scholarly journals Impact of Personal Protective Equipment on Out-of-Hospital Cardiac Arrest Resuscitation in Coronavirus Pandemic

Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1291
Author(s):  
Hye-Young Ko ◽  
Jong-Eun Park ◽  
Da-Un Jeong ◽  
Tae-Gun Shin ◽  
Min-Seob Sim ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Personal Protective Equipment ◽  
Medical Staff ◽  
Gas Analysis ◽  
Subjective Perception ◽  
Protective Equipment ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Hospital Cardiac Arrest

Background and Objectives: This retrospective study evaluated the clinical impact of enhanced personal protective equipment (PPE) on the clinical outcomes in patients with out-of-hospital cardiac arrest. Moreover, by focusing on the use of a powered air-purifying respirator (PAPR), we investigated the medical personnel’s perceptions of wearing PAPR during cardiopulmonary resuscitation. Materials and Methods: According to the arrival time at the emergency department, the patients were categorized into a conventional PPE group (1 August 2019 to 20 January 2020) and an enhanced PPE group (21 January 2020, to 31 August 2020). The primary outcomes of this analysis were the return of spontaneous circulation (ROSC) rate. Additionally, subjective perception of the medical staff regarding the effect of wearing enhanced PPE during cardiopulmonary resuscitation (CPR) was evaluated by conducting a survey. Results: This study included 130 out-of-hospital cardiac arrest (OHCA) patients, with 73 and 57 patients in the conventional and enhanced PPE groups, respectively. The median time intervals to first intubation and to report the first arterial blood gas analysis results were longer in the enhanced PPE group than in the conventional PPE group (3 min vs. 2 min; p = 0.020 and 8 min vs. 3 min; p < 0.001, respectively). However, there were no significant differences in the ROSC rate (odds ratio (OR) = 0.79, 95% confidence interval (CI): 0.38–1.67; p = 0.542) and 1 month survival (OR 0.38, 95% CI: 0.07–2.10; p = 0.266) between the two groups. In total, 67 emergent department (ED) professionals responded to the questionnaire. Although a significant number of respondents experienced inconveniences with PAPR use, they agreed that PAPR was necessary during the CPR procedure for protection and reduction of infection transmission. Conclusion: The use of enhanced PPE, including PAPR, affected the performance of CPR to some extent but did not alter patient outcomes. PAPR use during the resuscitation of OHCA patients might positively impact the psychological stability of the medical staff.

scholarly journals Dynamic changes in arterial blood gas during cardiopulmonary resuscitation in out-of-hospital cardiac arrest

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Seok-In Hong ◽  
June-Sung Kim ◽  
Youn-Jung Kim ◽  
Won Young Kim
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Gas Analysis ◽  
University Hospital ◽  
Arterial Line ◽  
Blood Gas ◽  
Dynamic Changes ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Hospital Cardiac Arrest

AbstractWe aimed to investigate the prognostic value of dynamic changes in arterial blood gas analysis (ABGA) measured after the start of cardiopulmonary resuscitation (CPR) for return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA). This prospective observational study was conducted at the emergency department of a university hospital from February 2018 to February 2020. All blood samples for gas analysis were collected from a radial or femoral arterial line, which was inserted during CPR. Changes in ABGA parameters were expressed as delta (Δ), defined as the values of the second ABGA minus the values of the initial ABGA. The primary outcome was sustained ROSC. Out of the 80 patients included in the analysis, 13 achieved sustained ROSC after in-hospital resuscitation. Multivariable logistic analysis revealed that ΔpaO2 (odds ratio [OR] = 1.023; 95% confidence interval [CI] = 1.004–1.043, p = 0.020) along with prehospital shockable rhythm (OR = 84.680; 95% CI = 2.561–2799.939, p = 0.013) and total resuscitation duration (OR = 0.881; 95% CI = 0.805–0.964, p = 0.006) were significant predictors for sustained ROSC. Our study suggests a possible association between ΔpaO2 in ABGA during CPR and an increased rate of sustained ROSC in the late phase of OHCA.

