Optimal cardiopulmonary resuscitation duration for favorable neurological outcomes after out-of-hospital cardiac arrest

Background A favorable neurological outcome is closely related to patient characteristics and total cardiopulmonary resuscitation (CPR) duration. The total CPR duration consists of pre-hospital and in-hospital durations. To date, consensus is lacking on the optimal total CPR duration. Therefore, this study aimed to determine the upper limit of total CPR duration, the optimal cut-off time at the pre-hospital level, and the time to switch from conventional CPR to alternative CPR such as extracorporeal CPR. Methods We conducted a retrospective observational study using prospective, multi-center registry of out-of-hospital cardiac arrest (OHCA) patients between October 2015 and June 2019. Emergency medical service–assessed adult patients (aged ≥ 18 years) with non-traumatic OHCA were included. The primary endpoint was a favorable neurological outcome at hospital discharge. Results Among 7914 patients with OHCA, 577 had favorable neurological outcomes. The optimal cut-off for pre-hospital CPR duration in patients with OHCA was 12 min regardless of the initial rhythm. The optimal cut-offs for total CPR duration that transitioned from conventional CPR to an alternative CPR method were 25 and 21 min in patients with initial shockable and non-shockable rhythms, respectively. In the two groups, the upper limits of total CPR duration for achieving a probability of favorable neurological outcomes < 1% were 55–62 and 24–34 min, respectively, while those for a cumulative proportion of favorable neurological outcome > 99% were 43–53 and 45–71 min, respectively. Conclusions Herein, we identified the optimal cut-off time for transitioning from pre-hospital to in-hospital settings and from conventional CPR to alternative resuscitation. Although there is an upper limit of CPR duration, favorable neurological outcomes can be expected according to each patient’s resuscitation-related factors, despite prolonged CPR duration.

Why Bystanders Did Not Perform Cardiopulmonary Resuscitation on Out-of-Hospital Cardiac Arrest Patients: A Multi-Center Study in Hanoi (Vietnam)

Aim: The aim of this study was to determine why bystanders did not use formal Emergency Medical Services (EMS) or conduct cardiopulmonary resuscitation (CPR) on the scene for out-of-hospital cardiac arrest (OHCA) patients in Hanoi, Vietnam. Methods: This was a prospective, observational study of OHCA patients admitted to five tertiary hospitals in the Hanoi area from June 2018 through January 2019. The data were collected through interviews (using a structured questionnaire) with bystanders. Results: Of the 101 patients, 79% were aged <65 years, 71% were men, 79% were witnessed to collapse, 36% were transported to the hospital by formal EMS, and 16% received bystander CPR at the scene. The most frequently indicated reason for not using EMS by the attendants was “using a private vehicle or taxi is faster” (85%). The reasons bystanders did not conduct CPR at the scene included “not recognizing the ailment as cardiac arrest” (60%), “not knowing how to perform CPR” (33%), and “being afraid of doing harm to patients” (7%). Only seven percent of the bystanders had been trained in CPR. Conclusion: The information revealed in this study provides useful information to indicate what to do to increase EMS use and CPR provision. Spreading awareness and training among community members regarding EMS roles, recognition of cardiac arrest, CPR skills, and dispatcher training to assist bystanders are crucial to improve the outcomes of OHCA patients in Vietnam.

Optimal Mean Arterial Pressure for Favorable Neurological Outcomes in Survivors after Extracorporeal Cardiopulmonary Resuscitation

We evaluated the optimal mean arterial pressure (MAP) for favorable neurological outcomes in patients who underwent extracorporeal cardiopulmonary resuscitation (ECPR). Adult patients who underwent ECPR were included. The average MAP was obtained during 6, 12, 24, 48, 72, and 96 h after cardiac arrest, respectively. Primary outcome was neurological status upon discharge, as assessed by the Cerebral Performance Categories (CPC) scale (range from 1 to 5). Overall, patients with favorable neurological outcomes (CPC 1 or 2) tended to have a higher average MAP than those with poor neurological outcomes. Six models were established based on ensemble algorithms for machine learning, multiple logistic regression and observation times. Patients with average MAP around 75 mmHg had the least probability of poor neurologic outcomes in all the models. However, those with average MAPs below 60 mmHg had a high probability of poor neurological outcomes. In addition, based on an increase in the average MAP, the risk of poor neurological outcomes tended to increase in patients with an average MAP above 75 mmHg. In this study, average MAPs were associated with neurological outcomes in patients who underwent ECPR. Especially, maintaining the survivor’s MAP at about 75 mmHg may be important for neurological recovery after ECPR.

Understanding Cardiopulmonary Resuscitation Determines the Readiness of Doing Basic Life Support

Introduction: Cardiopulmonary Resuscitation (CPR) is an emergency lifesaving procedure performed when the heart stops beating. Basic Life Support (BLS) is the initial action to save life-saving conditions. BLS is one of the most important components in CPR. BLS greatly determines the fate of the next life-threatening victim. This study aimed to know the relationship of understanding CPR to readiness to do BLS for students of Faculty of Medicine, Universitas Airlangga, Surabaya.Methods: This was non-experimental study using the design of analytic and descriptive statistics. The sample of this study was the students of Faculty of Medicine, class of 2015, Universitas Airlangga, Surabaya and was taken by probability sampling method with a simple random sampling technique. Data retrieval was performed by giving a questionnaire to 100 respondents. This study was conducted in February 2019. The results of this study were then analyzed by SPSS using the Spearman test.Results: The results of this study showed that the most level of understanding CPR was in the good category with 56 people (56%), while the readiness to do BLS was mostly in the moderate category with 55 people (55%). Based on the results of statistical tests using the Spearman test, there was a relationship between the level of understanding CPR and the readiness to do BLS for students of Faculty of Medicine, Universitas Airlangga, Surabaya.Conclusion: There was relationship between the level of understanding CPR and the readiness to do BLS for students of Faculty Medicine, Universitas Airlangga, Surabaya.

Successful Use of Extracorporeal Life Support and Continuous Renal Replacement Therapy in the Treatment of Cardiogenic Shock Induced by Tumor Lysis Syndrome in a Pediatric Patient With Lymphoma: A Case Report

The use of extracorporeal membrane oxygenation (ECMO) in the treatment of cardiopulmonary failure in children with malignant tumors is controversial. There are few reports on the use of ECMO in the treatment of children with tumor lysis syndrome. This article reports a case of a 9-year-old girl who presented with hyperkalemia and cardiogenic shock. The discovery of an abdominal mass with critical ultrasound provided key evidence for the initial diagnosis of tumor lysis syndrome. Cardiopulmonary resuscitation was performed for 1 h. Veno-arterial ECMO was installed at the bedside to provide cardiopulmonary support for the patient and was combined with continuous renal replacement therapy (CRRT) to improve her internal environment. The patient was ultimately diagnosed with mature B-cell lymphoma with tumor lysis syndrome. A severe electrolyte disorder led to cardiogenic shock. After the electrolyte imbalance was corrected, the patient's heart function gradually improved, ECMO was successfully weaned, and chemotherapy was continued with the support of CRRT. One month after ECMO weaning, the organ function of the patient had recovered and there were no serious complications. In this case report, we paid attention to the rapid diagnosis of the etiology behind a patient's shock with critical ultrasound as well as the initiation and management of extracorporeal cardiopulmonary resuscitation (ECPR), which provided us with valuable experience using VA-ECMO on critically ill children with tumors. It is also important evidence for the use of ECMO in the treatment of children with cardiopulmonary arrest secondary to malignancy.