between ventilation strategies and patient outcomes, ultimately enhancing resuscitation efforts and patient survival rates. Integrating real-time ventilation feedback devices both in and out of the hospital during cardiac arrest presents an opportunity for quality improvement and adherence to national standards., Competing Interests: Declaration of Competing Interest The authors do not have a financial interest or relationship to disclose regarding this research project., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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13. Extracorporeal cardiopulmonary resuscitation: lifesaving for the right patient, at the right time and in the right place.
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Weerwind PW and Vranken NPA
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- Humans, Heart, Respiration, Artificial, Heart Arrest therapy, Cardiopulmonary Resuscitation
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- 2023
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14. Characterization of non-cardiac arrest PulsePoint activations in public and private settings.
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Blackwood J, Daya MR, Sorenson B, Schaeffer B, Dawson M, Charter M, Nania JM, Charbonneau J, Robertson J, Mancera M, Carbon C, Jorgenson DB, Gao M, Price R, Rosse C, and Rea T
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- Humans, Prospective Studies, Respiration, Artificial, Cardiopulmonary Resuscitation methods, Emergency Medical Services, Out-of-Hospital Cardiac Arrest epidemiology, Out-of-Hospital Cardiac Arrest therapy
- Abstract
Background: Geospatial smartphone application alert systems are used in some communities to crowdsource community response for out-of-hospital cardiac arrest (OHCA). Although the clinical focus of this strategy is OHCA, dispatch identification of OHCA is imperfect so that activation may occur for the non-arrest patient. The frequency and clinical profile of such non-arrest patients has not been well-investigated., Methods: We undertook a prospective 3-year cohort investigation of patients for whom a smartphone geospatial application was activated for suspected OHCA in four United States communities (total population ~1 million). The current investigation evaluates those patients with an activation for suspected OHCA who did not experience cardiac arrest. The volunteer response cohort included off-duty, volunteer public safety personnel (verified responders) notified regardless of location (public or private) and laypersons notified to public locations. The study linked the smartphone application information with the EMS records to report the frequency, condition type, and EMS treatment for these non-arrest patients., Results: Of 1779 calls where volunteers were activated, 756 had suffered OHCA, resulting in 1023 non-arrest patients for study evaluation. The most common EMS assessments were syncope (15.9%, n=163), altered mental status (15.5%, n=159), seizure (14.3%, n=146), overdose (13.0%, n=133), and choking (10.5%, n=107). The assessment distribution was similar for private and public locations. Overall, the most common EMS interventions included placement of an intravenous line (43.1%, n=441), 12-Lead ECG(27.9%, n=285), naloxone treatment (9.8%, n=100), airway or ventilation assistance (8.7%, n=89), and oxygen administration (6.6%, n=68)., Conclusions: More than half of patients activated for suspected OHCA had conditions other than cardiac arrest. A subset of these conditions may benefit from earlier care that could be provided by both layperson and public safety volunteers if they were appropriately trained and equipped., (© 2023. The Author(s).)
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- 2023
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15. Not all supraglottic airways seem equal in cardiopulmonary resuscitation and the patient cares.
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Venema A and Noordergraaf GJ
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- Humans, Respiration, Artificial, Airway Management, Intubation, Intratracheal, Cardiopulmonary Resuscitation
- Abstract
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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- 2023
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16. Use of a Portable Mechanical Ventilator during Cardiopulmonary Resuscitation is Feasible, Improves Respiratory Parameters, and Prevents the Decrease of Dynamic Lung Compliance.
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Palácio MÂG, Paiva EF, Oliveira GBF, Azevedo LCP, Pedron BG, Santos ESD, and Timerman A
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- Animals, Lung, Lung Compliance, Respiration, Artificial, Swine, Ventilators, Mechanical, Ventricular Fibrillation, Cardiopulmonary Resuscitation
- Abstract
Background: For practical and protective ventilation during cardiopulmonary resuscitation (CPR), a 150-grams mechanical ventilator (VLP2000E) that limits peak inspiratory pressure (PIP) during simultaneous ventilation with chest compressions was developed., Objectives: To evaluate the feasibility of VLP2000E ventilation during CPR and to compare monitored parameters versus bag-valve ventilation., Methods: A randomized experimental study with 10 intubated pigs per group. After seven minutes of ventricular fibrillation, 2-minute CPR cycles were delivered. All animals were placed on VLP2000E after achieving return of spontaneous circulation (ROSC)., Results: Bag-valve and VLP2000E groups had similar ROSC rate (60% vs. 50%, respectively) and arterial oxygen saturation in most CPR cycles, different baseline tidal volume [0.764 (0.068) vs. 0.591 (0.123) L, p = 0.0309, respectively] and, in 14 cycles, different PIP [52 (9) vs. 39 (5) cm H2O, respectively], tidal volume [0.635 (0.172) vs. 0.306 (0.129) L], ETCO2[14 (8) vs. 27 (9) mm Hg], and peak inspiratory flow [0.878 (0.234) vs. 0.533 (0.105) L/s], all p < 0.0001. Dynamic lung compliance (≥ 0.025 L/cm H2O) decreased after ROSC in bag-valve group but was maintained in VLP2000E group [0.019 (0.006) vs. 0.024 (0.008) L/cm H2O, p = 0.0003]., Conclusions: VLP2000E ventilation during CPR is feasible and equivalent to bag-valve ventilation in ROSC rate and arterial oxygen saturation. It produces better respiratory parameters, with lower airway pressure and tidal volume. VLP2000E ventilation also prevents the significant decrease of dynamic lung compliance observed after bag-valve ventilation. Further preclinical studies confirming these findings would be interesting.
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- 2023
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17. Effects of Chest Compression on Ventilation Quality during Cardiopulmonary Resuscitation.
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Ding B, Pan C, Pang J, Wang J, Li K, Xu F, and Chen Y
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- Humans, Animals, Swine, Respiration, Artificial, Ventilators, Mechanical, Tidal Volume, Cardiopulmonary Resuscitation
- Abstract
Ventilation is an important part of cardiopulmonary resuscitation (CPR). The advanced airway mode and 30:2 mode are used for intubated and non-intubated patients, respectively. It is debatable that passive produced by 30 compressions can provide adequate tidal volume for 30:2 mode. In addition, the fragmented ventilation caused by continuous compression may result in ineffective ventilation. In the study, one pig was anaesthetized and intubated for 2 CPRs. Continuous chest compressions with ventilation and continuous chest compressions without mechanical ventilation were performed in 2 CPRs, respectively. Three 10-minute data segments including a period of normal ventilation (V segment), a period of only compressions without ventilation (C segment), and a period of compressions with ventilation (C-V segment) were used to analyze peek flow (PF), peek pressure (PP) and tidal volume. All the data was presented as mean ± standard deviation. Chest compression resulted in 14.90% increase in mean PP (2401.40 ± 94.75 Pa vs 2822.06 ± 291.10 Pa, p<0.05), 81.46% increase in average PF (319.58 ± 56.93 ml/s vs 579.92 ± 80.27 ml/s, p<0.05). The mean tidal volumes for C segment, V segment and C-V segment were 189.13 ml, 514.72 ml, and 429.26ml, respectively. Continuous compressions reduced the accumulative tidal volume, but when five compressions were made in one inspiratory phase, there is almost no loss of tidal volume (510.86 ± 47.24 ml vs 514.72 ± 29.25 ml, p<0.05). The study suggested the ventilator without feedback regulation might reduce the peek pressure during CPR and 5 compressions in 2 s inspiratory phase provided higher tidal volume.Clinical Relevance- This study shows that 150 chest compressions per minute provided greater tidal volume than 100 and 120 compressions per minute; continuous chest compressions could also provide a certain amount of oxygen supply.
