Abstract 159: Immediate Transnasal Evaporative Cooling During Resuscitation from Cardiac Arrest: The Cool Before Airway Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Marie-Sophie Grave ◽  
Raphael van Tulder ◽  
Alexander Nürnberger ◽  
Stergios Fykatas ◽  
Dieter Sebald ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Adverse Events ◽  
Therapeutic Hypothermia ◽  
Evaporative Cooling ◽  
Safety Data ◽  
Hospital Setting ◽  
Eligibility Criteria ◽  
Early Application ◽  
Technical Problems ◽  
The Subject

BACKGROUND: Therapeutic hypothermia is an integral part of the standard resuscitation care. One method to induce therapeutic hypothermia is transnasal evaporative cooling. PURPOSE/AIMS: We wanted to demonstrate that transnasal evaporative cooling initiated prior to achieving a protected airway during CPR in an out-of-hospital setting is safe and feasible. METHODS: Transnasal evaporative cooling via the RhinoChill® (RC) System (BeneChill Inc. San Diego, CA, USA) was initiated prior to a protected airway after initiating cardiac resuscitation, and was continued until either the subject was declared dead, standard institutional systemic cooling methods were implemented or cooling equipment (oxygen and perfluorcarbone) was empty. The subject was monitored throughout the hypothermia period, and followed until either death or hospital discharge. Clinical assessments and clinically relevant adverse events were documented over this period of time. RESULTS: In total 21 patients were included in this trial. Four of them had to be excluded subsequently. One patient had been excluded due to a pre-existing secured airway, the others due to user errors. Finally, 17 patients (f=6; mean age 65.5 years, CI95%: 57.7-73.4) met all the eligibility criteria and were included for further investigation. Device-related adverse events occurred in only two patients, which were mild and had no consequence on the patient’s outcome. One was reversible nose-whitening and the other epistaxis. According to the filed reports of the EMS personnel, no severe technical problems occurred by using the RC device that led to a delay or the impairment of quality of the CPR. The most common observed interruption in the application was a short blockage of the device (n=12). In four cases the bag-valve-mask-ventilation wasn’t possible due to blockage or a sealing lack and in two cases a moderate orificial fluid spraying was observed during chest compressions. CONCLUSIONS/RECOMMENDATIONS: Early application of the RC device, during cardiac arrest in the out-of-hospital setting of Vienna, is feasible, safe and easy to handle and does not delay or hinder CPR, or establishment of a secure intubation. For efficacy and further safety data additional studies will be needed.

scholarly journals Exploring patient safety outcomes for people with learning disabilities in acute hospital settings: a scoping review

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e047102
Author(s):  
Gemma Louch ◽  
Abigail Albutt ◽  
Joanna Harlow-Trigg ◽  
Sally Moore ◽  
Kate Smyth ◽  
...  
Keyword(s):  
Learning Disabilities ◽  
Patient Safety ◽  
Adverse Events ◽  
Grey Literature ◽  
Good Practice ◽  
Hospital Setting ◽  
Eligibility Criteria ◽  
Infant Outcomes ◽  
Safety Outcomes

ObjectivesTo produce a narrative synthesis of published academic and grey literature focusing on patient safety outcomes for people with learning disabilities in an acute hospital setting.DesignScoping review with narrative synthesis.MethodsThe review followed the six stages of the Arksey and O’Malley framework. We searched four research databases from January 2000 to March 2021, in addition to handsearching and backwards searching using terms relating to our eligibility criteria—patient safety and adverse events, learning disability and hospital setting. Following stakeholder input, we searched grey literature databases and specific websites of known organisations until March 2020. Potentially relevant articles and grey literature materials were screened against the eligibility criteria. Findings were extracted and collated in data charting forms.Results45 academic articles and 33 grey literature materials were included, and we organised the findings around six concepts: (1) adverse events, patient safety and quality of care; (2) maternal and infant outcomes; (3) postoperative outcomes; (4) role of family and carers; (5) understanding needs in hospital and (6) supporting initiatives, recommendations and good practice examples. The findings suggest inequalities and inequities for a range of specific patient safety outcomes including adverse events, quality of care, maternal and infant outcomes and postoperative outcomes, in addition to potential protective factors, such as the roles of family and carers and the extent to which health professionals are able to understand the needs of people with learning disabilities.ConclusionPeople with learning disabilities appear to experience poorer patient safety outcomes in hospital. The involvement of family and carers, and understanding and effectively meeting the needs of people with learning disabilities may play a protective role. Promising interventions and examples of good practice exist, however many of these have not been implemented consistently and warrant further robust evaluation.

scholarly journals Efficacy of Targeted Temperature Management after Pediatric Cardiac Arrest: A Meta-Analysis of 2002 Patients

