Abstract 11269: Recombinant Soluble Thrombomodulin in Prolonged Porcine Cardiac Arrest

Introduction: Sudden Cardiac Arrest (CA) affects more than 400,000 people per year in the United States. Although a third of these patients survive to hospital admission, another 60-70% go on to die due to failed recovery of vital organ function. Microvascular thrombosis has been suggested as a potential contributor to prolonged organ dysfunction, but no antithrombotic therapies have been shown to be beneficial and coagulofibrinolytic abnormalities in prolonged CA remain poorly understood. Objectives: To establish key biomarkers of porcine coagulation and fibrinolysis in the setting of prolonged CA and cardiopulmonary resuscitation (CPR) and test the ability of ART-123 (recombinant human thrombomodulin alpha) to reverse these abnormalities. Methods: 15 pigs (n=5 per group) underwent 8 minutes of no-flow CA followed by 50 minutes of mechanical CPR. Animals were randomized to receive saline or ART-123 (~1mg/kg) pre-arrest (5 minutes prior to ventricular fibrillation) or post-arrest (2 minutes after initiation of CPR). Results: Robust and ongoing activation of coagulation and fibrinolysis were detected throughout the resuscitation. After 50 minutes of CPR, plasma tests suggested consumptive coagulopathy, while whole blood testing (thromboelastography) indicated a persistent hypercoagulable state. ART-123 had a clear anticoagulant effect irrespective of timing (TAT complexes 381±25 vs. 238±18 vs. 226±12, p<0.01, and d-dimer 4.86±0.54 vs. 2.39±0.2 vs. 2.46±0.21 for vehicle, pre-arrest, post-arrest, p = 0.05). A pro-fibrinolytic effect was also observed, but only when the drug was given before no-flow, with a significant increase in levels of free endogenous tPA (1.2±0.12 vs. 3.29±0.29 vs. 1.72±0.3, p < 0.001) and corresponding suppression of free PAI-1 (0.59±0.15 vs. 0.14±0.01 vs. 0.41±0.09, p < 0.001). Conclusion: Our porcine CA model provides an excellent platform for evaluating antithrombotic interventions. Plasma testing after prolonged CA/CPR suggests consumptive coagulopathy, although TEG indicates a persistent hypercoagulable state. ART-123 given before no-flow or just after CPR demonstrates antithrombotic effects, although the specific modes of action depending on the timing of administration.

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Out-of-Hospital Resuscitation: Have We Gone Too Far?

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00004180 ◽

2006 ◽

Vol 21 (6) ◽

pp. 445-450 ◽

Cited By ~ 4

Author(s):

Corita Grudzen

Keyword(s):

Cardiac Arrest ◽

Prehospital Care ◽

Sudden Cardiac Arrest ◽

Hospital Setting ◽

The United States ◽

Spontaneous Circulation ◽

Emergency Medical ◽

Clinical Scenarios ◽

Life Sustaining Treatment ◽

Future Policy

AbstractAmericans are living longer and are more likely to be chronically or terminally ill at the time of death. Although surveys indicate that most people prefer to die at home, the majority of people in the United States die in acute care hospitals. Each year, approximately 400,000 persons suffer sudden cardiac arrest in the US, the majority occurring in the out-of-hospital setting. Mortality rates are high and reach almost 100% when prehospital care has failed to restore spontaneous circulation. Nonetheless, patients who receive little benefit or may wish to forgo life-sustaining treatment often are resuscitated. Risk versus harm of resuscitation efforts can be differentiated by various factors, including cardiac rhythm. Emergency medical services policy regarding resuscitation should consider its utility in various clinical scenarios. Patients, family members, emergency medical providers, and physicians all are important stakeholders to consider in decisions about out-of-hospital cardiac arrest. Ideally, future policy will place greater emphasis on patient preferences and quality of life by including all of these viewpoints.

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Abstract 147: Rapid Responder Operating Times for Out-of-hospital Cardiac Arrest Using Three Automated External Defibrillator Models

Circulation ◽

10.1161/circ.142.suppl_4.147 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Mengqi Gao ◽

Chenguang Liu ◽

Dawn Jorgenson

Keyword(s):

