Issues in Establishing the Refractory Out-of-Hospital Cardiac Arrest Treated with Mechanical CPR, Hypothermia, ECMO and Early Reperfusion (CHEER) Study

2012 ◽  
Vol 21 ◽  
pp. S163 ◽  
Author(s):  
D. Stub ◽  
S. Bernard ◽  
V. Pellegrino ◽  
K. Smith ◽  
T. Walker ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Early Reperfusion ◽  
Mechanical Cpr ◽  
Hospital Cardiac Arrest

scholarly journals The Effect of Implementing Mechanical Cardiopulmonary Resuscitation Devices on Out-of-Hospital Cardiac Arrest Patients in an Urban City of Taiwan

2021 ◽  
Vol 18 (7) ◽  
pp. 3636
Author(s):  
Yi-Rong Chen ◽  
Chi-Jiang Liao ◽  
Han-Chun Huang ◽  
Cheng-Han Tsai ◽  
Yao-Sing Su ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Primary Outcome ◽  
Medical Service ◽  
Spontaneous Circulation ◽  
High Quality ◽  
Urban City ◽  
Service Response Time ◽  
Mechanical Cpr ◽  
Hospital Cardiac Arrest

High-quality cardiopulmonary resuscitation (CPR) is a key element in out-of-hospital cardiac arrest (OHCA) resuscitation. Mechanical CPR devices have been developed to provide uninterrupted and high-quality CPR. Although human studies have shown controversial results in favor of mechanical CPR devices, their application in pre-hospital settings continues to increase. There remains scant data on the pre-hospital use of mechanical CPR devices in Asia. Therefore, we conducted a retrospective cohort study between September 2018 and August 2020 in an urban city of Taiwan to analyze the effects of mechanical CPR devices on the outcomes of OHCA; the primary outcome was attainment of return of spontaneous circulation (ROSC). Of 552 patients with OHCA, 279 received mechanical CPR and 273 received manual CPR, before being transferred to the hospital. After multivariate adjustment for the influencing factors, mechanical CPR was independently associated with achievement of any ROSC (OR = 1.871; 95%CI:1.195–2.930) and sustained (≥24 h) ROSC (OR = 2.353; 95%CI:1.427–3.879). Subgroup analyses demonstrated that mechanical CPR is beneficial in shorter emergency medical service response time (≤4 min), witnessed cardiac arrest, and non-shockable cardiac rhythm. These findings support the importance of early EMS activation and high-quality CPR in OHCA resuscitation.

Abstract 170: Challenges in Implementing an ECPR Program for Out of Hospital Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Meshe Chonde ◽  
Jeremiah Escajeda ◽  
Jonathan Elmer ◽  
Frank X Guyette ◽  
Arthur Boujoukos ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Inclusion Criteria ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Implementation Challenges ◽  
Shockable Rhythm ◽  
Bystander Cpr ◽  
Stay And Play ◽  
Load And Go ◽  
Mechanical Cpr ◽  
Hospital Cardiac Arrest

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) can treat cardiac arrest refractory to conventional therapy. Many institutions are interested in developing their own ECPR program. However, there are challenges in logistics and implementation. Hypothesis: Development of an ECPR team and identification of UPMC Presbyterian as a receiving center will increase recognition of potential ECPR candidates. Methods: We developed an infrastructure of Emergency Medical Services (EMS), Medic Command, and an in-hospital ECPR team. We identified inclusion criteria for patients with an out of hospital cardiac arrest (OHCA) likely to have a reversible arrest etiology and developed them into a simple checklist. These criteria were: witnessed arrest with bystander CPR, shockable rhythm, and ages 18 to 60. We trained local EMS crews to screen patients and review the checklist with a Command Physician prior to transport to our hospital. Results: From October 2015 to March 31 st 2018, there were 1165 dispatches for OHCA, of which 664 (57%) were treated and transported to the hospital and 120 to our institution. Of these, five patients underwent ECPR. Of the remaining cases, 64 (53%) had nonshockable rhythms, 48 (40%) were unwitnessed arrests, 50 (42%) were over age 60 and the remaining 20 (17%) had no documented reasons for exclusion. Prehospital CPR duration was 26 [IQR 25-40] min. Four patients (80%) underwent mechanical CPR with LUCAS device. Time from arrest to arrive on scene was 5 [IQR 4-6] min and time call MD command was 13 [IQR 7-21] min. Time to transport was 20 [IQR 19-21] min. Time from arrest to initiation of ECMO was 63 [IQR 59-69] min. Conclusions: ECPR is a relatively infrequent occurrence. Implementation challenges include prompt identification of patients with reversible OHCA causes, preferential transport to an ECPR capable facility and changing the focus of EMS in these select patients from a “stay and play” to a “load and go” mentality.

