Adult Advanced Life Support Research Articles

Conventional cardiopulmonary resuscitation-induced refractory cardiac arrest due to latent left ventricular outflow tract obstruction due to a sigmoid septum: a case report

BackgroundPatients with left ventricular outflow tract obstruction who do not exhibit a dynamic pressure gradient at rest, experience pressure gradient increases of ≥ 30 mmHg only during specific situations; this is called latent left ventricular outflow tract obstruction. It is provoked by increased cardiac contraction and preload and afterload depletion. There are a few reports of patients with it developing cardiac arrest. We present a case of latent left ventricular outflow tract obstruction in which the patient with a sigmoid septum experienced refractory pulseless electrical activity due to conventional advanced cardiac life support.Case presentationA 73-year-old Asian woman on escitalopram and lorazepam was transported to our hospital for chest and back pain with altered consciousness. On arrival, she was in shock and developed pulseless electrical activity. After initiation of conventional cardiopulmonary resuscitation according to adult advanced cardiovascular life support guidelines, she could not regain spontaneous circulation. She was ultimately resuscitated via venoarterial extracorporeal membrane oxygenation initiation. The only abnormal laboratory result at admission was anemia. Her hemodynamic status stabilized after red blood cell transfusion, and venoarterial extracorporeal membrane oxygenation was subsequently terminated. Transthoracic echocardiography showed a sigmoid septum; dobutamine-infused Doppler echocardiography revealed a significant outflow gradient, and continuous monitoring showed Brockenbrough–Braunwald sign, which confirmed a diagnosis of latent left ventricular outflow tract obstruction due to a sigmoid septum. As a result, carvedilol and verapamil were initiated. A follow-up dobutamine-infused Doppler echocardiography showed a reduction of outflow gradient, and she was discharged without any sequelae. Latent left ventricular outflow tract obstruction worsened due to increasing cardiac contraction and the depletion of preload and afterload. Depleted preload occurred due to dehydration and anemia, whereas depleted afterload occurred due to the prescribed drugs, which subsequently caused pulseless electrical activity. Moreover, β-stimulation from the adrenaline probably enhanced the hypercontractile state and caused refractory pulseless electrical activity in our case.ConclusionsPatients with latent left ventricular outflow tract obstruction can progress to cardiogenic shock and pulseless electrical activity due to increased cardiac contraction and depletion of preload and afterload. We should consider the patient’s underlying conditions that induced pulseless electrical activity.

Comparison of High and Low Fidelity Simulation on Adult Advanced Life Support Skill Attainment and Knowledge Improvement on FMUI Students

Teaching of adult advanced life support (ALS) using low fidelity simulation (LFS) and high fidelity simulation (HFS) gives different results, that can be caused by cultural background difference among students. This study aims to determine the comparison of HFS and LFS in ALS skill attainment and knowledge improvement on FMUI students. An experimental, randomized, single-blinded study with descriptive and analytic data presentation was conducted. Subjects were 39 FMUI students on the 3rd semester. All subjects had written pretest, lecture, and watched video demonstration. In training session, subjects were divided into two groups: LFS and HFS group. LFS group used ResusciAnne® and HFS group used SIMMAN3G®. There were written posttest and skill examination using SIMMAN3G®. Data collected were skill examination and written test scores. Statistical tests used were unpaired T test and Mann Whitney. The skill score in the LFS group was 47.8(39.1–56.5) and in the HFS group was 65.2(39.1–78.2), p = 0.02. The increase of knowledge score in LFS group was 42,75±13,90 (pretest knowledge score 35,25±9,93, posttest knowledge score 78,00±14,73) and HFS group 45.26±10.99 (pretest knowledge score 34.47±7.80, posttest knowledge score 79,74±10,20), p = 0.53. The use of HFS is better than LFS in attaining adult ALS skill on FMUI students and both methods provide equal result in knowledge improvement.

Major publications in the critical care pharmacotherapy literature in 2015.

Recently published practice guidelines and research reports on pharmacotherapy in critical care patient populations are summarized. The Critical Care Pharmacotherapy Literature Update (CCPLU) Group is composed of over 50 experienced critical care pharmacists who evaluate 31 peer-reviewed journals monthly to identify literature pertaining to pharmacotherapy in critical care populations. Articles are chosen for summarization in a monthly CCPLU Group publication on the basis of applicability and relevance to clinical practice and strength of study design. From January to December 2015, a total of 121 articles were summarized; of these, 3 articles presenting clinical practice guidelines and 12 articles presenting original research findings were objectively selected for inclusion in this review based on their potential to change or reinforce current evidence-based practice. The reviewed guidelines address the management of intracranial hemorrhage (ICH), adult advanced cardiac life support (ACLS) and post-cardiac arrest care, and the management of supraventricular tachycardia (SVT). The reviewed research reports address topics such as nutrition in critically ill adults, administration of β-lactams for severe sepsis, anticoagulant selection in the context of continuous renal replacement therapy, early goal-directed therapy in septic shock, magnesium use for neuroprotection in acute stroke, and progesterone use in patients with traumatic brain injury. Important recent additions to the critical care pharmacy literature include updated joint clinical practice guidelines on the management of spontaneous ICH, ACLS, and SVT.

