Cardiac Resuscitation

2019 ◽  
Author(s):  
Samuel A Tisherman
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Early Recognition ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Optimal Timing ◽  
Sources Of Information ◽  
Multiple Sources ◽  
Hospital Cardiac Arrest

Sudden cardiac death, whether in the hospital or out of the hospital, is a leading cause of death. Early recognition and activation of an emergency response, following the “chain of survival”, is critical. High quality Cardiopulmonary Resuscitation (CPR) should be initiated as soon as possible. Rescue breaths can be added when a qualified medical professional is available. Once emergency medical services personnel arrive for an out of hospital cardiac arrest or the “code team” arrives for an in hospital cardiac arrest, the Advanced Cardiovascular Life Support (ACLS) algorithm should be followed. For patients with pulseless ventricular tachycardia or ventricular fibrillation, early defibrillation improves the chances for restoration of spontaneous circulation and survival. The use of vasopressors and anti-arrhythmics are part of the protocol, though the benefits are unclear. Once trained airway providers are available, placement of an advanced airway, either supraglottic or endotracheal, can be considered after several minutes of CPR-ACLS, though optimal timing and clear benefit have not been established. For patients who remain comatose after resuscitation, initiation of Targeted Temperature Management can improve outcomes. Neuroprognostication is complex and should be delayed for at least 3-5 days after resuscitation and should be based upon multiple sources of information. This review contains 1 figure, 5 tables, and 44 references. Keywords: Cardiac arrest, cardiopulmonary resuscitation, anti-arrhythmics, airway management, targeted temperature management, prognostication 

Cardiac Resuscitation

2019 ◽  
Author(s):  
Samuel A Tisherman
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Early Recognition ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Optimal Timing ◽  
Sources Of Information ◽  
Multiple Sources ◽  
Hospital Cardiac Arrest

Sudden cardiac death, whether in the hospital or out of the hospital, is a leading cause of death. Early recognition and activation of an emergency response, following the “chain of survival”, is critical. High quality Cardiopulmonary Resuscitation (CPR) should be initiated as soon as possible. Rescue breaths can be added when a qualified medical professional is available. Once emergency medical services personnel arrive for an out of hospital cardiac arrest or the “code team” arrives for an in hospital cardiac arrest, the Advanced Cardiovascular Life Support (ACLS) algorithm should be followed. For patients with pulseless ventricular tachycardia or ventricular fibrillation, early defibrillation improves the chances for restoration of spontaneous circulation and survival. The use of vasopressors and anti-arrhythmics are part of the protocol, though the benefits are unclear. Once trained airway providers are available, placement of an advanced airway, either supraglottic or endotracheal, can be considered after several minutes of CPR-ACLS, though optimal timing and clear benefit have not been established. For patients who remain comatose after resuscitation, initiation of Targeted Temperature Management can improve outcomes. Neuroprognostication is complex and should be delayed for at least 3-5 days after resuscitation and should be based upon multiple sources of information. This review contains 1 figure, 5 tables, and 44 references. Keywords: Cardiac arrest, cardiopulmonary resuscitation, anti-arrhythmics, airway management, targeted temperature management, prognostication 

Cardiac Resuscitation

2019 ◽  
Author(s):  
Samuel A Tisherman
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Early Recognition ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Optimal Timing ◽  
Sources Of Information ◽  
Multiple Sources ◽  
Hospital Cardiac Arrest

Sudden cardiac death, whether in the hospital or out of the hospital, is a leading cause of death. Early recognition and activation of an emergency response, following the “chain of survival”, is critical. High quality Cardiopulmonary Resuscitation (CPR) should be initiated as soon as possible. Rescue breaths can be added when a qualified medical professional is available. Once emergency medical services personnel arrive for an out of hospital cardiac arrest or the “code team” arrives for an in hospital cardiac arrest, the Advanced Cardiovascular Life Support (ACLS) algorithm should be followed. For patients with pulseless ventricular tachycardia or ventricular fibrillation, early defibrillation improves the chances for restoration of spontaneous circulation and survival. The use of vasopressors and anti-arrhythmics are part of the protocol, though the benefits are unclear. Once trained airway providers are available, placement of an advanced airway, either supraglottic or endotracheal, can be considered after several minutes of CPR-ACLS, though optimal timing and clear benefit have not been established. For patients who remain comatose after resuscitation, initiation of Targeted Temperature Management can improve outcomes. Neuroprognostication is complex and should be delayed for at least 3-5 days after resuscitation and should be based upon multiple sources of information. This review contains 1 figure, 5 tables, and 44 references. Keywords: Cardiac arrest, cardiopulmonary resuscitation, anti-arrhythmics, airway management, targeted temperature management, prognostication 

scholarly journals 2019 American Heart Association Focused Update on Pediatric Advanced Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Circulation ◽  
2019 ◽  
Vol 140 (24) ◽  
Author(s):  
Jonathan P. Duff ◽  
Alexis A. Topjian ◽  
Marc D. Berg ◽  
Melissa Chan ◽  
Sarah E. Haskell ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
American Heart Association ◽  
Life Support ◽  
American Heart ◽  
Heart Association ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Liaison Committee ◽  
Hospital Cardiac Arrest

