Pralidoxime administered during cardiopulmonary resuscitation facilitates successful resuscitation in a pig model of cardiac arrest

Sudden cardiac arrest is a leading cause of death worldwide. Despite significant advances in resuscitation science since the initial use of external chest compressions in humans nearly 60 years ago, there continues to be wide variability in rates of successful resuscitation across communities. The American Heart Association (AHA) and European Resuscitation Council emphasise the importance of high-quality chest compressions as the foundation of resuscitation care. We review the physiological basis for the association between chest compression quality and clinical outcomes and the scientific basis for the AHA’s key metrics for high-quality cardiopulmonary resuscitation. Finally, we highlight that implementation of strategies that promote effective chest compressions can improve outcomes in all patients with cardiac arrest.

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A big white dot after CPR

International Journal of Emergency Medicine ◽

10.1186/s12245-021-00376-3 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Sushma Kola ◽

Alexander D. Ginsburg ◽

Laura Harper ◽

Laura E. Walker ◽

Sherri Braksick ◽

...

Keyword(s):

Computed Tomography ◽

Cardiac Arrest ◽

Case Report ◽

Cardiopulmonary Resuscitation ◽

Basilar Artery ◽

Pulseless Electrical Activity ◽

Spontaneous Circulation ◽

Successful Resuscitation ◽

Ct Angiogram ◽

Neurologic Event

Abstract Introduction Patients may remain comatose after the resumption of spontaneous circulation with cardiopulmonary resuscitation. A primary neurologic event may precede a cardiac standstill. Case report We present a 33-year-old patient with successful resuscitation for pulseless electrical activity and a “normal computed tomography (CT) scan.” Further scrutiny showed a hyperdense basilar artery sign (‘big white dot’) that led to a CT angiogram confirming an embolus to the proximal basilar artery. His examination showed fixed and dilated midsize (mesencephalic) pupils and extensor posturing. Endovascular retrieval of the clot was successful, but there was a devastating ischemic injury to the brainstem. Conclusion This case reminds us to consider neurologic causes of cardiac arrest.

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Therapeutic Hypothermia Activates the Endothelin and Nitric Oxide Systems after Cardiac Arrest in a Pig Model of Cardiopulmonary Resuscitation

PLoS ONE ◽

10.1371/journal.pone.0064792 ◽

2013 ◽

Vol 8 (5) ◽

pp. e64792 ◽

Cited By ~ 10

Author(s):

Frank Zoerner ◽

Lars Wiklund ◽

Adriana Miclescu ◽

Cecile Martijn

Keyword(s):

Nitric Oxide ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Therapeutic Hypothermia ◽

Pig Model ◽

Oxide Systems

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Successful resuscitation from prolonged hypothermic cardiac arrest without extracorporeal life support: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-019-2282-6 ◽

2019 ◽

Vol 13 (1) ◽

Cited By ~ 2

Author(s):

Melanie Kuhnke ◽

Roland Albrecht ◽

Joerg C. Schefold ◽

Peter Paal

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Core Temperature ◽

Life Support ◽

Extracorporeal Life Support ◽

Weather Conditions ◽

Successful Resuscitation ◽

Case Presentation ◽

Favorable Neurological Outcome ◽

Level 1 Trauma Center

Abstract Background We report a case of successful prolonged cardiopulmonary resuscitation (5 hours and 44 minutes) following severe accidental hypothermia with cardiac arrest treated without rewarming on extracorporeal life support. Case presentation A 52-year-old Italian mountaineer, was trapped in a crevasse and rescued approximately 7 hours later by a professional rescue team. After extrication, he suffered a witnessed cardiac arrest with ventricular fibrillation. Immediate defibrillation and cardiopulmonary resuscitation were started. His core temperature was 26.0 °C. Due to weather conditions, air transport to an extracorporeal life support center was not possible. Thus, he was rewarmed with conventional rewarming methods in a rural hospital. Auto-defibrillation occurred at a core temperature of 29.8 °C after 5 hours and 44 minutes of continued cardiopulmonary resuscitation. With a core temperature of 33.4 °C, he was finally admitted to a level 1 trauma center and extracorporeal life support was no longer required. Seven weeks following the accident, he was discharged home with complete neurological recovery. Conclusions Successful rewarming from severe hypothermia without extracorporeal life support use as performed in this case suggests that patients with primary hypothermic cardiac arrest have a chance of a favorable neurological outcome even after several hours of cardiac arrest when cardiopulmonary resuscitation and conventional rewarming are performed continuously. This may be especially relevant in remote areas, where extracorporeal life support rewarming is not available.

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