scholarly journals Factors associated with outcomes in traumatic cardiac arrest patients without prehospital return of spontaneous circulation

Injury ◽  
2019 ◽  
Vol 50 (1) ◽  
pp. 4-9 ◽  
Author(s):  
Yi-Chuan Chen ◽  
Kai-Hsiang Wu ◽  
Kuang-Yu Hsiao ◽  
Ming-Szu Hung ◽  
Yi-Chen Lai ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
Factors Associated ◽  
Traumatic Cardiac Arrest

Prehospital predictors for return of spontaneous circulation in traumatic cardiac arrest

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Axel Benhamed ◽  
Valentine Canon ◽  
Eric Mercier ◽  
Matthieu Heidet ◽  
Amaury Gossiome ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
Traumatic Cardiac Arrest

scholarly journals Out-of-Hospital Perimortem Cesarean Section as Resuscitative Hysterotomy in Maternal Posttraumatic Cardiac Arrest

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Francesca Gatti ◽  
Marco Spagnoli ◽  
Simone Maria Zerbi ◽  
Dario Colombo ◽  
Mario Landriscina ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Cesarean Section ◽  
Surgical Intervention ◽  
Hemodynamic Instability ◽  
Spontaneous Circulation ◽  
Traditional Treatment ◽  
Return Of Spontaneous Circulation ◽  
Traumatic Cardiac Arrest ◽  
Perimortem Cesarean Section

The optimal treatment of a severe hemodynamic instability from shock to cardiac arrest in late term pregnant women is subject to ongoing studies. However, there is an increasing evidence that early “separation” between the mother and the foetus may increase the restoration of the hemodynamic status and, in the cardiac arrest setting, it may raise the likelihood of a return of spontaneous circulation (ROSC) in the mother. This treatment, called Perimortem Cesarean Section (PMCS), is now termed as Resuscitative Hysterotomy (RH) to better address the issue of an early Cesarean section (C-section). This strategy is in contrast with the traditional treatment of cardiac arrest characterized by the maintenance of cardiopulmonary resuscitation (CPR) maneuvers without any emergent surgical intervention. We report the case of a prehospital perimortem delivery by Caesarean (C) section of a foetus at 36 weeks of gestation after the mother’s traumatic cardiac arrest. Despite the negative outcome of the mother, the choice of performing a RH seems to represent up to date the most appropriate intervention to improve the outcome in both mother and foetus.

Abstract 140: Prehospital Protocols for Post-Return of Spontaneous Circulation Care Are Highly Variable

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Justin L Benoit ◽  
Jason T McMullan ◽  
Michael F Spigner ◽  
James J Menegazzi
Keyword(s):  
United States ◽  
Cardiac Arrest ◽  
A Priori ◽  
The United States ◽  
Spontaneous Circulation ◽  
Data Abstraction ◽  
Prehospital Treatment ◽  
Return Of Spontaneous Circulation ◽  
Traumatic Cardiac Arrest ◽  
Hospital Transport

Introduction: Up to 40% of out-of-hospital cardiac arrest patients will re-arrest in the immediate post-return of spontaneous circulation (post-ROSC) period, and re-arrest is associated with decreased survival. Cardiac arrest guidelines are equivocal regarding what post-ROSC care should be provided in the prehospital setting and when hospital transport should occur. Prehospital protocols must balance the benefit of time-dependent hospital-based care with the risk of early re-arrest. We sought to describe current prehospital protocols for post-ROSC care. Hypothesis: Prehospital protocols for post-ROSC care will be variable. Methods: A single trained abstractor systematically reviewed a purposive sample of prehospital protocols for adult non-traumatic cardiac arrest from the United States using an a priori standardized data abstraction form. Protocols were either stand-alone or integrated into intra-arrest care. Exclusion criteria were non-911 ground transport agencies and protocols not revised since the 2015 guideline update. All protocols were publically available via the Internet. Data abstraction was conducted in May 2019. The number of protocols that met pre-defined criteria were counted and summarized. Results: We identified and reviewed 82 prehospital protocols from 46 states and the District of Columbia. Seven protocols were excluded due to the revision date, leaving 75 protocol included in the study (Table). Six protocols (8%) provide no guidance on prehospital post-ROSC care. ECG acquisition (63/75 [84%]) and transport to specific post-ROSC hospitals (overall 55/75 [73%], but 22/55 [40%] are only if STEMI present) are common but not universal. Only 9 (12%) provide any guidance on when to initiate transport post-ROSC, with 4 (5%) requiring a post-ROSC stabilization period of at least 5 minutes prior to transport. Conclusion: Prehospital treatment and transport protocols for post-ROSC care are highly variable across the United States.

