scholarly journals Towards individualised treatment of out-of-hospital cardiac arrest patients: an update on technical innovations in the prehospital chain of survival

2021 ◽  
Author(s):  
J. Thannhauser ◽  
J. Nas ◽  
R. A. Waalewijn ◽  
N. van Royen ◽  
J. L. Bonnes ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Text Message ◽  
Critical Time ◽  
Second Phase ◽  
Technological Developments ◽  
Chain Of Survival ◽  
Technical Innovations ◽  
Hospital Cardiac Arrest

AbstractOut-of-hospital cardiac arrest (OHCA) is a major healthcare problem, with approximately 200 weekly cases in the Netherlands. Its critical, time-dependent nature makes it a unique medical situation, of which outcomes strongly rely on infrastructural factors and on-scene care by emergency medical services (EMS). Survival to hospital discharge is poor, although it has substantially improved, to roughly 25% over the last years. Recognised key factors, such as bystander resuscitation and automated external defibrillator use at the scene, have been markedly optimised with the introduction of technological innovations. In an era with ubiquitous smartphone use, the Dutch digital text message alert platform HartslagNu (www.hartslagnu.nl) increasingly contributes to timely care for OHCA victims. Guidelines emphasise the role of cardiac arrest recognition and early high-quality bystander resuscitation, which calls for education and improved registration at HartslagNu. As for EMS care, new technological developments with future potential are the selective use of mechanical chest compression devices and extracorporeal life support. As a future innovation, ‘smart’ defibrillators are under investigation, guiding resuscitative interventions based on ventricular fibrillation waveform characteristics. Taken together, optimisation of available prehospital technologies is crucial to further improve OHCA outcomes, with particular focus on more available trained volunteers in the first phase and additional research on advanced EMS care in the second phase.

Out-of-hospital cardiac arrest: role of percutaneous coronary intervention

2018 ◽  
pp. 351-360
Author(s):  
Peter Radsel ◽  
Marko Noc
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cardiac Arrest ◽  
Life Support ◽  
Significant Coronary Artery Disease ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Chain Of Survival ◽  
Artery Disease ◽  
A Chain ◽  
Hospital Cardiac Arrest

Out-of-hospital cardiac arrest (OHCA) remains the leading cause of death in developed countries, with an annual incidence from 36 to 81 events per 100,000. Prehospital treatment includes immediate recognition, bystander cardiopulmonary resuscitation, defibrillation, and advanced cardiac life support known as a ‘chain of survival’. Owing to improvements in the ‘chain of survival’, the proportion of patients with re-establishment of spontaneous circulation on the field may nowadays exceed 50%. This leads to increased hospital admission observed in communities with mature prehospital emergency services. According to autopsy and immediate coronary angiography (CAG), significant coronary artery disease may be documented in more than 70% of patients. Moreover, in the presence of ST-elevation myocardial infarction (STEMI) in post-resuscitation electrocardiogram, acute thrombotic lesions may be found in up to 90%. However, the absence of STEMI does not exclude obstructive or thrombotic coronary stenosis, which may be present in 25–58% of patients. Because of these findings, interventional cardiologists are increasingly alerted for immediate CAG and percutaneous coronary intervention in OHCA patients.

scholarly journals Early initiation of extracorporeal life support in refractory out-of-hospital cardiac arrest: Design and rationale of the INCEPTION trial

2019 ◽  
Vol 210 ◽  
pp. 58-68 ◽  
Author(s):  
Martine E. Bol ◽  
Martje M. Suverein ◽  
Roberto Lorusso ◽  
Thijs S.R. Delnoij ◽  
George J. Brandon Bravo Bruinsma ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Early Initiation ◽  
Hospital Cardiac Arrest

scholarly journals Strengthening Links in the “Chain of Survival”: A Singapore Perspective

2002 ◽  
Vol 9 (3) ◽  
pp. 121-125 ◽  
Author(s):  
Ra Charles ◽  
F Lateef ◽  
V Anantharaman
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Life Support ◽  
Advanced Cardiac Life Support ◽  
Basic Cardiac Life Support ◽  
Chain Of Survival ◽  
Bystander Cpr ◽  
Mean Time ◽  
Hospital Cardiac Arrest ◽  
Ambulance Crew