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- 2023
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18. Comment on: Association between prehospital airway type and oxygenation and ventilation in out-of-hospital cardiac arrest.
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Jouffroy R and Vivien B
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- Humans, Respiration, Artificial, Airway Management, Out-of-Hospital Cardiac Arrest therapy, Cardiopulmonary Resuscitation, Emergency Medical Services
- Abstract
Competing Interests: Declaration of Competing Interest RJ and BV have no conflicts of interest to declare.
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- 2023
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19. Mechanical ventilation with ten versus twenty breaths per minute during cardio-pulmonary resuscitation for out-of-hospital cardiac arrest: A randomised controlled trial.
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Prause G, Zoidl P, Eichinger M, Eichlseder M, Orlob S, Ruhdorfer F, Honnef G, Metnitz PGH, and Zajic P
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- Adult, Humans, Respiration, Artificial, Positive-Pressure Respiration, Pressure, Out-of-Hospital Cardiac Arrest therapy, Cardiopulmonary Resuscitation
- Abstract
Aim of the Study: This study sought to assess the effects of increasing the ventilatory rate from 10 min
-1 to 20 min-1 using a mechanical ventilator during cardio-pulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) on ventilation, acid-base-status, and outcomes., Methods: This was a randomised, controlled, single-centre trial in adult patients receiving CPR including advanced airway management and mechanical ventilation offered by staff of a prehospital physician response unit (PRU). Ventilation was conducted using a turbine-driven ventilator (volume-controlled ventilation, tidal volume 6 ml per kg of ideal body weight, positive end-expiratory pressure (PEEP) 0 mmHg, inspiratory oxygen fraction (FiO2 ) 100%), frequency was pre-set at either 10 or 20 breaths per minute according to week of randomisation. If possible, an arterial line was placed and blood gas analysis was performed., Results: The study was terminated early due to slow recruitment. 46 patients (23 per group) were included. Patients in the 20 min-1 group received higher expiratory minute volumes [8.8 (6.8-9.9) vs. 4.9 (4.2-5.7) litres, p < 0.001] without higher mean airway pressures [11.6 (9.8-13.6) vs. 9.8 (8.5-12.0) mmHg, p = 0.496] or peak airway pressures [42.5 (36.5-45.9) vs. 41.4 (32.2-51.7) mmHg, p = 0.895]. Rates of ROSC [12 of 23 (52%) vs. 11 of 23 (48%), p = 0.768], median pH [6.83 (6.65-7.05) vs. 6.89 (6.80-6.97), p = 0.913], and median pCO2 [78 (51-105) vs. 86 (73-107) mmHg, p > 0.999] did not differ between groups., Conclusion: 20 instead of 10 mechanical ventilations during CPR increase ventilation volumes per minute, but do not improve CO2 washout, acidaemia, oxygenation, or rate of ROSC., Clinicaltrials: gov Identifier: NCT04657393., (Copyright © 2023 Elsevier B.V. All rights reserved.)- Published
- 2023
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20. Mechanical ventilation during cardiopulmonary resuscitation: influence of positive end-expiratory pressure and head-torso elevation.
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Segond N, Terzi N, Duhem H, Bellier A, Aygalin M, Fuste L, Viglino D, Fontecave-Jallon J, Lurie K, Guérin C, and Debaty G
- Subjects
- Humans, Positive-Pressure Respiration, Lung, Tidal Volume, Thorax, Respiration, Artificial, Cardiopulmonary Resuscitation
- Abstract
Background: Efficient ventilation is important during cardiopulmonary resuscitation (CPR). Nevertheless, there is insufficient knowledge on how the patient's position affects ventilatory parameters during mechanically assisted CPR. We studied ventilatory parameters at different positive end-expiratory pressure (PEEP) levels and when using an inspiratory impedance valve (ITD) during horizontal and head-up CPR (HUP-CPR)., Methods: In this human cadaver experimental study, we measured tidal volume (V
T ) and pressure during CPR at different randomized PEEP levels (0, 5 or 10 cmH2 O) or with an ITD. CPR was performed, in the following order: horizontal (FLAT), at 18° and then at 35° head-thorax elevation. During the inspiratory phase we measured the net tidal volume (VT ) adjusted to predicted body weight (VT PBW), reversed airflow (RAF), and maximum and minimum airway pressure (Pmax and Pmin )., Results: Using ten thawed fresh-frozen cadavers we analyzed the inspiratory phase of 1843 respiratory cycles, 229 without CPR and 1614 with CPR. In a mixed linear model, thoracic position and PEEP significantly impacted VT PBW (p < 0.001 for each), and the insufflation time, thoracic position and PEEP significantly affected the RAF (p < 0.001 for each) and Pmax (p < 0.001). For Pmin , only PEEP was significant (p < 0.001). In subgroup analysis, at 35° VT PBW and Pmax were significantly reduced compared with the flat or 18° position., Conclusion: When using mechanical ventilation during CPR, it seems that the PEEP level and patient position are important determinants of respiratory parameters. Moreover, tidal volume seems to be lower when the thorax is positioned at 35°., (Copyright © 2022 Elsevier B.V. All rights reserved.)- Published
- 2023
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21. Association between prehospital airway type and oxygenation and ventilation in out-of-hospital cardiac arrest.
