Standards for Resuscitation After Cardiac Surgery

2015 ◽  
Vol 35 (2) ◽  
pp. 30-38 ◽  
Author(s):  
S. Jill Ley
Keyword(s):  
United States ◽  
Cardiac Arrest ◽  
Cardiac Surgery ◽  
Heart Surgery ◽  
Life Support ◽  
Survival Rates ◽  
Advanced Life Support ◽  
The United States ◽  
High Survival ◽  
Essential Components

Of the 250 000 patients who undergo major cardiac operations in the United States annually, 0.7% to 2.9% will experience a postoperative cardiac arrest. Although Advanced Cardiac Life Support (ACLS) is the standard approach to management of cardiac arrest in the United States, it has significant limitations in these patients. The European Resuscitation Council (ERC) has endorsed a new guideline specific to resuscitation after cardiac surgery that advises important, evidence-based deviations from ACLS and is under consideration in the United States. The ACLS and ERC recommendations for resuscitation of these patients are contrasted on the basis of the essential components of care. Key to this approach is the rapid elimination of reversible causes of arrest, followed by either defibrillation or pacing (as appropriate) before external cardiac compressions that can damage the sternotomy, cautious use of epinephrine owing to potential rebound hypertension, and prompt resternotomy (within 5 minutes) to promote optimal cerebral perfusion with internal massage, if prior interventions are unsuccessful. These techniques are relatively simple, reproducible, and easily mastered in Cardiac Surgical Unit–Advanced Life Support courses. Resuscitation of patients after heart surgery presents a unique opportunity to achieve high survival rates with key modifications to ACLS that warrant adoption in the United States.

Cardiac Arrest After Cardiac Surgery: An Evidence-Based Resuscitation Protocol

2019 ◽  
Vol 39 (1) ◽  
pp. 15-25 ◽  
Author(s):  
Patrick Michaelis ◽  
Richard J. Leone
Keyword(s):  
United States ◽  
Cardiac Arrest ◽  
Cardiac Surgery ◽  
Life Support ◽  
The United States ◽  
Current Evidence ◽  
Evidence Based ◽  
Clinical Implementation ◽  
European Resuscitation Council ◽  
Resuscitation Guidelines

More than 250 000 cardiac surgical procedures are performed annually in the United States. Postoperative cardiac arrest rates range from 0.7% to 5.2%. This article reviews current evidence for cardiac arrest resuscitation after cardiac surgery. The evaluation included resuscitation guidelines and 22 studies identified through a MEDLINE search. Evidence-based resuscitation differs from advanced cardiovascular life support guidelines. European Resuscitation Council guidelines include correcting reversible causes of arrest, applying defibrillation/pacing before external cardiopulmonary resuscitation, resternotomy within 5 minutes if electrical therapies fail, and restricting epinephrine use to avoid rebound hypertension. A 2017 Society of Thoracic Surgeons protocol derived from European Resuscitation Council guidelines is now standard of care in the United States. Evidence-based practices can improve survival and reduce resternotomy rates. This article describes the clinical implementation of the Society of Thoracic Surgeons guidelines.

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.

Abstract 17127: Sports-Related Sudden Cardiac Arrest: Comparison of Survival Outcomes in Europe versus the United States

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Eloi Marijon ◽  
Audrey Uy-Evanado ◽  
Florence Dumas ◽  
Carmen Teodeorescu ◽  
Kyndaron Reinier ◽  
...  
Keyword(s):  
United States ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Response Times ◽  
Survival Rates ◽  
Sudden Cardiac Arrest ◽  
The United States ◽  
Population Based ◽  
Sports Activity ◽  
Bystander Cardiopulmonary Resuscitation

