Extended cardiopulmonary resuscitation: from high fidelity simulation scenario to the first clinical applications in Poznan out-of-hospital cardiac arrest program

Perfusion ◽  
2020 ◽  
pp. 026765912098181
Author(s):  
Maciej Sip ◽  
Mateusz Puslecki ◽  
Marek Dabrowski ◽  
Tomasz Klosiewicz ◽  
Radoslaw Zalewski ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Sudden Cardiac Arrest ◽  
Real Life ◽  
Drug Eluting Stent ◽  
Medical Simulation ◽  
High Fidelity ◽  
High Fidelity Simulation ◽  
Simulation Scenario ◽  
Hospital Cardiac Arrest

Background: The outcomes of out-of-hospital cardiac arrest (OHCA) patients are poor. In some OHCA cases, the reason is potentially reversible cardiac or aortic disease. It was suggested previously that high-quality cardiopulmonary resuscitation (CPR) followed by extracorporeal membrane oxygenation (ECMO) support may improve the grave prognosis of OHCA. However, extended CPR (ECPR) with ECMO application is an extremely invasive and cutting-edge procedure. The purpose of this article is to describe how high-fidelity medical simulation as a safe tool enabled implementation of the complex, multi-stage ECPR procedure. Method: A high fidelity simulation of OHCA in street conditions was prepared and carried out as part of a ECPR procedure implemented in an in-hospital area. The simulation tested communication and collaboration of several medical teams from the pre-hospital to in-hospital phases along with optimal use of equipment in management of a sudden cardiac arrest (SCA) patient. Results: The critical and weak points of an earlier created scenario were collected into a simulation scenario checklist of ECPR algorithm architecture. A few days later, two ECPR procedures followed by cardiologic interventions for OHCA patients (one pulmonary artery embolectomy for acute pulmonary thrombosis and one percutaneous coronary artery angioplasty with drug eluting stent implantation for acute occlusion of the left anterior descending artery), were performed for the first time in Poland. The protocol was activated five times in the first 2 months of the POHCA Program. Conclusion: High fidelity medical simulation in real-life conditions was confirmed to be a safe, useful tool to test and then implement the novel and complex medical procedures. It enabled to find, analyze and solve the weakest points of the earlier developed theoretical protocol and eventually succeed in clinical application of complete ECPR procedure.

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

Circulation ◽  
2020 ◽  
Vol 141 (12) ◽  
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.

Assessment of the management of a sudden cardiac arrest (CA) in primary care setting by means of high-fidelity simulation

Resuscitation ◽  
2015 ◽  
Vol 96 ◽  
pp. 149
Author(s):  
Antonio Casal Sanchez ◽  
Luis Sanchez Santos ◽  
Antonio Rodriguez Nuñez ◽  
Jose Flores Arias ◽  
Antonio Iglesias Vazquez
Keyword(s):  
Primary Care ◽  
Cardiac Arrest ◽  
Care Setting ◽  
Primary Care Setting ◽  
Sudden Cardiac Arrest ◽  
High Fidelity ◽  
High Fidelity Simulation

Comparison of sudden cardiac arrest resuscitation performance data obtained from in-hospital incident chart review and in situ high-fidelity medical simulation

Resuscitation ◽  
2010 ◽  
Vol 81 (4) ◽  
pp. 463-471 ◽  
Author(s):  
Leo Kobayashi ◽  
David G. Lindquist ◽  
Ilse M. Jenouri ◽  
Kevin M. Dushay ◽  
Donna Haze ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Chart Review ◽  
Sudden Cardiac Arrest ◽  
Performance Data ◽  
Medical Simulation ◽  
High Fidelity

scholarly journals Optimization of End-to-End Convolutional Neural Networks for Analysis of Out-of-Hospital Cardiac Arrest Rhythms during Cardiopulmonary Resuscitation

Sensors ◽  
2021 ◽  
Vol 21 (12) ◽  
pp. 4105
Author(s):  
Irena Jekova ◽  
Vessela Krasteva
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
High Performance ◽  
Signal To Noise Ratio ◽  
Random Search ◽  
Real Life ◽  
Computationally Efficient ◽  
Significant Drop ◽  
End To End ◽  
Hospital Cardiac Arrest

