scholarly journals Adverse Hemodynamic Effects of Interrupting Chest Compressions for Rescue Breathing During Cardiopulmonary Resuscitation for Ventricular Fibrillation Cardiac Arrest

Circulation ◽  
2001 ◽  
Vol 104 (20) ◽  
pp. 2465-2470 ◽  
Author(s):  
Robert A. Berg ◽  
Arthur B. Sanders ◽  
Karl B. Kern ◽  
Ronald W. Hilwig ◽  
Joseph W. Heidenreich ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Cardiopulmonary Resuscitation ◽  
Hemodynamic Effects ◽  
Chest Compressions ◽  
Rescue Breathing

scholarly journals Automatic and manual devices for cardiopulmonary resuscitation: A review

2018 ◽  
Vol 10 (1) ◽  
pp. 168781401774874 ◽  
Author(s):  
Carlo Remino ◽  
Manuela Baronio ◽  
Nicola Pellegrini ◽  
Francesco Aggogeri ◽  
Riccardo Adamini
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Early Recognition ◽  
Hemodynamic Effects ◽  
Chest Compressions ◽  
High Quality ◽  
Working Space ◽  
Meta Analyses ◽  
Positioning Time ◽  
Actuation Method

Rate of survival without any neurological consequence after cardiac arrest is driven not only by early recognition but also by high-quality cardiopulmonary resuscitation. Because the effectiveness of the manual cardiopulmonary resuscitation is usually impaired by rescuers’ fatigue, devices have been devised to improve it by appliances or ergonomic solutions. However, some devices are thought to replace the manual resuscitation altogether, either mimicking its action or generating hemodynamic effects with working principles which are entirely different. This article reviews such devices, both manual and automatic. They are mainly classified by actuation method, applied force, working space, and positioning time. Most of the trials and meta-analyses have not demonstrated that chest compressions given with automatic devices are more effective than those given manually. However, advances in clinical research and technology, with an improved understanding of the organizational implications of their use, are constantly improving the effectiveness of such devices.

Effectiveness of a Dispatcher-Assisted Cardiopulmonary Resuscitation Program Developed by the Thailand National Institute of Emergency Medicine (NIEMS)

2021 ◽  
pp. 1-6
Author(s):  
Chuenruthai Angkoontassaneeyarat ◽  
Chaiyaporn Yuksen ◽  
Chetsadakon Jenpanitpong ◽  
Pemika Rukthai ◽  
Marisa Seanpan ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Medicine ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Health Care Providers ◽  
Care Providers ◽  
Chest Compressions ◽  
Threatening Condition ◽  
Life Threatening

Abstract Background: Out-of-hospital cardiac arrest (OHCA) is a life-threatening condition with an overall survival rate that generally does not exceed 10%. Several factors play essential roles in increasing survival among patients experiencing cardiac arrest outside the hospital. Previous studies have reported that implementing a dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) program increases bystander CPR, quality of chest compressions, and patient survival. This study aimed to assess the effectiveness of a DA-CPR program developed by the Thailand National Institute for Emergency Medicine (NIEMS). Methods: This was an experimental study using a manikin model. The participants comprised both health care providers and non-health care providers aged 18 to 60 years. They were randomly assigned to either the DA-CPR group or the uninstructed CPR (U-CPR) group and performed chest compressions on a manikin model for two minutes. The sequentially numbered, opaque, sealed envelope method was used for randomization in blocks of four with a ratio of 1:1. Results: There were 100 participants in this study (49 in the DA-CPR group and 51 in the U-CPR group). Time to initiate chest compressions was statistically significantly longer in the DA-CPR group than in the U-CPR group (85.82 [SD = 32.54] seconds versus 23.94 [SD = 16.70] seconds; P <.001). However, the CPR instruction did not translate into better performance or quality of chest compressions for the overall sample or for health care or non-health care providers. Conclusion: Those in the CPR-trained group applied chest compressions (initiated CPR) more quickly than those who initiated CPR based upon dispatch-based CPR instructions.

Abstract 590: Evaluation of the Effects of Cardiac Arrest and CPR Using Intracardiac Echocardiography

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Martin C Burke ◽  
Kiam K Lim ◽  
Matthew Smelley ◽  
John F Beshai ◽  
Susan S Kim ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Thrombus Formation ◽  
Venous Access ◽  
Intracardiac Echocardiography ◽  
Direct Visualization ◽  
Chest Compressions ◽  
Right Heart ◽  
The Right ◽  
Current Energy

For every minute of cardiac arrest, mortality increases by 10%. Still, the variablity of meaningful neurologic survival suggests multiple factors involved in the hypoxia and encephalopathy of cardiac arrest (CA). We studied the cardiac chamber environment during ventricular fibrillation and asystole using direct ultrasound visualization using real-time intracardiac echocardiography (ICE). Four pigs were studied under general anesthesia per protocol. Venous access was obtained for catheter placement within the right heart. A bipolar paciing wire was placed into the right ventricle. A 10 French Acuson ICE catheter was placed into the right atrium using fluoroscopy. Baseline images were obtained. Ventricular fibrillation was induced using direct current energy. 30 minutes of ventricular fibrillation and terminal asystole was observed. Chest compressions were delivered intermittently with direct visualization of effects. Intra-chamber thrombus was quantified by chamber and by arrhythmia. All subjects began to form intracardiac thrombus within 1 minute of ventricular fibrillation. The persistence of sinus rhythm during fibrillation prevented thrombus formation in the atria and the basal portions of both ventricles. The thrombus was predominantly in the right heart within the first 4 minutes of CA. ICE documents that chest compressions completely clear the thrombus when delivered within the first five minutes of CA. Asystole led to more solidified thrombus that was more difficult to clear. Thrombus formation during CA is marked and may be a predominant reason for neurologic damage post resuscitation. Asystole was associated with complete chamber thrombus in comparison to ventricular fibrillation.