Association between early arterial blood gas tensions and neurological outcome in adult patients following in-hospital cardiac arrest

Resuscitation ◽  
2015 ◽  
Vol 89 ◽  
pp. 1-7 ◽  
Author(s):  
Chih-Hung Wang ◽  
Chien-Hua Huang ◽  
Wei-Tien Chang ◽  
Min-Shan Tsai ◽  
Tsung-Chien Lu ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Adult Patients ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Hospital Cardiac Arrest

A pilot assessment of alpha-stat vs pH-stat arterial blood gas analysis after cardiac arrest

2015 ◽  
Vol 30 (1) ◽  
pp. 138-144 ◽  
Author(s):  
Glenn M. Eastwood ◽  
Satoshi Suzuki ◽  
Cristina Lluch ◽  
Antoine G. Schneider ◽  
Rinaldo Bellomo
Keyword(s):  
Cardiac Arrest ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Arterial Blood Gas Analysis ◽  
Ph Stat

scholarly journals Role of blood gas analysis during cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients

Medicine ◽  
2016 ◽  
Vol 95 (25) ◽  
pp. e3960 ◽  
Author(s):  
Youn-Jung Kim ◽  
You Jin Lee ◽  
Seung Mok Ryoo ◽  
Chang Hwan Sohn ◽  
Shin Ahn ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Hospital Cardiac Arrest

scholarly journals Beyond the limits - ECPR in putative fatal circumstances

CJEM ◽  
2018 ◽  
Vol 20 (S2) ◽  
pp. S70-S73
Author(s):  
Ingo Graeff ◽  
Sylvia Schacher ◽  
Stefan Lenkeit ◽  
Catherine N. Widmann ◽  
Jens-Christian Schewe
Keyword(s):  
Cardiac Arrest ◽  
Water Immersion ◽  
Heart Association ◽  
Prognostic Indicators ◽  
European Resuscitation Council ◽  
Eligibility Criteria ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Hospital Cardiac Arrest

AbstractThe eligibility criteria for applying extracorporeal cardiopulmonary resuscitation (ECPR) in patients with cardiac arrest are currently unclear. For those patients with hypothermic cardiac arrest, the European Resuscitation Council (ERC) Guidelines recommend considering ECPR only for patients with potassium <8 mmol/L and a body temperature below 32°C, whereas the American Heart Association Guidelines (AHA) do not express this in a specific manner.We report the case of an urban unwitnessed out-of-hospital cardiac arrest patient found with her head immersed in water at a temperature of 23°C. The patient presented an unclear history and a dire combination of clinical and laboratory parameters (asystole, arterial blood gas: pH 6.8, potassium 8.3 mmol/L, lactate 16.0 mmol/L). Despite these poor prognostic indicators, ECPR was initiated after 95 minutes of CPR and the patient survived with a good neurological outcome.This case highlights the uncertainty in ECPR eligibility and prognostication, especially in those with hypothermia and water immersion for whom aggressive therapies may be warranted. Further data and improved strategies are required to delineate candidacy for this resource-intensive procedure better.

scholarly journals Association Between Neurological Outcomes and Extreme Hyperoxia in Patients with Out-of-Hospital Cardiac Arrest Who Underwent Extracorporeal Cardiopulmonary Resuscitation: A Retrospective Observational Study from a Multicenter Registry

2021 ◽  
Author(s):  
Masahiro Kashiura ◽  
Hideto Yasuda ◽  
Yuki Kishihara ◽  
Keiichiro Tominaga ◽  
Masaaki Nishihara ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Analysis Model ◽  
Neurological Outcomes ◽  
Arterial Blood ◽  
The Impact ◽  
Hospital Cardiac Arrest

