Reanimation – praktische Umsetzung von Leitlinien und Standards in der Klinik

2020 ◽  
Vol 145 (08) ◽  
pp. 555-568
Author(s):  
Alexander Kersten
Keyword(s):  
Cardiac Arrest ◽  
Daily Practice ◽  
Spontaneous Circulation ◽  
Interdisciplinary Treatment ◽  
Health Concern ◽  
Mortality And Morbidity ◽  
Cardio Pulmonary Resuscitation ◽  
Strong Focus ◽  
Underlying Diseases

AbstractOut of hospital cardiac arrest (OHCA) requiring cardio-pulmonary resuscitation (CPR) remains a mojor public health concern. OHCA affects nearly 275 000 people in Europe annualy with more than 70 000 of those in Germany alone. It represents of the major causes of death in Europe.In 40 % of patients CPR is successful and leads to a return of spontaneous circulation (ROSC). Due to the relevance of OHCA and CPR detailed guidelines with sound scientific foundation exist. However, even after successful CPR, mortality and morbidity remain high due to the severity of underlying diseases and sequelae of OHCA and CPR itself. Thus, optimization of the initial CPR treatment with reducing overall no-flow time (time from collaps with cardiac arrest to start of CPR) and optimization and streamlining of treatment algorithms and quality in hospitals receiving patients after cardiac arrest have been a strong focus to improve overall survival. Current guidelines suggest creation of Cardiac Arrest Centers as specialized hospitals who focus on high quality of post-resuscitation care with standardized processes and interdisciplinary treatment of patients after OHCA to establish fast, secure and effective treatment that is widely available in all regions.This article will address the relevant items to be considered in daily practice of resuscitation and post-resuscitation care for cardiac arrest.

scholarly journals The Influence of COVID-19 on Out-Hospital Cardiac Arrest Survival Outcomes: An Updated Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (23) ◽  
pp. 5573
Author(s):  
Karol Bielski ◽  
Agnieszka Szarpak ◽  
Miłosz Jaroslaw Jaguszewski ◽  
Tomasz Kopiec ◽  
Jacek Smereka ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Meta Analysis ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Survival Outcomes ◽  
Cochrane Central Register ◽  
Mortality And Morbidity ◽  
Hospital Cardiac Arrest

Cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest (OHCA) is associated with poor prognosis. Because the COVID-19 pandemic may have impacted mortality and morbidity, both on an individual level and the health care system as a whole, our purpose was to determine rates of OHCA survival since the onset of the SARS-CoV2 pandemic. We conducted a systematic review and meta-analysis to evaluate the influence of COVID-19 on OHCA survival outcomes according to the PRISMA guidelines. We searched the literature using PubMed, Scopus, Web of Science and Cochrane Central Register for Controlled Trials databases from inception to September 2021 and identified 1775 potentially relevant studies, of which thirty-one articles totaling 88,188 patients were included in this meta-analysis. Prehospital return of spontaneous circulation (ROSC) in pre-COVID-19 and COVID-19 periods was 12.3% vs. 8.9%, respectively (OR = 1.40; 95%CI: 1.06–1.87; p < 0.001). Survival to hospital discharge in pre- vs. intra-COVID-19 periods was 11.5% vs. 8.2% (OR = 1.57; 95%CI: 1.37–1.79; p < 0.001). A similar dependency was observed in the case of survival to hospital discharge with the Cerebral Performance Category (CPC) 1–2 (6.7% vs. 4.0%; OR = 1.71; 95%CI: 1.35–2.15; p < 0.001), as well as in the 30-day survival rate (9.2% vs. 6.4%; OR = 1.63; 95%CI: 1.13–2.36; p = 0.009). In conclusion, prognosis of OHCA is usually poor and even worse during COVID-19.

scholarly journals Post-cardiac arrest syndrome in adult hospitalized patients

2021 ◽  
Author(s):  
Estivalis G. Acosta-Gutiérrez ◽  
Andrés M. Alba-Amaya ◽  
Santiago Roncancio-Rodríguez ◽  
José Ricardo Navarro-Vargas
Keyword(s):  
Cardiac Arrest ◽  
Latin American ◽  
Myocardial Dysfunction ◽  
Spontaneous Circulation ◽  
Neurologic Recovery ◽  
One Year ◽  
Meta Analyses ◽  
Post Cardiac Arrest Syndrome ◽  
Hospital Cardiac Arrest