This 2019 focused update to the American Heart Association pediatric advanced life support guidelines follows the 2018 and 2019 systematic reviews performed by the Pediatric Life Support Task Force of the International Liaison Committee on Resuscitation. It aligns with the continuous evidence review process of the International Liaison Committee on Resuscitation, with updates published when the International Liaison Committee on Resuscitation completes a literature review based on new published evidence. This update provides the evidence review and treatment recommendations for advanced airway management in pediatric cardiac arrest, extracorporeal cardiopulmonary resuscitation in pediatric cardiac arrest, and pediatric targeted temperature management during post–cardiac arrest care. The writing group analyzed the systematic reviews and the original research published for each of these topics. For airway management, the writing group concluded that it is reasonable to continue bag-mask ventilation (versus attempting an advanced airway such as endotracheal intubation) in patients with out-of-hospital cardiac arrest. When extracorporeal membrane oxygenation protocols and teams are readily available, extracorporeal cardiopulmonary resuscitation should be considered for patients with cardiac diagnoses and in-hospital cardiac arrest. Finally, it is reasonable to use targeted temperature management of 32°C to 34°C followed by 36°C to 37.5°C, or to use targeted temperature management of 36°C to 37.5°C, for pediatric patients who remain comatose after resuscitation from out-of-hospital cardiac arrest or in-hospital cardiac arrest.

Targeted temperature management in patients undergoing extracorporeal life support after out-of-hospital cardiac arrest: an EURO-ELSO 2018 annual conference survey

Perfusion ◽  
2019 ◽  
Vol 34 (8) ◽  
pp. 714-716
Author(s):  
Caroline Rolfes ◽  
Ralf M Muellenbach ◽  
Philipp M Lepper ◽  
Tobias Spangenberg ◽  
Justyna Swol ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Bleeding Risk ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Annual Conference ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Hospital Cardiac Arrest

Targeted temperature management and extracorporeal life support, particularly extracorporeal membrane oxygenation in patients undergoing cardiopulmonary resuscitation, represent outcome-enhancing strategies for patients following in- and out-of-hospital cardiac arrest. Although targeted temperature management with hypothermia between 32°C and 34°C and extracorporeal cardiopulmonary resuscitation bear separate potentials to improve outcome after out-of-hospital cardiac arrest, each is associated with bleeding risk and risk of infection. Whether the combination imposes excessive risk on patients is, however, unknown.

scholarly journals Extracorporeal Cardiopulmonary Resuscitation for Out‐of‐Hospital Cardiac Arrest in Adult Patients

2020 ◽  
Vol 9 (7) ◽  
Author(s):  
Akihiko Inoue ◽  
Toru Hifumi ◽  
Tetsuya Sakamoto ◽  
Yasuhiro Kuroda
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
The United States ◽  
Adult Patients ◽  
Temperature Management ◽  
Secondary Brain Injury ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Hospital Cardiac Arrest

Abstract Extracorporeal cardiopulmonary resuscitation (ECPR) followed by targeted temperature management has been demonstrated to significantly improve the outcomes of out‐of‐hospital cardiac arrest (OHCA) in adult patients. Although recent narrative and systematic reviews on extracorporeal life support in the emergency department are available in the literature, they are focused on the efficacy of ECPR, and no comprehensively summarized review on ECPR for OHCA in adult patients is available. In this review, we aimed to clarify the prevalence, pathophysiology, predictors, management, and details of the complications of ECPR for OHCA, all of which have not been reviewed in previous literature, with the aim of facilitating understanding among acute care physicians. The leading countries in the field of ECPR are those in East Asia followed by those in Europe and the United States. ECPR may reduce the risks of reperfusion injury and deterioration to secondary brain injury. Unlike conventional cardiopulmonary resuscitation, however, no clear prognostic markers have been identified for ECPR for OHCA. Bleeding was identified as the most common complication of ECPR in patients with OHCA. Future studies should combine ECPR with intra‐aortic balloon pump, extracorporeal membrane oxygenation flow, target blood pressure, and seizure management in ECPR.

Does Targeted Temperature Management Improve Neurological Outcome in Extracorporeal Cardiopulmonary Resuscitation (ECPR)?