Structuring feedback and debriefing to achieve mastery learning goals.

Mastery learning is a powerful educational strategy in which learners gain knowledge and skills that are rigorously measured against predetermined mastery standards with different learners needing variable time to reach uniform outcomes. Central to mastery learning are repetitive deliberate practice and robust feedback that promote performance improvement. Traditional health care simulation involves a simulation exercise followed by a facilitated postevent debriefing in which learners discuss what went well and what they should do differently next time, usually without additional opportunities to apply the specific new knowledge. Mastery learning approaches enable learners to "try again" until they master the skill in question. Despite the growing body of health care simulation literature documenting the efficacy of mastery learning models, to date insufficient details have been reported on how to design and implement the feedback and debriefing components of deliberate-practice-based educational interventions. Using simulation-based training for adult and pediatric advanced life support as case studies, this article focuses on how to prepare learners for feedback and debriefing by establishing a supportive yet challenging learning environment; how to implement educational interventions that maximize opportunities for deliberate practice with feedback and reflection during debriefing; describing the role of within-event debriefing or "microdebriefing" (i.e., during a pause in the simulation scenario or during ongoing case management without interruption), as a strategy to promote performance improvement; and highlighting directions for future research in feedback and debriefing for mastery learning.

European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support

Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK School of Clinical Sciences, University of Bristol, UK Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany Warwick Medical School, University of Warwick, Coventry, UK Heart of England NHS Foundation Trust, Birmingham, UK Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany SAMU de Paris, Department of Anaesthesiology and Intensive Care, Necker University Hospital, Paris, France Anaesthesia, Intensive Care and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and Helsinki University, elsinki, Finland Centre of Postgraduate Medical Research & Education, Bournemouth University, Bournemouth, UK Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway edical Cardiac Anaesthesia and Cardiac Intensive Care, NIHR Southampton Respiratory Biom outhampton, UK

European Resuscitation Council Guidelines for Resuscitation 2015: Section 11. The ethics of resuscitation and end-of-life decisions

1. Introduction. From ILCOR Policy Statements to ERC Model Guidelines. 2. Adult Basic Life Support. 2.1 Introduction. 2.2 The 1998 European Resuscitation Council Guidelines for Adult Basic Life Support. 2.2.1 ILCOR Advisory Statements. 2.2.2 Sequence of actions. 2.3 Course content. 2.4 Risk to the rescuer. 3. Adult Advanced Life Support. 3.1 The 1998 European Resuscitation Council Guidelines for Adult Advanced Life Support. 3.2 ERC AALS@ model course proposal. 3.3 PostResuscitation care. 4. Paediatric Life Support. 4.1 Introduction. 4.2 ILCOR Paediatric Working Group Advisory Statement. 4.3 The 1998 ERC Guidelines for Paediatric Life Support. Sequence of actions. 4.4 The 1998 ERC Guidelines for Paediatric Life Support. PLS training programme. 4.5 The 1998 ERC Guidelines for Resuscitation of babies at birth. 5. Automated External Defibrillation. 5.1 ILCOR Advisory statement on early defibrillation. 5.2 The 1998 ERC Guidelines for automated external defibrillation by EMS providers and first responsders. 5.3 Course content. 6. The 1998 ERC Guidelines For The Management of the Airway and Ventilation during Resuscitation. 7. Peri-arrest Arrhythmias: Management of Arrhythmias Associated with Cardiac Arrest. 8. The Prehospital Management of Acute Heart Attacks. 9. Ethics in Out-of-Hospital Cardiopulmonary Resuscitation. 9.1 Ethical principles in out-of-hospital cardiopulmonary resuscitation. 9.2 The ethics of resuscitation in clinical practice.

