Advanced Cardiac Life Support Medications Research Articles

Spontaneous Coronary Artery Dissection Presenting as Electrical Storm: A Case Report.

Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction in patients of younger age without typical atherosclerotic risk factors and can present with ventricular arrhythmia such as ventricular tachycardia (VT) or ventricular fibrillation (VF). Electrical storm (ES) is defined as greater than or equal to 3 episodes of VT or VF occurring within 24 hours. A healthy 38-year-old-male developed chest pain while exercising at the gym and presented to the emergency department unresponsive in a ventricular arrhythmia defined as ES. The patient's cardiac arrest was initially refractory to standard defibrillation and Advanced Cardiac Life Support medications. He was ultimately diagnosed with SCAD of the left anterior descending artery, which was stented. The patient survived neurologically intact after a 13-day hospital stay. Spontaneous coronary artery dissection is a significant cause of acute coronary syndrome and occurs in healthier patients without cardiac risk factors. Electrical storm represents a unique manifestation of SCAD. Emergency physicians should maintain a heightened suspicion for SCAD for accurate diagnosis and treatment.

Successful Resuscitation from Refractory Ventricular Fibrillation by BLS Providers Employing Double Sequential External Defibrillation: A Case Report

Double sequential external defibrillation (DSED) is a novel treatment option for cardiac arrest patients in refractory ventricular fibrillation (VF). There is limited research, however, examining the efficacy of this treatment in clinical practice. Previous research is further confounded by the use of other treatments such as advanced cardiac life support medications. We present the case of the successful use of DSED for refractory out-of-hospital cardiac arrest without the use of advanced life support care.

When the Female Heart Stops: Sex and Gender Differences in Out-of-Hospital Cardiac Arrest Epidemiology and Resuscitation

Sex- and gender-based differences are emerging as clinically significant in the epidemiology and resuscitation of patients with out-of-hospital cardiac arrest (OHCA). Female patients tend to be older, experience arrest in private locations, and have fewer initial shockable rhythms (ventricular fibrillation/ventricular tachycardia). Despite standardized algorithms for the management of OHCA, women are less likely to receive evidence-based interventions, including advanced cardiac life support medications, percutaneous coronary intervention, and targeted temperature management. While some data suggest a protective mechanism of estrogen in the heart, brain, and kidney, its role is incompletely understood. Female patients experience higher mortality from OHCA, prompting the need for sex-specific research.

Abstract 321: Sodium Bicarbonate Use During In-hospital Pediatric Cardiopulmonary Resuscitation - A Report From the American Heart Association Get With The Guidelines-Resuscitation®

OBJECTIVES: The 2005 and 2010 Pediatric Advanced Life Support (PALS) Guidelines do not recommend using sodium bicarbonate (SB) during cardiopulmonary resuscitation (CPR) except for select resuscitation situations. We hypothesize that SB is used frequently during in-hospital pediatric CPR and its use is associated with worse survival to hospital discharge when given outside of these recommended resuscitation situations. PATIENTS AND METHODS: We analyzed data from 8602 consecutive pediatric CPR events (patients < 18 yrs) submitted to the American Heart Association Get With The Guidelines-Resuscitation from January 2000 through September 2010. The primary outcome was survival to hospital discharge. Secondary outcomes included event survival, 24 hr survival, and neurologic outcome. Multivariable logistic regression was performed to analyze the association between SB use and outcomes. RESULTS: SB was used in 3923 (46%) of 8602 events. The incidence of SB use between 2000-2005 vs. 2006-2010 was 54% vs. 41% (p <0.001; Fig. 1). After adjustment for confounding factors (e.g. event location, illness category, arrest rhythm, concurrent advanced cardiac life support medications, and duration of CPR > 15 mins), the use of SB during CPR was associated with decreased survival to discharge (OR: 0.62; 95% CI: 0.54, 0.71), but not unfavorable neurologic outcome (OR 0.73; 95% CI 0.50, 1.05). In the settings of metabolic/electrolyte abnormalities, toxicologic abnormalities/overdose /poisoning, and high potassium, SB use during CPR was not associated with worse survival to discharge (OR: 0.78; 95% CI: 0.56; 1.09) or unfavorable neurologic outcome (OR 1.05; 95% CI: 0.37, 2.97). After excluding patients in the settings of metabolic/electrolyte abnormalities, toxicologic abnormalities, and hyperkalemia, SB use during CPR (n = 5270) continued to be associated with worse survival to discharge (OR: 0.61; 95% CI: 0.53, 0.71) and unfavorable neurologic outcome (OR: 0.64; 95% CI: 0.43, 0.95). CONCLUSIONS: Sodium bicarbonate continues to be used frequently during in-hospital pediatric CPR, yet there is a significant trend towards less routine use over the last decade. Sodium bicarbonate use is associated with decreased survival to hospital discharge and unfavorable neurologic outcome when given outside PALS recommendations.

