Issue Highlights

Abstract

HomeCirculationVol. 116, No. 25Issue Highlights Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBIssue Highlights Originally published18 Dec 2007https://doi.org/10.1161/CIRCULATIONAHA.107.187683Circulation. 2007;116:2893EFFECTIVENESS OF BYSTANDER-INITIATED CARDIAC-ONLY RESUSCITATION FOR PATIENTS WITH OUT-OF-HOSPITAL CARDIAC ARREST, by Iwami et al.andSURVIVAL IS SIMILAR AFTER STANDARD TREATMENT AND CHEST COMPRESSION ONLY IN OUT-OF-HOSPITAL BYSTANDER CARDIOPULMONARY RESUSCITATION, by Bohm et al.Cardiopulmonary resuscitation (CPR) is often performed by bystanders who do not have advanced medical training. There is a question about the efficacy of the addition of rescue breathing to chest compressions in terms of survival and outcomes. Additionally, bystanders may be more hesitant to perform mouth-to-mouth breathing, which may delay or limit cardiac resuscitation. In this issue of Circulation, 2 separate articles by Iwami and colleagues and Bohm and colleagues address these important topics. Iwami and colleagues report a prospective Japanese population-based 5-year observational study of consecutive patients who developed cardiac arrest out of hospital and received attempted CPR by emergency responders. They analyzed outcomes in nearly 5000 witnessed cardiac arrests and found similar rates for survival with a good neurological outcome in those victims who, within 15 minutes of arrest, received either conventional CPR or cardiac-only CPR without addition of rescue breathing. Unfortunately, the survival with favorable neurological outcome rate was only 4% to 5% in both groups. Not surprisingly, survival with good neurological outcome was very poor among victims who received CPR more than 15 minutes after cardiac arrest. Bohm and colleagues describe the results of a Swedish cardiac arrest registry, evaluating the 1-month survival in victims who received bystander standard CPR compared with that of cardiac arrest victims receiving bystander cardiac-only resuscitation. In this 15-year study, most of the 11|275 patients received standard CPR, with only 10% receiving chest compressions only. However, the authors also found no difference in the 1-month survival rate, which was approximately 7% overall. The results of both of these studies are concordant. They support the use of early cardiac resuscitation and suggest that mouth-to-mouth breathing may not have significant additional benefit if chest compressions are promptly initiated. These studies may have important implications in terms of guidelines for bystander resuscitation, CPR training, and public health. See pp 2900 and 2908 (and editorial p 2894).PRASUGREL COMPARED WITH HIGH LOADING- AND MAINTENANCE-DOSE CLOPIDOGREL IN PATIENTS WITH PLANNED PERCUTANEOUS CORONARY INTERVENTION: THE PRASUGREL IN COMPARISON TO CLOPIDOGREL FOR INHIBITION OF PLATELET ACTIVATION AND AGGREGATION–THROMBOLYSIS IN MYOCARDIAL INFARCTION 44 TRIAL, by Wiviott et al.For patients with acute coronary syndromes, and particularly for those undergoing percutaneous intervention (PCI), the use of clopidogrel has evolved toward higher loading doses and potentially higher maintenance dosing. This practice is driven by the desire to achieve greater levels of platelet inhibition and to overcome the specter of resistance. Recent data from the very large randomized controlled TRITON-TIMI 38 study demonstrated that prasugrel, a potent thienopyridine, reduced rates of ischemic events but resulted in a small increase in risk of major bleeding in patients with acute coronary syndromes and PCI compared with standard dose clopidogrel. In this issue of Circulation, Wiviott and colleagues compare inhibition of platelet aggregation with prasugrel to that of high dose clopidogrel in patients undergoing PCI in the PRINCIPLE-TIMI 44 study. At 2 important time points (6 hours after loading and 14 days into maintenance), the use of prasugrel was associated with a greater degree of inhibition of platelet aggregation than was clopidogrel, a finding that emerged very early and was seen at all time points. These data suggest that this agent can allow more potent platelet inhibition than even aggressive current strategies, and they provide an underlying mechanism for the clinical findings in the TRITON study. See p 2923.Visit http://circ.ahajournals.orgCardiology Patient PageNew Concepts of Cardiopulmonary Resuscitation for the Lay Public: Continuous-Chest-Compression CPR. See p e566.Images in Cardiovascular MedicineRight Atrial Mass in a Patient With T-Cell Chronic Lymphocytic Leukemia: An Unusual Mechanism of Thrombus Formation. See p e569. Download figureDownload PowerPointCorrespondence.See p e573. Previous Back to top Next FiguresReferencesRelatedDetails December 18, 2007Vol 116, Issue 25 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.107.187683 Originally publishedDecember 18, 2007 PDF download Advertisement