Adult In-hospital Cardiac Arrest (IHCA) is defined as the loss of circulation of an in-patient. Following high-quality cardiopulmonary resuscitation (CPR), if the return of spontaneous circulation (ROSC) is achieved, the post-cardiac arrest syndrome develops (PCAS). This review is intended to discuss the current diagnosis and treatment of PCAS. To approach this topic, a bibliography search was conducted through direct digital access to the scientific literature published in English and Spanish between 2014 and 2020, in MedLine, SciELO, Embase and Cochrane. This search resulted in 248 articles from which original articles, systematic reviews, meta-analyses and clinical practice guidelines were selected for a total of 56 documents. The etiologies may be divided into 56% of in-hospital cardiac, and 44% of non-cardiac arrests. The incidence of this physiological collapse is up to 1.6 cases/1,000 patients admitted, and its frequency is higher in the intensive care units (ICU), with an overall survival rate of 13% at one year. The primary components of PCAS are brain injury, myocardial dysfunction and the persistence of the precipitating pathology. The mainstays for managing PCAS are the prevention of cardiac arrest, ventilation support, control of peri-cardiac arrest arrythmias, and interventions to optimize neurologic recovery. A knowledgeable healthcare staff in PCAS results in improved patient survival and future quality of life. Finally, there is clear need to do further research in the Latin American Population.

Abstract 483: Out of Hospital Cardiac Arrest Outcomes After Transitioning to Pit Crew Model

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Mohinder Reddy Vindhyal ◽  
Paul M Ndunda ◽  
Shravani Vindhyal ◽  
Brent Duran
Keyword(s):  
Cardiac Arrest ◽  
Vegetative State ◽  
Fire Department ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
Cardio Pulmonary Resuscitation ◽  
Improved Outcomes ◽  
Before And After ◽  
Hospital Cardiac Arrest ◽  
Model Approach

Introduction: One of the leading causes of untimely death as per the Resuscitation Outcomes Consortium Epistry for cardiac arrest is out of hospital cardiac arrest (OHCA). Adoption of the choreographed approach of the pit crew model resuscitation improved outcomes after OHCA in some previous studies. Hypothesis: Compare outcomes post OHCA before and after adopting a pit crew model approach in one of the largest counties in Kansas. Methods: The data was collected before (2010 – 2012) and after the pit crew (2013-2016) approach from 2010 to 2016. The patient demographics and resuscitation variables were similar and comparable including the emergency and fire department personnel. The primary outcome was the proportion of patients having sustained return of spontaneous circulation (ROSC). Secondary outcomes were average number of pauses >10 seconds, cerebral performance post return of spontaneous circulation, and average cardio-pulmonary resuscitation (CPR) cycles to ROSC. Results: The patients who had sustained ROSC post pit crew approach was 67.9% vs 32.1% (p=< 0.001). Average number of CPR pause time > 10 seconds post pit crew model was 1 vs 5 (p=0.01). Cerebral performance post return of spontaneous circulation using pit crew approach with good cerebral performance was 47% vs 56% (p=0.2), moderate cerebral disability was 17% vs 23% (p=0.19), severe cerebral disability was 8% vs 11% (p=0.44) and in coma/vegetative state was 8% vs 16% (p=0.001). Average CPR cycles to ROSC was 6.63. Conclusion: This focused model of high-quality CPR performance with individualized assigned tasks with minimal interruptions has shown increased numbers of sustained ROSC. The pit crew model approach also has showed decline in the rates of cerebral performance especially with moderate and severe cerebral performance including the patients in coma or vegetative state which is mainly through continuous cerebral perfusion pressures. More studies with better follow-up care in coordination with hospital outcomes will be key for the pit crew approach to be adopted.