2021 ◽  
Vol 10 (7) ◽  
pp. 1389
Author(s):  
Wojciech Wieczorek ◽  
Jarosław Meyer-Szary ◽  
Milosz J. Jaguszewski ◽  
Krzysztof J. Filipiak ◽  
Maciej Cyran ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Adverse Events ◽  
Therapeutic Hypothermia ◽  
Hospital Discharge ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
One Year

Cardiac arrest (CA) is associated with high mortality and poor life quality. Targeted temperature management (TTM) or therapeutic hypothermia is a therapy increasing the survival of adult patients after CA. The study aim was to assess the feasibility of therapeutic hypothermia after pediatric CA. We performed a systematic review and meta-analysis of randomized controlled trials and observational studies evaluating the use of TTM after pediatric CA. The primary outcome was survival to hospital discharge or 30-day survival. Secondary outcomes included a one-year survival rate, survival with a Vineland adaptive behavior scale (VABS-II) score ≥ 70, and occurrence of adverse events. Ten articles (n = 2002 patients) were included, comparing TTM patients (n = 638) with controls (n = 1364). In a fixed-effects meta-analysis, survival to hospital discharge in the TTM group was 49.7%, which was higher than in the non-TTM group (43.5%; odds ratio, OR = 1.22; 95% confidence interval, CI: 1.00, 1.50; p = 0.06). There were no differences in the one-year survival rate or the occurrence of adverse events between the TTM and non-TTM groups. Altogether, the use of TTM was associated with a higher survival to hospital discharge; however, it did not significantly increase the annual survival. Additional high-quality prospective studies are necessary to confer additional TTM benefits.

THERAPEUTIC HYPOTERMIA IN THE COMPLEX TREATMENT OF POST-RESUSCITATION DISEASE

2021 ◽  
Vol 22 (1) ◽  
pp. 76-80
Author(s):  
V. Niković ◽  
R. Bulajić ◽  
D. Kojić ◽  
S. Vujaćić ◽  
D. Zogović ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Therapeutic Hypothermia ◽  
Clinical Management ◽  
Neurological Outcome ◽  
Current Evidence ◽  
Complex Treatment ◽  
Current State ◽  
The Subject

This article is about of two cases of successful cardiopulmonary resuscitation (CPR) and using therapeutic hypothermia as a important part of treatment of post-resuscitation disease. Current evidence supports that induction of therapeutic hypothermia in selected patients after cardiac arrest can improve neurological outcome. It is hoped that by summarizing the current state of knowledge on the subject and highlighting issues on clinical management will enable more patients to benefit from the therapy. 

Outcome, timing and adverse events in therapeutic hypothermia after out-of-hospital cardiac arrest

2009 ◽  
Vol 53 (7) ◽  
pp. 926-934 ◽  
Author(s):  
N. NIELSEN ◽  
J. HOVDENES ◽  
F. NILSSON ◽  
S. RUBERTSSON ◽  
P. STAMMET ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Adverse Events ◽  
Therapeutic Hypothermia ◽  
Hospital Cardiac Arrest

scholarly journals Therapeutic hypothermia promotes cerebral blood flow recovery and brain homeostasis after resuscitation from cardiac arrest in a rat model

2018 ◽  
Vol 39 (10) ◽  
pp. 1961-1973 ◽  
Author(s):  
Qihong Wang ◽  
Peng Miao ◽  
Hiren R Modi ◽  
Sahithi Garikapati ◽  
Raymond C Koehler ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Arrest ◽  
Cerebral Blood Flow ◽  
Therapeutic Hypothermia ◽  
Neurological Outcome ◽  
Spontaneous Circulation ◽  
Early Application ◽  
Information Quantity ◽  
Multiple Parameters ◽  
Baseline Levels

Laboratory and clinical studies have demonstrated that therapeutic hypothermia (TH), when applied as soon as possible after resuscitation from cardiac arrest (CA), results in better neurological outcome. This study tested the hypothesis that TH would promote cerebral blood flow (CBF) restoration and its maintenance after return of spontaneous circulation (ROSC) from CA. Twelve Wistar rats resuscitated from 7-min asphyxial CA were randomized into two groups: hypothermia group (7 H, n = 6), treated with mild TH (33–34℃) immediately after ROSC and normothermia group (7 N, n = 6,37.0 ± 0.5℃). Multiple parameters including mean arterial pressure, CBF, electroencephalogram (EEG) were recorded. The neurological outcomes were evaluated using electrophysiological (information quantity, IQ, of EEG) methods and a comprehensive behavior examination (neurological deficit score, NDS). TH consistently promoted better CBF restoration approaching the baseline levels in the 7 H group as compared with the 7 N group. CBF during the first 5–30 min post ROSC of the two groups was 7 H:90.5% ± 3.4% versus 7 N:76.7% ± 3.5% ( P < 0.01). Subjects in the 7 H group showed significantly better IQ scores after ROSC and better NDS scores at 4 and 24 h. Early application of TH facilitates restoration of CBF back to baseline levels after CA, which in turn results in the restoration of brain electrical activity and improved neurological outcome.

