scholarly journals Interim Singapore guidelines for basic and advanced life support for paediatric patients with suspected or confirmed COVID-19

2021 ◽  
Author(s):  
GY Ong ◽  
BHZ Ng ◽  
YH Mok ◽  
JSM Ong ◽  
N Ngiam ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Best Practices ◽  
Healthcare Workers ◽  
Life Support ◽  
Advanced Life Support ◽  
First Aid ◽  
Local Context ◽  
Paediatric Patients ◽  
Improved Outcomes ◽  
Paediatric Cardiac Arrest

The COVID-19 pandemic has resulted in significant challenges for the resuscitation of paediatric patients, especially for infants and children who are suspected or confirmed to be infected. Thus, the paediatric subcommittee of the Singapore Resuscitation and First Aid Council developed interim modifications to the current Singapore paediatric guidelines using extrapolated data from the available literature, local multidisciplinary expert consensus and institutional best practices. It is hoped that this it will provide a framework during the pandemic for improved outcomes in paediatric cardiac arrest patients in the local context, while taking into consideration the safety of all community first responders, medical frontline providers and healthcare workers.

scholarly journals Сardiopulmonary and cerebral resuscitation: new European Resuscitation Council Guidelines for resuscitation 2021

2021 ◽  
Vol 17 (8) ◽  
pp. 6-19
Author(s):  
L.V. Usenko ◽  
А.V. Tsarev ◽  
Yu.Yu. Kobelatsky
Keyword(s):  
Cardiac Arrest ◽  
Healthcare Workers ◽  
Basic Life Support ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Advanced Life Support ◽  
European Resuscitation Council ◽  
Improved Outcomes ◽  
Electrical Defibrillation

The article presents the current changes in the algorithm of cardiopulmonary and cerebral resuscitation (CPCR), adopted by the European Council for Resuscitation in 2021. The article presents the principles of basic life support and advanced life support, inclu-ding taking into account the European recommendations published in 2020, dedicated to the specifics of CPCR in the context of the COVID-19 pandemic. The main focus of CPCR in the COVID-19 pandemic is that the safety of healthcare workers should never be compromised, based on the premise that the time it takes to ensure that care is delivered safely to rescuers is acceptable part of the CPCR process. The principles of electrical defibrillation, including in patients with coronavirus disease who are in the prone position, pharmacological support of CPCR, modern monitoring capabilities for assessing the quality of resuscitation measures and identifying potentially reversible causes of cardiac arrest, the use of extracorporeal life support techno-logies during CPR are highlighted. The modern principles of intensive care of the post-resuscitation syndrome are presented, which makes it possible to provide improved outcomes in patients after cardiac arrest.

Abstract 12018: Cardiac Ultrasound Performed During Cardiac Arrest has Potential to Detect Pulmonary Embolism as a Reversible Cause of Cardiac Arrest when Compared to Hypoxia and Ventricular Fibrillation - A Randomized Porcine Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Rasmus Aagaard ◽  
Philip Caap ◽  
Nicolaj C Hansson ◽  
Morten T Bøtker ◽  
Asger Granfeldt ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Life Support ◽  
Advanced Life Support ◽  
Ultrasound Images ◽  
Cardiac Ultrasound ◽  
Pilot Studies ◽  
Hypoxia Group ◽  
Rhythm Analysis

Introduction: Survival from non-shockable cardiac arrest is unlikely unless a reversible cause is identified and treated. Guidelines state that ultrasound has the potential to identify reversible causes. Currently, ultrasonographic findings from patients with spontaneous circulation are extrapolated to patients in cardiac arrest. While right ventricular (RV) dilation is a finding normally associated with pulmonary embolism (PE), porcine studies have shown that RV dilation is also seen in ventricular fibrillation (VF) and severe hypoxia. No studies have investigated how causes of cardiac arrest affect RV size during resuscitation. Hypothesis: The RV diameter is larger during resuscitation of cardiac arrest caused by PE when compared to hypoxia and VF. Methods: Pigs were anesthetized and randomized to cardiac arrest induced by VF, hypoxia, or PE. Advanced life support (ALS) was preceded by 7 minutes of untreated cardiac arrest. Cardiac ultrasound images of the RV from a subcostal 5-chamber view were obtained during induction of cardiac arrest and ALS. The RV diameter was measured two centimeters from the aortic valve at end diastole. RV diameter at 3rd rhythm analysis was the primary endpoint. Based on pilot studies a sample size of 8 animals in each group was needed. Results: Eight animals were included in each group. RV diameter was not statistically different at baseline (mean (95%CI)) in VF: 19.8 (18.0-21.5) mm, hypoxia: 19.8 (16.6-22.9) mm, and PE: 21.8 (19.2-24.3) mm. During induction of cardiac arrest the RV diameter increased to 29.6 (27.3-31.9) mm in the hypoxia group and 38.0 (33.4-42.6) mm in the PE group (difference to baseline and between groups, both p<0.01). Induction of VF caused an immediate increase in the RV diameter to 25.0 (21.2-28.8) mm (difference to baseline p<0.01). At 3rd rhythm analysis, RV diameter was 32.4 (28.6-36.2) mm in the PE group, which was significantly larger than both the hypoxia group at 23.3 (19.5-27.0) mm and the VF group at 24.9 (22.2-27.5) mm (difference between groups p<0.01). Conclusions: Cardiac arrest due to VF, hypoxia, and PE all caused an increase in RV diameter. During resuscitation the RV was larger in PE compared to VF and hypoxia. Cardiac ultrasound thus has the potential to detect PE during resuscitation.