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Song SR, Kim KH, Park JH, Song KJ, and Shin SD
- Subjects
- Humans, Intubation, Intratracheal, Airway Management, Respiration, Artificial, Out-of-Hospital Cardiac Arrest therapy, Emergency Medical Services, Cardiopulmonary Resuscitation
- Abstract
Objectives: This study aimed to evaluate the association between prehospital airway type and oxygenation and ventilation in out-of-hospital cardiac arrest (OHCA)., Methods: This retrospective observational study included OHCA patients who visited the emergency departments (EDs) between October 2015 and June 2021. The study groups were categorized according to the prehospital airway type: endotracheal intubation (ETI), supraglottic airway (SGA), or bag-valve-mask ventilation (BVM). The primary outcome was good oxygenation: partial pressure of oxygen (PaO2) ≥ 60 mmHg on the first arterial blood gas (ABG) test. The secondary outcome was good ventilation: partial pressure of carbon dioxide (PaCO2) ≤ 45 mmHg. Multivariate logistic regression was conducted to calculate the adjusted odds ratio (AOR) and 95% confidence interval (CI)., Results: A total of 7,372 patients were enrolled during the study period: 1,819 patients treated with BVM, 706 with ETI, and 4,847 who underwent SGA. In multivariable logistic regression analysis for good oxygenation outcomes, the ETI group showed a higher AOR than the BVM group (AOR [95% CIs]: 1.30 [1.06-1.59] in ETI and 1.05 [0.93-1.20] in SGA groups). Regarding good ventilation, the ETI group showed a higher AOR, and the SGA group showed a lower AOR compared to the BVM group (AOR [95% CIs] 1.33 [1.02-1.74] in the ETI and 0.83 (0.70-0.99) in the SGA groups). There was no significant difference in survival to discharge., Conclusions: ETI was significantly associated with good oxygenation and good ventilation compared to BVM in patients with OHCA, particularly during longer transports. This should be taken into consideration when deciding the prehospital advanced airway management in patients with OHCA., Competing Interests: Declaration of Competing Interest No authors have other relationships, conditions, or circumstances that present potential conflicts of interest., (Copyright © 2022 Elsevier Inc. All rights reserved.)
- Published
- 2023
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22. Prevalence, Management, and Outcomes Related to Preoperative Medical Orders for Life Sustaining Treatment (MOLST) in an Adult Surgical Population: Preoperative MOLST and Code Status Discussions.
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Tanious M, Lindvall C, Cooper Z, Tukan N, Peters S, Streid J, Fields K, and Bader A
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- Humans, Adult, Prevalence, Retrospective Studies, Respiration, Artificial, Boston, Cardiopulmonary Resuscitation
- Abstract
Objective: To determine prevalence of documented preoperative code status discussions and postoperative outcomes (specifically mortality, readmission, and discharge disposition) of patients with completed MOLST forms before surgery., Summary of Background Data: A MOLST form documents patient care preference regarding treatment limitations. When considering surgery in these patients, preoperative discussion is necessary to ensure concordance of care. Little is known about prevalence of these discussions and postoperative outcomes., Methods: A retrospective cohort study was conducted consisting of all patients having surgery during a 1-year period at a tertiary care academic center in Boston, Massachusetts., Results: Among 21,787 surgical patients meeting inclusion criteria, 402 (1.8%) patients had preoperative MOLST. Within the MOLST, 224 (55.7%) patients had chosen to limit cardiopulmonary resuscitation and 214 (53.2%) had chosen to limit intubation and mechanical ventilation. Code status discussion was documented presurgery in 169 (42.0%) patients with MOLST. Surgery was elective or nonurgent for 362 (90%), and median length of stay (Q1, Q3) was 5.1 days (1.9, 9.9). The minority of patients with preoperative MOLST were discharged home [169 (42%), and 103 (25.6%) patients were readmitted within 30 days. Patients with preoperative MOLST had a 30-day mortality of 9.2% (37 patients) and cumulative 90-day mortality of 14.9% (60 patients)., Conclusions: Fewer than half of surgical patients with preoperative MOLST have documented code status discussions before surgery. Given their high risk of postoperative mortality and the diversity of preferences found in MOLST, thoughtful discussion before surgery is critical to ensure concordant perioperative care., Competing Interests: The authors report no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2023
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23. Manual vs. mechanical ventilation in patients with advanced airway during CPR.
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Senthilnathan M, Ravi R, Suganya S, and Kumar Sivakumar R
- Subjects
- Adult, Humans, Respiration, Artificial, Pressure, Cardiopulmonary Resuscitation, Heart Arrest therapy
- Abstract
Early chest compressions and rapid defibrillation are important components of cardiopulmonary resuscitation (CPR). American heart association (AHA) recommends two breaths to be delivered for every 30 compressions for an adult cardiac arrest victim. Patient with an advanced airway like endotracheal tube (ETT) should be given one breath every 6 s without interruptions in chest compression (10 breaths per minute). All of the modern mechanical ventilators have option to generate spontaneous breaths by the patient if the patient has spontaneous respiratory efforts. During CPR, the mechanical ventilator is fallaciously sensing the chest compressions as patient's spontaneous trigger and thereby it delivers higher respiratory rates. Avoiding excessive ventilation is one of the components of high quality CPR as excessive ventilation decreases venous return thereby decreasing the cardiac output and also it affects intra-thoracic pressure thereby adversely affects intra-arterial pressure. As modern ventilators have trigger for spontaneous breaths and they will be erroneously triggered by chest compressions, it would be prudent to use volume marked resuscitation bags or manual breathing devices (manual self-inflating resuscitation bag, Bain's circuit) for delivering breaths which can be synchronised with compression phase of CPR at RR of 10 breaths per min with advanced airway in place. If any patient who is on mechanical ventilation develops cardiac arrest, patient should be disconnected from the mechanical ventilator and should be ventilated manually. Manual ventilation with aforementioned breathing devices should be used in a patient without and with advanced airway devices during CPR., Competing Interests: Declaration of competing interest None., (Copyright © 2022 Cardiological Society of India. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved.)
- Published
- 2022
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24. Investigating the Airway Opening Index during cardiopulmonary resuscitation.