Out-of-hospital cardiac arrest

2021 ◽  
pp. 76-87
Author(s):  
Jerry P Nolan ◽  
Christian Hassager
Keyword(s):  
Cardiac Arrest ◽  
Basic Life Support ◽  
Life Support ◽  
Spontaneous Circulation ◽  
Neurological Injury ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Medical Emergencies ◽  
Hospital Cardiac Arrest

Cardiac arrest is the most extreme of medical emergencies. If the victim is to have any chance of high-quality neurological recovery, cardiac arrest must be diagnosed quickly, followed by summoning for help as basic life support (chest compressions and ventilations) is started. In most cases, the initial rhythm will be shockable, but this will have often deteriorated to a non-shockable rhythm by the time a monitor and/or defibrillator is applied. While basic life support will sustain some oxygen delivery to the heart and brain and will help to slow the rate of deterioration in these vital organs, it is important to achieve restoration of a spontaneous circulation as soon as possible (by defibrillation if the rhythm is shockable). Once return of spontaneous circulation is achieved, the quality of post-cardiac arrest management will influence the patient's final neurological and cardiological outcome. These interventions aim to restore myocardial function and minimize neurological injury.

Abstract 17412: Current Experience and Limitations of Extracorporeal Cardiopulmonary Resuscitation for Cardiac Arrest: A Single-Center Retrospective Study

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Aditi Singhvi ◽  
Nirav Patel ◽  
Jason A Gluck
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Selection Criteria ◽  
Spontaneous Circulation ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Neurologic Outcomes ◽  
Time To Initiation ◽  
Central Access ◽  
Refractory Cardiac Arrest

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) may be considered for select cardiac arrest patients for whom the suspected etiology of the arrest is potentially reversible. In adults, the survival to discharge with ECPR is reportedly 22% to 33%, with better outcomes for in-hospital arrests. Outcomes with ECPR depend on multiple factors including, location of arrest, etiology, duration and quality of CPR, time to initiation of ECMO, and post-arrest management. There is no consensus regarding patient selection or management of these patients. We report our preliminary experiences with ECPR for refractory cardiac arrest. Methods: Patients who underwent ECPR between January 2013 and May 2018 were identified. The characteristics of the arrest, CPR duration, cannulation procedure, post-arrest management, complications, survival and neurologic outcomes were retrospectively reviewed. Results: A total of 24 ECPR events were identified. The median age was 60 years. The median CPR duration and time from collapse to initiation of ECMO were 35 (IQR 25.5-68) and 68 (IQR 45.5-144.5) min, respectively. Peripheral and central access sites were employed in 19 and 5 cases, respectively. Return of spontaneous circulation was achieved in 21 patients (87.5%). PCI was performed on 4 and pulmonary embolectomy on 3 patients. Median duration of ECMO support was 84 (IQR 24-168) hours. Major complications occurred in 17 patients (70.8%). Nine patients (37.5%) were successfully weaned from ECMO and 7 (29.2%) survived to hospital discharge. All of the survivors had a favorable neurologic outcome. Conclusions: ECPR as part of a comprehensive multi-faceted approach for select patients with refractory cardiac arrest may improve outcomes. We noted an improvement in outcomes over time. This could be attributed to improved selection criteria as well as clinical management. The development of selection criteria may help identify patients most likely to benefit from the use of ECPR. This would have significant resource implications for hospitals with ECMO programs.

Abstract 1804: Is CPR Quality Improving? A Retrospective Study Of Out-of-hospital Cardiac Arrest

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Theresa M Olasveengen ◽  
Lars Wik ◽  
Jo Kramer-Johansen ◽  
Kjetil Sunde ◽  
Morten Pytte ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Scientific Evidence ◽  
Spontaneous Circulation ◽  
Quality Analysis ◽  
Medical Systems ◽  
Chest Compressions ◽  
Chi Square ◽  
Transthoracic Impedance ◽  
Cpr Quality