Availability and use of capnography for in-hospital cardiac arrests in the United Kingdom

BackgroundAirway complications occur more frequently outside the operating theatre and in emergency situations. Capnography remains the gold standard for confirming correct endotracheal tube placement, retaining high sensitivity and specificity in cardiac arrest. The 2010 European Resuscitation Council guidelines for adult advanced life support recommended waveform capnography in this setting. We investigated current UK practice relating to the availability and use of this technology during cardiac arrest. MethodsBetween June and November 2014, a study was conducted of all UK acute hospitals with both a level three adult intensive care unit (ICU) and an emergency department (ED). A telephone questionnaire was administered examining intubation practice and utilisation of capnography within the ED, ICU and general wards. ResultsTwo hundred and eleven hospitals met the inclusion criteria. The response rate was 100%. Arrests were mainly attended by anaesthesia (48%) and ICU physicians (38%) of registrar grade (56%). The ability to measure end tidal carbon dioxide (ETCO2) was available in all but 4 EDs; most used in waveform devices. Most ICUs were similar. However, in 67% of hospitals surveyed, it was not possible to measure ETCO2 in general wards. Where available, 87% used capnography to confirm ETT placement with less than 50% using ETCO2 to determine CPR effectiveness and 8% to prognosticate. ConclusionsWe believe this is the first study of its kind to fully investigate the availability and use of capnography during cardiac arrest throughout the hospital. Whilst equipment provision appears adequate in critical care areas, it is insufficient in general wards.

Family presence during resuscitation (FPDR): A survey of emergency personnel in Victoria, Australia.

Family presence during resuscitation (FPDR) has been endorsed internationally by resuscitation councils since the year 2000; however, the extent to which FPDR is practiced in emergency settings requires further investigation. Emergency personnel (n=347) from 18 participating emergency departments across the state of Victoria, Australia completed a 10-page questionnaire, which was designed to develop an understanding of the current practice and implementation of FPDR and to ascertain the differences in practice between adult and paediatric resuscitations. Emergency personnel update their adult and paediatric advanced life support qualifications annually with 87% of nurses and 65% of doctors completing adult life support and 72% of nurses and 49% of doctors completing paediatric advanced life support training. The majority of nursing staff reported support for FPDR (83%) with over 70% indicating that it is apart of their current practice. There was strong agreement from both nurses (79%) and doctors (77%) that the family have the right to be present. A family support person was deemed as essential by nurses (92%) and doctors (89%) when allowing family to be present. A factor analysis was conducted on participant statements, revealing four codes; impact on professional practice and performance, personnel beliefs about FPDR, professional satisfaction and the importance of a support person and saying goodbye. A family support person was highlighted as essential to the successful implementation of FPDR, together with the development of a comprehensive training the education program for emergency personnel. FPDR continues to be a significant issue and further investigation into FPDR practice and implementation in the ED is warranted.

Availability of appropriate airway monitoring at UK in-hospital cardiac arrest

Airway complications are more common outside the operating theatre and in emergency situations. Capnography remains the gold standard of confirming correct endotracheal tube (ETT) placement, retaining high sensitivity and specificity in cardiac arrest [1]. The 2010 European Resuscitation Council guidelines for adult advanced life support recommended waveform capnography in this setting [2]. Failure to use capnography was also identified as a major contributor to airway-related morbidity and mortality in a national UK audit [3]. We sought to investigate current practice relating to the availability and use of capnography equipment cardiac arrest within UK hospitals.

On the Need for Precise, Concise Communication during Resuscitation: A Proposed Solution

On the Need for Precise, Concise Communication during Resuscitation: A Proposed Solution

JRC蘇生ガイドライン2010 第2章 成人の二次救命処置（ALS） ［8］心拍再開後の集中治療および［9］予後判定

JRC蘇生ガイドライン2010は，2010年に公開されたCoSTR（International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations，心肺蘇生と緊急心血管治療の科学についての国際コンセンサスと治療推奨）を基準として，その後公表された文献および我が国の業績を追加し，日本蘇生協議会・日本救急医療財団のJRC（日本版）ガイドライン作成合同委員会にて2011年秋に作成，公表された。日本集中治療医学会は，“心肺蘇生ガイドライン”改定作業委員会を設け，第2章 成人の二次救命処置（ALS）の中の［8］心拍再開後の集中治療および［9］予後判定の部分を担当したので，ここに転載する。

Pharmacotherapy of Pediatric Advanced Life Support and Toxicological Emergencies

Guidelines for pediatric advanced life support have been available for nearly a quarter of a century. Recommendations for the pharmacological management of pediatric cardiac arrest have changed over these years. Several important differences have been observed between adult advanced cardiac life support and pediatric advanced life support that must be recognized when children require resuscitation, such as the cause of the arrest, age-specific monitoring parameters, weight-based medication dosing, and obstacles in obtaining venous access. To make matters more complicated, differences also exist across neonatal and pediatric age spectrums. In addition, some toxicological emergencies commonly occurring in children require pharmacological management with agents that have a unique mechanism of action for cardiac support.

Options for intravascular access during resuscitation of adults

For most emergency care teams, initial intravascular access is performed intravenously, despite the challenges posed by low cardiac output physiology. Intraosseous (IO) access has been included in recent Resuscitation Council UK (2010) adult advanced life support (ALS) guidelines for cases in which intravenous access is difficult or unavailable. This article discusses how the use of IO access devices can improve ALS therapy for patients who are in, or who are at risk of, cardiac arrest.