Cardiac Arrest ◽

Life Support ◽

Operating Time ◽

Sudden Cardiac Arrest ◽

The United States ◽

Automated External Defibrillator ◽

Simulation Studies ◽

Time Intervals ◽

Shock Delivery ◽

External Defibrillator

Background: Early defibrillation with an automated external defibrillator (AED) is crucial for improving the survival rate in out-of-hospital resuscitation from sudden cardiac arrest (SCA). Chance of survival decreases by 7% to 10% for every minute that defibrillation is delayed. While simulation studies have been used to assess AED usability factors, our objective was to report the actual operating time for three Philips AED models used in SCA responses. Methods: A convenience dataset recorded by Philips AEDs (HS1, FRx, or FR3) was obtained from Europe and the United States from 2007 - 2018. The HS1 is intended for minimally trained or untrained individuals, the FRx is for Basic Life Support (BLS), and the FR3 is for both BLS and Advanced Life Support (ALS) responders. A retrospective analysis was conducted to report the operating time intervals for cases where a shock was delivered after initial rhythm analysis. The study analyzed 90 HS1, 46 FRx and 32 FR3 cases. Results: Compared with HS1, both FRx (p < 0.001) and FR3 (p = 0.001) responders spent less time in placing pads on the patient after powering on the AED (Figure 1) as expected. Similarly, time intervals from the start of shock advised prompt to first shock delivery for FRx (p = 0.02) and FR3 (p < 0.01) are shorter than for HS1. Time from AED power-on to first shock was within 90 seconds in 74.4% (67 of 90) HS1 cases, 97.8% (45 of 46) FRx cases, and 100% (32 of 32) FR3 cases. On average, the FR3 and FRx responders were able to deliver the first shock within 48 seconds. Conclusions: The analysis shows that responders were able to quickly apply the AEDs and respond to the shock advisory prompt for all three AED models despite different training levels. This real-world performance is better than most reported simulation studies, however, this analysis cannot convey variety of activities that account for the differences in timing (e.g. pads applied before power-on, or compressions began before applying pads, etc.).

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Abstract 246: Therapeutic Hypothermia Mimicking Peptide Administration During Cardiopulmonary Resuscitation Improved Cardiac Arrest Survival in Swine

Circulation ◽

10.1161/circ.142.suppl_4.246 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Matt Oberdier ◽

Jing Li ◽

Dan Ambinder ◽

Xiangdong Zhu ◽

Sarah Fink ◽

...

Keyword(s):

Cardiac Arrest ◽

Therapeutic Hypothermia ◽

Venous Blood ◽

Plasma Concentrations ◽

Sudden Cardiac Arrest ◽

The United States ◽

Rapid Onset ◽

Spontaneous Circulation ◽

Control Group ◽

Swine Model

Background: Out-of-hospital sudden cardiac arrest is a leading cause of death in the United States, affecting over 350,000 people per year with an overall survival rate around 10%. CPR, defibrillation, and therapeutic hypothermia are common resuscitation strategies, but hypothermia is difficult to implement timely to achieve survival benefit. A cell-permeable peptide TAT-PHLPP9c has been shown to alter metabolic pathways similar to hypothermia, and decreases the release of two biomarkers, taurine and glutamate, during the high osmotic stress of heart stunning and brain injury in a mouse arrest model. Hypothesis: TAT-PHLPP9c, given during CPR, enhances 24-hour survival in a swine ventricular fibrillation (VF) model. Methods: In 14 (8 controls and 6 treated) sedated, intubated, and mechanically ventilated swine, after 5 min of VF, ACLS with vest CPR and periodic defibrillations was performed. Venous blood samples were collected at baseline, after 2 min of CPR, and at 2 and 30 min after return of spontaneous circulation (ROSC). The animals were survived up to 24 hrs and plasma samples were analyzed for glutamate and taurine in 2 controls and 1 animal given peptide. Results: Three of the control animals had ROSC, but none survived for 24 hrs, while 4 of 6 treated animals achieved neurologically intact survival at 24 hrs (p < 0.02). Compared to baseline, both taurine and glutamate plasma concentrations increased in the control group, but the increase was reduced substantially by the peptide treatment at 30 min after ROSC (Figure). Conclusion: The use of the cooling mimicking peptide TAT-PHLPP9c administered during CPR significantly improved 24-hour survival in this swine model of cardiac arrest. It reduced the increase of cerebral and myocardial metabolic biomarkers, which encourages utilizing a strategy of cell-permeable peptides for intravenous administration for more rapid onset of hypothermia-like salutary effects than are possible with current CPR cooling devices.

