Optimal Fluoroscopic Angles for Percutaneous Coronary Intervention During Mechanical Cardiopulmonary Resuscitation in Cardiac Arrest Patients.

BackgroundThis study aims to construct a clinical prediction model and create a visual line chart depicting the risk of acute kidney injury (AKI) following resuscitation in cardiac arrest (CA) patients. Additionally, the study aims to validate the clinical predictive accuracy of the developed model.MethodsData were retrieved from the Dryad database, and publicly shared data were downloaded. This retrospective cohort study included 347 successfully resuscitated patients post-cardiac arrest from the Dryad database. Demographic and clinical data of patients in the database, along with their renal function during hospitalization, were included. Through data analysis, the study aimed to explore the relevant influencing factors of acute kidney injury (AKI) in patients after cardiopulmonary resuscitation. The study constructed a line chart prediction model using multivariate logistic regression analysis with post-resuscitation shock status (Post-resuscitation shock refers to the condition where, following successful cardiopulmonary resuscitation after cardiac arrest, some patients develop cardiogenic shock.), C reactive protein (CRP), Lactate dehydrogenase (LDH), and Alkaline phosphatase (ALP) identified as predictive factors. The predictive efficiency of the fitted model was evaluated by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve.ResultsMultivariate logistic regression analysis showed that post-resuscitation shock status, CRP, LDH, and PAL were the influencing factors of AKI after resuscitation in CA patients. The calibration curve test indicated that the prediction model was well-calibrated, and the results of the Decision Curve Analysis (DCA) demonstrated the clinical utility of the model constructed in this study.ConclusionPost-resuscitation shock status, CRP, LDH, and ALPare the influencing factors for AKI after resuscitation in CA patients. The clinical prediction model constructed based on the above indicators has good clinical discriminability and practicality.

Introduction: This study is conducted to determine the correlation between patient’s age and advanced response time with the outcome of Cardio Pulmonary Resuscitation in cardiac arrest patients. Methods: This was an analytic observational cross-sectional study, evaluating correlation between patient’s age and advanced response time with the outcome of Cardio Pulmonary Resuscitation in cardiac arrest patients. This study used the primary data from Cardio Pulmonary Resuscitation sheets from February to August 2018 at Dr. Soetomo General Hospital, Surabaya. The data were analysed with Chi Square and Contingency Coefficient using SPSS version 22.0. Results: The results showed that 84.6% cardiac arrest patients who experience ROSC are over 40 years old, and 92.3% cardiac arrest patients who experience ROSC have advanced response time ≤ 5 minutes. After being tested using Chi Square, patient’s age was not statistically influencing the outcome in cardiac arrest patients (p = 0.507), but advanced response time was statistically influencing the outcome in cardiac arrest patients (p = 0.001). Conclusion: There was no statistically influence of patient’s age towards the outcome in cardiac arrest patients, but there was a significant influence of advance response time towards the outcome in cardiac arrest patients.

The Comparison of Manual and Mechanical Chest Compression on Survival and Long-Term Neurological Outcome of Nontraumatic Out-of-Hospital Cardiac Arrest Patients.

Emergency Department Cardiopulmonary Bypass in the Treatment of Human Cardiac Arrest

Usefulness of admission matrix metalloproteinase 9 as a predictor of early mortality after cardiopulmonary resuscitation in cardiac arrest patients

Cardiac arrest can occur anywhere in the hospital area, whether it is in the emergency room, patients who are already in care, outpatients, the patient's family, visitors, or the community of the hospital at work. The literature of the review aims to determine the role of emergency nurses in the administration of pulmonary heart resuscitation in cardiac arrest patients. Literature review through several stages, namely making questions, identification, eligibility, selection of article inclusion, and screening. The Selection Process is listed in the framework of the review literature and obtained the results of article 8 articles. The data showed similar results related to the role of nurses in assisting cardiac arrest patients in hospitals. The results of the article in the review focused on the role of nurses in providing life support to patients with cardiac arrest, almost from all articles reviewed discussing the knowledge, experience, and skills of nurses in providing CPR. The role of nurses in the emergency room in providing life support to cardiac arrest patients is to improve the knowledge, experience, and skills in performing CPR. One way to improve the knowledge, experience, and skills of nurses in providing CPR to cardiac arrest patients is to participate in various training such as Basic Trauma Cardiac Life Support (BTCLS) or Advanced Cardiac Life Support (ATCLS).