Introduction The concept of the chain of survival is widely accepted. The four links viz. early access, early cardiopulmonary resuscitation (CPR), early defibrillation and early Advanced Cardiac Life Support (ACLS) are related to survival after pre-hospital cardiac arrest. Owing to the dismal survival-to-discharge figures locally, we conducted this study to identify any weaknesses in the chain, looking in particular at bystander CPR rates and times to Basic Cardiac Life Support (BCLS) and ACLS. Methods and materials A retrospective cohort study was conducted in the Emergency Department of an urban tertiary 1500-bed hospital. Over a 12-month period, all cases of non-trauma out-of-hospital cardiac arrest were evaluated. Results A total of 142 cases of non-trauma out-of-hospital cardiac arrest were identified; the majority being Chinese (103/142, 72.5%) and male (71.8%) with a mean age of 64.3±7.8 years (range 23–89 yrs). Most patients (111/142, 78.2%) did not receive any form of life support until arrival of the ambulance crew. Mean time from collapse to arrival of the ambulance crew and initiation of BCLS and defibrillation was 9.2±3.5 minutes. Mean time from collapse to arrival in the Emergency Department (and thus ACLS) was 16.8±7.1 minutes. Three patients (2.11%) survived to discharge. Conclusion There is a need to (i) facilitate layperson training in bystander CPR, and (ii) enhance paramedic training to include ACLS, in order to improve the current dismal survival outcomes from out-of-hospital cardiac arrest in Singapore.

Extracorporeal life support for refractory out-of-hospital cardiac arrest: Should we still fight for? A single-centre, 5-year experience

2016 ◽  
Vol 204 ◽  
pp. 70-76 ◽  
Author(s):  
Matteo Pozzi ◽  
Catherine Koffel ◽  
Xavier Armoiry ◽  
Isabelle Pavlakovic ◽  
Jean Neidecker ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Single Centre ◽  
Hospital Cardiac Arrest

Emergency Extracorporeal Life Support After Prolonged Out-of-Hospital Cardiac Arrest

2014 ◽  
Vol 28 (4) ◽  
pp. 1024-1026 ◽  
Author(s):  
Gabriel Putzer ◽  
Birgit Mair ◽  
Herbert Hangler ◽  
Mathias Ströhle ◽  
Peter Mair
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Hospital Cardiac Arrest

scholarly journals Comparison of Mechanical Support with Impella or Extracorporeal Life Support in Post-Cardiac Arrest Cardiogenic Shock: A Propensity Scoring Matching Analysis

2021 ◽  
Vol 10 (16) ◽  
pp. 3583
Author(s):  
Styliani Syntila ◽  
Georgios Chatzis ◽  
Birgit Markus ◽  
Holger Ahrens ◽  
Christian Waechter ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiogenic Shock ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Survival Rates ◽  
Limb Ischemia ◽  
Spontaneous Circulation ◽  
Access Site ◽  
Baseline Characteristics ◽  
Hospital Cardiac Arrest

Our aim was to compare the outcomes of Impella with extracorporeal life support (ECLS) in patients with post-cardiac arrest cardiogenic shock (CS) complicating acute myocardial infarction (AMI). This was a retrospective study of patients resuscitated from out of hospital cardiac arrest (OHCA) with post-cardiac arrest CS following AMI (May 2015 to May 2020). Patients were supported either with Impella 2.5/CP or ECLS. Outcomes were compared using propensity score-matched analysis to account for differences in baseline characteristics between groups. 159 patients were included (Impella, n = 105; ECLS, n = 54). Hospital and 12-month survival rates were comparable in the Impella and the ECLS groups (p = 0.16 and p = 0.3, respectively). After adjustment for baseline differences, both groups demonstrated comparable hospital and 12-month survival (p = 0.36 and p = 0.64, respectively). Impella patients had a significantly greater left ventricle ejection-fraction (LVEF) improvement at 96 h (p < 0.01 vs. p = 0.44 in ECLS) and significantly fewer device-associated complications than ECLS patients (15.2% versus 35.2%, p < 0.01 for relevant access site bleeding, 7.6% versus 20.4%, p = 0.04 for limb ischemia needing intervention). In subgroup analyses, Impella was associated with better survival in patients with lower-risk features (lactate < 8.6 mmol/L, time from collapse to return of spontaneous circulation < 28 min, vasoactive score < 46 and Horowitz index > 182). In conclusion, the use of Impella 2.5/CP or ECLS in post-cardiac arrest CS after AMI was associated with comparable adjusted hospital and 12-month survival. Impella patients had a greater LVEF improvement than ECLS patients. Device-related access-site complications occurred more frequently in patients with ECLS than Impella support.

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