Background: Sports-related sudden cardiac arrest (sport SCA) has always attracted attention and the United States and European Union have developed divergent strategies for prevention over the last decade; notably regarding screening of younger athletes but also for SCA prevention in middle-aged and senior individuals. In this context, the extent to which outcomes of sports SCA differ between Europe and the USA have not been characterized. Methods: SCA cases aged 15-75 years were identified in two large prospective, population-based SCA programs, one in the Paris region (Paris-SDEC) and the other in a Northwestern US metro region (Oregon-SUDS) between 2002 and 2012. Cases of SCA, occurring during sports activity were compared between the two regions. Results: Of the 7,357 cases studied, 290 (4%) occurred during sports, with very similar proportions in both regions: 86 out of 1,894 (4.5%) in Oregon and 204 out of 5,463 (3.8%) in Paris. Subjects’ characteristics of cases in both programs were very similar (Paris vs. Oregon, respectively, for all results following), regarding age (50.7±14 vs. 50.4±13 years, P=0.55), male proportion (94%vs. 92%, P=0.53), past medical history of ≥2 cardiovascular risk factors (16% vs. 23%, P=0.16) and/or heart disease (10% vs. 8%, P=0.55). There was a high proportion of witnessed events in both populations (89% vs. 90%, P=0.94). However, we observed significant differences with more bystander cardiopulmonary resuscitation in Paris (63% vs. 48%, P=0.02), faster response time in Oregon (8.3±6 vs. 6.9±4 min, P=0.05), and more initially shockable rhythms in Oregon (52% vs. 70%, P=0.006). Overall, resuscitation outcomes were very similar for return of spontaneous circulation (26% vs. 33%, P=0.21) and survival to hospital discharge (27% vs. 26%, P=0.80). Conclusions: On either side of the Atlantic, burden and characteristics of sports-related SCA are very similar. Survival rates are approximately one in four cases. Optimizing bystander cardiopulmonary resuscitation rates and emergency response times could further improve outcomes. Deployment of uniform, effective strategies for screening and prevention are likely to make the greatest impact on sports SCA.

Rapid On-site Defibrillation versus Community Program

2002 ◽  
Vol 17 (2) ◽  
pp. 102-106 ◽  
Author(s):  
J.C. Fedoruk ◽  
D. Paterson ◽  
M. Hlynka ◽  
K.Y. Fung ◽  
Michael Gobet ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Clinical Epidemiology ◽  
Survival Rates ◽  
Advanced Life Support ◽  
Data Series ◽  
Retrospective Data ◽  
Staff Nurse ◽  
Camera System ◽  
Hospital Cardiac Arrest

AbstractIntroduction:For patients who suffer out-of-hospital cardiac arrest, the time from collapse to initial defibrillation is the single most important factor that affects survival to hospital discharge. The purpose of this study was to compare the survival rates of cardiac arrest victims within an institution that has a rapid defibrillation program with those of its own urban community, tiered EMS system.Methods:A logistic regression analysis of a retrospective data series (n = 23) and comparative analysis to a second retrospective data series (n = 724) were gathered for the study period September 1994 to September 1999. The first data series included all persons at Casino Windsor who suffered a cardiac arrest. Data collected included: age, gender, death/survival (neurologically intact discharge), presenting rhythm (ventricular fibrillation (VF), ventricular tachycardia (VT), or other), time of collapse, time to arrival of security personnel, time to initiation of cardiopulmonary resuscitation (CPR) prior to defibrillation (when applicable), time to arrival of staff nurse, time to initial defibrillation, and time to return of spontaneous circulation (if any). Significantly, all arrests within this series were witnessed by the surveillance camera system, allowing time of collapse to be accurately determined rather than estimated. These data were compared to those of similar events, times, and intervals for all patients in the greater Windsor area who suffered cardiac arrest. This second series was based upon the Ontario Prehospital Advanced Life Support (OPALS) Study database, as coordinated by the Clinical Epidemiology Unit of the Ottawa Hospital, University of Ottawa.Results:The Casino Windsor had 23 cases of cardiac arrests. Of the cases, 13 (56.5%) were male and 10 (43.5%) were female. All cases (100%) were witnessed. The average of the ages was 61.1 years, of the time to initial defibrillation was 7.7 minutes, and of the time for EMS to reach the patient was 13.3 minutes. The presenting rhythm was VF/VT in 91% of the case. Fifteen patients were discharged alive from hospital for a 65% survival rate. The Greater Windsor Study area included 668 cases of out-of-hospital cardiac arrest: Of these, 410 (61.4%) were male and 258 (38.6%) were female, 365 (54.6%) were witnessed, and 303 (45.4%) were not witnessed. The initial rhythm was VF/VT was in 34.3%. Thirty-seven (5.5%) were discharged alive from the hospital.Conclusion:This study provides further evidence that PAD Programs may enhance cardiac arrest survival rates and should be considered for any venue with large numbers of adults as well as areas with difficult medical access.