BackgroundCardiopulmonary resuscitation is the most urgent and critical step in the rescue of patients with cardiac arrest. However, only about 10% of patients with out-of-hospital cardiac arrest survive to discharge. Surprisingly, there is growing evidence that open-chest cardiopulmonary resuscitation is superior to closed-chest cardiopulmonary resuscitation. Meanwhile, The Western Trauma Association and The European Resuscitation Council encouraged thoracotomy in certain circumstances for trauma patients. But whether open-chest cardiopulmonary resuscitation is superior to closed-chest cardiopulmonary resuscitation remains undetermined. Therefore, the aim of this study was to summarize current studies on open-chest cardiopulmonary resuscitation in a systematic review, comparing it to closed-chest cardiopulmonary resuscitation, in a meta-analysis.MethodsIn this systematic review and meta-analysis, we searched the PubMed, EmBase, Web of Science, and Cochrane Library databases from inception to May 2019 investigating the effect of open-chest cardiopulmonary resuscitation and closed-chest cardiopulmonary resuscitation in patients with cardiac arrest, without language restrictions. Statistical analysis was performed using Stata 12.0 software. The primary outcome was return of spontaneous circulation. The secondary outcome was survival to discharge.ResultsSeven observational studies were eligible for inclusion in this meta-analysis involving 8548 patients. No comparative randomized clinical trial was reported in the literature. There was no significant difference in return of spontaneous circulation and survival to discharge between open-chest cardiopulmonary resuscitation and closed-chest cardiopulmonary resuscitation in cardiac arrest patients. The odds ratio (OR) were 0.92 (95%CI 0.36–2.31, P > 0.05) and 0.54 (95%CI 0.17–1.78, P > 0.05) for return of spontaneous circulation and survival to discharge, respectively. Subgroup analysis of cardiac arrest patients with trauma showed that closed-chest cardiopulmonary resuscitation was associated with higher return of spontaneous circulation compared with open-chest cardiopulmonary resuscitation (OR = 0.59 95%CI 0.37–0.94, P < 0.05). And subgroup analysis of cardiac arrest patients with non-trauma showed that open-chest cardiopulmonary resuscitation was associated with higher ROSC compared with closed-chest cardiopulmonary resuscitation (OR = 3.12 95%CI 1.23–7.91, P < 0.05).ConclusionsIn conclusion, for patients with cardiac arrest, we should implement closed-chest cardiopulmonary resuscitation as soon as possible. However, for cardiac arrest patients with chest trauma who cannot perform closed-chest cardiopulmonary resuscitation, open-chest cardiopulmonary resuscitation should be implemented as soon as possible.