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Bhandari S, Coult J, Counts CR, Bulger NE, Kwok H, Latimer AJ, Sayre MR, Rea TD, and Johnson NJ
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- Capnography methods, Carbon Dioxide, Humans, Retrospective Studies, Cardiopulmonary Resuscitation methods, Out-of-Hospital Cardiac Arrest therapy
- Abstract
Introduction: Chest compressions during CPR induce oscillations in capnography (E
T CO2 ) waveforms. Studies suggest ET CO2 oscillation characteristics are associated with intrathoracic airflow dependent on airway patency. Oscillations can be quantified by the Airway Opening Index (AOI). We sought to evaluate multiple methods of computing AOI and their association with return of spontaneous circulation (ROSC)., Methods: We conducted a retrospective study of 307 out-of-hospital cardiac arrest (OHCA) cases in Seattle, WA during 2019. ET CO2 and chest impedance waveforms were annotated for the presence of intubation and CPR. We developed four methods for computing AOI based on peak ET CO2 and the oscillations in ET CO2 during chest compressions (ΔET CO2 ). We examined the feasibility of automating ΔET CO2 and AOI calculation and evaluated differences in AOI across the methods using nonparametric testing (α = 0.05)., Results: Median [interquartile range] AOI across all cases using Methods 1-4 was 28.0 % [17.9-45.5 %], 20.6 % [13.0-36.6 %], 18.3 % [11.4-30.4 %], and 22.4 % [12.8-38.5 %], respectively (p < 0.001). Cases with ROSC had a higher median AOI than those without ROSC across all methods, though not statistically significant. Cases with ROSC had a significantly higher median [interquartile range] ΔET CO2 of 7.3 mmHg [4.5-13.6 mmHg] compared to those without ROSC (4.8 mmHg [2.6-9.1 mmHg], p < 0.001)., Conclusion: We calculated AOI using four proposed methods resulting in significantly different AOI. Additionally, AOI and ΔET CO2 were larger in cases achieving ROSC. Further investigation is required to characterize AOI's ability to predict OHCA outcomes, and whether this information can improve resuscitation care., Competing Interests: Conflicts of Interest NJJ receives funding from the National Institutes of Health, the Centers for Disease Control and Prevention, and University of Washington Royalty Research Fund and serves on the Scientific Advisory Board for Opticyte, LLC. JC receives funding by a grant provided to the University of Washington by the Washington Research Foundation. HK, MRS, and TDR receive funding provided to the University of Washington by the American Heart Association Strategically Focused Research Network on Arrhythmias and Sudden Cardiac Death., (Published by Elsevier B.V.)- Published
- 2022
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25. Neonatal simulation training decreases the incidence of chest compressions in term newborns.
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Schwindt EM, Stockenhuber R, Kainz T, Stumptner N, Henkel M, Hefler L, and Schwindt JC
- Subjects
- Humans, Incidence, Infant, Newborn, Respiration, Artificial, Resuscitation education, Retrospective Studies, Cardiopulmonary Resuscitation methods, Simulation Training
- Abstract
Aim of the Study: To determine the effectiveness of a multidimensional neonatal simulation-based medical education training programme on direct and indirect patient outcome parameters., Methods: This was a retrospective analytical study with a historical control group in a level II neonatal care unit (1,700 births per year). A multidimensional interdisciplinary training programme on neonatal resuscitation was implemented in 2015; pre-training (2012-2014) and post-training (2015-2019) eras were compared in terms of mortality (direct outcome) and the received intervention level immediately after birth (indirect outcome). Intervention levels were defined as follows: A) short-term non-invasive ventilation, B) prolonged non-invasive ventilation (>5 inflation breaths), C) chest compressions., Results: Of 13,950 neonates born during the study period, 826 full-term newborns received one of the three intervention levels for adaptation after birth. A total of 284 (34.4%) patients received short-term non-invasive ventilation (A), 477 (57.8%) had prolonged ventilation (B), and 65 (7.9%) chest compressions (C), respectively. Comparing the pre- and post-training eras, there was no significant reduction in mortality, and no significant changes were found in groups A or B. However, the risk for chest compressions (group C) decreased significantly from 0.91% in the pre-training era to 0.20% in the post-training era (p < 0.001)., Conclusion: Although there was no significant effect on neonatal mortality, regular interdisciplinary simulation training decreased the number of administered chest compressions immediately after birth. Further studies are needed to test indirect outcome-related parameters, such as frequency of chest compressions as a measure of effectiveness and impact of medical training., Competing Interests: Declaration of Competing Interest ES is a neonatal consultant at the Medical University Vienna and managing partner/CEO of SIMCharacters Training GmbH (Austria), a company providing medical simulation training in German-speaking countries. JS is managing director of SIMCharacters GmbH and SIMCharacters Training GmbH (Austria). The training sessions analysed in this study were ordered from SIMCharacters Training GmbH by the Paediatric Department and conducted against payment. There is no other financial or related benefit in relation to this manuscript. The other authors declare that they have no known competing interests., (Copyright © 2022 Elsevier B.V. All rights reserved.)
- Published
- 2022
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26. 6-Year-Old Male Drowning Complicated by Cardiac Arrest and Ensuing Metabolic and Respiratory Acidosis: Should Presence of Pulses Lead Clinicians to Pursue Prolonged Cardiopulmonary Resuscitation?
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Livshits D, George M, Sokup B, Jeong J, Patel N, and Kindschuh M
- Subjects
- Male, Child, Humans, Respiration, Artificial, Drowning, Acidosis, Respiratory, Cardiopulmonary Resuscitation methods, Heart Arrest etiology, Heart Arrest therapy
- Abstract
Background: Drowning is one of the leading causes of death in the pediatric population. Patients arriving to the emergency department (ED) with submersion injuries are often asymptomatic and well-appearing, but can sometimes present critically ill and require prolonged resuscitation. The question of how long to continue resuscitation of a pediatric patient with a submersion injury is a difficult question to answer., Case Report: We present a case of 6-year-old boy was found by his friends submerged in sea water for 10-15 min. The patient was rescued by lifeguards and evaluated by emergency medical personnel, who found him breathing spontaneously but unresponsive. En route to hospital, the patient became apneic, cardiopulmonary resuscitation (CPR) was started, and the patient was intubated. The patient arrived to the ED in cardiopulmonary arrest, CPR was continued and epinephrine was administered. Return of spontaneous circulation was achieved after 42 min in the ED. Initial laboratory test results showed severe acidosis and chest x-ray study showed diffuse interstitial edema. Ventilator settings were adjusted in accordance with lung protective ventilation strategies and the acidosis began to improve. Over the next several days, the patient was weaned to noninvasive ventilation modalities and eventually made a complete neurologic recovery and continued to be a straight-A student. Why Should an Emergency Physician Be Aware of This?We make the case that, in select drowning patients, duration of CPR longer than 30 min can potentially result in favorable neurologic outcomes. Prolonged CPR should be especially strongly considered in patients with a pulse at any point during evaluation. With the combination of prolonged CPR and judicious use of lung protective mechanical ventilation strategies, we were able to successfully treat the patient in our case., (Copyright © 2022 Elsevier Inc. All rights reserved.)
- Published
- 2022
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27. The importance of measuring ventilation during resuscitation.
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Idris AH
- Subjects
- Humans, Respiration, Respiration, Artificial, Cardiopulmonary Resuscitation, Resuscitation
- Published
- 2022
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28. A pilot evaluation of respiratory mechanics during prehospital manual ventilation.