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Telecommunicator Cardiopulmonary Resuscitation: A Policy Statement From the American Heart Association

Circulation ◽

10.1161/cir.0000000000000744 ◽

2020 ◽

Vol 141 (12) ◽

Cited By ~ 5

Author(s):

Michael Christopher Kurz ◽

Bentley J. Bobrow ◽

Julie Buckingham ◽

Jose G. Cabanas ◽

Mickey Eisenberg ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Sudden Cardiac Arrest ◽

The United States ◽

Hospital Environment ◽

Policy Statement ◽

Initial Care ◽

Chain Of Survival ◽

Lay Rescuer ◽

Hospital Cardiac Arrest

Every year in the United States, >350 000 people have sudden cardiac arrest outside of a hospital environment. Sudden cardiac arrest is the unexpected loss of heart function, breathing, and consciousness and is commonly the result of an electric disturbance in the heart. Unfortunately, only ≈1 in 10 victims survives this dramatic event. Early access to 9-1-1 and early cardiopulmonary resuscitation (CPR) are the first 2 links in the chain of survival for out-of-hospital cardiac arrest. Although 9-1-1 is frequently accessed, in the majority of cases, individuals with out-of-hospital cardiac arrest do not receive lay rescuer CPR and wait for the arrival of professional emergency rescuers. Telecommunicators are the true first responders and a critical link in the cardiac arrest chain of survival. In partnership with the 9-1-1 caller, telecommunicators have the first opportunity to identify a patient in cardiac arrest and provide initial care by delivering CPR instructions while quickly dispatching emergency medical services. The telecommunicator and the caller form a unique team in which the expertise of the telecommunicator is provided just in time to a willing caller, transforming the caller into a lay rescuer delivering CPR. The telecommunicator CPR (T-CPR) process, also previously described as dispatch CPR, dispatch-assisted CPR, or telephone CPR, represents an important opportunity to improve survival from sudden cardiac arrest. Conversely, failure to provide T-CPR in this manner results in preventable harm. This statement describes the public health impact of out-of-hospital cardiac arrest, provides guidance and resources to construct and maintain a T-CPR program, outlines the minimal acceptable standards for timely and high-quality delivery of T-CPR instructions, and identifies strategies to overcome common implementation barriers to T-CPR.

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School Nurses on the Front Lines of Healthcare: Emergencies Associated With Sport and Physical Activities (Part 2): Sudden Cardiac Arrest, Hypovolemic Shock, and Spinal Cord Injury

NASN School Nurse ◽

10.1177/1942602x211046048 ◽

2021 ◽

pp. 1942602X2110460

Author(s):

Thomas P. Swaffield ◽

Robert P. Olympia

Keyword(s):

Physical Activity ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Cardiac Arrest ◽

Sudden Cardiac Arrest ◽

Hypovolemic Shock ◽

The United States ◽

Physical Activities ◽

Cord Injury ◽

Life Threatening

Sport participation is an important part of the development, both physically and mentally, of children and adolescents in the United States. Illness and injury associated with sport and physical activities may occur in the school setting. Although most sport-related illness and injury in students are considered minor emergencies, life-threatening illnesses or injuries may occur. It is important for the school nurse to recognize potential life-threatening emergencies associated with sport and physical activity, to initiate stabilization of the student with life-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow up at their primary healthcare provider’s office, or directly to the closest emergency department via Emergency Medical Services). This article specifically describes the initial assessment and management of three potentially life-threatening conditions associated with sport and physical activity, namely sudden cardiac arrest, hypovolemic shock, and spinal cord injury.

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Abstract 17127: Sports-Related Sudden Cardiac Arrest: Comparison of Survival Outcomes in Europe versus the United States

Circulation ◽

10.1161/circ.130.suppl_2.17127 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Eloi Marijon ◽

Audrey Uy-Evanado ◽

Florence Dumas ◽

Carmen Teodeorescu ◽

Kyndaron Reinier ◽

...

Keyword(s):

United States ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Response Times ◽