Abstract 141: Resuscitation Time Bias in an Observational Study of Mechanical Chest Compression CPR

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Michael K Levy ◽  
Karl B Kern ◽  
Dana Yost ◽  
Bjarne Madsen Hardig ◽  
Fred W Chapman
Keyword(s):  
Cardiac Arrest ◽  
Observational Studies ◽  
Spontaneous Circulation ◽  
Prolonged Treatment ◽  
Device Application ◽  
Group Response ◽  
Device Use ◽  
One Year ◽  
Mechanical Cpr ◽  
Hospital Cardiac Arrest

Recent observational studies have found associations between poorer outcomes and treatment that included mechanical CPR devices, contradicting findings from randomized trials. Resuscitation time bias is a systematic error occurring in observational studies of interventions applied to pulseless patients later in resuscitation attempts. Previous observational studies lack data on duration of resuscitation, a factor strongly related to outcome. We retrospectively analyzed cardiac arrest data to learn how resuscitation time and device use relate to clinical outcomes, and determine whether resuscitation time bias was present. Methods and Results: We analyzed data from all 49 patients with ventricular fibrillation, out-of-hospital cardiac arrest treated by our emergency medical service in one year. We compared 19 patients who received only standard manual CPR (the sCPR group) to 30 patients who received manual followed by mechanical CPR (the mCPR group). Response to CPR differed between groups even before device application. All sCPR patients achieved return of spontaneous circulation (ROSC), and did so after a median (IQR) of 3.3 (2.2-5.1) minutes of manual CPR. Patients in the mCPR group failed to get ROSC through 6.9 (5.3-11.0) min of manual CPR; mCPR patients that did get ROSC did so after 11.2 (5.7-23.8) additional minutes of CPR, delivered by a mechanical device. mCPR patients also received significantly more defibrillations and ALS drugs. ROSC and survival to hospital discharge were higher in the sCPR than the mCPR group (100% vs. 70%, P = 0.008; 74% vs. 43%, P = 0.045). Conclusion: Only patients remaining pulseless after early resuscitation efforts received mechanical CPR. Consequently, mechanical CPR devices assisted by facilitating prolonged treatment of patients who already had lower chances of survival before device application. Resuscitation time bias was present, and must be considered when interpreting registry reports comparing sCPR and mCPR.

An assessment of ventilation and perfusion markers in out-of-hospital cardiac arrest patients receiving mechanical CPR with endotracheal or supraglottic airways

Resuscitation ◽  
2018 ◽  
Vol 122 ◽  
pp. 61-64 ◽  
Author(s):  
Torben K. Becker ◽  
Aric W. Berning ◽  
Arjun Prabhu ◽  
Clifton W. Callaway ◽  
Francis X. Guyette ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Mechanical Cpr ◽  
Hospital Cardiac Arrest ◽  
Ventilation And Perfusion

Mechanical CPR with a load distributing band device in out-of-hospital cardiac arrest. An Utstein categories based analysis

Resuscitation ◽  
2018 ◽  
Vol 130 ◽  
pp. e44
Author(s):  
Simone Savastano ◽  
Enrico Baldi ◽  
Alessandra Palo ◽  
Maurizio Raimondi ◽  
Mirko Belliato ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Mechanical Cpr ◽  
Hospital Cardiac Arrest

Abstract 222: Optimizing the Application of a Mechanical Chest Compression Device Within a High-Performance CPR Approach to Out-of-Hospital Cardiac Arrest Resuscitation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Michael Levy ◽  
Dana Yost ◽  
Robert G Walker ◽  
Erich A Scheunemann ◽  
Steve R Mendive
Keyword(s):  
Cardiac Arrest ◽  
Chest Compression ◽  
High Performance ◽  
Fire Department ◽  
Electronic Record ◽  
Device Application ◽  
Resuscitation Effort ◽  
Mechanical Cpr ◽  
Large Improvement ◽  
Hospital Cardiac Arrest

