scholarly journals RESUSCITATION AFTER CARDIAC SURGERY AWARENESS, AN EGYPTIAN MULTICENTRE SURVEY

2021 ◽  
Author(s):  
Moslem Abdelghafar ◽  
Taher Abdelmoiem ◽  
Alaa Mohamed ◽  
Mohamed Abdalla
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Surgery ◽  
Life Support ◽  
Action Plan ◽  
Advanced Life Support ◽  
Cardiac Massage ◽  
External Cardiac Massage ◽  
Hospital Cardiac Arrest ◽  
Training Protocol ◽  
Question Survey

Aim: Cardiac surgery patients have different resuscitative needs than other patients who experience in-hospital cardiac arrest, this was addressed in the guidelines. However, it is unknown how widely the guidelines are practiced, or a training protocol is followed in different cardiac surgery units in Egypt. Methods: A 21-question survey is created and included: Participants demographics, Prevalence of cardiac arrest, Cardiac arrest protocol, Emergency resternotomy technique, Training protocols. Survey was disseminated through social media messaging platforms during the period between November 2020 and January 2021. Results: 95 responses were from 11 centres across Egypt. 68.5% of the respondents were surgeons, 76.8% of participants were junior surgeons. For patients who go into VF after cardiac surgery, respondents would attempt a median of 3 shocks with only 24.2% commencing defibrillation shocks before external cardiac massage, while the majority initiating CPR immediately and performing emergency resternotomy in a median time of 10 mins. 56.8% would give 1 mg of adrenaline as soon the cardiac arrest was established. If a surgeon was not available, only 36.8% of respondents would allow any trained personnel to perform the emergency resternotomy. Only 9.5% practice regularly on emergency sternotomies. 75% think tailored training is important and staff should be oriented about it in the future. Conclusion: An action plan is required to improve the awareness of the junior surgeons with the Cardiac Advanced Life Support Protocol.

scholarly journals Resuscitation After Cardiac Surgery Awareness an Egyptian Multicentre Survey

2021 ◽  
Vol 23 (Supplement_D) ◽  
Author(s):  
Moslem Abdelghafar ◽  
Taher Abdelmoneim ◽  
Alaa Mohamed ◽  
Mohamed Abdalla
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Life Support ◽  
Action Plan ◽  
Care Staff ◽  
Annual Number ◽  
Cardiac Massage ◽  
Average Percentage ◽  
Shockable Rhythm

Abstract Introduction There has been an increasing recognition that cardiac surgery patients have different resuscitative needs than other medical and surgical patients who experience in-hospital cardiac arrest. This was addressed in the 2010 European Resuscitation Council Guidelines and the 2010 American Heart Association Guidelines. However, it’s unknown how widely the guidelines are practiced, or a training protocol is followed in different units in Egypt. Objectives This national survey aims to identify the views and common practice of Egyptian cardiac teams regarding resuscitation after cardiac surgery. Methods A 21-question survey is created based on a prior survey used by the EACTS guidelines committee. Questions included the following topics: Participants demographics, Prevalence of cardiac arrest in the intensive care unit, Cardiac arrest with ventricular fibrillation or non-shockable rhythm, Emergency resternotomy technique, Training and arrest protocols. Survey dissemination was through social media platforms, mobile messaging applications and emails during the time period between November 2020 and January 2021. Results Of 126 responses, 95 were suitable for inclusion. Responses were from 11 centres across Egypt. 68.5% of the respondents were surgeons while cardiac anaesthetists and intensivists formed 12.6% and 18.9% respectively. 76.8% of participants were middle-grade doctors, consultant participation was 23.2%. The median annual number of cases performed in the units was 480 and this ranged from 10 to 3000. The average percentage of cardiac arrests was 7%, Median survival to hospital discharge of all arrests was 33% For patients who go into VF after cardiac surgery, respondents would attempt a mean of 5 shocks with only 24.2% commencing defibrillation shocks before external cardiac massage, while the majority initiating CPR immediately. They would perform emergency resternotomy in a mean time of 12 mins and in 15 mins if the rhythm was not shockable. 56.8% would give 1 mg of adrenaline as soon the cardiac arrest was established, only 6.3% thought that it should be given rarely or not at all. If a surgeon was not immediately available 36.8% of respondents would be happy for any trained personnel to perform the emergency resternotomy while 58.9% expect only the surgeon to perform the resternotomy. 49.4% of the participants have not practised any training to perform an emergency sternotomy. 41% of the respondents state they occasionally practice or talk with the staff about it. Only 9.5% practice regularly on emergency sternotomies. 25% assume current training is enough and does not need modification, while 75% think tailored training is important and staff should be oriented about it in the future. Conclusion An action plan is required to improve the awareness of the junior surgeons with the Cardiac Advanced Life Support Protocol. Proper training of the intensive care staff to implement the protocol in a timely organised manner is needed. Assessment of the rhythm before starting external chest compressions is the corner stone in cardiac patients undergoing cardiac arrest. VF/pVT rhythm, 3 defibrillation shocks are given first; for the non- shockable rhythm, the emergency pacing switched on, this is followed by compressions till resternomtomy. Emergency resternotomy under 5 minutes is the only effective way to save patients with tamponade and extreme hypovolemia.