Aim of the study: To evaluate quality of cardiopulmonary resuscitation (CPR) performed by a physician-manned ambulance, and assess whether it changed with time influenced by developing scientific evidence and guideline changes. Materials and methods: Retrospective, observational study of all cardiac arrest patients (except trauma) older than 18 years treated between May 2003 and December 2006 by the physician-manned ambulance in Oslo. CPR quality was assessed from continuous electronic recordings from the defibrillators (LIFEPAK 12, Physio-Control or a modified Heartstart 4000, Philips Medical Systems). Ventilations were assessed from changes in transthoracic impedance, chest compressions from transthoracic impedance for LIFEPAK 12 and from an accelerometer for Heartstart 4000 (nine patients). Values are given as mean ± SD and differences analysed with ANOVA and unpaired Student’s t-test with Bonferroni correction. Results: Forty-eight of 169 consecutive cases were excluded from CPR quality analysis, 47 due to missing defibrillator data and one due to short arrest time (<1 min). Hands-off intervals (fraction of time without spontaneous circulation where no chest compressions are given) were reduced from 0.18±0.11 in 2003 to 0.10±0.06 in 2006 (p=0.03). Compression and ventilation rates were significantly reduced from 122±12 and 16±3 per minute respectively in 2003 to 111±10 and 12±3 in 2006 (p<0.0001 and p=0.001). In 2003–4 10% were discharged alive vs. 16 % in 2005–6 (p=0.3, Chi square test). Conclusion: High quality CPR is achievable out-of-hospital, and the improvement with time could reflect developing scientific evidence focusing on reducing hands-off intervals and hyperventilation. Quality of CPR from May 2003 to 2006.

Management after resuscitation from cardiac arrest

2016 ◽  
Author(s):  
Jerry P. Nolan ◽  
Michael J. A. Parr
Keyword(s):  
Cardiac Arrest ◽  
Systems Approach ◽  
Mild Hypothermia ◽  
Myocardial Dysfunction ◽  
Spontaneous Circulation ◽  
Targeted Temperature Management ◽  
Organ Injury ◽  
Temperature Management ◽  
Optimized Treatment

Systemic ischaemia during cardiac arrest and the reperfusion response after return of spontaneous circulation (ROSC) cause the post-cardiac arrest syndrome (PCAS). The severity and duration of this syndrome is determined by the cause and duration of cardiac arrest, quality of resuscitation, and interventions after ROSC. Four key clinical components are recognized—post-cardiac arrest brain injury, myocardial dysfunction, other organ ischaemia/reperfusion (e.g. liver, kidney), and potential persistence of the precipitating pathology causing the cardiac arrest. The interventions applied after ROSC impact significantly on the quality of survival. All components of the PCAS need to be addressed if outcome is to be optimized; treatment should start immediately after ROSC. An ‘ABCDE’ (Airway, Breathing, Circulation, Disability, Exposure) systems approach is used to identify and treat physiological abnormalities and organ injury. All survivors of out-of-hospital cardiac arrest should be considered for urgent coronary angiography unless the cause of cardiac arrest is clearly non-cardiac or continued treatment is considered futile. Targeted temperature management (mild hypothermia and avoidance of hyperthermia) should be considered for those patients who remain comatose after ROSC. If targeted temperature management has been used, early prognostication on outcome is unreliable and should be delayed until 3 days after return to normothermia; it should not rely on just one modality.

Cardiopulmonary resuscitation and the post-cardiac arrest syndrome

2015 ◽  
Author(s):  
Jerry P Nolan
Keyword(s):  
Cardiac Arrest ◽  
Basic Life Support ◽  
Life Support ◽  
Spontaneous Circulation ◽  
Neurological Injury ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Medical Emergencies ◽  
Post Cardiac Arrest Syndrome

Cardiac arrest is the most extreme of medical emergencies. If the victim is to have any chance of high-quality neurological recovery, cardiac arrest must be diagnosed quickly, followed by summoning for help as basic life support (chest compressions and ventilations) is started. In most cases, the initial rhythm will be shockable, but this will have often deteriorated to a non-shockable rhythm by the time a monitor and/or defibrillator is applied. While basic life support will sustain some oxygen delivery to the heart and brain and will help to slow the rate of deterioration in these vital organs, it is important to achieve restoration of a spontaneous circulation as soon as possible (by defibrillation if the rhythm is shockable). Once return of spontaneous circulation is achieved, the quality of post-cardiac arrest management will influence the patient’s final neurological outcome. These interventions aim to restore myocardial function and minimize neurological injury.

