scholarly journals Standards for Studies of Neurological Prognostication in Comatose Survivors of Cardiac Arrest: A Scientific Statement From the American Heart Association

Circulation ◽  
2019 ◽  
Vol 140 (9) ◽  
Author(s):  
Romergryko G. Geocadin ◽  
Clifton W. Callaway ◽  
Ericka L. Fink ◽  
Eyal Golan ◽  
David M. Greer ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Poor Outcome ◽  
Writing Group ◽  
Life Sustaining Treatment ◽  
Poor Outcomes

Significant improvements have been achieved in cardiac arrest resuscitation and postarrest resuscitation care, but mortality remains high. Most of the poor outcomes and deaths of cardiac arrest survivors have been attributed to widespread brain injury. This brain injury, commonly manifested as a comatose state, is a marker of poor outcome and a major basis for unfavorable neurological prognostication. Accurate prognostication is important to avoid pursuing futile treatments when poor outcome is inevitable but also to avoid an inappropriate withdrawal of life-sustaining treatment in patients who may otherwise have a chance of achieving meaningful neurological recovery. Inaccurate neurological prognostication leading to withdrawal of life-sustaining treatment and deaths may significantly bias clinical studies, leading to failure in detecting the true study outcomes. The American Heart Association Emergency Cardiovascular Care Science Subcommittee organized a writing group composed of adult and pediatric experts from neurology, cardiology, emergency medicine, intensive care medicine, and nursing to review existing neurological prognostication studies, the practice of neurological prognostication, and withdrawal of life-sustaining treatment. The writing group determined that the overall quality of existing neurological prognostication studies is low. As a consequence, the degree of confidence in the predictors and the subsequent outcomes is also low. Therefore, the writing group suggests that neurological prognostication parameters need to be approached as index tests based on relevant neurological functions that are directly related to the functional outcome and contribute to the quality of life of cardiac arrest survivors. Suggestions to improve the quality of adult and pediatric neurological prognostication studies are provided.

scholarly journals Out-of-Hospital Cardiac Arrest Resuscitation Systems of Care: A Scientific Statement From the American Heart Association

Circulation ◽  
2018 ◽  
Vol 137 (21) ◽  
Author(s):  
James J. McCarthy ◽  
Brendan Carr ◽  
Comilla Sasson ◽  
Bentley J. Bobrow ◽  
Clifton W. Callaway ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
American Heart Association ◽  
American Heart ◽  
Systems Of Care ◽  
Heart Association ◽  
Scientific Statement ◽  
Hospital Cardiac Arrest

scholarly journals Post out-of-hospital cardiac arrest care in a tertiary care center in southern Thailand: From emergency department to intensive care unit

2019 ◽  
Vol 27 (3) ◽  
pp. 155-161 ◽  
Author(s):  
Veerapong Vattanavanit ◽  
Supattra Uppanisakorn ◽  
Thanapon Nilmoje
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
American Heart Association ◽  
American Heart ◽  
Medical Intensive Care Unit ◽  
Heart Association ◽  
Temperature Management ◽  
Medical Intensive Care ◽  
Hospital Cardiac Arrest

Background: Out-of-hospital cardiac arrest results in a high mortality rate. The 2015 American Heart Association guideline for post-cardiac arrest was launched and adopted into our institutional policy. Objectives: We aimed to evaluate post-cardiac arrest care and compare the results with the 2015 American Heart Association guideline and clinical outcomes of out-of-hospital cardiac arrest patients. Methods Included in this study were all adult patients who survived out-of-hospital cardiac arrest and were admitted to the Medical Intensive Care Unit of Songklanagarind Hospital, Thailand. The retrospective review was from 1 January 2016 to 31 December 2017. Results: From a total of 161 post-cardiac arrest patients admitted to the medical intensive care unit, 69 out-of-hospital cardiac arrest patients were identified. The most common cause of arrest was presumed cardiac in origin (45.0%) in which the majority was acute myocardial infarction (67.8%). Coronary intervention and targeted temperature management were performed in 27.5% and 13% of all out-of-hospital cardiac arrest patients, respectively. Survival to hospital discharge was 42%. Independent factors associated with survival to discharge were shockable rhythms, lower adrenaline doses, and the absence of hypotension at medical intensive care unit admission. Conclusion: Compliance with the 2015 American Heart Association post-cardiac arrest care guideline was low in our institution, especially in coronary intervention and targeted temperature management.

