P1705The association between pre-shock ventricular fibrillation duration and shock success during out-of-hospital cardiac arrest

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Nas ◽  
J Thannhauser ◽  
P M Van Grunsven ◽  
G Meinsma ◽  
N Van Royen ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Chest Compression ◽  
Real World ◽  
Interquartile Range ◽  
Chest Compressions ◽  
Duration Time ◽  
Hospital Cardiac Arrest

Abstract Background After the first shock, most ventricular fibrillation (VF) out-of-hospital cardiac arrest (OHCA) patients require subsequent shocks before organized rhythm is restored. Currently, all those shocks are given after a fixed 2 or 3-minute chest compression interval, resulting in many unsuccessful shocks. However, recently new defibrillators have been developed that can recognize VF during chest compressions, and enable earlier shocks immediately upon detection of VF. This prompts the question whether VF of shorter duration is associated with higher shock success. Purpose To study the association between pre-shock VF-duration and shock success in all subsequent shocks during OHCA. Methods Detailed VF-study on a subset of our prospective, real-world cardiac arrest-registry, focusing on patients with ≥2 shocks for VF and available ECG-tracings. These were scrutinized to determine VF-duration (time from VF-onset until shock) and shock success (return of organized rhythm within 1 min. after the shock). All first shocks were excluded. Results We studied 397 shocks from 101 patients. Of these, 77% were male and median age was 64 (interquartile range [IQR] 54–76) years. Overall shock success was 51% and survival to discharge was 19%. Overall median pre-shock VF-duration was 221s (IQR 125–433). The median pre-shock VF-duration was shorter before a successful (171s [IQR 75–295]) than before an unsuccessful shock (334s [IQR 174–740]), p<0.001. Shock success decreased from 75% in the quartile with the shortest to 21% in the quartile with the longest pre-shock VF-duration, p for trend<0.001 (Figure 1). Figure 1 Conclusion In shocks following the first defibrillation attempt, VF of shorter duration is associated with higher proportions of shock success. In an era of defibrillators that are able to recognize VF during chest compressions, our findings prompt the question whether shock upon detection of VF may improve the dismal outcomes of VF cardiac arrest. Acknowledgement/Funding None

Abstract 12769: Amplitude-Spectral Area of the Ventricular Fibrillation Waveform and Chest Compression Quality in Witnessed and Unwitnessed Out-Of-Hospital Cardiac Arrest: Can We Predict Who is Unlikely to Survive?

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Julia Indik ◽  
Zacherie Conover ◽  
Meghan McGovern ◽  
Annemarie Silver ◽  
Daniel Spaite ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Hospital Discharge ◽  
Chest Compression ◽  
Stepwise Logistic Regression ◽  
Individual Subject ◽  
Spectral Area ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

Background: Previous investigations in human out of hospital cardiac arrest (OHCA) due to ventricular fibrillation (VF) have shown that the frequency-based waveform characteristic, amplitude spectral area (AMSA) predicts defibrillation success and is associated with survival to hospital discharge. We evaluated the relative strength of factors associated with hospital discharge including witnessed/unwitnessed status, chest compression (CC) quality and AMSA. We then investigated if there is a threshold value for AMSA that can identify patients who are unlikely to survive. Methods: Adult OHCA patients (age ≥18), with initial rhythm of VF from an Utstein-Style database (collected from 2 EMS systems) were analyzed. AMSA was measured from the waveform immediately prior to each shock, and averaged for each individual subject (AMSA-ave). Univariate and stepwise multivariable logistic regression, and receiver-operator-characteristic (ROC) analyses were performed. Factors analyzed: age, sex, witnessed status, time from dispatch to monitor/defibrillator application, number of shocks, mean CC rate, depth, and release velocity (RV). Results: 140 subjects were analyzed, [104 M (74%), age 62 ± 14 yrs, witnessed 65%]. Survival was 38% in witnessed and 16% in unwitnessed arrest. In univariate analyses, age (P=0.001), witnessed status (P=0.009), AMSA-ave (P<0.001), mean CC depth (P=0.025), and RV (P< 0.001) were associated with survival. Stepwise logistic regression identified AMSA-ave (P<0.001), RV (P=0.001) and age (P=0.018) as independently associated with survival. The area under the curve (ROC analysis) was 0.849. The probability of survival was < 5% in witnessed arrest for AMSA-ave < 5 mV-Hz, and in unwitnessed arrest for AMSA-ave < 15 mV-Hz. Conclusion: In OHCA with an initial rhythm of VF, AMSA-ave and CC RV are highly associated with survival. Further study is needed to evaluate whether AMSA-ave may be useful to identify patients highly unlikely to survive.

scholarly journals Effect of Early Supraglottic Airway Device Insertion on Chest Compression Fraction during Simulated Out-of-Hospital Cardiac Arrest: Randomised Controlled Trial