scholarly journals External validation of multimodal termination of resuscitation rules for out-of-hospital cardiac arrest patients in the COVID-19 era

2020 ◽  
Author(s):  
Haewon Jung ◽  
Mijin Lee ◽  
Jae Wan Cho ◽  
Sang Hun Lee ◽  
Suk Hee Lee ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Disease Transmission ◽  
Life Support ◽  
External Validation ◽  
Advanced Life Support ◽  
Survival Outcomes ◽  
Shock Delivery ◽  
Treatment Protocols ◽  
Multicenter Observational Study ◽  
Hospital Cardiac Arrest

Abstract Background: Futile resuscitation for out-of-hospital cardiac arrest (OHCA) patients in the coronavirus disease (COVID)-19 era can lead to risk of disease transmission and unnecessary transport. Various existing basic or advanced life support (BLS or ALS, respectively) rules for the termination of resuscitation (TOR) have been derived and validated in North America and Asian countries. This study aimed to evaluate the external validation of these rules in predicting the survival outcomes of OHCA patients in the COVID-19 era.Methods: This was a multicenter observational study using the WinCOVID-19 Daegu registry data collected during February 18–March 31, 2020. The subjects were patients who showed cardiac arrest of presumed cardiac etiology. The outcomes of each rule were compared to the actual patient survival outcomes. The sensitivity, specificity, false positive value (FPV), and positive predictive value (PPV) of each TOR rule were evaluated. Results: In total, 170 of the 184 OHCA patients were eligible and evaluated. TOR was recommended for 122 patients based on the international basic life support termination of resuscitation (BLS-TOR) rule, which showed 85% specificity, 74% sensitivity, 0.8% FPV, and 99% PPV for predicting unfavorable survival outcomes. When the traditional BLS-TOR rules and KoCARC TOR rule II were applied to our registry, one patient met the TOR criteria but survived at hospital discharge. With regard to the FPV (upper limit of 95% confidence interval <5%), specificity (100%), and PPV (>99%) criteria, only the KoCARC TOR rule I, which included a combination of three factors including not being witnessed by emergency medical technicians, presenting with an asystole at the scene, and not experiencing prehospital shock delivery or return of spontaneous circulation, was found to be superior to all other TOR rules. Conclusion: Among the previous nine BLS and ALS TOR rules, KoCARC TOR rule I was most suitable for predicting poor survival outcomes and showed improved diagnostic performance. Further research on variations in resources and treatment protocols among facilities, regions, and cultures will be useful in determining the feasibility of TOR rules for COVID-19 patients worldwide.

scholarly journals Out of hospital cardiac arrest in Western Sydney - an analysis of outcomes and estimation of future eCPR eligibility

2021 ◽  
Author(s):  
Pramod Chandru ◽  
Tatum Priyambada Mitra ◽  
Nitesh Dutt Dhanekula ◽  
Mark Dennis ◽  
Adam Eslick ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Rescue Therapy ◽  
A Priori ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Eligibility Criteria ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Poor Outcomes ◽  
Hospital Cardiac Arrest