Survival Rates ◽

Sudden Cardiac Arrest ◽

The United States ◽

Population Based ◽

Sports Activity ◽

Bystander Cardiopulmonary Resuscitation

Background: Sports-related sudden cardiac arrest (sport SCA) has always attracted attention and the United States and European Union have developed divergent strategies for prevention over the last decade; notably regarding screening of younger athletes but also for SCA prevention in middle-aged and senior individuals. In this context, the extent to which outcomes of sports SCA differ between Europe and the USA have not been characterized. Methods: SCA cases aged 15-75 years were identified in two large prospective, population-based SCA programs, one in the Paris region (Paris-SDEC) and the other in a Northwestern US metro region (Oregon-SUDS) between 2002 and 2012. Cases of SCA, occurring during sports activity were compared between the two regions. Results: Of the 7,357 cases studied, 290 (4%) occurred during sports, with very similar proportions in both regions: 86 out of 1,894 (4.5%) in Oregon and 204 out of 5,463 (3.8%) in Paris. Subjects’ characteristics of cases in both programs were very similar (Paris vs. Oregon, respectively, for all results following), regarding age (50.7±14 vs. 50.4±13 years, P=0.55), male proportion (94%vs. 92%, P=0.53), past medical history of ≥2 cardiovascular risk factors (16% vs. 23%, P=0.16) and/or heart disease (10% vs. 8%, P=0.55). There was a high proportion of witnessed events in both populations (89% vs. 90%, P=0.94). However, we observed significant differences with more bystander cardiopulmonary resuscitation in Paris (63% vs. 48%, P=0.02), faster response time in Oregon (8.3±6 vs. 6.9±4 min, P=0.05), and more initially shockable rhythms in Oregon (52% vs. 70%, P=0.006). Overall, resuscitation outcomes were very similar for return of spontaneous circulation (26% vs. 33%, P=0.21) and survival to hospital discharge (27% vs. 26%, P=0.80). Conclusions: On either side of the Atlantic, burden and characteristics of sports-related SCA are very similar. Survival rates are approximately one in four cases. Optimizing bystander cardiopulmonary resuscitation rates and emergency response times could further improve outcomes. Deployment of uniform, effective strategies for screening and prevention are likely to make the greatest impact on sports SCA.

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P059: Paramedic compliance with a novel defibrillation strategy in a large, urban EMS system in the United States

CJEM ◽

10.1017/cem.2017.261 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S98

Author(s):

J.M. Goodloe ◽

L.D. Vinson ◽

M.L. Cox ◽

B.D. Burns

Keyword(s):

Cardiac Arrest ◽

Ventricular Fibrillation ◽

Electronic Medical Records ◽

Medical Records ◽

Sudden Cardiac Arrest ◽

The United States ◽

Energy Strategy ◽

Specific Analysis ◽

Hands On ◽

Software Code

Introduction: Emergency Medical Services (EMS) care confers distinct impact upon survivability from sudden cardiac arrest. Many studies have been conducted regarding EMS interventions for cardiac arrest, though fewer studies have been published detailing specific analysis of paramedic compliance with standing orders, particularly those involving a novel energy strategy in defibrillation. Methods: Adults in sudden cardiac arrest with resuscitation initiated, including at least one defibrillation, between July 1, 2016 and December 1, 2016 were enrolled. Education on a novel defibrillation strategy, involving weight-based joule settings and double sequential external defibrillation (DSED) was delivered in classroom and internet-accessed settings. Paramedics then performed hands-on practice in DSED. All resuscitations were reviewed from electronic medical records (EMRs) completed by treating paramedics, alongside telemetry and defibrillation events recorded, transmitted, and analyzed in proprietary software (CODE-STAT™, Physio-Control Corporation, Redmond, WA). All ECGs and defibrillation events were reviewed by an emergency physician to determine energy settings used by paramedics for determining the accuracy of compliance with protocol-based standing orders. Results: During the 5 month study period, the paramedics involved treated 133 adults in sudden cardiac arrest involving perceived ventricular fibrillation that was treated with at least one defibrillation. 76/90 (84.4%) with estimated weight <100 kg were treated with correct joule settings, though only 7/43 (16.3%) with estimated weight ≥100kg received all defibrillations at 360J as protocol-specified. 26/44 (59.1%) in refractory ventricular fibrillation, defined as requiring a fourth defibrillation, received DSED as protocol-specified. Conclusion: Paramedics, when specifically trained on a novel defibrillation strategy, involving both weight-based joule settings and use of DSED for refractory ventricular fibrillation, are inconsistently able to quickly and successfully incorporate that strategy in EMS resuscitation care. Further educational endeavours are warranted to achieve higher defibrillation strategy protocol compliance.

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Clinical Predictive Models of Sudden Cardiac Arrest: A Survey of the Current Science and Analysis of Model Performances

Journal of the American Heart Association ◽

10.1161/jaha.119.017625 ◽

2020 ◽

Vol 9 (16) ◽

Author(s):

Richard T. Carrick ◽

Jinny G. Park ◽

Hannah L. McGinnes ◽

Christine Lundquist ◽

Kristen D. Brown ◽

...

