Abstract 64: A Tale of Seven EMS Systems: An Impedance Threshold Device and Improved CPR Techniques Double Survival Rates After Out-of-Hospital Cardiac Arrest

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Tom P Aufderheide ◽  
Marvin Birnbaum ◽  
Charles Lick ◽  
Brent Myers ◽  
Laurie Romig ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Life Support ◽  
Survival Rates ◽  
Heart Association ◽  
Outcome Data ◽  
Therapeutic Interventions ◽  
Threshold Device ◽  
Hospital Cardiac Arrest ◽  
Impedance Threshold Device

Introduction: Maximizing outcomes after cardiac arrest depends on optimizing a sequence of interventions from collapse to hospital discharge. The 2005 American Heart Association (AHA) Guidelines recommended many new interventions during CPR (‘New CPR’) including use of an Impedance Threshold Device (ITD). Hypothesis: The combination of the ITD and ‘New CPR’ will increase return of spontaneous circulation (ROSC) and hospital discharge (HD) rates in patients with an out-of-hospital cardiac arrest. Methods: Quality assurance data were pooled from 7 emergency medical services (EMS) systems (Anoka Co., MN; Harris Co., TX; Madison, WI; Milwaukee, WI; Omaha, NE; Pinellas Co., FL; and Wake Co., NC) where the ITD (ResQPOD®, Advanced Circulatory Systems; Minneapolis, MN) was deployed for >3 months. Historical or concurrent control data were used for comparison. The EMS systems simultaneously implemented ‘New CPR’ including compression/ventilation strategies to provide more compressions/min and continuous compressions during Advanced Life Support. All sites stressed the importance of full chest wall recoil. The sites have a combined population of ~ 3.2 M. ROSC data were available from all sites; HD data were available as of June 2007 from 5 sites (MN, TX, Milwaukee, NE, NC). Results: A total of 893 patients treated with ‘New CPR’ + ITD were compared with 1424 control patients. The average age of both study populations was 64 years; 65% were male. Comparison of the ITD vs controls (all patients) for ROSC and HD [Odds ratios (OR), (95% confidence intervals), and Fisher’s Exact Test] were: 37.9% vs 33.8% [1.2, (1.02, 1.40), p=0.022] and 15.7% vs 7.9% [2.2, (1.53, 3.07), p<0.001], respectively. Patients with ventricular fibrillation had the best outcomes in both groups. Neurological outcome data are pending. Therapeutic hypothermia was used in some patients (MN, NC) after ROSC. Conclusion: Adoption of the ITD + ‘New CPR’ resulted in only a >10% increase in ROSC rates but a doubling of hospital discharge rates, from 7.9% to 15.7%, (p<0.001). These data represent a currently optimized sequence of therapeutic interventions during the performance of CPR for patients in cardiac arrest and support the widespread use of the 2005 AHA CPR Guidelines including use of the ITD.

Abstract 29: Comparison of Amiodarone versus Lidocaine for Treatment of In-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Deborah S Wagner ◽  
Humaira Nawer ◽  
Steven L Kronick ◽  
James A Cranford ◽  
Steven M Bradley ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Randomized Clinical Trials ◽  
Life Support ◽  
Cerebral Performance Category ◽  
Heart Association ◽  
The United States ◽  
Neurologic Outcome ◽  
Multivariable Logistic Regression Analysis ◽  
Hospital Cardiac Arrest

Introduction: Over 200,000 patients are treated annually in the United States for in-hospital cardiac arrest (IHCA). Patients with an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT) have a survival rate of less than 50%. The current American Heart Association (AHA) Advanced Cardiovascular Life Support guidelines suggest amiodarone or lidocaine as first-line agents for shock-refractory VF/pVT based on randomized clinical trials in adults with out-of-hospital cardiac arrest. Based on these results, we hypothesized that amiodarone and lidocaine have equivalent efficacy in treating hospitalized patients with VF/pVT. Methods: This is a retrospective risk-adjusted cohort study using the AHA Get with the Guidelines-Resuscitation® (GWTG-R) registry. The study included adult patients between January 1, 2000 to December 31, 2014 with IHCA due to VF/pVT that received either amiodarone or lidocaine. The primary outcome was return of spontaneous circulation (ROSC). Secondary outcomes were 24-hour survival, survival to hospital discharge, and survival with favorable neurologic outcome based on Cerebral Performance Category (CPC) 1 or 2. Results: A total of 14,630 events were included in the analysis. Among patients who met inclusion criteria, 68.7% (n=10,058) were treated with amiodarone and 31.3% (n=4,572) were treated with lidocaine. Results from multivariable logistic regression analysis showed that, controlling for 19 covariates, ROSC rates were not statistically different with lidocaine treatment vs. amiodarone (AOR = 1.02, 95% CI 0.94, 1.11). However, lidocaine treatment was associated with higher odds of a) 24-hour survival, AOR = 1.14, 95% CI 1.06, 1.23; b) survival to discharge, AOR = 1.15, 95% CI 1.06, 1.24; and c) favorable neurologic outcome at hospital discharge, AOR = 1.21, 95% CI 1.11, 1.31. Conclusion: In adult IHCA patients with VF/pVT, treatment with lidocaine compared to amiodarone was not associated with higher ROSC rates, but was associated with higher rates of survival and favorable neurological outcomes. Additional research is needed to determine the optimal antiarrhythmic therapy for VF/pVT in IHCA.