2021 ◽  
Vol 11 (1) ◽  
pp. 217
Author(s):  
Loric Stuby ◽  
Laurent Jampen ◽  
Julien Sierro ◽  
Maxime Bergeron ◽  
Erik Paus ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Chest Compression ◽  
Controlled Trial ◽  
Face Mask ◽  
Airway Device ◽  
Supraglottic Airway ◽  
Chest Compressions ◽  
The Difference ◽  
Randomised Controlled ◽  
Hospital Cardiac Arrest

Early insertion of a supraglottic airway (SGA) device could improve chest compression fraction by allowing providers to perform continuous chest compressions or by shortening the interruptions needed to deliver ventilations. SGA devices do not require the same expertise as endotracheal intubation. This study aimed to determine whether the immediate insertion of an i-gel® while providing continuous chest compressions with asynchronous ventilations could generate higher CCFs than the standard 30:2 approach using a face-mask in a simulation of out-of-hospital cardiac arrest. A multicentre, parallel, randomised, superiority, simulation study was carried out. The primary outcome was the difference in CCF during the first two minutes of resuscitation. Overall and per-cycle CCF quality of compressions and ventilations parameters were also compared. Among thirteen teams of two participants, the early insertion of an i-gel® resulted in higher CCFs during the first two minutes (89.0% vs. 83.6%, p = 0.001). Overall and per-cycle CCF were consistently higher in the i-gel® group, even after the 30:2 alternation had been resumed. In the i-gel® group, ventilation parameters were enhanced, but compressions were significantly shallower (4.6 cm vs. 5.2 cm, p = 0.007). This latter issue must be addressed before clinical trials can be considered.

Relation between the force of chest compression and recurrent ventricular fibrillation in out-of-hospital cardiac arrest

Resuscitation ◽  
2010 ◽  
Vol 81 (2) ◽  
pp. S74 ◽  
Author(s):  
D. Aschieri ◽  
V. Pelizzoni ◽  
A. Cavanna ◽  
Q. Villani Giovanni ◽  
A. Capucci
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Chest Compression ◽  
Hospital Cardiac Arrest

Abstract 17534: The Most Appropriate Number of Personnel Needed for Chest Compressions for In-hospital Cardiac Arrest: A Randomized, Crossover Manikin Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Shunsuke Yamanaka ◽  
Kei Nishiyama ◽  
Hiroyuki Hayashi ◽  
Ji Young Huh
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Healthcare Providers ◽  
Preliminary Evaluation ◽  
Chest Compressions ◽  
Rescue Team ◽  
Manikin Study ◽  
Hospital Cardiac Arrest

Background: Effective chest compression (CC) is vital in cardiopulmonary resuscitation (CPR), and rescuer’s fatigue negatively affects quality of CPR. However, there is no consensus on the appropriate number of personnel needed for CC to avoid rescuer’s fatigue. Objective: We determined the appropriate number of personnel needed for 30-min CPR in a rescue-team in a hospital. Methods: We conducted a preliminary randomized, crossover, manikin trial on healthcare providers. We divided them into Groups A to D according to the intervals between the 2-min CC and assigned a different interval to each group. Groups A, B, C, and D performed CCs at 2-, 4-, 6-, and 8-min intervals as in 2, 3, 4, and 5 personnel, respectively. All participants performed CCs for 30 min with different intervals depending on the assigned group; participants allocated to Groups A, B, C, and D performed 8, 5, 4, and 3 cycles, respectively. We compared the differences between first cycle and the second to the last cycle Results: We enrolled 42 participants (age: 25.2±4.2, men 47.6%) for the preliminary evaluation. We used Kruskal-Wallis for the analysis. Participants in the less interval Groups A and B performed faster (A: -24.28±15.18, B: -7.90±13.49, C: -11.27±17.01, D: -2.38±3.31, P=0.03) and shallower CCs (A: -4.42±6.92, B: -3.18±5.43, C: -0.18±5.74, D: -1.23±4.10, P=0.62). Women-rescuers performed faster (A: -27.25±12.23, B: -7.00±13.97, C: -8.16±19.26, D: 3.16±4.66, P= 0.05) and shallower CCs (A: -6.25±7.54, B: -3.00±6.89, C: -3.66±3.32, D: -0.16±4.35, P=0.58). However, CCs of men-rescuers were not faster (A: -20.33±20.65, B: -9.00±14.44, C: -15.00±15.11, D: -7.14±16.70, P= 0.60) or shallower (A: -2.00±6.55 B: -3.40±3.78, C: 4.00±5.33, D: -2.14±3.98, P=0.06). Conclusion: At least four rescuers (Group C) may be needed to reduce rescuer’s fatigue for 30-min CPR. If the team only includes women, more personnel would be needed as women experience fatigue faster.

scholarly journals Resumption of Chest Compressions After Successful Defibrillation and Risk for Recurrence of Ventricular Fibrillation in Out-of-Hospital Cardiac Arrest

2014 ◽  
Vol 7 (4) ◽  
pp. 633-639 ◽  
Author(s):  
Zacherie Conover ◽  
Karl B. Kern ◽  
Annemarie E. Silver ◽  
Bentley J. Bobrow ◽  
Daniel W. Spaite ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Chest Compressions ◽  
Hospital Cardiac Arrest
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