Abstract Background: To investigate the impact of hyperoxia that developed immediately after extracorporeal membrane oxygenation (ECMO)-assisted cardiopulmonary resuscitation (ECPR) on patients’ 30-day neurological outcomes after out-of-hospital cardiac arrest (OHCA). Methods: This study retrospectively analyzed data from the Japanese OHCA registry from June 2014 to December 2017. We analyzed adult patients (18 years or older) who had undergone ECPR. Eligible patients were divided into the following three groups based on their initial partial pressure of oxygen in arterial blood (PaO2) levels after ECMO pump-on: normoxia group, PaO2 ≤ 200 mm Hg; moderate hyperoxia group, 200 mm Hg < PaO2 ≤ 400 mm Hg; and extreme hyperoxia group, PaO2 > 400 mm Hg. The primary and secondary outcomes were 30-day favorable neurological outcomes. Logistic regression statistical analysis model of 30-day favorable neurological outcomes was performed after adjusting for multiple propensity scores calculated using pre-ECPR covariates and for confounding factors post-ECPR.Results: Of the 34 754 patients with OHCA enrolled in the registry, 847 were included. The median PaO2 level was 300 mm Hg (interquartile range: 148–427 mm Hg). Among the eligible patients, 277, 313, and 257 were categorized as normoxic, moderately hyperoxic, and extremely hyperoxic, respectively. Moderate hyperoxia was not significantly associated with neurologically favorable outcomes compared with normoxia as a reference (adjusted odds ratio, 0.86; 95% confidence interval: 0.55–1.35; p = 0.51). However, extreme hyperoxia was associated with less neurologically favorable outcomes when compared with normoxia (adjusted odds ratio, 0.48; 95% confidence interval: 0.29–0.82; p = 0.007).Conclusions: For patients with OHCA who received ECPR, extreme hyperoxia (PaO2 > 400 mm Hg) was associated with poor neurological outcomes. Avoidance of extreme hyperoxia may improve neurological outcomes in patients with OHCA treated with ECPR.

Abstract 244: Preliminary Results on Angiotensin II as a Novel Vasopressor in Modeled Out-of-Hospital Cardiac Arrest and Cardiopulmonary Resuscitation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Tobias Neumann ◽  
Simon-Richard Finke ◽  
Marlen Assam ◽  
Jakob Emrich ◽  
Alexander Fuchs ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Angiotensin Ii ◽  
Cardiopulmonary Resuscitation ◽  
Continuous Infusion ◽  
Position Statement ◽  
Spontaneous Circulation ◽  
Optimal Dosage ◽  
Arterial Blood ◽  
Distributive Shock ◽  
Hospital Cardiac Arrest

Introduction: The PARAMEDIC2-trial reported a higher survival rate comparing standard epinephrine treatment with placebo, but severe neurologic impairment was found more often in patients who received epinephrine. Angiotensin II (AT2) has been recently authorized by FDA and EMA to treat distributive shock in adults. It is not approved as a vasopressor in the treatment of cardiac arrest (CA) and has not been studied in a standardized model of out-of hospital cardiac arrest with subsequent guideline-based cardiopulmonary resuscitation (CPR) before. Hypothesis: AT2 administration during CPR will 1. result in higher rates for return of spontaneous circulation (ROSC) after modeled out-of-hospital CA and 2. will achieve a greater increase in mean arterial blood pressure (MAP) compared to standard epinephrine bolus regimen. Methods: After legal approval (81-02.04.2019A072) and in conformance with the AHA position statement (Circulation 1985; 71:849A), we conducted a prospective, randomized trial in 25 swine weighing 32 to 43.5 kilogram bodyweight (kgBW) under general anesthesia. In 22 swine randomized to intervention groups i) EPI or ii) AT2, ventricular fibrillation was induced electrically and mechanical ventilation was discontinued. After 10 minutes (min) of untreated CA, ventilation was resumed and CPR was performed adapted to current guidelines for up to 56 min. After the third unsuccessful defibrillation (6 min CPR), swine received either i) boluses of epinephrine 0.01 mg/kgBW every 4 min or ii) an initial bolus of AT2 (25 μg/kgBW) followed by continuous infusion at 1 μg/kgBW/min. Three animals served as sham controls and received identical treatment but neither CA nor CPR. Results: ROSC was achieved in 7/22 swine and in 5/20 requiring vasopressors (EPI 1/10 vs. AT2 4/10, n. s.). The initial vasopressor bolus increased MAP significantly more in AT2 compared to EPI (p = 0.03). However, this could not be maintained under continuous infusion of AT2. Conclusions: For the first time, we have demonstrated the feasibility of successful guideline-based CPR using AT2 as sole vasopressor. But still, questions such as the optimal dosage remain. We strongly encourage larger trials to investigate this newly available drug also for the treatment of CA.

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