THE IMPACT OF A NEW CPR ASSIST DEVICE ON RATE OF RETURN OF SPONTANEOUS CIRCULATION IN OUT-OF-HOSPITAL CARDIAC ARREST

Objective. The San Francisco Fire Department deployed an automated, load-distributing-band chest compression device (AutoPulse, Revivant Corporation) to evaluate its function in a large urban emergency medical services (EMS) service. A retrospective chart review was undertaken to determine whether the AutoPulse had altered short-term patient outcome, specifically, return of spontaneous circulation (ROSC). Methods. AutoPulse cardiopulmonary resuscitation (A-CPR) was used by paramedic captains responding to adult cardiac arrests with an average ±SD response time of 15 ± 5 minutes. The primary endpoint was patient arrival to an emergency department with measurable spontaneous pulses. The manual CPR comparison group was case-matched for age, gender, initial presenting electrocardiogram rhythm, andthe number of doses of Advanced Cardiac Life Support medications as a proxy for treatment time. Matching was performed by an investigator blinded to outcome andtreatment group. Results. Sixty-nine AutoPulse uses were matched to 93 manual-CPR-only cases. A-CPR showed improvement in the primary outcome when compared with manual CPR with any presenting rhythm (A-CPR 39%, manual 29%, p = 0.003). When patients were classified by first presenting rhythm, shockable rhythms showed no difference in outcome (A-CPR 44%, manual 50%, p = 0.340). Outcome was improved with A-CPR in initial presenting asystole andapproached significance with pulseless electrical activity (PEA)(asystole: A-CPR 37%, manual 22%, p = 0.008; PEA: A-CPR 38%, manual 23%, p = 0.079). Conclusion. The AutoPulse may improve the overall likelihood of sustained ROSC andmay particularly benefit patients with nonshockable rhythms. A prospective randomized trial comparing the AutoPulse with manual CPR in the setting of out-of-hospital sudden cardiac arrest is under way.

Tenecteplase and Return of Spontaneous Circulation After Refractory Cardiopulmonary Arrest

Even with the benefit of cardiopulmonary resuscitation, the prognosis of cardiac arrest remains poor. Multiple case series describe survival with the use of thrombolytic therapy for refractory cardiac arrest. Presumably thrombolysis treats that subset of cardiac arrest cases resulting from fulminant pulmonary embolism, or perhaps massive myocardial infarctions. Published reports to date have dealt exclusively with streptokinase, urokinase, reteplase, or recombinant tissue plasminogen activator. The authors report the first case of return of spontaneous circulation with the administration of tenecteplase. Tenecteplase is a recently developed reengineered isomer of tissue plasminogen activator that possesses many properties of the ideal cardiac arrest thrombolytic agent. It is bolus dosed, stable at room temperature before reconstitution, and is compatible with most other advanced cardiac life support medications. Because of clinical equivalency and its logistical advantages, tenecteplase should be evaluated as an alternative to other thrombolytics in future trials involving cardiac arrest.