Clinical Experience Does Not Correlate with the Perceived Need for Cardiopulmonary Resuscitation Training

BackgroundThe efficiency of cardiopulmonary resuscitation (CPR) training is dependent upon different influencing factors, such as the presented concepts, the participants' willingness to learn, and the interval between training sessions. However, the optimal interval for refreshing CPR training is less clear. ObjectiveWe evaluated the perceived need of simulator-based CPR training for nurses and correlated it with their clinical experience. MethodsThe 60 invited nurses were trained in simulator-based CPR. Knowledge about adult advanced life support was evaluated using a questionnaire after training, and participants rated their desired individual frequency of simulator-based training as well as the value of the presented training using a six-point Likert scale. The same questions were asked again after 1 year. ResultsAll participants agreed about the usefulness of this type of simulator-based training. The average number of correct answers about typical facts in adult advanced life support showed an almost bell-shaped distribution, with the highest point at 6–15 years of clinical experience and the lowest points at≤5 and≥21 years. The desired training-frequency need was inversely correlated with clinical experience. ConclusionsThere is a high interest in CPR training among nursing staff. Self-assessment about the training-frequency need was inversely correlated with clinical experience. However, the average number of correct answers on resuscitation questions decreased with clinical experience. Therefore, the training effectiveness seems to be extremely dependent on clinical experience, and therefore, training experienced senior nurses might be more challenging than training novice nurses.

A systematic review of retention of adult advanced life support knowledge and skills in healthcare providers

ObjectiveAdvanced life support (ALS) guidelines are widely adopted for healthcare provider training with recommendations for retraining every two years or longer. This systematic review studies the retention of adult ALS knowledge and skills following completion of an ALS course in healthcare providers. MethodsWe retrieved original articles using Medline, CINAHL, Cochrane Library, and PubMed, and reviewed reference citations to identify additional studies. We extracted data from included articles using a structured approach and organized outcomes by evaluation method, and knowledge and skills retention. ResultsAmong 336 articles retrieved, 11 papers were included. Most studies used multiple-choice questionnaires to evaluate knowledge retention and cardiac arrest simulation or other skills tests to evaluate skills retention. All studies reported variable rates of knowledge or skills deterioration over time, from 6 weeks to 2 years after training. Two studies noted retention of knowledge at 18 months and up to 2 years, and one reported skills retention at 3 months. Clinical experience, either prior to or after the courses, has a positive impact on retention of knowledge and skills. ConclusionThere is a lack of large well-designed studies examining the retention of adult ALS knowledge and skills in healthcare providers. The available evidence suggests that ALS knowledge and skills decay by 6 months to 1 year after training and that skills decay faster than knowledge. Additional studies are needed to help provide evidence-based recommendations for assessment of current knowledge and skills and need for refresher training to maximize maintenance of ALS competency.

Major changes in the European resuscitation council guidelines for cardiopulmonary resuscitation 2010 in the field of adult basic and advanced life support

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Pharmacotherapy of Pediatric Advanced Life Support and Toxicological Emergencies

Guidelines for pediatric advanced life support have been available for nearly a quarter of a century. Recommendations for the pharmacological management of pediatric cardiac arrest have changed over these years. Several important differences have been observed between adult advanced cardiac life support and pediatric advanced life support that must be recognized when children require resuscitation, such as the cause of the arrest, age-specific monitoring parameters, weight-based medication dosing, and obstacles in obtaining venous access. To make matters more complicated, differences also exist across neonatal and pediatric age spectrums. In addition, some toxicological emergencies commonly occurring in children require pharmacological management with agents that have a unique mechanism of action for cardiac support.

Post‐resuscitation Therapy in Adult Advanced Life Support. ARC and NZRC Guideline 2010

Emergency Medicine AustralasiaVolume 23, Issue 3 p. 292-296 Post-resuscitation Therapy in Adult Advanced Life Support. ARC and NZRC Guideline 2010 Australian Resuscitation Council, New Zealand Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation CouncilSearch for more papers by this author Australian Resuscitation Council, New Zealand Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation CouncilSearch for more papers by this author First published: 14 June 2011 https://doi.org/10.1111/j.1742-6723.2011.01422_15.xCitations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume23, Issue3June 2011Pages 292-296 RelatedInformation

Equipment and Techniques in Adult Advanced Life Support. ARC and NZRC Guideline 2010

Equipment and Techniques in Adult Advanced Life Support. ARC and NZRC Guideline 2010

Protocols for Adult Advanced Life Support. ARC and NZRC Guideline 2010

Protocols for Adult Advanced Life Support. ARC and NZRC Guideline 2010