Advanced Cardiovascular Life Support Post–Cardiac Surgery

2020 ◽  
pp. 153-160
Author(s):  
Caryl Bailey ◽  
Michael Faulkner
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Surgery ◽  
European Association ◽  
Life Support ◽  
Cardiac Massage ◽  
Early Defibrillation ◽  
External Cardiac Massage ◽  
Emergency Mode ◽  
Post Cardiac Surgery ◽  
Asynchronous Pacing

This chapter explores advanced cardiovascular life support (ACLS) after cardiac surgery. In 2009, the European Association of Cardiothoracic Surgeons provided recommendations for the management of post–cardiac surgery arrest, which have since been augmented by publication of consensus guidelines from the European Resuscitation Council in 2015 and the Society of Thoracic Surgeons in 2017. These guidelines are preferred over traditional ACLS guidelines for cardiac arrest resuscitation of post–cardiac surgery patients. Ventricular fibrillation is the cause of 25%–50% of cardiac arrests in post–cardiac surgery patients. Guidelines recommend up to 3 attempted shocks prior to external cardiac massage (ECM) if they can be delivered within 1 minute of arrest. Early defibrillation is often successful in this population and minimizes potential intrathoracic trauma from ECM on a fresh sternotomy. In patients with severe bradycardia or asystole, the epicardial pacer should be set to emergency mode, which provides dual-chamber, asynchronous pacing at 80–100 bpm with maximum atrial and ventricular amperage. Resternotomy within 5 minutes is recommended when resuscitation after cardiac arrest has been unsuccessful or when cardiac arrest from tamponade is highly likely.

scholarly journals Impact of In Situ Education on Management of Cardiac Arrest after Cardiac Surgery

2021 ◽  
Vol 23 (2) ◽  
pp. 54-61
Author(s):  
Bhargavi Gali ◽  
◽  
Grace Arteaga ◽  
Glen Au ◽  
Vitaly Herasevich
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Surgery ◽  
Life Support ◽  
Advanced Life Support ◽  
Cardiac Massage ◽  
Chest Compressions ◽  
In Situ Simulation ◽  
Before And After ◽  
Initial Medication

Background: Advanced life support interventions have been modified for patients who have recently undergone sternotomy for cardiac surgery and have new suture lines. We aimed to determine whether the use of in-situ simulation increased adherence to the cardiac surgery unit-advanced life support algorithm (CSU-ALS) for patients with cardiac arrest after cardiac surgery (CAACS). Methods: This was a retrospective chart review of cardiac arrest management of patients who sustained CAACS before and after implementation of in-situ simulation scenarios utilizing CSU-ACLS in place of traditional advanced cardiac life support. We utilized classroom education of CSU-ACLS followed by in-situ high-fidelity simulated scenarios of patients with CAACS.. Interprofessional learners (n = 210) participated in 18 in-situ simulations of CAACS. Two groups of patients with CAACS were retrospectively compared before and after in situ training (preimplementation, n=22 vs postimplementation, n=38). Outcomes included adherence to CSU-ALS for resuscitation, delay in initiation of chest compressions, use of defibrillation and pacing before external cardiac massage, and time to initial medication. Results: Chest compressions were used less often in the postimplementation vs the preimplementation period (11/22 [29%] vs 13/38 [59%], P = 0.02). Time to initial medication administration, use of defibrillation and pacing, return to the operating room, and survival were similar between periods. Conclusion: In this pilot, adherence to a key component of the CSU-ALS algorithm—delaying initiation of chest compressions—improved

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.

Cardiac Advanced Life Support–Surgical Guideline

2014 ◽  
Vol 25 (2) ◽  
pp. 123-129 ◽  
Author(s):  
Cheryl Herrmann
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Surgery ◽  
Ventricular Arrhythmias ◽  
Life Support ◽  
Recovery Period ◽  
Advanced Life Support ◽  
Postoperative Recovery

Cardiac arrest in the immediate postoperative recovery period in a patient who underwent cardiac surgery is typically related to reversible causes—tamponade, bleeding, ventricular arrhythmias, or heart blocks associated with conduction problems. When treated promptly, 17% to 79% of patients who experience cardiac arrest after cardiac surgery survive to discharge. The Cardiac Advanced Life Support–Surgical (CALS-S) guideline provides a standardized algorithm approach to resuscitation of patients who experience cardiac arrest after cardiac surgery. The purpose of this article is to discuss the CALS-S guideline and how to implement it.

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