2021 ◽  
pp. 088506662110189
Author(s):  
Merry Huang ◽  
Aaron Shoskes ◽  
Migdady Ibrahim ◽  
Moein Amin ◽  
Leen Hasan ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Survival Outcomes ◽  
Pool Data ◽  
Good Neurological Outcome ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Over Time

Purpose: Targeted temperature management (TTM) is a standard of care in patients after cardiac arrest for neuroprotection. Currently, the effectiveness and efficacy of TTM after extracorporeal cardiopulmonary resuscitation (ECPR) is unknown. We aimed to compare neurological and survival outcomes between TTM vs non-TTM in patients undergoing ECPR for refractory cardiac arrest. Methods: We searched PubMed and 5 other databases for randomized controlled trials and observational studies reporting neurological outcomes or survival in adult patients undergoing ECPR with or without TTM. Good neurological outcome was defined as cerebral performance category <3. Two independent reviewers extracted the data. Random-effects meta-analyses were used to pool data. Results: We included 35 studies (n = 2,643) with the median age of 56 years (interquartile range [IQR]: 52-59). The median time from collapse to ECMO cannulation was 58 minutes (IQR: 49-82) and the median ECMO duration was 3 days (IQR: 2.0-4.1). Of 2,643, 1,329 (50.3%) patients received TTM and 1,314 (49.7%) did not. There was no difference in the frequency of good neurological outcome at any time between TTM (29%, 95% confidence interval [CI]: 23%-36%) vs. without TTM (19%, 95% CI: 9%-31%) in patients with ECPR ( P = 0.09). Similarly, there was no difference in overall survival between patients with TTM (30%, 95% CI: 22%-39%) vs. without TTM (24%, 95% CI: 14%-34%) ( P = 0.31). A cumulative meta-analysis by publication year showed improved neurological and survival outcomes over time. Conclusions: Among ECPR patients, survival and neurological outcome were not different between those with TTM vs. without TTM. Our study suggests that neurological and survival outcome are improving over time as ECPR therapy is more widely used. Our results were limited by the heterogeneity of included studies and further research with granular temperature data is necessary to assess the benefit and risk of TTM in ECPR population.

scholarly journals Echocardiographic parameters during prolonged targeted temperature Management in out-of-hospital Cardiac Arrest Survivors to predict neurological outcome – a post-hoc analysis of the TTH48 trial

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Thomas Hvid Jensen ◽  
Peter Juhl-Olsen ◽  
Bent Roni Ranghøj Nielsen ◽  
Johan Heiberg ◽  
Christophe Henri Valdemar Duez ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Left Ventricular Ejection ◽  
Secondary Outcome ◽  
Ventricular Ejection Fraction ◽  
Hospital Cardiac Arrest

Abstract Background Transthoracic echocardiographic (TTE) indices of myocardial function among survivors of out-of-hospital cardiac arrest (OHCA) have been related to neurological outcome; however, results are inconsistent. We hypothesized that changes in average peak systolic mitral annular velocity (s’) from 24 h (h) to 72 h following start of targeted temperature management (TTM) predict six-month neurological outcome in comatose OHCA survivors. Methods We investigated the association between peak systolic velocity of the mitral plane (s’) and six-month neurological outcome in a population of 99 patients from a randomised controlled trial comparing TTM at 33 ± 1 °C for 24 h (h) (n = 47) vs. 48 h (n = 52) following OHCA (TTH48-trial). TTE was conducted at 24 h, 48 h, and 72 h after reaching target temperature. The primary outcome was 180 days neurological outcome assessed by Cerebral Performance Category score (CPC180) and the primary TTE outcome measure was s’. Secondary outcome measures were left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), e’, E/e’ and tricuspid annular plane systolic excursion (TAPSE). Results Across all three scan time points s’ was not associated with neurological outcome (ORs: 24 h: 1.0 (95%CI: 0.7–1.4, p = 0.98), 48 h: 1.13 (95%CI: 0.9–1.4, p = 0.34), 72 h: 1.04 (95%CI: 0.8–1.4, p = 0.76)). LVEF, GLS, E/e’, and TAPSE recorded on serial TTEs following OHCA were neither associated with nor did they predict CPC180. Estimated median e’ at 48 h following TTM was 5.74 cm/s (95%CI: 5.27–6.22) in patients with good outcome (CPC180 1–2) vs. 4.95 cm/s (95%CI: 4.37–5.54) in patients with poor outcome (CPC180 3–5) (p = 0.04). Conclusions s’ assessed on serial TTEs in comatose survivors of OHCA treated with TTM was not associated with CPC180. Our findings suggest that serial TTEs in the early post-resuscitation phase during TTM do not aid the prognostication of neurological outcome following OHCA. Trial registration NCT02066753. Registered 14 February 2014 – Retrospectively registered,

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