Abstract 309: A Novel Method to Predict Survival From Ventricular Fibrillation Arrest During Chest Compressions

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Jason Coult ◽  
Lawrence D Sherman ◽  
Jennifer Blackwood ◽  
Heemun Kwok ◽  
Peter J Kudenchuk ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Characteristic Curve ◽  
Amplitude Spectrum ◽  
Support Vector ◽  
Chest Compressions ◽  
Time Frequency ◽  
Model Combining ◽  
Spectrum Area ◽  
Care Guidelines

Background: Quantitative measures of the ventricular fibrillation (VF) electrocardiogram (ECG) such as Amplitude Spectrum Area (AMSA) assess myocardial physiology and predict cardiac arrest outcomes, offering the potential to guide resuscitation care. Guidelines recommend minimally-interrupted chest compressions (CCs) during resuscitation, but CCs corrupt the ECG and must be paused for analysis. We therefore sought to develop a novel measure to predict survival without requiring CC pause. Methods and Results: Five-second VF ECG segments were collected with CCs and without CCs prior to 2755 defibrillation shocks in 1151 patients with out-of-hospital cardiac arrest. The cohort was divided into a training set to develop the measure and a test set to evaluate performance. Using segments from 460 training patients, we designed an adaptive filter to remove CC artifacts based on chest impedance and ECG characteristics, derived novel time-frequency and amplitude features of the filtered VF ECG, and trained a Support Vector Machine (SVM) model combining these novel features to predict survival with favorable neurologic status. In 691 test cases, area under the receiver operating characteristic curve (AUC) for predicting survival using the SVM was 0.74 (95% CI: 0.71-0.77) with CCs and 0.74 (95% CI: 0.71-0.76) without CCs (Figure 1). By comparison, AUC for predicting survival using AMSA was 0.70 (95% CI: 0.67-0.73) with CCs (p=0.001 for difference versus SVM) and 0.73 (95% CI: 0.71-0.76) without CCs (p=0.68 for difference versus SVM). Conclusions: VF waveform measures such as AMSA predict functional survival when obtained during ongoing CCs, but prognostic performance is reduced compared to CC-free analysis. However, an SVM-based measure combining novel VF waveform features enabled similar prediction with and without CCs. Machine learning combinations of features optimized for use during CCs may thus afford a means for VF prognosis during uninterrupted CCs.

P490Time boundaries of three-phase time-sensitive model for ventricular fibrillation cardiac arrest

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
Y Goto ◽  
A Funada ◽  
T Maeda ◽  
F Okada ◽  
Y Goto
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Phase Time ◽  
Emergency Medical ◽  
Three Phase ◽  
Emergency Medical Services Personnel ◽  
Neurologically Intact

Abstract Funding Acknowledgements Japan Society for the Promotion of Science (KAKENHI Grant No. 18K09999) Background Recent clinical evidence has suggested that the pathophysiology of ventricular fibrillation (VF) cardiac arrest may consist of three time-sensitive phases, namely electrical, circulatory, and metabolic. According to this model of cardiopulmonary resuscitation (CPR), the optimal treatment of cardiac arrest is phase-specific. The potential survival benefit of bystander cardiopulmonary resuscitation (BCPR) depends in part on ischemic time (i.e., the collapse-to-shock interval), with the greatest benefit occurring during the circulatory (second) phase. However, the time boundaries between phases are not precisely defined in the current literature. Purpose The purpose of the present study was to determine the time boundaries of the three-phase time-sensitive model for VF cardiac arrest. Methods We reviewed 20,741 adult patients with initial VF after witnessed out-of-hospital cardiac arrest from a presumed cardiac origin who were included in the All-Japan Utstein-style registry from 2013 to 2017. We excluded patients who underwent bystander defibrillation prior to arrival of emergency medical services personnel. The study end point was 1-month neurologically intact survival (Cerebral Performance Category scale 1 or 2). Collapse-to-shock interval was defined as the time from collapse to first shock delivery by emergency medical services personnel. Patients were divided into two groups, BCPR (n = 11,606, 56.0%) and non-BCPR (n = 9135, 44.0%), according to whether they had received BCPR or not. Results The rate of 1-month neurologically intact survival in the BCPR group was significantly higher than that in the non-BCPR group (27.9% [3237/11,606] vs 17.9% [1632/9135], P &lt; 0.0001; adjusted odds ratio [OR], 1.90; 95% confidence interval [CI], 1.75–2.07; P &lt; 0.0001). Overall, increased collapse-to-shock interval was associated with significantly decreased adjusted odds of 1-month neurologically intact survival (adjusted OR for each 1-minute increase, 0.94; 95% CI, 0.93–0.95; P &lt; 0.0001). In the BCPR group, the ranges of collapse-to-shock interval that were associated with increased adjusted 1-month neurologically intact survival were from 7 minutes (adjusted OR, 1.95; 95% CI, 1.44–2.63; P &lt; 0.0001) to 17 minutes (adjusted OR, 2.82; 95% CI, 1.62–4.91; P = 0.0002) as compared with those in the non-BCPR group. However, the increase in neurologically intact survival of the BCPR group became statistically insignificant as compared with that of the non-BCPR group when the collapse-to-shock interval was outside these ranges. Conclusions The above-mentioned findings suggest that the time boundaries of the three-phase time-sensitive model for VF cardiac arrest may be as follows: electrical phase, from collapse to &lt;7 minutes; circulatory phase, from 7 to 17 minutes; and metabolic phase, &gt;17 minutes onward from collapse.

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