Tidal Volume Delivery and Endotracheal Tube Leak during Cardiopulmonary Resuscitation in Intubated Newborn Piglets with Hypoxic Cardiac Arrest Exposed to Different Modes of Ventilatory Support

AbstractObjectiveTo evaluate aerosol-spread in cardiopulmonary resuscitation (CPR) using different methods of airway management. Knowledge about aerosol-spread is vital during the SARS-CoV-2-Pandemic.MethodsTo evaluate feasibility we nebulized ultraviolet sensitive detergents into the artificial airway of a resuscitation dummy and performed CPR. The spread of the visualized aerosol was documented by a camera. In a second approach we applied nebulized detergents into human cadavers by an endotracheal tube and detected aerosol-spread during chest compressions the same way. We did recordings with undergoing compression-only-CPR, with a surgical mask and with an inserted laryngeal tube with and without a connected airway filter.ResultsMost aerosol-spread at the direction of the provider was visualized during compression-only-CPR. The use of a surgical mask deflected the spread. Inserting a laryngeal tube connected to an airway filter lead to a remarkable reduction of aerosol-spread.ConclusionThe early insertion of a laryngeal tube connected to an airway filter before starting chest compression may be good for two things – the treatment of hypoxemia as the likeliest cause of cardiac arrest and for staff protection during CPR.

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Web-based Compared to Personal Automated External Defibrillator Assisted Cardiopulmonary Resuscitation Training for Dental Students: Randomized Controlled Trial (Preprint)

10.2196/preprints.18952 ◽

2020 ◽

Author(s):

Antonia Postina ◽

Jürgen Hoffmann ◽

Till Sebastian Mutzbauer

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Tidal Volume ◽

Chest Compression ◽

Dental Students ◽

Basic Knowledge ◽

Web Based ◽

The Web ◽

Personal Tutor

BACKGROUND Cardiopulmonary resuscitation (CPR) is rarely performed by dental staff. The availability of automated external defibrillators (AED) is increasing. Personal tutor training with a manikin is the most common way to teach CPR. But internet-learning approaches, such as video-based teaching, are gaining popularity. OBJECTIVE This pilot study has been designed to compare the performance of CPR after two teaching methods in a simulated cardiac arrest situation. A personal tutor demonstration was compared with a web-based video demonstration. The main hypothesis was that more than 70% of the participants of the tutor-instructed group would start CPR within 10 seconds (s), while only up to 30% of the participants of the web-based video-instructed group would start within this time. METHODS One group of dental students received a 5.5 minutes (min) AED-CPR demonstration by a tutor on a manikin (T-/control group n=23 teams of two). A second group watched a 7min web-based AED-CPR instruction video (W-/intervention group n=23 teams of two). No repetition was offered, no questions or practice allowed. CPR performance was video-recorded and analyzed by two examiners. RESULTS No differences concerning the onset and quality of CPR were found. Students started CPR after detection of cardiac arrest with a minimum delay (median=6s (T)/6s (W); IQR=5/7; P=.52). Tidal volume and chest compression depths were insufficient in both groups (tidal volume: median=14 milliliters (ml) (T)/58ml (W); IQR=218.5/148.5; P=.9; depths: median=30 millimeters (mm) (T)/20mm (W); IQR=12.5/10; P=.02). Tutor-instructed teams compressed deeper, but both groups did not meet the recommended standard. Chest compression rate was in the recommended interval (median=113 (T)/111 compressions/minute (W); IQR=24.5/20; P=.46). More students of the web-based video-instructed group had problems using the AED (T=7 teams; W=14; P=.04) but all except one team continued CPR. They did not focus on the problems with the AED and were able to trigger a shock (T=21 teams; W=19; P=.38). Restart of CPR after the shock within 10s was achieved at almost equal time intervals (median=5s (T)/6s (W); IQR=3/4; P=.54). CONCLUSIONS Dental students can acquire basic knowledge in AED-assisted CPR in similar quality by a short web-based video simulation compared with a short demonstration by a tutor. Contrary to expectations, most parameters of CPR and AED performance quality of web-based video-instructed group were not different to students of the tutor-instructed group. The recommended tidal volume had not been achieved in both groups. Chest compression depth seems to be a parameter that has been more difficult to teach to the web-based video-instructed group. No delays of standard CPR measures were observed after detection of cardiac arrest in both groups. The use of the AED did not distract the attention of the rescuers from the simulated patient. CLINICALTRIAL DRKS00012404