Abstract 72: Addition of Real-Time CPR Feedback Improves Immediate Outcomes for Out-of-Hospital Cardiac Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
◽  
John Freese ◽  
Mark Menegus ◽  
Jeffrey Rabrich ◽  
Todd Slesinger ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Real Time ◽  
Life Support ◽  
Control Period ◽  
Survival Rates ◽  
Specific Effect ◽  
Heart Association ◽  
Urban Setting ◽  
Term Survival ◽  
Hospital Cardiac Arrest

Introduction: The 2010 American Heart Association Guidelines stated that “cardiopulmonary resuscitation prompt and feedback devices may be useful for training rescuers and may be useful as part of an overall strategy to improve the quality of CPR for actual cardiac arrests.” We sought to assess the effect of one such device on OOHCA outcomes in a large, urban setting. Methodology: Out-of-hospital cardiac arrest data from two consecutive twelve-month periods was analyzed: August 1, 2010 - July 31, 2011 (control) and August 1, 2011 - July 31, 2012 (CPR feedback). During the CPR feedback period, defibrillators capable of providing real-time audible and visual CPR feedback were added to standard prehospital resuscitation care. Results: There were 850 and 748 bystander witnessed arrests of cardiac etiology in the two periods. Patient and arrest characteristics for the two groups did not differ with respect to age, gender, race, response time, bystander witnessed status, or the frequency of bystander CPR. As compared to the control period, the addition of real-time CPR feedback resulted in a significant improvement in immediate outcomes: return of spontaneous circulation, or ROSC (39.59% vs. 47.71%, p=0.001); sustained ROSC (31.17% vs. 36.14%, p= 0.037). However, there was no improvement in survival to hospital admission (24.88% vs. 25.32%, p=0.85) or survival to hospital discharge (5.63% vs. 6.72%, p=0.43). In addition, among those survivors for whom neurologic status is known, the addition of CPR feedback did not significantly change the proportion of survivors considered neurologically intact (70.37% vs 65.63%, all p=0.78). Conclusions: The addition of real-time CPR feedback to a large urban EMS system’s resuscitation care resulted in significant improvements in immediate survival but did not affect overall survival rates. It is also possible earlier introduction of these devices (through their use by first responder and/or earlier arriving basic life support units) may provide greater benefit. Further data analysis is required to determine the specific effect of CPR feedback devices on long-term survival and to optimize their use in resuscitation care.

scholarly journals A Trial of an Impedance Threshold Device in Out-of-Hospital Cardiac Arrest

2011 ◽  
Vol 365 (9) ◽  
pp. 798-806 ◽  
Author(s):  
Tom P. Aufderheide ◽  
Graham Nichol ◽  
Thomas D. Rea ◽  
Siobhan P. Brown ◽  
Brian G. Leroux ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Threshold Device ◽  
Hospital Cardiac Arrest ◽  
Impedance Threshold Device

Abstract 038: American Heart Association Mission: Lifeline Breakthrough Series Collaborative Improving the Survival Rates for Out of Hospital Cardiac Arrest by Focusing on Early CPR With an Emphasis on Chest Compressions

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Charles R Siegel ◽  
Anjan Chakrabarti ◽  
Lewis Siegel ◽  
Forrest Winslow ◽  
Thomas Hall
Keyword(s):  
Cardiac Arrest ◽  
Quality Improvement ◽  
Performance Measures ◽  
Effective Diffusion ◽  
Survival Rates ◽  
Public Health Problem ◽  
Heart Association ◽  
Performance Measure ◽  
Compression Rate ◽  
Hospital Cardiac Arrest

