This page is a collection of articles, videos and protocols for cardiac arrest.
This is an area that is changing rapidly and fortunately for the better.
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Cutting Edge INtra cardiac arrest care
The link here is to a lecture by Dr Scott Weingart in 2013 (so already probably dated) but it gives a very good perspective on cardiac arrest and where ACLS protocols fit in all this. To go to the videolink CLICK HERE .
Resuscitation. 2014 Mar;85(3):336-42.
The impact of peri-shock pause on survival from out-of-hospital shockable cardiac arrest during the Resuscitation Outcomes Consortium PRIMED trial.
Cheskes, S, Schmicker RH, et al
OBJECTIVE: To determine the impact of peri-shock pause on survival from OHCA during the ROC PRIMED randomized controlled trial.
METHODS: We included patients in the ROC PRIMED trial who suffered OHCA between June 2007 and November 2009, presented with a shockable rhythm and had CPR process data for at least one shock. We used multivariable logistic regression to determine the association between peri-shock pause duration and survival to hospital discharge.
RESULTS: Among 2006 patients studied, the median (IQR) shock pause duration was: pre-shock pause 15s (8, 22); post-shock pause 6s (4, 9); and peri-shock pause 22.0 s (14, 31). After adjusting for Utstein predictors of survival as well as CPR quality measures, the odds of survival to hospital discharge were significantly higher for patients with pre-shock pause <10s (OR: 1.52, 95% CI: 1.09, 2.11) and peri-shock pause <20s (OR: 1.82, 95% CI: 1.17, 2.85) when compared to patients with pre-shock pause ≥ 20s and peri-shock pause ≥ 40s. Post-shock pause was not significantly associated with survival to hospital discharge. Results for neurologically intact survival (Modified Rankin Score ≤ 3) were similar to our primary outcome.
In patients with cardiac arrest presenting in a shockable rhythm during the ROC PRIMED trial, shorter pre- and peri-shock pauses were significantly associated with higher odds of survival. Future cardiopulmonary education and technology should focus on minimizing all peri-shock pauses
But then this article appeared in the NEJM November 9, 2015
Similar Survival Rates with Continuous or Interrupted CPR for Out-of-Hospital Cardiac Arrest
N Engl J Med 2015 Nov 9. Koster RW. N Engl J Med 2015 Nov 9.
Both groups in this randomized trial received very high-quality compressions. Recent American Heart Association guidelines recommend changes to cardiopulmonary resuscitation (CPR) including that compressions be fast (100–120/minute), deep (5–6 cm), and continuous (NEJM JW Emerg Med Dec 2015 and Circulation 2015; 132[Suppl 2]:S315). However, the recommendation about compressions was based on retrospective cohort and animal studies and prospective studies involving multi-intervention bundles.
To tease out whether continuous compressions independently improve survival in out-of- hospital cardiac arrest, Resuscitation Outcomes Consortium investigators performed a cluster randomized trial involving 114 emergency medical services agencies in North America. They randomized adults with nontraumatic cardiac arrest to receive continuous compressions (100 compressions/minute with asynchronous positive-pressure ventilation at 10 ventilations/minute) or interrupted compressions (30 compressions followed by 2 positive-pressure ventilations).
Other basic and advanced life support interventions were not standardized. Of 23,711 patients analyzed, 53% received continuous compressions. Rates of survival to hospital discharge (the primary outcome) were similar in the continuous- and interrupted-compression groups (9.0% and 9.7%, P=0.07), as were rates of survival with favorable neurologic function (7.0% and 7.7%). Compressions were delivered in the two groups at similar depth (mean, 4.8 and 4.9 cm, respectively) and speed (mean, 110 and 109/minute, respectively). Mean pre- and post-shock pauses were the same in the two groups (pre-shock, 12 seconds; post-shock, 6 seconds).
Comment by NEJM reviewer Ali Raja
This well-done study demonstrates that continuous and interrupted high-quality compressions are equally effective. The take-home message is that high-quality CPR saves lives, regardless of compression strategy. I will continue to use continuous CPR, simply because it is easier to coordinate, but no matter which compression/ventilation strategy you use, good communication within your team remains essential.
favorable survival after in-hospital cardiac arrest: a randomized clinical trial
JAMA. 2013 Jul 17;310(3):270-9.
Mentzelopoulos SD, Malachias S, Chamos C, Konstantopoulos D, Ntaidou T, Papas et al.
