Sex disparities in prehospital advanced cardiac life support in out-of-hospital cardiac arrest in South Korea

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.

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Pupillary Light Reflex Is Not Abolished by Epinephrine and Atropine Given During Advanced Cardiac Life Support in Patients Who Achieve Return of Spontaneous Circulation

Journal of Intensive Care Medicine ◽

10.1177/0885066620906802 ◽

2020 ◽

pp. 088506662090680

Author(s):

Natalie Achamallah ◽

Jeffrey Fried ◽

Rebecca Love ◽

Yuri Matusov ◽

Rohit Sharma

Keyword(s):

Cardiac Arrest ◽

Life Support ◽

Advanced Cardiac Life Support ◽

Spontaneous Circulation ◽

Pupillary Light Reflex ◽

Return Of Spontaneous Circulation ◽

Neurologic Recovery ◽

Light Reflex ◽

Pupillary Light ◽

Hospital Cardiac Arrest

Introduction: Absence of pupillary light reflex (PLR) is a well-studied indicator of poor neurologic recovery after cardiac arrest. Interpretation of absent PLR is difficult in patients with hypothermia or hypotension, or who have electrolyte or acid-base disturbances. Additionally, many studies exclude patients who receive epinephrine or atropine from their analysis on the basis that these drugs are thought to abolish the PLR. This observational cohort study assessed for presence or absence of PLR in in-hospital cardiac arrest patients who received epinephrine with or without atropine during advanced cardiac life support and achieved return of spontaneous circulation (ROSC). Methods: Pupil size and reactivity were assessed in adult patients who had an in-hospital cardiac arrest, received epinephrine with or without atropine, and achieved ROSC. Measurements were taken using a NeurOptics NPi-200 infrared pupillometer. Results: Forty patients had pupillometry performed within 1 hour (median: 6 minutes) after ROSC. Of these only 1 (2.5%) patient had nonreactive pupils at first measurement after ROSC. The remaining 39 (97.5%) had reactive pupils. Of the 19 patients who had pupils checked within 3 minutes of ROSC, 100% had reactive pupils. Degree of pupil responsiveness was not correlated with cumulative dose of epinephrine. Ten patients received atropine in addition to epinephrine, including the sole patient with nonreactive pupils. The remaining 9 (90%) had reactive pupils. Conclusion: Epinephrine and atropine do not abolish the PLR in patients who achieve ROSC after in-hospital cardiac arrest. Lack of pupillary response in the post-arrest patient should not be attributed to these drugs.

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Impact of advanced cardiac life support-skilled paramedics on survival from out-of-hospital cardiac arrest in a statewide emergency medical service

Emergency Medicine Journal ◽

10.1136/emj.2005.033365 ◽

2007 ◽

Vol 24 (2) ◽

pp. 134-138 ◽

Cited By ~ 34

Author(s):

J. Woodall ◽

M. McCarthy ◽

T. Johnston ◽

V. Tippett ◽

R. Bonham

Keyword(s):

Cardiac Arrest ◽

Emergency Medical Service ◽

Medical Service ◽

Life Support ◽

Advanced Cardiac Life Support ◽

Emergency Medical ◽

Hospital Cardiac Arrest

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Advanced cardiac life support in out-of-hospital cardiac arrest

ACC Current Journal Review ◽

10.1016/j.accreview.2004.10.071 ◽

2004 ◽

Vol 13 (11) ◽

pp. 63-64

Author(s):

I.G. Stiell ◽

G.A. Wells ◽

B. Field

Keyword(s):

Cardiac Arrest ◽

Life Support ◽

Advanced Cardiac Life Support ◽

Hospital Cardiac Arrest

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An experimental algorithm versus standard advanced cardiac life support in a swine model of out-of-hospital cardiac arrest

Annals of Emergency Medicine ◽

10.1016/s0196-0644(05)80211-2 ◽

1993 ◽

Vol 22 (2) ◽

pp. 235-239 ◽

Cited By ~ 33

Author(s):

James J Menegazzi ◽

Eric A Davis ◽

Donald M Yealy ◽

Renee L Molner ◽

Kristine A Nicklas ◽

...

Keyword(s):

Cardiac Arrest ◽

Life Support ◽

Advanced Cardiac Life Support ◽

Swine Model ◽

Experimental Algorithm ◽

Hospital Cardiac Arrest

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Advanced cardiac life support training improves long-term survival from in-hospital cardiac arrest

Resuscitation ◽

10.1016/j.resuscitation.2006.06.039 ◽

2007 ◽

Vol 72 (3) ◽

pp. 458-465 ◽

Cited By ~ 84

Author(s):

Miguel Antonio Moretti ◽

Luiz Antonio Machado Cesar ◽

Amit Nusbacher ◽

Karl B. Kern ◽

Sergio Timerman ◽

...