High performance of the shock advisory analysis of the electrocardiogram (ECG) during cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA) is important for better management of the resuscitation protocol. It should provide fewer interruptions of chest compressions (CC) for non-shockable organized rhythms (OR) and Asystole, or prompt CC stopping for early treatment of shockable ventricular fibrillation (VF). Major disturbing factors are strong CC artifacts corrupting raw ECG, which we aimed to analyze with optimized end-to-end convolutional neural network (CNN) without pre-filtering or additional sensors. The hyperparameter random search of 1500 CNN models with 2–7 convolutional layers, 5–50 filters and 5–100 kernel sizes was done on large databases from independent OHCA interventions for training (3001 samples) and validation (2528 samples). The best model, named CNN3-CC-ECG network with three convolutional layers (filters@kernels: 5@5,25@20,50@20) presented Sensitivity Se(VF) = 89%(268/301), Specificity Sp(OR) = 91.7%(1504/1640), Sp(Asystole) = 91.1%(3325/3650) on an independent test OHCA database. CNN3-CC-ECG’s ability to effectively extract features from raw ECG signals during CPR was comprehensively demonstrated, and the dependency on the CPR corruption level in ECG was tested. We denoted a significant drop of Se(VF) = 74.2% and Sp(OR) = 84.6% in very strong CPR artifacts with a signal-to-noise ratio of SNR < −9 dB, p < 0.05. Otherwise, for strong, moderate and weak CC artifacts (SNR > −9 dB, −6 dB, −3 dB), we observed insignificant performance differences: Se(VF) = 92.5–96.3%, Sp(OR) = 93.4–95.5%, Sp(Asystole) = 92.6–94.0%, p > 0.05. Performance stability with respect to CC rate was validated. Generalizable application of the optimized computationally efficient CNN model was justified by an independent OHCA database, which to our knowledge is the largest test dataset with real-life cardiac arrest rhythms during CPR.

scholarly journals Impact of telephone cardiopulmonary resuscitation on the return of spontaneous circulation in patients with out-of-hospital cardiac arrest

2020 ◽  
Vol 7 (4) ◽  
pp. 256-260
Author(s):  
Jerzy Jaskuła ◽  
Karolina Niemczyk
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Sudden Cardiac Arrest ◽  
Spontaneous Circulation ◽  
Medical System ◽  
Quality Monitoring ◽  
Return Of Spontaneous Circulation ◽  
Live Instruction ◽  
Telephone Cardiopulmonary Resuscitation ◽  
Hospital Cardiac Arrest

The aim: Research aim is the evaluation of return of spontaneous circulation (ROSC) ratio among the individuals with out-of-hospital sudden cardiac arrest (SCA), depending on the so-called Telephone Cardiopulmonary Resuscitation (TCPR). T-CPR is based on live instruction given by the dispatcher to incident witness, who is performing CPR efforts until the EMS team arrives on scene. Material and methods: Research was based on the analysis of 782 entries (from EMS documentation) which recorded SCA and CPR. Emergency call voice recording has been rehearsed for each case, in order to confirm the capability of recognizing SCA and providing T-CPR instructions. Data was divided into two groups and the results have been compared. The ROSC ratio for both groups (“T-CPR” and “No T-CPR”) were analyzed along with the type of incident location. Results: The research has shown that 26,4% of all SCA cases researched ended up with the ROSC. In 94% of cases the dispatcher had succeeded in encouraging the witness to perform CPR with telephone instruction (T-CPR) until the EMS team has arrived. In the “T-CPR” group, 28,7% of cases have ended with ROSC. In the “No T-CPR” group, 19,7% of cases have ended with ROSC (28,7% vs. 19,7%). Conclusions: The T-CPR should be utilized by dispatcher in the form of uniform protocol. In the process of training dispatchers there should be special emphasis on the skill of recognizing SCA upon receiving a call. The evaluation of SCA recognition, T-CPR undertaken and ROSC ratio may be an effective indicator of quality monitoring within the State Emergency Medical System.

Quality of bystander cardiopulmonary resuscitation during real-life out-of-hospital cardiac arrest

Resuscitation ◽  
2017 ◽  
Vol 120 ◽  
pp. 63-70 ◽  
Author(s):  
Tore Gyllenborg ◽  
Asger Granfeldt ◽  
Freddy Lippert ◽  
Ingunn Skogstad Riddervold ◽  
Fredrik Folke
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Real Life ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Hospital Cardiac Arrest

Management of out-of hospital cardiac arrest patients with extracorporeal cardiopulmonary resuscitation in 2021

2021 ◽  
pp. 1-10
Author(s):  
Christopher Gaisendrees ◽  
Matias Vollmer ◽  
Sebastian G Walter ◽  
Ilija Djordjevic ◽  
Kaveh Eghbalzadeh ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Hospital Cardiac Arrest

scholarly journals Contacts to the healthcare system prior to out-of-hospital cardiac arrests