Introduction: Out-of-hospital cardiac arrest (OHCA) remains a highly morbid public health problem. Despite improving practices and clear guidelines, mortality from this condition remains high at 90%, with survivors often suffering from poor neurologic outcomes. To determine the feasibility of quality improvement collaboratives to narrow gaps between evidence-based practice and patient care for OHCA, we conducted a pilot study of the AHA Resuscitation Collaborative. Methods: Eight emergency medical service agencies participated in the quality improvement collaborative pilot project. We identified several OHCA performance measures to assess the quality of care, guide collaborative activities, and monitor change in performance over time. Over the course of four learning sessions, participants were trained in quality improvement and performance measurement, analyzed performance measure results, and shared successes and challenges. Results: Five remaining agencies underwent the process outlined in Figure 1. Adherence to performance measures, including compression rate compliance (Figure 2), improved over the course of the collaborative. Compression rate compliance in Figure 2 corresponds to the process improvement efforts of the Chesapeake Fire Department with achievement of goals for optimal range of chest compression rate between 100 and 120 compressions per minute during resuscitations. Conclusion: As demonstrated in Virginia, the collaborative approach was an effective framework to improve OHCA care. Improvement in performance measures, the evident commitment of dedicated peers and colleagues, consistent collaboration, and the effective diffusion of best practices all support the continued use of this model.

Abstract 2003: More Chest Compressions and Fewer Shocks Are Given During Out-of-Hospital Cardiac Arrest Resuscitation With the 2005 AHA Guidelines

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Lynn J White ◽  
Sarah A Cantrell ◽  
Robert Cronin ◽  
Shawn Koser ◽  
David Keseg ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Survival Rates ◽  
Automated Analysis ◽  
Spontaneous Circulation ◽  
Chest Compressions ◽  
Convenience Sample ◽  
Care Protocol ◽  
Before And After ◽  
Hospital Cardiac Arrest

Introduction Long pauses without chest compressions (CC) have been identified in CPR provided by EMS professionals for out-of-hospital cardiac arrest (OOHCA). The 2005 AHA ECC CPR guidelines emphasize CC. The 2005 AHA Basic Life Support (BLS) for Healthcare Professionals (HCP) course introduced a training method with more CPR skills practice during the DVD based course. The purpose of this before/after study was to determine whether CC rates increased after introduction of the 2005 course. Methods This urban EMS system has 400 cardiac etiology OOHCA events annually. A convenience sample of 49 continuous electronic ECG recordings of VF patients was analyzed with the impedance channel of the LIFEPAK 12 (Physio-Control, Redmond WA) and proprietary software. A trained researcher verified the automated analysis. Each CC during the resuscitation attempt and pauses in CC before and after the first defibrillation shock were noted. The time of return of spontaneous circulation (ROSC) was determined by medical record review and onset of regular electrical activity without CC. Medical records were reviewed for outcome to hospital discharge. The EMS patient care protocol for VF was changed on July 1, 2006 to comply with the 2005 AHA ECC guidelines. Cases were grouped by the OOHCA date: 9/2004 to 12/31/2006 (pre) and 7/1/2006 to 4/21/2007 (post). EMS personnel began taking the 2005 BLS for HCP course during spring 2006. Monthly courses over 3 years will recertify 1500 personnel. Results 29 cases were analyzed from the pre group and 20 from the post group. Compressions per minute increased from a mean (±SD) of 47 ± 16 pre to 75 ± 33 post (P < 0.01). The mean count of shocks given per victim decreased from 4.5 ± 4.0 pre to 2.8 ± 1.8 post (P < 0.04). The CC pause before the first shock was unchanged (23.6 ± 18.4 seconds to 22.1 ± 17.9). but the CC pause following that shock decreased significantly from 48.7 ± 63.2 to 11.8 ± 22.5 (p=0.008). Rates of ROSC (55% pre, 50% post) and survival to discharge (15% pre, 13% post) were similar. Conclusion Following introduction of the 2005 BLS for HCP course and the EMS protocol change, the quality of CPR delivered to victims of OOHCA improved significantly compared with pre-2006 CPR. The sample size was too small to detect differences in survival rates.