Keyword(s):

Cardiac Arrest ◽

Life Support ◽

Advanced Cardiac Life Support ◽

Term Survival ◽

Long Term Survival ◽

Hospital Cardiac Arrest

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Mobile App to Improve House Officers’ Adherence to Advanced Cardiac Life Support Guidelines: Quality Improvement Study

JMIR mhealth and uhealth ◽

10.2196/15762 ◽

2020 ◽

Vol 8 (5) ◽

pp. e15762

Author(s):

Vittal Hejjaji ◽

Ali O Malik ◽

Poghni A Peri-Okonny ◽

Merrill Thomas ◽

Yuanyuan Tang ◽

...

Keyword(s):

Cardiac Arrest ◽

Quality Improvement ◽

Chest Compression ◽

Life Support ◽

Advanced Cardiac Life Support ◽

Mobile App ◽

Absolute Difference ◽

Quality Improvement Initiative ◽

The Impact ◽

Hospital Cardiac Arrest

Background Effective and timely delivery of cardiac arrest interventions during in-hospital cardiac arrest resuscitation is associated with greater survival. Whether a mobile app that provides timely reminders of critical interventions improves adherence to Advanced Cardiovascular Life Support (ACLS) guidelines among house officers, who may lack experience in leading resuscitations, remains unknown. Objective The aim of this study was to assess the impact of a commercially available, dynamic mobile app on house officers’ adherence to ACLS guidelines. Methods As part of a quality improvement initiative, internal medicine house officers were invited to participate and randomized to lead 2 consecutive cardiac arrest simulations, one with a novel mobile app and one without a novel mobile app. All simulations included 4 cycles of cardiopulmonary resuscitation with different cardiac arrest rhythms and were video recorded. The coprimary end points were chest compression fraction and number of correct interventions in each simulation. The secondary end point was incorrect interventions, defined as interventions not indicated by the 2015 ACLS guidelines. Paired t tests compared performance with and without the mobile app. Results Among 53 house officers, 26 house officers were randomized to lead the first simulation with the mobile app, and 27 house officers were randomized to do so without the app. Use of the mobile app was associated with a higher number of correct ACLS interventions (out of 7; mean 6.2 vs 5.1; absolute difference 1.1 [95% CI 0.6 to 1.6]; P<.001) as well as fewer incorrect ACLS interventions (mean 0.3 vs 1.0; absolute difference –0.7 [95% CI –0.3 to –1.0]; P<.001). Simulations with the mobile app also had a marginally higher chest compression fraction (mean 90.9% vs 89.0%; absolute difference 1.9% [95% CI 0.6% to 3.4%]; P=.007). Conclusions This proof-of-concept study suggests that this novel mobile app may improve adherence to ACLS protocols, but its effectiveness on survival in real-world resuscitations remains unknown.

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Abstract 154: Guideline Removal of Atropine and Survival After Adult In-Hospital Cardiac Arrest With Non-Shockable Rhythms

Circulation ◽

10.1161/circ.138.suppl_2.154 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Mathias J Holmberg ◽

Ari Moskowitz ◽

Sebastian Wiberg ◽

Lise Witten ◽

Anne V Grossestreuer ◽

...

Keyword(s):

Time Series ◽

Cardiac Arrest ◽

Life Support ◽

Interrupted Time Series ◽

Exposure Period ◽

Advanced Cardiac Life Support ◽

Mean Difference ◽

Interrupted Time Series Analysis ◽

Post Exposure ◽

Hospital Cardiac Arrest

Introduction: Atropine was removed from the 2010 American Heart Association’s Advanced Cardiac Life Support guidelines as routine management of non-shockable cardiac arrest, although the evidence to support or refute the use of atropine is lacking. In a previous study, atropine usage was shown to subsequently decline markedly. Whether removing atropine from the guidelines has affected survival remains unknown. Methods: Using the Get With The Guidelines®-Resuscitation registry, we included adult patients with an index in-hospital cardiac arrest between 2006-2015. Non-shockable and shockable cardiac arrest patients with high vs. low propensity score to receive atropine were separated into two cohorts. An interrupted time-series analysis was used to compare survival before (pre-exposure) and after (post-exposure) introduction of the 2010 guidelines. A difference-in-difference approach was used to compare the interrupted time-series results between the non-shockable and shockable cohorts to account for guideline changes unrelated to atropine. Results: We included 21,822 non-shockable and 4,268 shockable cardiac arrests. Patient characteristics were similar between the pre-exposure and post-exposure period. Atropine was used for 9,170 (86%) non-shockable and 733 (34%) shockable cardiac arrests in the pre-exposure period and 3,903 (35%) non-shockable and 339 (16%) shockable cardiac arrests in the post-exposure period. The change over time in survival from the pre-exposure to the post-exposure period was not significantly different for the non-shockable compared to the shockable cohort (mean difference: 2.0% [95%CI: -0.7, 4.6] per year, p = 0.15, Figure). The immediate change in survival after introducing the guidelines was also not different between the cohorts (mean difference: 3.9% [95%CI: -2.2, 10], p = 0.21, Figure). Conclusions: The removal of atropine from the 2010 guidelines was not associated with a change in survival in our analysis.

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