scholarly journals Out-of-hospital resuscitation of a 3 month old boy presenting with recurrent ventricular fibrillation cardiac arrest: a case report

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Peter Kingsley ◽  
Jonathan Merefield ◽  
Robert G. Walker ◽  
Fred W. Chapman ◽  
Mark Faulkner
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Spontaneous Circulation ◽  
Health Conditions ◽  
National Guidelines ◽  
Strong Focus ◽  
Load And Go ◽  
Recurrent Nature ◽  
Sudden Collapse

AbstractA 3 month old boy, with no known health conditions, suffered a sudden collapse at home. On first EMS arrival, ventricular fibrillation (VF) cardiac arrest was identified and resuscitation following UK national guidelines was initiated. He remained in cardiac arrest for over 25 min, during which he received 10 defibrillation shocks, each effective, but with VF reoccurring within a few seconds of each of the first 9. A return of spontaneous circulation (ROSC) was achieved after the 10th shock. The resuscitation was conducted fully in his home, with the early involvement of Advanced Paramedic Practitioners specialising in critical care (APP- CC). Throughout his resuscitation, there remained a strong focus on delivering quality resuscitation in situ, rather than a ‘load and go’ approach that would have resulted in very early conveyance to hospital with on-going CPR.The patient was subsequently discharged home and is making an excellent recovery. The arrest was later determined to have been caused by a primary arrhythmia as a result of a previously unidentified non-obstructive variant hypertrophic cardiomyopathy.We present data downloaded from the defibrillator used during the resuscitation that illustrates clearly the recurrent nature of his fibrillation.

Abstract 230: Bystander Cardio Pulmonary Resuscitation Quality: Potential for Improvements in Cardiac Arrest Resuscitation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Richard Chocron ◽  
Julia Jobe ◽  
Madeleine Kim ◽  
Sally Guan ◽  
Carol Fahrenbruch ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Performance Metrics ◽  
Compression Rate ◽  
Traumatic Cardiac Arrest ◽  
Cardio Pulmonary Resuscitation ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Cpr Quality ◽  
Critical Intervention

Background: Bystander cardiopulmonary resuscitation (CPR) is a critical intervention to improve survival following out-of-hospital cardiac arrest (OHCA). We evaluated the quality of bystander CPR and whether performance varied according to the number of bystanders or provision of telecommunicator assistance (TCPR) to identify opportunities to improve care. Methods: We conducted a cohort investigation of non-traumatic cardiac arrest occurring in a large metropolitan EMS system during a 6-month period. Information about bystander care was ascertained through review of the 9-1-1 recordings in addition to EMS and hospital information to determine bystander CPR status (none vs TCPR vs unassisted), the number of bystanders on-scene, and CPR performance metrics of compression fraction and compression rate. Results: Of the 428 eligible OHCA, average age was 62.9 years (+/- 16.6), 31.5% (n=135) were female, and 76.4% (n=327) received bystander CPR. Of those receiving bystander CPR, 43.7% (n=143) received unassisted CPR and 56.3% (n=184) involved TCPR; 35.2% (N=115) had one bystander, 33.3% (N=109) had 2 bystanders, and 31.5% (n=103) had 3 or more bystanders. Overall CPR fraction was 59% with a compression rate of 88 per minute. CPR differed according to TCPR status (compression fraction=52% and rate=87 per minute for TCPR vs 69% and 102 for unassisted CPR, p<0.05 for each comparison) and the number of bystanders (compression fraction=55% and rate=87 per minute for 1 bystander, 59% and 89 for 2 bystanders, 65% and 97 for >=3 bystanders, test for trend p<0.05 for each metric). Additional bystander actions were uncommon to include rotation of compressors (3.1%) or application of an AED (8.0%). Conclusion: Overall bystander CPR quality as gauged by fraction and compression rate approached guideline goals though performance depended upon the type of CPR and number of bystanders. The findings suggest opportunities for how CPR quality and early defibrillation may be improved.

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