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Yang BY, Blackwood JE, Shin J, Guan S, Gao M, Jorgenson DB, Boehl JE, Sayre MR, Kudenchuk PJ, Rea TD, Kwok H, and Johnson NJ
- Subjects
- Humans, Pilot Projects, Prospective Studies, Respiration, Artificial, Respiratory Mechanics, Tidal Volume, Cardiopulmonary Resuscitation, Emergency Medical Services, Heart Arrest
- Abstract
Introduction: Respiratory mechanics, such as tidal volume (V
T ) and inspiratory pressures, may affect outcome in hospitalized patients with respiratory failure. Little is known about respiratory mechanics in the prehospital setting., Methods: In this prospective, pilot investigation of patients receiving prehospital advanced airway placement, paramedics applied a device to measure respiratory mechanics. We evaluated tidal volume (VT ) per predicted body weight (VT PBW) to determine the proportion of breaths within the lung-protective range of 4-10 mL/kg per PBW overall, according to ventilation bag volume (large versus small) and cardiac arrest status (active CPR, post-ROSC, non-arrest)., Results: Over 16-months, 7371 post-intubation breaths were measured in 54 patients, 32 patients with cardiac arrest and 22 with other conditions. Paramedics ventilated 19 patients with a small bag and 35 patients with a large bag. Overall, mean VT was 435 mL (95% CI 403, 467); VT PBW was 7.0 mL/kg (95% CI 6.4, 7.6) with 75% within the lung-protective range. Mean VT PBW and peak pressure differed according to arrest status (absolute difference -0.36 mL/kg and 32 cmH2 O for active CPR compared to post-ROSC), though not according to bag size., Conclusions: We observed that measuring respiratory mechanics in the prehospital setting was feasible. Tidal volumes were generally delivered within a safe range. Respiratory mechanics varied most significantly with active CPR with lower VT PBW and higher peak pressures, though did not seem to be affected by bag size. Future work might examine the relationship between respiratory mechanics and outcomes, which may identify opportunities to improve clinical outcomes., (Copyright © 2022 Elsevier B.V. All rights reserved.)- Published
- 2022
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29. Outcome of cardiopulmonary resuscitation with different ventilation modes in adults: A meta-analysis.
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Tang Y, Sun M, and Zhu A
- Subjects
- Adult, Airway Management methods, Humans, Intubation, Intratracheal methods, Respiration, Artificial, Cardiopulmonary Resuscitation methods, Emergency Medical Services methods, Out-of-Hospital Cardiac Arrest
- Abstract
Background: The optimal airway management strategy for cardiac arrest remains unclear. This study aimed to compare the effects of different initial airway interventions on improving clinical outcomes based on the 2010 cardiopulmonary resuscitation (CPR) guidelines and later., Methods: We searched PubMed, EMBASE, and the Cochrane Library for CPR articles tailored to each database from October 19, 2010, to July 31, 2021, to compare endotracheal intubation (ETI), supraglottic airway (SGA), or bag-valve-mask ventilation (BMV). The initial results and long-term results were investigated by meta-analysis., Results: Twenty-five articles (n = 196,486) were included. The ROSC rate in the ETI group (ES = 0.49, 95% CI: 0.38-0.59) was significantly higher than that in the SGA group (ES = 0.27, 95% CI: 0.20-0.34) and BMV group (ES = 0.24, 95% CI: 0.17-0.31). The rate of ROSC upon admission to the hospital in the ETI group (ES = 0.27, 95% CI: 0.13-0.42) was significantly higher than that in the SGA group (ES = 0.18, 95% CI: 0.13-0.23) and BMV group (ES = 0.16, 95% CI: 0.10-0.22). Compared with the BMV group (ES = 0.09, 95% CI: 0.04-0.14) and the SGA group (ES = 0.08, 95% CI: 0.05-0.10), the ETI group (ES = 0.14, 95% CI: 0.10-0.17) had a higher discharge rate, but all of the groups had the same neurological outcome (ETI group [ES = 0.06, 95% CI: 0.04-0.08], BMV group [ES = 0.05, 95% CI: 0.03-0.08] and SGA group [ES = 0.04, 95% CI: 0.03-0.05])., Conclusions: Opening the airway is significantly associated with improved clinical outcomes, and the findings suggest that effective ETI based on mask ventilation should be implemented as early as possible once the patient has experienced cardiac arrest., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Inc. All rights reserved.)
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- 2022
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30. The impact of standardised goals of care documentation on the use of cardiopulmonary resuscitation, mechanical ventilation, and intensive care unit admissions in older patients: a retrospective observational analysis.
- Author
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Dignam C, Brown M, Horwood C, and Thompson CH
- Subjects
- Aged, Aged, 80 and over, Australia, Documentation, Hospitalization, Humans, Intensive Care Units, Patient Care Planning, Resuscitation Orders, Retrospective Studies, Cardiopulmonary Resuscitation, Respiration, Artificial
- Abstract
Background In South Australian hospitals, 'Do Not Resuscitate' orders have been replaced by '7-Step Pathway Acute Resuscitation Plans', a standardised form and approach that encourages shared decision-making while providing staff with clarity about goals of care. This initiative has led to increased rates of documentation about treatment preferences, including 'Not-For-Cardiopulmonary Resuscitation'. Aim To quantify any effect of the 7-Step Pathway form versus previous 'Do Not Resuscitate' orders on cardiopulmonary resuscitation, mechanical ventilation, and/or intensive care unit admission during hospitalisation. Methods We completed a retrospective, observational study in two Australian tertiary hospitals using interrupted time-series analysis. We examined the number of medical inpatients aged 70 years and over who received one or more Intensive Treatments-cardiopulmonary resuscitation, mechanical ventilation, or intensive care unit admission-in the 2 years before and 2 years after the introduction of the form. Results There were 2759 Intensive Treatments across 66 051 inpatient admissions; 1304/32 489 (4.0%) pre-intervention and 1455/33 562 post-intervention (4.3%). Sub-group analysis of those who died in hospital showed 400/1669 (24%) received Intensive Treatments pre-intervention and 382/1624 post-intervention (24%). Interrupted time-series analysis suggested that the intervention did not significantly alter Intensive Treatments over time at Hospital 1 and was associated with a significant slowing of the already decreasing use of Intensive Treatments at Hospital 2. Among patients who died in hospital, there was minimal change at either site. Conclusions There was no reduction in Intensive Treatments in older medical inpatients following the introduction of standardised goals of care documentation.
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- 2022
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31. Gastric Perforation Secondary to Bag-Valve Mask Ventilation Following Opioid Overdose.
- Author
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Vemuru SR, Stettler GR, Betz ME, and Ferrigno L
- Subjects
- Humans, Manikins, Masks, Respiration, Artificial, Cardiopulmonary Resuscitation, Opiate Overdose
- Published
- 2022
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32. Death After Crevasse Rescue in Antarctica.