Abstract 18070: Therapies Optimizing Organ Perfusion and Protection After Out-of-hospital Cardiac Arrest Improves Survival With Favorable Neurologic Outcome

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Michael J Jacobs ◽  
Leo S Derevin ◽  
Sue Duval ◽  
James E Pointer ◽  
Karl A Sporer
Keyword(s):  
Cardiac Arrest ◽  
Survival Rates ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Outcome Data ◽  
Neurological Function ◽  
Inverse Association ◽  
Advanced Airway ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

Introduction: Survival rates with favorable neurologic function after out-of-hospital cardiac arrest (OHCA) have remained low for decades. Hypothesis: Use of therapies focused on better perfusion during CPR using mechanical adjuncts and protective post-resuscitation care would improve survival and neurologic outcomes after OHCA compared to conventional CPR and care. Methods: OHCA outcomes in Alameda County, CA, USA, population 1.5 million, from December 2009-2011 when there was incomplete availability and use of impedance threshold device [ITD], mechanical CPR [MCPR], and hospital therapeutic hypothermia [HTH], were compared to 2012 when all were available and more widely used. Return of Spontaneous Circulation (ROSC), survival and Cerebral Performance Category (CPC) scores were compared using univariate and multivariable analyses. Results: Of the 3008 non-traumatic OHCAs who received CPR during the study period, >95% of survival outcome data were available. From 2009-11 to 2012, there was an increase in ROSC from 28.6% to 34.1% (p=0.002; OR=1.28; CI=1.09, 1.51) and a non-significant increase in hospital discharge from 10.5% to 12.3% (p=0.14; OR=1.17; CI=0.92, 1.49). There was, however, an 80% increase in survival with favorable neurological function between the two periods, as determined by CPC≤2, from 4.4% to 7.9% (p<0.001; unadjusted OR=1.85; CI=1.35, 2.54). After adjusting for witnessed arrest, bystander CPR, initial rhythm (VT/VF vs. others), placement of an advanced airway, EMS response time, and age, the adjusted OR was 1.60 (1.11, 2.31; p=0.012). Using a stepwise regression model, the most important independent positive predictors of CPC≤2 were 2012 (p=0.019), witnessed (p<0.001), initial rhythm VT/VF (p<0.001), and advanced airway (inverse association p<0.001). Additional analyses of the three therapies, separately and in combination, demonstrated that for all patients admitted to the hospital, ITD use with HTH had the most impact on survival to discharge with CPC≤2 of 24%. Conclusions: Therapies (ITD, MCPR, HTH) developed to enhance circulation during CPR and cerebral recovery after ROSC, significantly improved survival with favorable neurological function by 80% following OHCA.

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.

scholarly journals Comparison of Mechanical Support with Impella or Extracorporeal Life Support in Post-Cardiac Arrest Cardiogenic Shock: A Propensity Scoring Matching Analysis

2021 ◽  
Vol 10 (16) ◽  
pp. 3583
Author(s):  
Styliani Syntila ◽  
Georgios Chatzis ◽  
Birgit Markus ◽  
Holger Ahrens ◽  
Christian Waechter ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiogenic Shock ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Survival Rates ◽  
Limb Ischemia ◽  
Spontaneous Circulation ◽  
Access Site ◽  
Baseline Characteristics ◽  
Hospital Cardiac Arrest

Our aim was to compare the outcomes of Impella with extracorporeal life support (ECLS) in patients with post-cardiac arrest cardiogenic shock (CS) complicating acute myocardial infarction (AMI). This was a retrospective study of patients resuscitated from out of hospital cardiac arrest (OHCA) with post-cardiac arrest CS following AMI (May 2015 to May 2020). Patients were supported either with Impella 2.5/CP or ECLS. Outcomes were compared using propensity score-matched analysis to account for differences in baseline characteristics between groups. 159 patients were included (Impella, n = 105; ECLS, n = 54). Hospital and 12-month survival rates were comparable in the Impella and the ECLS groups (p = 0.16 and p = 0.3, respectively). After adjustment for baseline differences, both groups demonstrated comparable hospital and 12-month survival (p = 0.36 and p = 0.64, respectively). Impella patients had a significantly greater left ventricle ejection-fraction (LVEF) improvement at 96 h (p < 0.01 vs. p = 0.44 in ECLS) and significantly fewer device-associated complications than ECLS patients (15.2% versus 35.2%, p < 0.01 for relevant access site bleeding, 7.6% versus 20.4%, p = 0.04 for limb ischemia needing intervention). In subgroup analyses, Impella was associated with better survival in patients with lower-risk features (lactate < 8.6 mmol/L, time from collapse to return of spontaneous circulation < 28 min, vasoactive score < 46 and Horowitz index > 182). In conclusion, the use of Impella 2.5/CP or ECLS in post-cardiac arrest CS after AMI was associated with comparable adjusted hospital and 12-month survival. Impella patients had a greater LVEF improvement than ECLS patients. Device-related access-site complications occurred more frequently in patients with ECLS than Impella support.

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