Cardiac Arrest 2012

BackgroundPrehospital Traumatic cardiac arrest has a high fatality rate despite advances in trauma systems and resuscitation strategies. Mechanical chest compression devices have been increasingly adopted to optimize cardiopulmonary resuscitation (CPR) during Emergency Medical Services (EMS) transportation. We aimed to evaluate the impact of CPR (mechanical during transportation versus manual CPR only at the scene) on survival among trauma patients.MethodsA retrospective analysis was conducted for patients who received CPR at the scene and during transportation to the hospital between 2016 and 2024.ResultsA total of 610 patients sustaining blunt traumatic cardiac arrest were included. The mean age was 34 ± 12.6 years; 94.6% were male, and 5.4% were female patients. Two hundred twenty (36.1%) received mechanical CPR during transportation to the hospital, and 390 (63.9%) received manual CPR only at the scene. Compared with the manual CPR group, the mechanical CPR group had higher rates of primary chest injury (30.5% vs. 20.5%; p = 0.006), bystander CPR (15.9% vs. 6.7%; p = 0.001), adrenaline administrations (95% vs. 26.4%; p = 0.001), and initial non-shockable rhythm (80% vs. 27.2%; p = 0.001). The two groups were comparable in median Injury Severity Score (ISS), head Abbreviated Injury Score (AIS), and total transport time. Mechanical CPR was associated with a markedly higher survival to hospital arrival (98.6% vs. 38.5%, p = 0.001), however, the rate of return of spontaneous circulation (ROSC) on arrival to the hospital remained low in both groups (10.5% with mechanical CPR vs. 5.9% with manual CPR, p = 0.041), and the overall 30-day survival rate for the entire cohort was just 0.7% (n = 4/610). The first 24-hour in-hospital survival rate was significantly higher in the mechanical CPR group than in the manual CPR group (93.1% vs. 89.3%). Among survivors to hospital arrival, the 30-day survival rate was 1.1% (n = 4/367) overall, 2.7% (n = 4/150), in the manual CPR group, and 0% (n = 0/217) in the mechanical CPR group. Age-gender-adjusted predictors for ROSC at handover were ISS (aOR 0.97; 95% confidence interval (CI) 0.95–0.99, p = 0.03) and thoracentesis (aOR 3.9; 95% CI 1.50–9.98, p = 0.005).ConclusionsMechanical CPR in prehospital blunt traumatic cardiac arrest was associated with improved survival to hospital arrival compared with manual CPR; however, in-hospital mortality remained extremely high. These findings suggest that mechanical CPR may facilitate transport of patients in traumatic cardiac arrest without substantially improving overall outcomes. While mechanical devices can provide continuous chest compressions during transport, their impact on meaningful survival in the trauma setting appears limited. The effect of potential iatrogenic injuries associated with the CPR process itself was lacking in this study. Further studies are needed to clarify the role and indication of prehospital mechanical CPR in traumatic cardiac arrest.Clinical trial numberNot applicable for this retrospective study.

An update on the mechanical versus manual cardiopulmonary resuscitation in cardiac arrest patients

326 Chest Compression Fraction and Ventilation Rate Among Patients With Cardiopulmonary Arrest in an Urban, Academic Emergency Department

ObjectiveThe purpose of this study was to assess whether a photoplethysmography (PPG) sensor in a smart watch can accurately recognise the return of spontaneous circulation (ROSC) in cardiac arrest patients...

The goal of this study was to investigate the association between total epinephrine dosage during resuscitation and acute kidney injury after return of spontaneous circulation in patients with cardiac arrest. We performed a secondary analysis of previously published data on the resuscitation of cardiac arrest patients. Bivariate, multivariate logistic regression, and subgroup analyses were conducted to investigate the association between total epinephrine dosage during resuscitation and acute kidney injury after return of spontaneous circulation. A total of 312 eligible patients were included. The mean age of the patients was 60.8 ± 15.2 years. More than half of the patients were male (73.4%) and had an out-of-hospital cardiac arrest (61.9%). During resuscitation, 125, 81, and 106 patients received ≤2, 3 - 4, and ≥5 mg epinephrine, respectively. After return of spontaneous circulation, there were 165 patients (52.9%) and 147 patients (47.1%) with and without acute kidney injury, respectively. Both bivariate and multivariate analysis showed a statistically significant association between total epinephrine dosage and acute kidney injury. The subgroup analysis showed that the strength of the association between epinephrine dosage and acute kidney injury varied by location of cardiac arrest. Further multivariate regression analysis found that the association between epinephrine dosage and acute kidney injury was only observed in patients with in-hospital cardiac arrest after adjusting for multiple confounding factors. Compared with in-hospital cardiac arrest patients who received ≤2 mg of epinephrine, patients with 3–4 mg of epinephrine or ≥5 mg of epinephrine had adjusted odds ratios of 4.2 (95% confidence interval 1.0–18.4) and 11.3 (95% confidence interval 2.0–63.0), respectively, to develop acute kidney injury. Therefore, we concluded that a higher epinephrine dosage during resuscitation was associated with an increased incidence of acute kidney injury after return of spontaneous circulation in adult patients with in-hospital cardiac arrest.