- Author
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Giesbrecht GG and Brock JR
- Subjects
- Antarctic Regions, Cold Temperature, Humans, Male, Respiration, Artificial, Cardiopulmonary Resuscitation, Hypothermia therapy
- Abstract
We present a case report of a helicopter pilot who fell into a crevasse during a fuel delivery in Antarctica. He was trapped alone in the crevasse for 3 h while waiting for a rescue team to arrive, and a further 1 h during the extrication process. His condition deteriorated during the extrication and he lost consciousness and signs of life minutes after being dragged over the lip of the crevasse. He was then loaded into the rescue helicopter and treated with intermittent cardiopulmonary resuscitation during the 39-min return flight. Initial esophageal temperature on arrival at the Davis Base medical facility was 24.2°C. After 18 h of further treatment (mechanical ventilation with warm humidified O
2 , with internal and external warming) he was pronounced dead. The cause of death was hypothermia with minimal physical injury. This case highlights some of the extra challenges facing operational, rescue, and medical personnel in an isolated location. These complications include the tendency for flight crew to remove cold weather clothing during flight due to restricted mobility and excessive heat load from cabin heating; extended time for arrival of the rescue crew; extrication in a confined space; limited helicopter cabin space for transporting the rescue team and their rescue and medical equipment; and extended transport time to the nearest medical facility., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)- Published
- 2022
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33. The association of modifiable mechanical ventilation settings, blood gas changes and survival on extracorporeal membrane oxygenation for cardiac arrest.
- Author
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Tonna JE, Selzman CH, Bartos JA, Presson AP, Ou Z, Jo Y, Becker LB, Youngquist ST, Thiagarajan RR, Austin Johnson M, Cho SM, Rycus P, and Keenan HT
- Subjects
- Adult, Humans, Prospective Studies, Respiration, Artificial, Retrospective Studies, Cardiopulmonary Resuscitation, Extracorporeal Membrane Oxygenation, Heart Arrest therapy
- Abstract
Research Question: Given the relative independence of ventilator settings from gas exchange and plasticity of blood gas values during extracorporeal cardiopulmonary resuscitation (ECPR), do mechanical ventilation parameters and blood gas values influence survival?, Methods: Observational cohort study of 7488 adult patients with ECPR from the Extracorporeal Life Support Organization (ELSO) Registry. We performed case-mix adjustment for severity of illness and patient type using generalized estimating equation logistic regression to determine factors associated with hospital survival accounting for clustering by center, standardizing variables by 1 standard deviation (SD) of their values. We examined non-linear relationships between ventilatory and blood gas values with hospital survival., Results: Hospital survival was decreased with higher PaO
2 on ECMO (OR 0.69, per 1SD increase [95% CI 0.64, 0.74]; p < 0.001) and with any relative changes in PaCO2 (pre-arrest to on-ECMO) in a non-linear fashion. Survival was worsened with any peak inspiratory pressure >20 cmH2 0 (OR 0.69, per 1SD [0.64, 0.75]; p < 0.001) and above 40% fraction of inspired oxygen (OR 0.75, per 1SD [0.69, 0.82]; p < 0.001), and with higher dynamic driving pressure (OR 0.72, per 1 SD increase [0.65, 0.79]; <0.001). Ventilation settings and blood gas values varied widely across hospitals, but were not associated with annual hospital ECPR case volume., Conclusion: Lower ventilatory pressures, avoidance of hyperoxia, and relatively unchanged CO2 (pre- to on-ECMO) were all associated with survival in patients after ECPR, yet varied across hospitals. Our findings represent potential targets for prospective trials for this rapidly growing therapy to test if these associations have causality., (Copyright © 2022 Elsevier B.V. All rights reserved.)- Published
- 2022
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34. Continuous chest compressions with asynchronous ventilations increase carotid blood flow in the perinatal asphyxiated lamb model.
- Author
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Vali P, Lesneski A, Hardie M, Alhassen Z, Chen P, Joudi H, Sankaran D, and Lakshminrusimha S
- Subjects
- Animals, Animals, Newborn, Blood Gas Analysis, Blood Pressure, Disease Models, Animal, Humans, Infant, Newborn, Sheep, Asphyxia Neonatorum physiopathology, Cardiopulmonary Resuscitation methods, Carotid Arteries physiopathology, Regional Blood Flow, Respiration, Artificial
- Abstract
Background: The neonatal resuscitation program (NRP) recommends interrupted chest compressions (CCs) with ventilation in the severely bradycardic neonate. The conventional 3:1 compression-to-ventilation (C:V) resuscitation provides 90 CCs/min, significantly lower than the intrinsic newborn heart rate (120-160 beats/min). Continuous CC with asynchronous ventilation (CCCaV) may improve the success of return of spontaneous circulation (ROSC)., Methods: Twenty-two near-term fetal lambs were randomized to interrupted 3:1 C:V (90 CCs + 30 breaths/min) or CCCaV (120 CCs + 30 breaths/min). Asphyxiation was induced by cord occlusion. After 5 min of asystole, resuscitation began following NRP guidelines. The first dose of epinephrine was given at 6 min. Invasive arterial blood pressure and left carotid blood flow were continuously measured. Serial arterial blood gases were collected., Results: Baseline characteristics between groups were similar. Rate of and time to ROSC was similar between groups. CCCaV was associated with a higher PaO
2 (partial oxygen tension) (22 ± 5.3 vs. 15 ± 3.5 mmHg, p < 0.01), greater left carotid blood flow (7.5 ± 3.1 vs. 4.3 ± 2.6 mL/kg/min, p < 0.01) and oxygen delivery (0.40 ± 0.15 vs. 0.13 ± 0.07 mL O2 /kg/min, p < 0.01) compared to 3:1 C:V., Conclusions: In a perinatal asphyxiated cardiac arrest lamb model, CCCaV showed greater carotid blood flow and cerebral oxygen delivery compared to 3:1 C:V resuscitation., Impact: In a perinatal asphyxiated cardiac arrest lamb model, CCCaV improved carotid blood flow and oxygen delivery to the brain compared to the conventional 3:1 C:V resuscitation. Pre-clinical studies assessing neurodevelopmental outcomes and tissue injury comparing continuous uninterrupted chest compressions to the current recommended 3:1 C:V during newborn resuscitation are warranted prior to clinical trials., (© 2021. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)- Published
- 2021
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35. Modified Two-Rescuer CPR With a Two-Handed Mask-Face Seal Technique Is Superior To Conventional Two-Rescuer CPR With a One-Handed Mask-Face Seal Technique.