Adverse events and their relation to mortality in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia*

2011 ◽  
Vol 39 (1) ◽  
pp. 57-64 ◽  
Author(s):  
Niklas Nielsen ◽  
Kjetil Sunde ◽  
Jan Hovdenes ◽  
Richard R. Riker ◽  
Sten Rubertsson ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Adverse Events ◽  
Therapeutic Hypothermia ◽  
Hospital Cardiac Arrest

scholarly journals The impact of therapeutic hypothermia in elderly out-of-hospital cardiac arrest: A multicenter retrospective observational propensity-matched study

2019 ◽  
pp. 102490791989049
Author(s):  
Jeong Ho Park ◽  
Seung Pill Choi ◽  
Kyu Nam Park ◽  
Yoo Dong Son ◽  
Hoon Lim ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Propensity Score ◽  
Adverse Events ◽  
Elderly Patients ◽  
Propensity Score Matching ◽  
Therapeutic Hypothermia ◽  
Neurologic Outcomes ◽  
Significant Difference ◽  
The Impact ◽  
Hospital Cardiac Arrest

Background: The therapeutic hypothermia protocol for out of hospital cardiac arrest is not standardized and the decision to apply therapeutic hypothermia relies on a physician’s judgment. Elderly patients who rely on this judgment are less likely to receive therapeutic hypothermia. Objectives: This study aimed to provide an analysis of the impact and utility of therapeutic hypothermia on elderly out of hospital cardiac arrest. Methods: This was a multicenter, retrospective, observational, registry-based study from 2007 to 2012. Adults who suffered out-of-hospital cardiac arrest and were treated with therapeutic hypothermia were included. We divided the patients into a group of elderly patients 65 years or older and a group of young adults under 65 years old and compared the neurologic outcomes and adverse events after one-to-one matching by propensity score. Results: In total, 930 patients were enrolled in the study. Among these patients, 343 were ⩾65 years, while 587 were <65 years. Of the adverse events in therapeutic hypothermia, hyperglycemia (51.31%), hypotension (41.98%) during cooling was more frequent in aged ⩾65 years and rebound hyperthermia (7.14%) and hypotension (29.93%) during rewarming. After propensity score matching was applied to all subjects of the study, 247 matched pairs of patients were available. The two groups showed no statistically significant difference in the adverse events during therapeutic hypothermia. Conclusion: Elderly patients exhibited a decreased survival to hospital discharge and good neurologic outcomes. The two groups showed no differences in the frequency of adverse events during therapeutic hypothermia, when comparing in a propensity score matching cohort analysis.

Prehospital haemostatic dressings for trauma: a systematic review

2018 ◽  
Vol 35 (7) ◽  
pp. 449-457 ◽  
Author(s):  
Adam J Boulton ◽  
Christopher T Lewis ◽  
David N Naumann ◽  
Mark J Midwinter
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Controlled Trial ◽  
Safety Data ◽  
Risk Of Bias ◽  
Eligibility Criteria ◽  
Level Of Evidence ◽  
Prehospital Treatment ◽  
Mortality And Morbidity ◽  
Randomised Controlled

BackgroundHaemorrhage is a major cause of mortality and morbidity following both military and civilian trauma. Haemostatic dressings may offer effective haemorrhage control as part of prehospital treatment.AimTo conduct a systematic review of the clinical literature to assess the prehospital use of haemostatic dressings in controlling traumatic haemorrhage, and determine whether any haemostatic dressings are clinically superior.MethodsMEDLINE and EMBASE databases were searched using predetermined criteria. The reference lists of all returned review articles were screened for eligible studies. Two authors independently undertook the search, performed data extraction, and risk of bias and Grading of Recommendations, Assessment, Development and Evaluation quality assessments. Meta-analysis could not be undertaken due to study and clinical heterogeneity.ResultsOur search yielded 470 studies, of which 17 met eligibility criteria, and included 809 patients (469 military and 340 civilian). There were 15 observational studies, 1 case report and 1 randomised controlled trial. Indications for prehospital haemostatic dressing use, wound location, mechanism of injury, and source of bleeding were variable. Seven different haemostatic dressings were reported with QuikClot Combat Gauze being the most frequently applied (420 applications). Cessation of bleeding ranged from 67% to 100%, with a median of 90.5%. Adverse events were only reported with QuikClot granules, resulting in burns. No adverse events were reported with QuikClot Combat Gauze use in three studies. Seven of the 17 studies did not report safety data. All studies were at risk of bias and assessed of ‘very low’ to ‘moderate’ quality.ConclusionsHaemostatic dressings offer effective prehospital treatment for traumatic haemorrhage. QuikClot Combat Gauze may be justified as the optimal agent due to the volume of clinical data and its safety profile, but there is a lack of high-quality clinical evidence, and randomised controlled trials are warranted.Level of evidenceSystematic review, level IV.

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