Advanced Cardiac Life Support Research Articles

PHYSICIANS' COMPETENCE IN TERMINATING CPR IN CARDIAC ARREST CASES AND FACTORS INFLUENCING THIS TERMINATION

The study aimed to evaluate the competence and knowledge of the cardiac arrest team regarding CPR termination and the factors that influence this termination. A cross-sectional study was conducted in the Department of Cardiology, Shifa International Hospital April 2022-April 2023). A total of 300 cardiac arrest team members (physicians and nurses) designated to perform advanced cardiac life support were included in the study. Questionnaires were distributed among the participants inquiring about their competence and knowledge about terminating CPR. Of 100 physicians, 40 (40%) were not competent enough to decide on CPR termination. 10% of physicians and 5% of nurses agreed to be aware of the ERC termination guidelines, and only one physician and one nurse could state the contents. The majority of the participants reported terminating resuscitation if the patient was older than 90 years, absent direct pupillary reflex, true asystole, and witnessed cardiac arrest without bystander resuscitation in 10 minutes. Based on the results, the physicians and nurses in Pakistan are not competent in decision-making regarding CPR termination in cardiac arrest patients and are unaware of the factors and guidelines while making such decisions.

A Study of Near-Death Experience in Patients With Chronic Kidney Disease.

The near-death experiences (NDE) in dialysis patients of our country have not been previously studied. The objective of this study is to investigate the characteristics of NDEs in patients on dialysis. We performed a cross sectional study of the adult patients of chronic kidney disease stage 5 without dialysis and on dialysis who survived cardiac arrest by cardiopulmonary resuscitation (CPR) as per ACLS (Advanced Cardiac Life Support) guidelines and who sustained pulseless ventricular tachycardia/ventricular fibrillation and received CPR and/or direct cardioversion. We used two scales, Greyson's NDE scale and Ring's Weighted Core Experience Index (WCEI). We performed the study between 2016 and 2018. A total of 29 patients were included. The data based on Greyson's NDE scale and Ring's Weighted Core Experience Index (WCEI)were collected. Our study brings a perspective of NDE in CKD and dialysis patients. A similar study of NDE in dialysis patients should be considered by other nephrologists.

Reevaluating the Latency Period Between CPR Recertifications Among Non–Allied Healthcare Providers

Cardiopulmonary Resuscitation, or CPR, is defined by the Mayo Clinic as a lifesaving technique that is useful in many emergencies such as a heart attack, stroke, choking or drowning, in which someone’s breathing and heartbeat has stopped. Under the guidelines put forth by the International Liaison Committee on Resuscitation (ILCOR) and the Emergency Cardiovascular Care organization (ECC), the American Red Cross and American Heart Association, the two largest CPR certification organizations in the US, currently require that an individual’s CPR certification be renewed every two-years. However, an increasing amount of data has suggested that non-allied healthcare providers, such as school-based personnel, may require more regular training and certification to maintain CPR proficiency levels.

Impact of COVID-19-adapted guidelines using different airway management strategies on resuscitation quality in out-of-hospital-cardiac-arrest – a randomised manikin study

BackgroundAlthough airway management for paramedics has moved away from endotracheal intubation towards extraglottic airway devices in recent years, in the context of COVID-19, endotracheal intubation has seen a revival. Endotracheal intubation has been recommended again under the assumption that it provides better protection against aerosol liberation and infection risk for care providers than extraglottic airway devices accepting an increase in no-flow time and possibly worsen patient outcomes.MethodsIn this manikin study paramedics performed advanced cardiac life support with non-shockable (Non-VF) and shockable rhythms (VF) in four settings: ERC guidelines 2021 (control), COVID-19-guidelines using videolaryngoscopic intubation (COVID-19-intubation), laryngeal mask (COVID-19-Laryngeal-Mask) or a modified laryngeal mask modified with a shower cap (COVID-19-showercap) to reduce aerosol liberation simulated by a fog machine. Primary endpoint was no-flow-time, secondary endpoints included data on airway management as well as the participants‘ subjective assessment of aerosol release using a Likert-scale (0 = no release–10 = maximum release) were collected and statistically compared. Continuous Data was presented as mean ± standard deviation. Interval-scaled Data were presented as median and Q1 and Q3.ResultsA total of 120 resuscitation scenarios were completed. Compared to control (Non-VF:11 ± 3 s, VF:12 ± 3 s) application of COVID-19-adapted guidelines lead to prolonged no-flow times in all groups (COVID-19-Intubation: Non-VF:17 ± 11 s, VF:19 ± 5 s;p ≤ 0.001; COVID-19-laryngeal-mask: VF:15 ± 5 s,p ≤ 0.01; COVID-19-showercap: VF:15 ± 3 s,p ≤ 0.01). Compared to COVID-19-Intubation, the use of the laryngeal mask and its modification with a showercap both led to a reduction of no-flow-time(COVID-19-laryngeal-mask: Non-VF:p = 0.002;VF:p ≤ 0.001; COVID-19-Showercap: Non-VF:p ≤ 0.001;VF:p = 0.002) due to a reduced duration of intubation (COVID-19-Intubation: Non-VF:40 ± 19 s;VF:33 ± 17 s; both p ≤ 0.01 vs. control, COVID-19-Laryngeal-Mask (Non-VF:15 ± 7 s;VF:13 ± 5 s;p > 0.05) and COVID-19-Shower-cap (Non-VF:15 ± 5 s;VF:17 ± 5 s;p > 0.05). The participants rated aerosol liberation lowest in COVID-19-intubation (median:0;Q1:0,Q3:2;p < 0.001vs.COVID-19-laryngeal-mask and COVID-19-showercap) compared to COVID-19-shower-cap (median:3;Q1:1,Q3:3 p < 0.001vs.COVID-19-laryngeal-mask) or COVID-19-laryngeal-mask (median:9;Q1:6,Q3:8).ConclusionsCOVID-19-adapted guidelines using videolaryngoscopic intubation lead to a prolongation of no-flow time. The use of a modified laryngeal mask with a shower cap seems to be a suitable compromise combining minimal impact on no-flowtime and reduced aerosol exposure for the involved providers.

