Thoracic Spine Fracture in a Survivor of Out-of-Hospital Cardiac Arrest with Mechanical CPR

AbstractThis is a report of a thoracic vertebral fracture in a 79-year-old male survivor of out-of-hospital cardiac arrest with chest compressions provided by a LUCAS 2 (Physio-Control Inc.; Lund Sweden) device. This is the first such report in the literature of a vertebral fracture being noted in a survivor of cardiac arrest where an automated compression device was used.MarshallRT, KotechaH, ChibaT, TennysonJ. Thoracic spine fracture in a survivor of out-of-hospital cardiac arrest with mechanical CPR. Prehosp Disaster Med. 2016;31(6):684–686.

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Mechanisms of mid-thoracic spine fracture/dislocation due to falls during horse racing: A report of two cases

Chinese Journal of Traumatology ◽

10.1016/j.cjtee.2021.07.003 ◽

2021 ◽

Author(s):

Paul C. Ivancic

Keyword(s):

Thoracic Spine ◽

Spine Fracture ◽

Fracture Dislocation ◽

Horse Racing ◽

Thoracic Spine Fracture

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

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18073636 ◽

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.

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

Circulation ◽

10.1161/circ.138.suppl_2.170 ◽

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.

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Abstract P82: Implementation Of New Resuscitation Guidelines Takes One-and-a-half Year

Circulation ◽

10.1161/circ.118.suppl_18.s_1463 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Jocelyn Berdowski ◽

Andra Schmohl ◽

Rudolph W Koster

Keyword(s):

Cardiac Arrest ◽

World Wide ◽

Prospective Observational Study ◽

Spontaneous Circulation ◽

Chest Compressions ◽

Return Of Spontaneous Circulation ◽

Resuscitation Guidelines ◽

Rhythm Analysis ◽

New Guidelines ◽

Hospital Cardiac Arrest

Objective- In November 2005, updated resuscitation guidelines were introduced world-wide, and will be revised again in 2010. This study aims to determine how long it takes to implement new guidelines. Methods- This was a prospective observational study. From July 2005 to January 2008, we included all patients with a non traumatic out-of-hospital cardiac arrest. Ambulance paramedics sent all continuous ECG registrations with impedance signal by modem. We excluded ECGs from patients with Return Of Spontaneous Circulation at arrival, incomplete ECG registrations, ECGs with technical deficits or with continuous chest compressions. The same guidelines needed to be used in over 75% of the registration time in order to be labeled. We classified ECGs as guidelines 2000 if the c:v ratio was 15:2, shock blocks were present and there was rhythm analysis after each shock; guidelines 2005 if the c:v ratio was 30:2, a single shock protocol was used and chest compressions was immediately resumed after shock or rhythm analysis in a no shock scenario. We accepted 10% deviations in the amount of compressions (13–17 for 2000 guidelines, 27–33 for 2005). Results- Of the 1703 analyzable ECGs, we classified 827 (48.6%) as guidelines 2000 and 624 (36.6%) as guidelines 2005. In the remaining 252 ECGs (14.8%) 31 used guidelines 1992, 137 applied guidelines 2000 with c:v ratio of 30:2 and 84 did not show distinguishable guideline usage. Since the introduction in November 2005, it took 17 months to apply new guidelines in over 80% of the cases (figure 1 ). Conclusion- Guideline changes are slowly implemented by professionals. This needs to be taken in consideration when new guideline revisions are considered.

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