- Author
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Gerber L, Botha M, and Laher AE
- Subjects
- Hand, Humans, Pressure, Respiration, Artificial, Cardiopulmonary Resuscitation, Manikins
- Abstract
Background: Bag-valve-mask (BVM) ventilation using a two-handed mask-face seal has been shown to be superior to a one-handed mask-face seal during cardiopulmonary resuscitation (CPR)., Objective: We aimed to compare CPR quality metrics during simulation-based two-rescuer CPR with a modified two-handed mask-face seal technique and two-rescuer CPR with the conventional one-handed mask-face seal technique., Methods: Participants performed two-rescuer CPR on a simulation manakin and alternated between the modified and conventional CPR methods. For the modified method, the first rescuer performed chest compressions and thereafter squeezed the BVM resuscitator bag during the ventilatory pause, while the second rescuer created a two-handed mask-face seal. For the conventional method, the first rescuer performed chest compressions and the second rescuer thereafter delivered rescue breaths by creating a mask-face seal with one hand and squeezing the BVM resuscitator bag with the other hand., Results: Among the 40 participants that were enrolled, the mean ± standard deviation (SD) delivered respiratory volume was significantly higher for the modified two-rescuer method (319.4 ± 71.4 mL vs. 190.2 ± 50.5 mL; p < 0.0001). There were no statistically significant differences between the two methods with regard to mean ± SD compression rate (117.05 ± 9.67 compressions/min vs. 118.08 ± 10.99 compressions/min; p = 0.477), compression depth (52.80 ± 5.57 mm vs. 52.77 ± 6.77 mm; p = 0.980), chest compression fraction (75.92% ± 2.14% vs. 76.57% ± 2.57%; p = 0.186), and ventilatory pause time (4.62 ± 0.64 s vs. 4.56 ± 0.43 s; p = 0.288)., Conclusions: With minor modifications to the conventional method of simulated two-rescuer CPR, rescuers can deliver significantly higher volumes of rescue breaths without compromising the quality of chest compressions., (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Published
- 2021
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36. Comparison of volume-controlled, pressure-controlled, and chest compression-induced ventilation during cardiopulmonary resuscitation with an automated mechanical chest compression device: A randomized clinical pilot study.
- Author
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Fuest K, Dorfhuber F, Lorenz M, von Dincklage F, Mörgeli R, Kuhn KF, Jungwirth B, Kanz KG, Blobner M, and Schaller SJ
- Subjects
- Humans, Pilot Projects, Respiration, Artificial, Tidal Volume, Cardiopulmonary Resuscitation, Out-of-Hospital Cardiac Arrest therapy
- Abstract
Aim of the Study: Automated mechanical chest compression devices (AMCCDs) can help performing high-quality cardiopulmonary resuscitation (CPR). Guidelines for CPR are lacking information about the optimal ventilation mode during CPR using AMCCDs. Aim of this pilot study was to compare three common ventilation modes during CPR using AMCCD., Methods: In this randomized controlled trial, we included patients with an out-of-hospital cardiac arrest arriving at the resuscitation room receiving chest compressions via AMCCD with an expected continuation of at least 15 min. Patients were randomly assigned to three groups: biphasic positive airway pressure with assisted spontaneous ventilation (BIPAP) with assisted spontaneous breathing, continuous positive airway pressure (CPAP) and volume-controlled ventilation (VCV). Outcomes were tidal volume, respiratory minute volume, and end-tidal CO
2 during the study period. Groups were compared using generalized linear models. Data is given as median and interquartile ranges., Results: Of 53 screened patients, 30 were randomized. The tidal volume was significantly (p < 0.05) lower in patients of the CPAP group (68 [64-83] ml) compared with those of the BIPAP (349 [137-500] ml), while the respiratory minute volume differed between the CPAP group (6.2 [5.3-8.1] l/min) and both the BIPAP (7.1 [6.7-10.2] l/min) and VCV group (7.2 [3.7-8.4] l/min)., Conclusions: All ventilation modes achieved an adequate respiratory minute volume during CPR with an AMCCD. However, BIPAP seems to be superior due to the higher tidal volume. Therefore, we recommend starting mechanical ventilation when using AMCCD with BIPAP ventilation to avoid risks related to dead space ventilation., Competing Interests: Declaration of Competing Interest BJ received honoraria for giving lectures from Pulsion Medical Systems SE (Feldkirchen, Germany). MB received research support not related to this manuscript from MSD (Haar, Germany), honoraria for giving lectures from GE Healthcare (Helsinki, Finland) and Grünenthal (Aachen, Germany). SJ Schaller reports grants and non-financial support from ESICM (Brussels, Belgium), Fresenius (Germany), Liberate Medical LLC (Crestwood, USA), Reactive Robotics GmbH (Munich, Germany), STIMIT AG (Nidau, Switzerland) as well as from Technical University of Munich, Germany, from national (e.g. DGAI) and international (e.g. ESICM) medical societies (or their congress organizers) in the field of anaesthesiology and intensive care, all outside the submitted work; SJS holds stocks in small amounts from Alphabeth Inc., Bayer AG, Rhön-Klinikum AG, and Siemens AG. These did not have any influence on this study. The other authors declare that they have no conflict of interest., (Copyright © 2021 Elsevier B.V. All rights reserved.)- Published
- 2021
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37. "Hard and Fast" Resuscitation Guidelines May Need a Bit of "Breathing" Room.
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Kurz, Michael Christopher
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RESUSCITATION , *CARDIOPULMONARY resuscitation , *CARDIAC arrest , *RESPIRATION , *CARDIAC patients - Abstract
This article discusses the importance of resuscitation guidelines in improving outcomes for cardiac arrest patients. It highlights the evolution of these guidelines over time, with a shift towards prioritizing circulation through prompt cardiopulmonary resuscitation (CPR) over airway management. The article also presents findings from a study that used thoracic bioimpedance technology to measure the effectiveness of bag-valve-mask ventilation during resuscitation efforts. The study found that adequate ventilation was associated with higher rates of survival and favorable neurological outcomes. While the study has some limitations, it suggests that attention to each aspect of resuscitation, including ventilation, may be crucial in saving more lives. [Extracted from the article]
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- 2023
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38. Letter to the Editor in regard to the 'Effects of COVID-19 on in-hospital cardiac arrest: incidence, causes, and outcome' by Roedl et al.'