scholarly journals 2019 American Heart Association Focused Update on Systems of Care: Dispatcher-Assisted Cardiopulmonary Resuscitation and Cardiac Arrest Centers: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Circulation ◽  
2019 ◽  
Vol 140 (24) ◽  
Author(s):  
Ashish R. Panchal ◽  
Katherine M. Berg ◽  
José G. Cabañas ◽  
Michael C. Kurz ◽  
Mark S. Link ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
American Heart Association ◽  
American Heart ◽  
Systems Of Care ◽  
Heart Association ◽  
Integrated System ◽  
Care Chain ◽  
Published Evidence ◽  
Hospital Cardiac Arrest

Survival after out-of-hospital cardiac arrest requires an integrated system of care (chain of survival) between the community elements responding to an event and the healthcare professionals who continue to care for and transport the patient for appropriate interventions. As a result of the dynamic nature of the prehospital setting, coordination and communication can be challenging, and identification of methods to optimize care is essential. This 2019 focused update to the American Heart Association systems of care guidelines summarizes the most recent published evidence for and recommendations on the use of dispatcher-assisted cardiopulmonary resuscitation and cardiac arrest centers. This article includes the revised recommendations that emergency dispatch centers should offer and instruct bystanders in cardiopulmonary resuscitation during out-of-hospital cardiac arrest and that a regionalized approach to post–cardiac arrest care may be reasonable when comprehensive postarrest care is not available at local facilities.

scholarly journals 2019 American Heart Association Focused Update on Pediatric Advanced Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Circulation ◽  
2019 ◽  
Vol 140 (24) ◽  
Author(s):  
Jonathan P. Duff ◽  
Alexis A. Topjian ◽  
Marc D. Berg ◽  
Melissa Chan ◽  
Sarah E. Haskell ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
American Heart Association ◽  
Life Support ◽  
American Heart ◽  
Heart Association ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Liaison Committee ◽  
Hospital Cardiac Arrest

This 2019 focused update to the American Heart Association pediatric advanced life support guidelines follows the 2018 and 2019 systematic reviews performed by the Pediatric Life Support Task Force of the International Liaison Committee on Resuscitation. It aligns with the continuous evidence review process of the International Liaison Committee on Resuscitation, with updates published when the International Liaison Committee on Resuscitation completes a literature review based on new published evidence. This update provides the evidence review and treatment recommendations for advanced airway management in pediatric cardiac arrest, extracorporeal cardiopulmonary resuscitation in pediatric cardiac arrest, and pediatric targeted temperature management during post–cardiac arrest care. The writing group analyzed the systematic reviews and the original research published for each of these topics. For airway management, the writing group concluded that it is reasonable to continue bag-mask ventilation (versus attempting an advanced airway such as endotracheal intubation) in patients with out-of-hospital cardiac arrest. When extracorporeal membrane oxygenation protocols and teams are readily available, extracorporeal cardiopulmonary resuscitation should be considered for patients with cardiac diagnoses and in-hospital cardiac arrest. Finally, it is reasonable to use targeted temperature management of 32°C to 34°C followed by 36°C to 37.5°C, or to use targeted temperature management of 36°C to 37.5°C, for pediatric patients who remain comatose after resuscitation from out-of-hospital cardiac arrest or in-hospital cardiac arrest.

scholarly journals 2019 American Heart Association Focused Update on Pediatric Basic Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Circulation ◽  
2019 ◽  
Vol 140 (24) ◽  
Author(s):  
Jonathan P. Duff ◽  
Alexis A. Topjian ◽  
Marc D. Berg ◽  
Melissa Chan ◽  
Sarah E. Haskell ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
American Heart Association ◽  
Basic Life Support ◽  
Life Support ◽  
American Heart ◽  
Heart Association ◽  
Liaison Committee ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

This 2019 focused update to the American Heart Association pediatric basic life support guidelines follows the 2019 systematic review of the effects of dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) on survival of infants and children with out-of-hospital cardiac arrest. This systematic review and the primary studies identified were analyzed by the Pediatric Task Force of the International Liaison Committee on Resuscitation. It aligns with the International Liaison Committee on Resuscitation’s continuous evidence review process, with updates published when the International Liaison Committee on Resuscitation completes a literature review based on new published evidence. This update summarizes the available pediatric evidence supporting DA-CPR and provides treatment recommendations for DA-CPR for pediatric out-of-hospital cardiac arrest. Four new pediatric studies were reviewed. A systematic review of this data identified the association of a significant improvement in the rates of bystander CPR and in survival 1 month after cardiac arrest with DA-CPR. The writing group recommends that emergency medical dispatch centers offer DA-CPR for presumed pediatric cardiac arrest, especially when no bystander CPR is in progress. No recommendation could be made for or against DA-CPR instructions when bystander CPR is already in progress.

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