Among patients with cardiac arrest, preliminary data have shown improved return of spontaneous circulation and survival to hospital discharge with the vasopressin-steroids-epinephrine (VSE) combination.
OBJECTIVE: To determine whether combined vasopressin-epinephrine during cardiopulmonary resuscitation (CPR) and corticosteroid supplementation during and after CPR improve survival to hospital discharge with a Cerebral Performance Category (CPC) score of 1 or 2 in vasopressor-requiring, in-hospital cardiac arrest.DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind, placebo-controlled, parallel-group trial performed from September 1, 2008, to October 1, 2010, in 3 Greek tertiary care centers (2400 beds) with 268 consecutive patients with cardiac arrest requiring epinephrine according to resuscitation guidelines (from 364 patients assessed for eligibility).
INTERVENTIONS: Patients received either vasopressin (20 IU/CPR cycle) plus epinephrine (1 mg/CPR cycle; cycle duration approximately 3 minutes) (VSE group, n?=?130) or saline placebo plus epinephrine (1 mg/CPR cycle; cycle duration approximately 3 minutes) (control group, n?=?138) for the first 5 CPR cycles after randomization, followed by additional epinephrine if needed. During the first CPR cycle after randomization, patients in the VSE group received methylprednisolone (40 mg) and patients in the control group received saline placebo. Shock after resuscitation was treated with stress-dose hydrocortisone (300 mg daily for 7 days maximum and gradual taper) (VSE group, n?=?76) or saline placebo (control group, n?=?73).
MAIN OUTCOMES AND MEASURES: Return of spontaneous circulation (ROSC) for 20 minutes or longer and survival to hospital discharge with a CPC score of 1 or 2. RESULTS: Follow-up was completed in all resuscitated patients. Patients in the VSE group vs patients in the control group had higher probability for ROSC of 20 minutes or longer (109/130 [83.9%] vs 91/138 [65.9%]; odds ratio [OR], 2.98; 95% CI, 1.39-6.40; P?=?.005) and survival to hospital discharge with CPC score of 1 or 2 (18/130 [13.9%] vs 7/138 [5.1%]; OR, 3.28; 95% CI, 1.17-9.20; P?=?.02). Patients in the VSE group with postresuscitation shock vs corresponding patients in the control group had higher probability for survival to hospital discharge with CPC scores of 1 or 2 (16/76 [21.1%] vs 6/73 [8.2%]; OR, 3.74; 95% CI, 1.20-11.62; P?=?.02), improved hemodynamics and central venous oxygen saturation, and less organ dysfunction. Adverse event rates were similar in the 2 groups.
CONCLUSION AND RELEVANCE: Among patients with cardiac arrest requiring vasopressors, combined vasopressin-epinephrine and methylprednisolone during CPR and stress-dose hydrocortisone in postresuscitation shock, compared with epinephrine/saline placebo, resulted in improved survival to hospital discharge with favorable neurological status.
What is the future of CPR?
March 23, 2015—Keith Lurie, MD, founder of Advanced Circulatory Systems, now part of ZOLL, and inventor of the ResQPOD® ITD, was among the 10 medical professionals chosen as the EMS 10: Innovators in EMS 2014. Nominated by their peers in recognition of their hard work, dedication, and selfless efforts to make a difference in the delivery of EMS or in the lives of patients and providers, the 10 were honored at a dinner held during the 2015 EMS Today Conference in late February.
Dr. Lurie was recognized for his research and innovation in the field of resuscitation and for helping to identify the profound consequences that poor-quality CPR has on survival. He was the first to use intrathoracic pressure regulation (IPR) as a therapy to increase preload, lower intracranial pressure, and improve perfusion in states of low blood flow. Based on IPR technology, he invented two impedance threshold devices (ITDs), the ResQPOD ITD for use in CPR and the ResQGARD® ITD for use in spontaneously breathing hypotensive patients. He also developed the ResQCPR™ System, which recently received FDA approval with an indication to “improve the likelihood of survival in adult patients with non-traumatic cardiac arrest.”
The ResQPOD creates a vacuum in the chest, pulling more blood back to the heart, lowering intracranial pressure and circulating more blood to the brain and other vital organs than CPR alone. Clinical studies show that it improves survival by as much as 75% when used in conjunction with high-quality CPR.
Yannopoulos D, et al. The Effect of CPR Quality: A Potential Confounder of CPR Clinical Trials. Circulation. 2014;130:A9
Below is a video of the new ResQCPR device.