scholarly journals New insights for adult cardiopulmonary resuscitation. Up-coming resuscitation guidelines 2010

Medicina ◽  
2010 ◽  
Vol 46 (9) ◽  
pp. 571 ◽  
Author(s):  
Andrius Pranskūnas ◽  
Paulius Dobožinskas ◽  
Vidas Pilvinis ◽  
Živilė Petkevičiūtė ◽  
Nedas Jasinskas ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Survival Rates ◽  
Advanced Life Support ◽  
Current Trends ◽  
Resuscitation Guidelines ◽  
Chain Of Survival ◽  
Meta Analyses

Despite advances in cardiac arrest care, the overall survival to hospital discharge remains poor. The objective of this paper was to review the innovations in cardiopulmonary resuscitation that could influence survival or change our understanding about cardiopulmonary resuscitation. We have performed a search in the MEDLINE and the Cochrane databases for randomized controlled trials, meta-analyses, expert reviews from December 2005 to March 2010 using the terms cardiac arrest, basic life support, and advanced life support. The lack of randomized trials during the last 5 years remains the main problem for crucial decisions in cardiopulmonary resuscitation. Current trends in cardiopulmonary resuscitation are toward minimizing the interruptions of chest compressions and improving the quality of cardiopulmonary resuscitation. In addition, attention should be paid to all the parts of chain of survival, which remains essential in improving survival rates.

Using Tele-Education to Train Civilian Physicians in an Area of Active Conflict: Certifying Iraqi Physicians in Pediatric Advanced Life Support from the United States

2011 ◽  
Vol 159 (3) ◽  
pp. 507-509.e1 ◽  
Author(s):  
Ross I. Donaldson ◽  
Deborah A. Mulligan ◽  
Kevin Nugent ◽  
Maricar Cabral ◽  
Eli R. Saleeby ◽  
...  
Keyword(s):  
United States ◽  
Life Support ◽  
Advanced Life Support ◽  
The United States

Analgesia in the Field

1989 ◽  
Vol 4 (1) ◽  
pp. 31-34 ◽  
Author(s):  
Ronald D. Stewart
Keyword(s):  
United States ◽  
Life Support ◽  
Prehospital Care ◽  
Advanced Life Support ◽  
The United States ◽  
Mass Casualty ◽  
Transport Systems ◽  
Medical Problems ◽  
Interhospital Transport ◽  
Injured Patients

Emergency Medical Services and the care of patients in the field have taken giant steps forward over the past decade. Born of the desire of physicians to influence the mortality rates of sudden cardiac death in the community, systems of advanced life support have taken root in the urban centers in the United Kingdom, Australia, the United States, and other countries (1-3). Although originally largely designed around the concept of “mobile coronary care,” these systems soon were deluged with calls for help from all sectors of the community, and faced a variety of medical problems. As trauma gradually became recognized for the killer and maimer of young lives that it is, regional programs of trauma care were developed in the United States and led gradually to the expansion of prehospital and interhospital transport systems in which critically injured patients were being moved about, often over long distances. The growth of emergency medicine as a specialty in its own right has encouraged the study and improvement of systems of disaster and mass casualty management.Although the focus of these efforts has been largely the overall reduction of death and disability in critically ill or injured patients, controversy continues around not only the extent of field intervention but also the influence of our efforts on the outcome of these patients (4, 5). The importance of particular interventions such as intravenous line placement, administration of certain medications, the use of the pneumatic anti-shock garment, and other sacred cows of prehospital care, all have been questioned of late (6, 7).