Background: Minimizing the chest compression pause associated with application of a mechanical CPR (mCPR) device is a key component of optimal integration of mCPR into the overall resuscitation process. As part of a multi-agency implementation project, Anchorage Fire Department deployed LUCAS mCPR devices on BLS and ALS vehicles for initiation early in resuscitation efforts. A 2012 report from that project identified the pause interval for mCPR device application as a key opportunity for quality improvement (QI). In early 2013 we began a QI initiative to reduce device application time and optimize the overall CPR process, which included education on the importance of minimizing pauses, training on techniques for efficient device application, and a requirement for two manual CPR cycles prior to initiation of mCPR. To assess QI initiative effectiveness, we compared key CPR process metrics from before to during and after its implementation. Methods: We included all cases of EMS-treated out-of-hospital cardiac arrest during 2012 and 2013 in which mCPR was used and the defibrillator electronic record was available. Continuous ECG and impedance data were analyzed to measure chest compression fraction, duration of the pause from last manual to first mechanical compression, and duration of the longest overall pause in the resuscitation effort. Results: Compared to cases from 2012 (n=61), median (25th, 75th percentile) duration of the pause prior to first mCPR compression for cases from 2013 (n=71) decreased from 21 (15, 31) to 7 (4, 12) seconds (p<0.001), while median chest compression fraction increased from 0.90 (0.88, 0.93) to 0.95 (0.93, 0.96) (p<0.001). Median duration of the longest pause decreased from 25 (20, 35) to 13 (10, 20) seconds (p<0.001), while the proportion of cases where the longest pause was for mCPR device application decreased from 74% to 32% (p<0.001). Conclusions: Our QI initiative substantially reduced the duration of the pause prior to first mCPR compression. Combined with the simultaneous significant increase in compression fraction and significant decrease in duration of the longest pause, this finding strongly suggests a large improvement in mCPR device application efficiency within an overall high-performance CPR process.

scholarly journals P109: Identifying patients who may benefit from extracorporeal membrane oxygenation (ECMO) after cardiac arrest in the urban emergency departments of Saskatchewan

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S114-S115
Author(s):  
P. Robinson ◽  
K. Sharanowski ◽  
N. Lalani ◽  
S. Harenberg ◽  
K. Lyster
Keyword(s):  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Emergency Departments ◽  
Critical Mass ◽  
Trauma Patients ◽  
Exclusion Criteria ◽  
Treatment Protocols ◽  
Membrane Oxygenation ◽  
Mechanical Cpr ◽  
Hospital Cardiac Arrest

Introduction: Emergency physician-initiated Extracorporeal Membrane Oxygenation (ECMO/ECPR/ECLS) is gaining critical mass as a successful rescue strategy for patients requiring resuscitation. Wang et al. (2014), Bellezzo et al. (2012) and others have demonstrated promising results of survival to discharge with good neurological function in patients who were resistant to existing treatment protocols after out-of-hospital cardiac arrest. As Saskatchewan does not yet utilize ECMO for cardiac arrest, the objective of this study was to examine the number of adult cardiac arrest patients in the urban emergency departments (EDs) of Saskatchewan who may benefit from the use of ECMO. Methods: Using a retrospective review, we identified 401 patients who died after presenting with cardiac arrest between January 1st, 2013 and December 31st, 2014. Of the original 401, 136 were female and 264 were male, with a mean age of 60.1±20.2 years. The charts of 22 (5.5%) trauma patients were excluded because the suitability of ECMO in these patients is uncertain. Results: For the 379 non-trauma patients, the mean resuscitation length was 41.6±32.8 minutes (median=42 minutes) and 125 of these patients received prehospital mechanical CPR. We applied Bellezzo et al.’s (2012) inclusion and exclusion criteria to identify prospective candidates for ECMO. In total, 53 patients (14.0%) with a mean age of 57.1±13.4 years old, represent suitable candidates for ECMO. 260 (68.6%) were deemed unsuitable either because they failed the inclusion criteria or met explicit exclusion criteria. The remainder (66 [17.4%]) were unsuitable because of age. Conclusion: With 1 in 7 patients potentially representing suitable candidates for ECMO, this is a technique that warrants consideration for implementation in the EDs of Saskatchewan.

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