Background Cardiac arrest (CA) is high‐risk for death and hard to rescue. There are two methods of chest compression: mechanical and manual. However, it remains unclear which provides better outcomes for patients. Therefore, we perform a systematic review and meta‐analysis for the efficacy of the two methods for CA patients. Method Randomized controlled trials (RCTs) and nonrandomized controlled trials (non‐RCTs) were searched from the Cochrane Library, PubMed, EMBASE, and Web of Science from the date of their establishment to 2 March 2024. RCTs were evaluated using Cochrane randomized trial bias risk tool and the Newcastle–Ottawa Scale for non‐RCTs. All statistical analyses were performed using Stata v18.0 and Review Manager v5.4. Results Twenty‐four studies included 10 RCTs and 14 non‐RCTs, and 224,245 CA patients. Manual extracorporeal cardiopulmonary resuscitation (CPR) may benefit CA patients in achieving return of spontaneous circulation (ROSC) (odds ratio [OR] = 0.90; 95% CI: 0.813–0.996; Z = −2.04; p = 0.04), admission survival rate (OR = 0.87; 95% CI: 0.80–0.94; Z = −3.64; p &lt; 0.05), and discharge survival rate (OR = 0.80; 95% CI: 0.66–0.98; Z = −2.21; p = 0.03). However, there was no significant difference in 30‐day survival rate (OR = 0.80; 95% CI: 0.43–1.48; Z = −0.72; p = 0.47), good restoration of neurologic functions (OR = 0.79; 95% CI: 0.60–1.05; Z = −1.46; p = 0.15), and complication rate (OR = 0.91; 95% CI: 0.47–1.75; Z = −0.29; p = 0.78). Conclusion Manual CPR showed advantages in ROSC, admission survival rate, and discharge survival rate, whereas there was no significant difference in 30‐day survival rate, good recovery of neurological function, and complication compared with mechanical chest compression. Compared with previous systematic reviews and meta‐analyses, this study is the first to report the advantages of manual CPR in ROSC. Large sample size and high‐quality RCTs are needed, as the existing evidence primarily comes from non‐RCTs.

Introduction: When the heart stops beating, blood flow throughout the body stops, which is known as cardiac arrest. Cardiopulmonary resuscitation (CPR) is necessary as quickly as feasible in cardiac arrest. When meeting cardiac arrest patients, nurses typically feel uneasy and anxious because they feel unqualified and untrained to do cardiopulmonary resuscitation.The purpose of this study is to thoroughly examine nurses' experiences with cardiopulmonary resuscitation in cardiac arrest patients in the ER Dharma Yadnya Hospital. Methods: a single case study qualitative research design utilizing thematic analysis methods. Snowball sampling is the sample method, and there are 6 participants. In-depth interviews were used to acquire the data. Results: (1) Cardiopulmonary resuscitation management, (2) Nurse's emotional description when performing CPR, (3) Supporting factors for the success of CPR, (4) Unstable family emotions, patient's physical condition and poor coordination of the medical team, (5) Nurses' calmness as seen from professionalism, (6) Practice taking action in panic situations and (7) psychological readiness prior to performing CPR. Conclusion: Despite having the skills to do CPR, ED nurses were anxious about performing it. They later experienced psychological harm as well. Education that encourages CPR skills and support networks to lessen psychological discomfort for ED nurses could be beneficial.