Aortic Root Dissection In A Patient With Previous Aortic Valve Replacement Due To External Automated Chest Compression Device For Cardiac Arrest

Myocardial damage from external cardiac massage can occur with either manual massage or with an automatic external device. We report the case of a patient with an aortic valve bioprosthesis undergoing advanced resuscitation with an automated external device for out-of-hospital-cardiac arrest, in whom the prolonged compressions caused an aortic root dissection.

Efficacy of a Simplified Feedback Trainer for High-Quality Chest Compression Training: A Randomized Controlled Simulation Study

Background: The most recent international guidelines recommended support training of chest compression (CC) using feedback devices. This study aimed to compare the training efficacy of a simplified feedback trainer with the traditional cardiopulmonary resuscitation (CPR) simulator in CPR training.Methods: A total of 60 soldiers were randomly allocated into three groups equally, trained with a simplified external cardiac massage (ECM) trainer named Soul SheathTM (SS) (SS group), a Resusci Anne manikin (RA group), or traditional simulation training with instructor feedback, respectively. After 7 days of training, the CPR skills were tested blindly in a 2-min assessment session. The primary outcome was the proportion of effective CC, and the secondary outcome included CC rate, depth, compression position, and extent of the release.Results: The percentage of effective CC achieved in the SS group was comparable with the RA group (77.0 ± 15.52 vs. 77.5 ± 10.73%, p = 0.922), and significantly higher than that in the control group (77.0 ± 15.52 vs. 66.8 ± 16.87%, p = 0.037). Both the SS and RA groups showed better CC performance than the control group in terms of CC rate (SS group vs. control group, P = 0.032 and RA group vs. control group, P = 0.026), the proportion of shallow CC (SS group vs. control group, P = 0.011 and RA group vs. control group, P = 0.017). No difference between the SS group and RA group was found in all the CC parameters.Conclusions: The simplified ECM trainer (SS) provides a similar efficacy to the traditional manikin simulator with feedback in CC training to improve the quality of CPR skills.

RESUSCITATION AFTER CARDIAC SURGERY AWARENESS, AN EGYPTIAN MULTICENTRE 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.

Advanced Cardiovascular Life Support Post–Cardiac Surgery

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.

A posição ideal das mãos durante a massagem cardíaca externa em adultos, divergindo das diretrizes atuais: Uma Revisão Sistemática / Ideal hand position during external cardiac massage in adults, diverging from current guidelines: A Systematic Review

A Ressuscitação cardiopulmonar (RCP) é uma técnica de emergência realizada com auxílio de compressão torácica e ventilação artificial, sendo preconizada como um padrão de ressuscitação. Esta revisão sistemática tem por objetivo sumarizar os resultados dos estudos realizados quanto à posição ideal das mãos durante a RCP bem como sugerir outras opções de posicionamento das mãos, visto que há evidências científicas de que as manobras atualmente usadas não são tão eficazes quanto se pensava. A metodologia foi conduzida conforme a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A busca se deu na base de dados PubMed e Cochrane, de maio a junho de 2019, conforme a seguinte estratégia de busca, somente com termos em inglês: hands and heart massage and heart arrest, usando os filtros: Humans; Adults e artigos dos últimos 12 anos, quando iniciaram os primeiros estudos sobre o assunto em questão. Os critérios de inclusão utilizados foram: estudos em seres humanos; idade maior de dezoito anos; abordagem direta acerca de que a recomendação do local ideal para massagem cardíaca atualmente preconizado nas diretrizes precisa ser revisto; identificação de novas formas de encontrar o ponto ideal das manobras de compressão torácica; artigos em inglês. Foram encontrados 49 artigos, sendo 24, restando 25 para leitura dos respectivos resumos. Destes foram selecionados apenas 7, incluindo os estudos resultantes das buscas e as referências adicionais encontradas manualmente. Conclui-se que, de fato, as estruturas intratorácicas que são comprimidas durante as manobras de ressuscitação aplicadas na linha intermamilar, são em sua maioria a via de saída do ventrículo esquerdo e ramos da aorta (raiz ou aorta ascendente). Logo, os efeitos hemodinâmicos para o paciente em parada cardíaca não são tão eficazes para a reversão do quadro, visto que, para tal, o ideal seria a compressão do ventrículo esquerdo.

Isolated right atrial rupture because of external cardiac massage after coronary artery bypass grafting

Background: Isolated right atrial rupture is a very rare catastrophic complication of cardiopulmonary resuscitation. Objective: We described a rare case of right atrial rupture after external cardiac massage. Methods: We reported the case of a 62-year-old male patient who developed excessive bleeding following external cardiac massage for sudden cardiac arrest in the intensive care unit after coronary artery bypass grafting. Results: This man underwent successful emergency repair of the tear of the right atrium without using cardiopulmonary bypass. Conclusion: Right atrial rupture can occur after external cardiac massage. An emergency repair is needed.