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Zylyftari ◽  
S.G Moller ◽  
M Wissenberg ◽  
F Folke ◽  
C.A Barcella ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
General Population ◽  
Healthcare System ◽  
Early Identification ◽  
Sudden Cardiac Arrest ◽  
Funding Source ◽  
Horizon 2020 ◽  
One Year ◽  
Public Grant ◽  
Hospital Cardiac Arrest

Abstract Background Patients who suffer a sudden out-of-hospital cardiac arrest (OHCA) may be preceded by warning symptoms and healthcare system contact. Though, is currently difficult early identification of sudden cardiac arrest patients. Purpose We aimed to examine contacts with the healthcare system up to two weeks and one year before OHCA. Methods OHCA patients were identified from the Danish Cardiac Arrest Registry (2001–2014). The pattern of healthcare contacts (with either general practitioner (GP) or hospital) within the year prior to OHCA of OHCA patients was compared with that of 9 sex- and age-matched controls from the background general population. Additionally, we evaluated characteristics of OHCA patients according to the type of healthcare contact (GP/hospital/both/no-contact) and the including characteristics of contacts, within two weeks prior their OHCA event. Results Out of 28,955 OHCA patients (median age of 72 (62–81) years and with 67% male) of presumed cardiac cause, 16,735 (57.8%) contacted the healthcare system (GP and hospital) within two weeks prior to OHCA. From one year before OHCA, the weekly percentages of contacts to GP were relatively constant (26%) until within 2 weeks prior to OHCA where they markedly increased (54%). In comparison, 14% of the general population contacted the GP during the same period (Figure). The weekly percentages of contacts with hospitals gradually increased in OHCA patients from 3.5% to 6.5% within 6 months, peaking at the second week (6.8%), prior to OHCA. In comparison, only 2% of the general population had a hospital contact in that period (Figure). Within 2 weeks of OHCA, patients contacted GP mainly by telephone (71.6%). Hospital diagnoses were heterogenous, where ischemic heart disease (8%) and heart failure (4.5%) were the most frequent. Conclusions There is an increase in healthcare contacts prior to “sudden” OHCA and overall, 54% of OHCA-patients had contacted GP within 2 weeks before the event. This could have implications for developing future strategies for early identification of patients prior to their cardiac arrest. Figure 1. The weekly percentages of contacts to GP (red) and hospital (blue) within one year before OHCA comparing the OHCA cases to the age- and sex-matched control population (N cases = 28,955; N controls = 260,595). Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): European Union's Horizon 2020

scholarly journals The Effect of Implementing Mechanical Cardiopulmonary Resuscitation Devices on Out-of-Hospital Cardiac Arrest Patients in an Urban City of Taiwan

2021 ◽  
Vol 18 (7) ◽  
pp. 3636
Author(s):  
Yi-Rong Chen ◽  
Chi-Jiang Liao ◽  
Han-Chun Huang ◽  
Cheng-Han Tsai ◽  
Yao-Sing Su ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Primary Outcome ◽  
Medical Service ◽  
Spontaneous Circulation ◽  
High Quality ◽  
Urban City ◽  
Service Response Time ◽  
Mechanical Cpr ◽  
Hospital Cardiac Arrest

High-quality cardiopulmonary resuscitation (CPR) is a key element in out-of-hospital cardiac arrest (OHCA) resuscitation. Mechanical CPR devices have been developed to provide uninterrupted and high-quality CPR. Although human studies have shown controversial results in favor of mechanical CPR devices, their application in pre-hospital settings continues to increase. There remains scant data on the pre-hospital use of mechanical CPR devices in Asia. Therefore, we conducted a retrospective cohort study between September 2018 and August 2020 in an urban city of Taiwan to analyze the effects of mechanical CPR devices on the outcomes of OHCA; the primary outcome was attainment of return of spontaneous circulation (ROSC). Of 552 patients with OHCA, 279 received mechanical CPR and 273 received manual CPR, before being transferred to the hospital. After multivariate adjustment for the influencing factors, mechanical CPR was independently associated with achievement of any ROSC (OR = 1.871; 95%CI:1.195–2.930) and sustained (≥24 h) ROSC (OR = 2.353; 95%CI:1.427–3.879). Subgroup analyses demonstrated that mechanical CPR is beneficial in shorter emergency medical service response time (≤4 min), witnessed cardiac arrest, and non-shockable cardiac rhythm. These findings support the importance of early EMS activation and high-quality CPR in OHCA resuscitation.

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