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Heather Newton, Jordan Duval-Arnould, Elizabeth Hunt, A. D. Krieg, and Bradford D. Winters
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Male ,medicine.medical_specialty ,Letter to the editor ,Coronavirus disease 2019 (COVID-19) ,Organ Dysfunction Scores ,Electric Countershock ,Critical Care and Intensive Care Medicine ,Outcome (game theory) ,Cohort Studies ,Corona virus disease ,Patient Admission ,Germany ,Medicine ,Humans ,Vasoconstrictor Agents ,Intensive care unit ,Letter to the Editor ,Pandemics ,Original Research ,Aged ,Retrospective Studies ,RC86-88.9 ,SARS-CoV-2 ,business.industry ,Incidence (epidemiology) ,Incidence ,COVID-19 ,Medical emergencies. Critical care. Intensive care. First aid ,Middle Aged ,Cardiac arrest ,Multiple organ failure ,Respiration, Artificial ,Hospitals ,Cardiopulmonary Resuscitation ,Drug Utilization ,Heart Arrest ,In-hospital cardiac arrest ,Emergency medicine ,Emergency Medicine ,Female ,business ,Respiratory Insufficiency - Abstract
Background Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), an emerging virus, has caused a global pandemic. Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has led to high hospitalization rates worldwide. Little is known about the occurrence of in-hospital cardiac arrest (IHCA) and high mortality rates have been proposed. The aim of this study was to investigate the incidence, characteristics and outcome of IHCA during the pandemic in comparison to an earlier period. Methods This was a retrospective analysis of data prospectively recorded during 3-month-periods 2019 and 2020 at the University Medical Centre Hamburg-Eppendorf (Germany). All consecutive adult patients with IHCA were included. Clinical parameters, neurological outcomes and organ failure/support were assessed. Results During the study period hospital admissions declined from 18,262 (2019) to 13,994 (2020) (− 23%). The IHCA incidence increased from 4.6 (2019: 84 IHCA cases) to 6.6 (2020: 93 IHCA cases)/1000 hospital admissions. Median stay before IHCA was 4 (1–9) days. Demographic characteristics were comparable in both periods. IHCA location shifted towards the ICU (56% vs 37%, p
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- 2021
39. Injury Characteristics and Hemodynamics Associated with Guideline-Compliant CPR in a Pediatric Porcine Cardiac Arrest Model
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Ericka L. Fink, Cornelia Genbrugge, Robert A. Berg, Allison C Koller, David D Salcido, and James J. Menegazzi
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Male ,Resuscitation ,Rib Fractures ,Thoracic Injuries ,Defibrillation ,Swine ,medicine.medical_treatment ,Hemodynamics ,Return of spontaneous circulation ,Article ,Asphyxia ,Random Allocation ,Intubation, Intratracheal ,Medicine ,Animals ,Cardiopulmonary resuscitation ,Mechanical ventilation ,Hemothorax ,business.industry ,General Medicine ,Guideline ,Respiration, Artificial ,Cardiopulmonary Resuscitation ,Advanced life support ,Heart Arrest ,Anesthesia ,Models, Animal ,Emergency Medicine ,Female ,business - Abstract
BACKGROUND: Guidelines for depth of chest compressions in pediatric cardiopulmonary resuscitation (CPR) are based on sparse evidence. OBJECTIVE: We sought to evaluate the performance of the two most widely recommended chest compression depth levels for pediatric CPR (1.5 inches and 1/3 the anterior-posterior diameter-APd) in a controlled swine model of asphyxial cardiac arrest. METHODS: We executed a 2-group, randomized laboratory study with an adaptive design allowing early termination for overwhelming injury or benefit. Forty mixed-breed domestic swine (mean weight = 26kg) were sedated, anesthetized and paralyzed along with endotracheal intubation and mechanical ventilation. Asphyxial cardiac arrest was induced with fentanyl overdose. Animals were untreated for 9 minutes followed by mechanical CPR with a target depth of 1.5 inches or 1/3 the APd. Advanced life support drugs were administered IV after 4 minutes of basic resuscitation followed by defibrillation at 14 minutes. The primary outcomes were return of spontaneous circulation (ROSC), hemodynamics and CPR-related injury severity. RESULTS: Enrollment in the 1/3 APd group was stopped early due to overwhelming differences in injury. Twenty-three animals were assigned to the 1.5 inch group and 15 assigned to the 1/3 APd group, per an adaptive group design. The 1/3 APd group had increased frequency of rib fracture (6.7 vs 1.7, p
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- 2021
40. Critically ill cancer patient's resuscitation: a Belgian/French societies' consensus conference
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Meert, Anne-Pascale, Wittnebel, Sebastian, Holbrechts, Stéphane, Toffart, Anne-Claire, Lafitte, Jean-Jacques, Piagnerelli, Michaël, Lemaitre, France, Peyrony, Olivier, Calvel, Laurent, Lemaitre, Jean, Canet, Emmanuel, Demoule, Alexandre, Darmon, Michael, Sculier, Jean-Paul, Voigt, Louis, Lemiale, Virginie, Pène, Frédéric, Schnell, David, Lengliné, Etienne, Berghmans, Thierry, Fiévet, Laurence, Jungels, Christiane, Wang, Xiaoxiao, Bold, Ionela, Pistone, Aureliano, Salaroli, Adriano, Grigoriu, Bogdan Dragos, Benoit, Dominique, and Critically ill cancer patients consensus conference group
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medicine.medical_specialty ,Resuscitation ,Critical Care ,Critical Illness ,Conference Reports and Expert Panel ,medicine.medical_treatment ,Context (language use) ,Critical Care and Intensive Care Medicine ,law.invention ,Belgium ,law ,Neoplasms ,Anesthesiology ,Intensive care ,medicine ,Humans ,Haematological ,Cardiopulmonary resuscitation ,Intensive care medicine ,Critically ill ,Cancer ,Mechanical ventilation ,business.industry ,Sciences bio-médicales et agricoles ,Respiration, Artificial ,Triage ,Intensive care unit ,Intensive Care Units ,ICU ,business ,Systematic Reviews as Topic - Abstract
To respond to the legitimate questions raised by the application of invasive methods of monitoring and life-support techniques in cancer patients admitted in the ICU, the European Lung Cancer Working Party and the Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique, set up a consensus conference. The methodology involved a systematic literature review, experts' opinion and a final consensus conference about nine predefined questions1. Which triage criteria, in terms of complications and considering the underlying neoplastic disease and possible therapeutic limitations, should be used to guide admission of cancer patient to intensive care units?2. Which ventilatory support [High Flow Oxygenation, Non-invasive Ventilation (NIV), Invasive Mechanical Ventilation (IMV), Extra-Corporeal Membrane Oxygenation (ECMO)] should be used, for which complications and in which environment?3. Which support should be used for extra-renal purification, in which conditions and environment?4. Which haemodynamic support should be used, for which complications, and in which environment?5. Which benefit of cardiopulmonary resuscitation in cancer patients and for which complications?6. Which intensive monitoring in the context of oncologic treatment (surgery, anti-cancer treatment …)?7. What specific considerations should be taken into account in the intensive care unit?8. Based on which criteria, in terms of benefit and complications and taking into account the neoplastic disease, patients hospitalized in an intensive care unit (or equivalent) should receive cellular elements derived from the blood (red blood cells, white blood cells and platelets)?9. Which training is required for critical care doctors in charge of cancer patients?, info:eu-repo/semantics/published
- Published
- 2021
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