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Faculty Opinions recommendation of Soluble epoxide hydrolase gene deletion reduces survival after cardiac arrest and cardiopulmonary resuscitation.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1097222.553232 ◽

2007 ◽

Author(s):

Deanna Kroetz

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Epoxide Hydrolase ◽

Gene Deletion ◽

Soluble Epoxide Hydrolase

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Impact of cardiopulmonary resuscitation on a cannot intubate, cannot oxygenate condition: a randomised crossover simulation research study of the interaction between two algorithms

BMJ Open ◽

10.1136/bmjopen-2019-030430 ◽

2019 ◽

Vol 9 (11) ◽

pp. e030430

Author(s):

Thomas Ott ◽

Jascha Stracke ◽

Susanna Sellin ◽

Marc Kriege ◽

Gerrit Toenges ◽

...

Keyword(s):

Decision Making ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Primary Outcome ◽

Research Study ◽

University Hospital ◽

Simulated Patients ◽

Stressful Situation ◽

Simulation Research ◽

Simulation Centre

ObjectivesDuring a ‘cannot intubate, cannot oxygenate’ situation, asphyxia can lead to cardiac arrest. In this stressful situation, two complex algorithms facilitate decision-making to save a patient’s life: difficult airway management and cardiopulmonary resuscitation. However, the extent to which competition between the two algorithms causes conflicts in the execution of pivotal treatment remains unknown. Due to the rare incidence of this situation and the very low feasibility of such an evaluation in clinical reality, we decided to perform a randomised crossover simulation research study. We propose that even experienced healthcare providers delay cricothyrotomy, a lifesaving approach, due to concurrent cardiopulmonary resuscitation in a ‘cannot intubate, cannot oxygenate’ situation.DesignDue to the rare incidence and dynamics of such a situation, we conducted a randomised crossover simulation research study.SettingWe collected data in our institutional simulation centre between November 2016 and November 2017.ParticipantsWe included 40 experienced staff anaesthesiologists at our tertiary university hospital centre.InterventionThe participants treated two simulated patients, both requiring cricothyrotomy: one patient required cardiopulmonary resuscitation due to asphyxia, and one patient did not require cardiopulmonary resuscitation. Cardiopulmonary resuscitation was the intervention. Participants were evaluated by video records.Primary outcome measuresThe difference in ‘time to ventilation through cricothyrotomy’ between the two situations was the primary outcome measure.ResultsThe results of 40 participants were analysed. No carry-over effects were detected in the crossover design. During cardiopulmonary resuscitation, the median time to ventilation was 22 s (IQR 3–40.5) longer than that without cardiopulmonary resuscitation (p=0.028), including the decision-making time.ConclusionCricothyrotomy, which is the most crucial treatment for cardiac arrest in a ‘cannot intubate, cannot oxygenate’ situation, was delayed by concurrent cardiopulmonary resuscitation. If cardiopulmonary resuscitation delays cricothyrotomy, it should be interrupted to first focus on cricothyrotomy.

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Management of out-of hospital cardiac arrest patients with extracorporeal cardiopulmonary resuscitation in 2021

Expert Review of Medical Devices ◽

10.1080/17434440.2021.1886076 ◽

2021 ◽

pp. 1-10

Author(s):

Christopher Gaisendrees ◽

Matias Vollmer ◽

Sebastian G Walter ◽

Ilija Djordjevic ◽

Kaveh Eghbalzadeh ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Hospital Cardiac Arrest

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How long should we run the code? Survival analysis based on location and duration of cardiopulmonary resuscitation (CPR) after in-hospital cardiac arrest

Journal of Community Hospital Internal Medicine Perspectives ◽

10.1080/20009666.2021.1877396 ◽

2021 ◽

Vol 11 (2) ◽

pp. 206-211

Author(s):

Ahmad Raza ◽

Ahmad Arslan ◽

Zain Ali ◽

Rajeshkumar Patel

Keyword(s):

Cardiac Arrest ◽

Survival Analysis ◽

Cardiopulmonary Resuscitation ◽

Hospital Cardiac Arrest

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Cardiac arrest complicating cardiogenic shock: from pathophysiological insights to Impella-assisted cardiopulmonary resuscitation in a pheochromocytoma-induced Takotsubo cardiomyopathy—a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab092 ◽