Physician Medical Direction and Advanced Life Support in the United States

1995 ◽  
Vol 2 (4) ◽  
pp. 274-278 ◽  
Author(s):  
Bartholomew J. Tortella ◽  
Robert F. Lavery ◽  
Ronald P. Cody ◽  
James Doran
Keyword(s):  
United States ◽  
Life Support ◽  
Advanced Life Support ◽  
The United States

scholarly journals Does ‘heads-up’ cardiopulmonary resuscitation improve outcomes for patients in out-of-hospital cardiac arrest? A systematic review

2020 ◽  
Vol 4 (4) ◽  
pp. 16-24
Author(s):  
Andrew Elphinstone ◽  
Samantha Laws
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Animal Studies ◽  
Life Support ◽  
Survival Rates ◽  
Advanced Life Support ◽  
Coronary Perfusion Pressure ◽  
Coronary Perfusion ◽  
Hospital Cardiac Arrest

Introduction: Survival rates for patients in out-of-hospital cardiac arrest have remained around 10% in the United Kingdom for the past seven years. If outcomes are to be improved, research into new methods of advanced life support is required. One such method may be ‘heads-up’ cardiopulmonary resuscitation.Methods: A systematic review of literature exploring heads-up cardiopulmonary resuscitation was conducted in an attempt to identify its effects on survival to discharge and neurological outcome.Results: A comprehensive search of CINAHL, MEDLINE and Google Scholar was undertaken. Six papers were classed as sufficiently relevant for inclusion. Included studies were generally of low quality and none studied the effect of heads-up cardiopulmonary resuscitation on out-of-hospital cardiac arrest patients. Animal studies identified a significant reduction in intracranial pressure and increase in cerebral and coronary perfusion pressure for use of augmented heads-up cardiopulmonary resuscitation in the porcine model of cardiac arrest.Conclusion: Further research is required to analyse the effects and potential benefits of augmented heads-up cardiopulmonary resuscitation in out-of-hospital cardiac arrest.

scholarly journals Cardiac Arrest during Hospitalization for Delivery in the United States, 1998–2011

2014 ◽  
Vol 120 (4) ◽  
pp. 810-818 ◽  
Author(s):  
Jill M. Mhyre ◽  
Lawrence C. Tsen ◽  
Sharon Einav ◽  
Elena V. Kuklina ◽  
Lisa R. Leffert ◽  
...  
Keyword(s):  
United States ◽  
Heart Failure ◽  
Cardiac Arrest ◽  
Amniotic Fluid ◽  
Cardiopulmonary Arrest ◽  
Temporal Trends ◽  
Survival Rates ◽  
The United States ◽  
Amniotic Fluid Embolism ◽  
Weighted Estimates

Abstract Background: The objective of this analysis was to evaluate the frequency, distribution of potential etiologies, and survival rates of maternal cardiopulmonary arrest during the hospitalization for delivery in the United States. Methods: By using data from the Nationwide Inpatient Sample during the years 1998 through 2011, the authors obtained weighted estimates of the number of U.S. hospitalizations for delivery complicated by maternal cardiac arrest. Clinical and demographic risk factors, potential etiologies, and outcomes were identified and compared in women with and without cardiac arrest. The authors tested for temporal trends in the occurrence and survival associated with maternal arrest. Results: Cardiac arrest complicated 1 in 12,000 or 8.5 per 100,000 hospitalizations for delivery (99% CI, 7.7 to 9.3 per 100,000). The most common potential etiologies of arrest included hemorrhage, heart failure, amniotic fluid embolism, and sepsis. Among patients with cardiac arrest, 58.9% of patients (99% CI, 54.8 to 63.0%) survived to hospital discharge. Conclusions: Approximately 1 in 12,000 hospitalizations for delivery is complicated by cardiac arrest, most frequently due to hemorrhage, heart failure, amniotic fluid embolism, or sepsis. Survival depends on the underlying etiology of arrest.

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