Inventory control for advanced cardiac life support medications

Inventory control for advanced cardiac life support medications

Inventory control for advanced cardiac life support medications

Inventory control for advanced cardiac life support medications

Emergency medical care for spectators attending national football league games

Objective. To analyze medical care facilities and resources available for spectators attending football games in the current National Football League (NFL) stadiums.Methods. A prospective, structured questionnaire regarding facilities, transportation, medications and equipment, personnel configuration, compensation, and communications was mailed to all 28 NFL organizations. Those failing to respond were interviewed by telephone using the identical questionnaire. Data were compiled using Lotus 1-2-3.Results. Data were collected from all 28 NFL organizations. Because two teams use the same stadium, results were calculated for 27 facilities (n = 27). The number of stadium first aid rooms ranges from 1 to 7, with an average of 2.4 ± 1.3 rooms per stadium (± 1 SD) and these vary in size from 120 to 2,000 square feet, with a mean of 434 ± 377 square feet. Each room is equipped with an average of 3.3 ± 2.9 stretchers (or tables), with telephones being present in 91% and sinks in 88% of all rooms. To provide contractual EMS coverage, stadiums use standard EMS system designs, including private (n = 19), fire department based (n = 7), municipal (city/county) (n = 5), volunteer (n = 4), and hospital (n = 3). Nine stadiums employ more than one type of provider. All stadiums have a minimum of one ambulance dedicated on-site for spectators, with a range of 1 to 7, and a mean of 2.9 ± 1.4. Golf carts are used for intrafacility patient transportation in 17 stadiums, with a range of 1 to 6, and a mean of 2.5 ± 1.3. Advanced Cardiac Life Support (ACLS) medications and equipment are present in all NFL stadiums and are provided by the private EMS company (n = 16), stadium (n = 10), fire EMS (n = 7), hospitals (n = 4), municipal EMS (n = 2), and the local NFL organization (n = 1). Several facilities have more than one provider of ACLS medications and equipment. The majority of stadiums dispense acetaminophen (n = 25) and aspirin (n = 24). Some dispense antacids (n = 7) and antihistamines (n = 6). The average stadium staffs 8 EMT-Bs, 7 EMT-Ps, 3 registered nurses, and 2 physicians. Nine stadiums pay a predesignated fee per game to an agency to provide emergency care to spectators. Medical personnel are compensated by an hourly rate (n = 15), a fixed rate per event (n = 9), overtime wages (n = 3), or volunteerism (n = 4). Four NFL organizations pay their medical personnel by more than one type of compensation. Courtesy seats are provided to physicians and nurses in 1 stadium and to just physicians in 8 stadiums, with a range of 2 to 6 and a mean of 3.3 ± 1.3. All stadiums use two-way radios for the communication and coordination of medical care in the stadium. Additionally, 20 use fixed telephones in the first aid rooms, 3 use cellular telephones, and 2 incorporate a pager system to dispatch personnel within the stadium.Conclusion. A wide variety of system designs, facilities, and personnel configurations are used to provide emergency medical care for spectators attending NFL games. This information may be useful for assisting those individuals responsible for organizing stadium medical coverage.

A Survey of Advanced Life Support Practices in the United States

AbstractStudy Objective:A national survey was conducted to determine the sponsorship of emergency medical services (EMS) projects, composition of EMS advanced life support (ALS) teams, types of medications and equipment carried, and procedures approved for use by EMS systems in the United States.Methods:A mail survey was sent to 211 training supervisors of EMS services across the United States in 1989. The survey requested demographic and service-related information, including types of EMS sponsorship, composition of ALS teams, medications and equipment carried, and procedures which personnel have been trained to use. Medications carried were correlated with advanced cardiac life support (ACLS), the American College of Emergency Physicians (ACEP) recommended drug lists, and with the sponsoring agency.Results:One-hundred seventy (70%) survey forms were returned. The major providers of ALS in the United States are fire departments (36%), followed by private providers (26%), hospitals (22%), and local governments (16%). The most common ALS team composition was two paramedics followed by one paramedic and one emergency medical technician (EMT). Most ALS services carry all of the recommended ACLS medications; a much smaller percentage carry all of the drugs recommended by ACEP. Fire department based ALS units carried the least number of medications; hospital-based ALS units carried the highest number of medications. Combined, over 80 different medications were carried by the services responding to the survey.Conclusion:The use of ACLS drugs and procedures are well-established nation-wide; less accepted are the medications recommended by ACEP. While over 80 different medications are carried by the EMS systems that responded to this survey, only a small fraction have been investigated in the prehospital setting.