2021 ◽

Vol 5 (3) ◽

Author(s):

Filippo Zilio ◽

Simone Muraglia ◽

Roberto Bonmassari

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Left Ventricle ◽

Cardiogenic Shock ◽

Takotsubo Cardiomyopathy ◽

Perfusion Pressure ◽

Coronary Perfusion Pressure ◽

Left Ventricular ◽

Coronary Perfusion ◽

Refractory Cardiac Arrest

Abstract Background A ‘catecholamine storm’ in a case of pheochromocytoma can lead to a transient left ventricular dysfunction similar to Takotsubo cardiomyopathy. A cardiogenic shock can thus develop, with high left ventricular end-diastolic pressure and a reduction in coronary perfusion pressure. This scenario can ultimately lead to a cardiac arrest, in which unloading the left ventricle with a peripheral left ventricular assist device (Impella®) could help in achieving the return of spontaneous circulation (ROSC). Case summary A patient affected by Takotsubo cardiomyopathy caused by a pheochromocytoma presented with cardiogenic shock that finally evolved into refractory cardiac arrest. Cardiopulmonary resuscitation was performed but ROSC was achieved only after Impella® placement. Discussion In the clinical scenario of Takotsubo cardiomyopathy due to pheochromocytoma, when cardiogenic shock develops treatment is difficult because exogenous catecholamines, required to maintain organ perfusion, could exacerbate hypertension and deteriorate the cardiomyopathy. Moreover, as the coronary perfusion pressure is critically reduced, refractory cardiac arrest could develop. Although veno-arterial extra-corporeal membrane oxygenation (va-ECMO) has been advocated as the treatment of choice for in-hospital refractory cardiac arrest, in the presence of left ventricular overload a device like Impella®, which carries fewer complications as compared to ECMO, could be effective in obtaining the ROSC by unloading the left ventricle.

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Does Targeted Temperature Management Improve Neurological Outcome in Extracorporeal Cardiopulmonary Resuscitation (ECPR)?

Journal of Intensive Care Medicine ◽

10.1177/08850666211018982 ◽

2021 ◽

pp. 088506662110189

Author(s):

Merry Huang ◽

Aaron Shoskes ◽

Migdady Ibrahim ◽

Moein Amin ◽

Leen Hasan ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Neurological Outcome ◽

Targeted Temperature Management ◽

Temperature Management ◽

Survival Outcomes ◽

Pool Data ◽

Good Neurological Outcome ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Over Time

Purpose: Targeted temperature management (TTM) is a standard of care in patients after cardiac arrest for neuroprotection. Currently, the effectiveness and efficacy of TTM after extracorporeal cardiopulmonary resuscitation (ECPR) is unknown. We aimed to compare neurological and survival outcomes between TTM vs non-TTM in patients undergoing ECPR for refractory cardiac arrest. Methods: We searched PubMed and 5 other databases for randomized controlled trials and observational studies reporting neurological outcomes or survival in adult patients undergoing ECPR with or without TTM. Good neurological outcome was defined as cerebral performance category <3. Two independent reviewers extracted the data. Random-effects meta-analyses were used to pool data. Results: We included 35 studies (n = 2,643) with the median age of 56 years (interquartile range [IQR]: 52-59). The median time from collapse to ECMO cannulation was 58 minutes (IQR: 49-82) and the median ECMO duration was 3 days (IQR: 2.0-4.1). Of 2,643, 1,329 (50.3%) patients received TTM and 1,314 (49.7%) did not. There was no difference in the frequency of good neurological outcome at any time between TTM (29%, 95% confidence interval [CI]: 23%-36%) vs. without TTM (19%, 95% CI: 9%-31%) in patients with ECPR ( P = 0.09). Similarly, there was no difference in overall survival between patients with TTM (30%, 95% CI: 22%-39%) vs. without TTM (24%, 95% CI: 14%-34%) ( P = 0.31). A cumulative meta-analysis by publication year showed improved neurological and survival outcomes over time. Conclusions: Among ECPR patients, survival and neurological outcome were not different between those with TTM vs. without TTM. Our study suggests that neurological and survival outcome are improving over time as ECPR therapy is more widely used. Our results were limited by the heterogeneity of included studies and further research with granular temperature data is necessary to assess the benefit and risk of TTM in ECPR population.

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