Abstract Background Refractory out of hospital cardiac arrest (OHCA) is associated with extremely poor outcomes. However, in selected patients extracorporeal cardiopulmonary resuscitation (eCPR) may be an effective rescue therapy, allowing time treat reversible causes. The primary goal was to estimate the potential future caseload of eCPR at historically 'low-volume' extracorporeal membrane oxygenation (ECMO) centres. Methods A 3-year observational study of OHCA presenting to the Emergency Department (ED of an urban referral centre without historical protocolised use of eCPR. Demographics and standard Utstein outcomes are reported. Further, an a priori analysis of each case for potential eCPR eligibility was conducted. A current eCPR selection criteria (from the 2-CHEER study) was used to determine eligibly. Results In the study window 248 eligible cardiac arrest cases were included in the OHCA registry. 30-day survival was 23.4% (n=58). The mean age of survivors was 55.4 years. 17 (6.8%) cases were deemed true refractory arrests and fulfilled the 2-CHEER eligibility criteria. The majority of these cases presented within “office hours” and no case obtained a return of spontaneous circulation standard advanced life support. Conclusions In this contemporary OHCA registry a significant number of refractory cases were deemed potential eCPR candidates reflecting a need for future interdisciplinary work to support delivery of this therapy.

Abstract 344: The Association Between ALS Response Interval and Out-of Hospital Cardiac Arrest Outcomes

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Brian Grunau ◽  
Takahisa Kawano ◽  
John Tallon ◽  
Frank Scheuermeyer ◽  
Joshua Reynolds ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Secondary Analysis ◽  
Advanced Life Support ◽  
Median Response ◽  
Neurological Outcomes ◽  
Spline Curves ◽  
Response Interval ◽  
Optimal Deployment ◽  
Hospital Cardiac Arrest

Objective: There is conflicting data in studies investigating the effectiveness of advanced life support (ALS) for out-of-hospital cardiac arrest (OHCA). Within a tiered BLS-ALS system, we sought to determine if the ALS response interval was associated with patient outcomes. Methods: This secondary analysis examined prospectively identified consecutive non-traumatic adult OHCAs from 2006-2016 in British Columbia. We excluded EMS-witnessed arrests and those not treated by ALS. The primary and secondary outcomes were survival and favorable neurological outcomes (mRS ≤3) at hospital discharge. Using logistic regression we estimated the association of ALS response interval (9-1-1 call to ALS arrival) and outcomes, adjusting for treatment year, response interval of the first EMS unit, and other baseline characteristics. We drew spline curves to illustrate this relationship. Results: Of 12,722 included cases, survival was 12%. The median response interval for the first EMS unit was 6.4 minutes (IQR 5.2 - 8.3) and for ALS was 11.8 minutes (IQR 8.7 - 16.5).The adjusted odds of survival and favourable neurological outcome for each additional minute in ALS response interval were 0.98 (95 % CI 0.96-0.99) and 0.98, (95% CI 0.97-0.99) respectively. The spline curve demonstrated an initial decline in survival probability that moderated at approximately 11 minutes. Conclusion: Among ALS-treated subjects within our tiered EMS system, earlier ALS arrival was associated with improved survival and favorable neurological outcomes. The greatest yield of ALS care may be prior to 11 minutes. This may help inform the optimal deployment configuration of prehospital providers.

Resuscitation on the field: basic and advanced life support and automatic external defibrillators

2019 ◽  
pp. 403-410
Author(s):  
Mark S. Link ◽  
Mark Estes III
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Basic Life Support ◽  
Life Support ◽  
Action Plan ◽  
Advanced Life Support ◽  
Advanced Cardiac Life Support ◽  
Screening Strategy ◽  
Automated External Defibrillators ◽  
Playing Field

Resuscitation on the playing field is at least as important as screening in the prevention of death. Even if a screening strategy is largely effective, individuals will suffer sudden cardiac arrests. Timely recognition of a cardiac arrest with rapid implementation of cardiopulmonary resuscitation (CPR) and deployment and use of automated external defibrillators (AEDs) will save lives. Basic life support, including CPR and AED use, should be a requirement for all those involved in sports, including athletes. An emergency action plan is important in order to render advanced cardiac life support and arrange for transport to medical centres.

Life-threatening emergencies

2012 ◽  
pp. 40-61
Author(s):  
Jonathan P. Wyatt ◽  
Robin N. Illingworth ◽  
Colin A. Graham ◽  
Kerstin Hogg ◽  
Michael J. Clancy ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Basic Life Support ◽  
Life Support ◽  
Central Venous Access ◽  
Treatment Algorithm ◽  
Advanced Life Support ◽  
Venous Access ◽  
Central Venous ◽  
Life Threatening

Anaphylaxis 42 Treatment algorithm for adults with anaphylaxis 44 Choking 45 Cardiac arrest 46 In-hospital resuscitation algorithm 47 Adult basic life support 48 Cardiac arrest management 50 Advanced life support algorithm 52 Notes on using the advanced life support algorithm 53 Post-resuscitation care 54 Central venous access ...

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