Keyword(s):

Cardiac Arrest ◽

Predictive Models ◽

Validation Studies ◽

Predictive Analytics ◽

External Validation ◽

Sudden Cardiac Arrest ◽

The United States ◽

Median Percentage ◽

Neurologic Recovery ◽

C Statistic

Background More than 500 000 sudden cardiac arrests (SCAs) occur annually in the United States. Clinical predictive models (CPMs) may be helpful tools to differentiate between patients who are likely to survive or have good neurologic recovery and those who are not. However, which CPMs are most reliable for discriminating between outcomes in SCA is not known. Methods and Results We performed a systematic review of the literature using the Tufts PACE (Predictive Analytics and Comparative Effectiveness) CPM Registry through February 1, 2020, and identified 81 unique CPMs of SCA and 62 subsequent external validation studies. Initial cardiac rhythm, age, and duration of cardiopulmonary resuscitation were the 3 most commonly used predictive variables. Only 33 of the 81 novel SCA CPMs (41%) were validated at least once. Of 81 novel SCA CPMs, 56 (69%) and 61 of 62 validation studies (98%) reported discrimination, with median c‐statistics of 0.84 and 0.81, respectively. Calibration was reported in only 29 of 62 validation studies (41.9%). For those novel models that both reported discrimination and were validated (26 models), the median percentage change in discrimination was −1.6%. We identified 3 CPMs that had undergone at least 3 external validation studies: the out‐of‐hospital cardiac arrest score (9 validations; median c‐statistic, 0.79), the cardiac arrest hospital prognosis score (6 validations; median c‐statistic, 0.83), and the good outcome following attempted resuscitation score (6 validations; median c‐statistic, 0.76). Conclusions Although only a small number of SCA CPMs have been rigorously validated, the ones that have been demonstrate good discrimination.

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Out of Hospital Pediatric Cardiac Arrest

Journal of Pediatrics & Neonatal Biology ◽

10.33140/jpnb.02.01.09 ◽

2018 ◽

Vol 2 (1) ◽

Keyword(s):

United States ◽

Overall Survival ◽

Cardiac Arrest ◽

Sudden Cardiac Arrest ◽

The United States ◽

Annual Incidence ◽

International Data ◽

Therapeutic Tools ◽

Hospital Pediatric ◽

Hospital Cardiac Arrest

Out of hospital cardiac arrest in the pediatric patient is an uncommon event [1]. Exact incidence of occurrence in the United States is difficult to determine as epidemiologic reporting is not nationally mandated. Previous data has suggested an annual incidence of 0.8- 6.0 per 100,000 patients [2]. International data has helped answer this question suggesting the annual incidence of pediatric sudden cardiac arrest of 0.23 percent [3]. Out of hospital cardiac arrest can be due to a variety of insults and accordingly, outcomes vary depending upon the initial insult. Overall survival in children aged 0-17 years old is approximately 7.2 percent [1] to 8.3 percent [4]. The purpose of this article is to review present therapeutic tools and recommendations available to the healthcare provider.

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A study to assess the knowledge regarding competency programme on cardio-pulmonary resuscitation of adult among the para medical students of selected paramedical college of, Hapur (U.P.)

10.36106/ijsr/0000051 ◽

2017 ◽

pp. 1-2

Author(s):

Manish K. Goyal

Keyword(s):

Cardiac Arrest ◽

Medical Students ◽

Sudden Cardiac Arrest ◽

Simple Random Sampling ◽

The United States ◽

Research Approach ◽

Adequate Knowledge ◽

Cardio Pulmonary Resuscitation ◽

And Gender ◽

Demographical Data

BACKGROUND OFTHE STUDY: Once life begins instincts begin to work and also to preserve it. For life by itself strives to live and not to die, and that is the normal natural process called life. Meanwhile there are many challenges too. But instincts again seek and find ways and means of 1 preserving that precious little life . Sudden cardiac arrest (SCA) is a leading cause of death among adults in the United States. Cardio pulmonary resuscitation (CPR) dramatically increases the chance of survival for a victim suffering from sudden cardiac arrest.2 2. OBJECTIVES :I.To assess the knowledge of the subjects regarding cardio pulmonary resuscitation among the Para medical students. II.To find out the association knowledge scores with their selected demographical variables of the subject among the Para medical students. MATERIAL METHODS : The study was conducted on 50 paramedical students at Rama Paramedical College, Pilkhuwa, Hapur.Univariate Descriptive research approach was adopted in this study. Non-experimental descriptive design, simple random sampling (table method) are used. The instrument used for data collection was structured knowledge questionnaire. RESULT: Study concludes that majority of paramedical students having 27(54%) poor knowledge, 23 (46%) average knowledge and none of the adequate knowledge. There was association between socio-demographical data variable with knowledge age, name of the course was significant and gender, last qualification, year of course, is any one health care provider, is any family member /relatives /friends suffered cardiac arrest , previous knowledge about CPR and source of knowledge about CPR was no significant. CONCLUSION: Study conclude that Rama paramedical college paramedical students having poor and average knowledge regarding the CPR.

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