scholarly journals LO07: Double sequential external defibrillation improves termination of ventricular fibrillation and return of spontaneous circulation in shock-refractory out-of- hospital cardiac arrest

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S9 ◽  
Author(s):  
S. Cheskes ◽  
A. Wudwud ◽  
L. Turner ◽  
S. Mcleod ◽  
J. Summers ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Standard Therapy ◽  
Controlled Trial ◽  
Spontaneous Circulation ◽  
Secondary Outcome ◽  
Return Of Spontaneous Circulation ◽  
Traumatic Cardiac Arrest ◽  
The Impact ◽  
Hospital Cardiac Arrest

Introduction: Despite significant advances in resuscitation efforts, there are some patients who remain in ventricular fibrillation (VF) after multiple shocks during out-of-hospital cardiac arrest (OHCA). Double sequential external defibrillation (DSED) has been proposed as a treatment option for patients in shock refractory VF. We sought to compare DSED to standard therapy with regards to VF termination and return of spontaneous circulation (ROSC) for patients presenting in shock refractory VF. Methods: We performed a retrospective review of all treated adult OHCA who presented in VF and received a minimum of three successive shocks over a two year period beginning on Jan 1, 2015 in four Canadian EMS agencies. Using ambulance call reports and defibrillator files, we compared VF termination (defined as the absence of VF at the rhythm check following defibrillation and 2 minutes of CPR) and VF termination into a perfusing rhythm with ROSC between patients who received standard therapy (CPR, defibrillation, epinephrine and antiarrhythmics) and those who received DSED (after on-line medical consultation) for shock refractory VF. Cases of traumatic cardiac arrest and those who presented in VF but terminated VF prior to 3 successive shocks were excluded. Results: Among 197 patients who met the study criteria for shock refractory VF, 161 (81.7%) patients received standard therapy and 36 (18.3%) received DSED. For the primary outcome, VF termination was significantly higher for DSED compared to standard therapy (63.9% vs 18.0%; Δ45.9%; 95% CI: 28.3 to 60.5). For the secondary outcome of VF termination into ROSC, DSED was associated with significantly higher ROSC compared to standard care (33.3% vs 13%; Δ20.3%; 95% CI:13.0 to 33.3). The median (IQR) number of failed standard shocks prior to DSED was 8 (6, 10). When DSED terminated VF, it did so with a single DSED shock in 69.6% of cases. Conclusion: Our observational findings suggest improved VF termination and ROSC are associated with DSED compared to standard therapy for shock refractory VF. An appropriately powered randomized controlled trial is required to assess the impact of DSED on patient-important outcomes.

Loperamide Induced Recurrent Torsades de Pointes: A Case Report

2021 ◽  
pp. 089719002110048
Author(s):  
Gregory G. Jackson ◽  
Christine R. Lopez ◽  
Elizabeth S. Bermudez ◽  
Nina E. Hill ◽  
Dan M. Roden ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Torsades De Pointes ◽  
Altered Mental Status ◽  
Spontaneous Circulation ◽  
Prior History ◽  
Common Phenomenon ◽  
Medical Providers ◽  
Return Of Spontaneous Circulation ◽  
History Of ◽  
Overdrive Pacing

Purpose: A case of loperamide-induced recurrent torsades de pointes is reported to raise awareness of an increasingly common phenomenon that could be encountered by medical providers during the current opioid epidemic. Summary: A 40 year-old-man with a prior history of opioid abuse who presented to the emergency department after taking up to 100 tablets of loperamide 2 mg daily for 5 years to blunt opioid withdrawal symptoms and was subsequently admitted to the intensive care unit for altered mental status and hyperthermia. The patient had prolonged QTc and 2 episodes of torsades de pointes (TdP) that resulted in cardiac arrest with return of spontaneous circulation. He was managed with isoproterenol, overdrive pacing, and methylnatrexone with no other events of TdP or cardiac arrest. Conclusion: A 40-year-old male who developed torsades de pointes from loperamide overdose effectively treated with overdrive pacing, isoproterenol, and methylnatrexone.

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