Impact of pre-existing history of heart failure on patient profile, therapeutic management and prognosis in cardiogenic shock: Insights from the FRENSHOCK registry

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Emergency and Acute Cardiovascular Care Working Group from the French Society of Cardiology Aims There is a large heterogeneity in patients presenting with cardiogenic shock (CS). To better apprehend this heterogeneity is crucial to adapt treatment and improve prognosis in these severe patients. Of note the presence (or absence) of a pre-existing history of chronic heart failure (CHF) at time of CS onset may be entire part of this heterogeneity and data focusing on this aspect are lacking. Methods We aimed to compare CS patients with new-onset HF to those with worsening CHF in the multicenter FRENSHOCK registry. Altogether, 772 CS patients were prospectively included: 433 with a previous history of CHF and 339 without. Worsening CHF patients were older (68 +/- 13.4 vs. 62.7 +/- 16.2, p&amp;lt;0.001) and had a greater burden of extra-cardiac co-morbidities. At admission, acute myocardial infarction was predominantly observed in the new-onset HF group (49.9% vs. 25.6%, p&amp;lt;0.001). When focusing on hemodynamic parameters, worsening CHF patients showed more congestion and higher ventricular filling pressures. Worsening CHF patients experienced higher in-hospital all-cause mortality (31.3% vs. 24.2%, p=0.029). Conclusions Our results emphasize the great heterogeneity of the patients presenting with CS. Worsening CHF patients had higher risk profile and this translated in a 30% increase in in-hospital all-cause mortality. The heterogeneity of this population prompts us to better determine the phenotype of CS patients to adapt their management.

Long-term survival and return to work after refractory out-of-hospital cardiac arrest managed with extracorporeal cardiopul-monary resuscitation; a nationwide follow-up study

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Rigshospitalets and Odense Universitetshospitals common foundation Background Survival after refractory out-of-hospital cardiac arrest (OHCA) is low. Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used for selected patients aiming to increase survival after refractory OHCA. However, ECPR is resource heavy and carries risk of poor functional status. Previous studies have shown favorable neurological outcome in the majority of survivors of OHCA managed with ECPR; yet the share of patients able to return to work has not previously been explored. Purpose The purpose of this study is to investigate the fraction of patients returning to work after OHCA managed with ECPR in a national cohort of refractory OHCA-patients. Methods Of about 44,000 OHCAs during the period of 2011-2020, this nationwide registry-based study included 812 refractory OHCA-patients in the working age between 18 years and 65 years (as 65 was the current age of retirement) who were in employment prior to the event. We excluded 113 ECPR-patients and 3,536 refractory OHCA-patients managed with standard advanced cardiac life support (sACLS) due to age or unemployment. We defined refractory OHCA as patients with OHCA brought to hospital with on-going CPR. Information on demographics, OHCA circumstances, status at hospital arrival, and survival were retrieved through the Danish Cardiac Arrest Register. Employment status were retrieved through the Danish Research Institute for Economic Analysis and Modelling database. Maintenance of work was defined as return to work without any sick leave relapse (&amp;gt;4 weeks) during six months of employment. Results Of 812 included refractory OHCA-patients, 137 patients received ECPR while 675 were managed with sACLS. ECPR-patients were slightly younger than sACLS-patients (median 51 vs. 53 years), a higher percentage male sex (84% vs. 79%), and more had favorable OHCA circumstances (witnessed arrest [80% vs. 64%], bystander CPR [75% vs. 67%], and shockable presenting rhythm [59% vs. 37%]). One-year survival was higher for ECPR-patients compared with sACLS-patients (24% vs. 7%, p&amp;lt;0.001). Of one-year survivors, less ECPR-patients were in employment one year after OHCA compared with sACLS-patients (48% vs. 77%, p=0.01). No difference in maintenance of work were found between ECPR- and sACLS-patients after OHCA (88% vs. 79%, p=0.7). Conclusion Survival was higher for refractory OHCA-patients receiving ECPR- compared to sACLS-therapy, which may reflect selection bias. One out of two ECPR patients returned to work and the majority maintained employment for at least six months. More sACLS-survivors returned to work compared with ECPR-survivors likely reflecting survival bias.

PO-02-227 ADVERSE EVENTS ASSOCIATED WITH AUTOMATIC EXTERNAL DEFIBRILLATOR - LIFEPAK: A STUDY FROM FOOD AND DRUG ADMINISTRATION MAUDE DATABASE

Automatic External defibrillator (AED) can analyze heart rhythms and allows operators to deliver treatment in patients with tachyarrhythmias or cardiac arrest with a shockable rhythm. The incidence of adverse events (AE) between different ED models is not well known. We sought to assess the type of AE associated with the AED – Lifepak series (Stryker, Kalamazoo, MI) using the FDA Manufacturer and User Facility Device Experience (MAUDE) database. The MAUDE database is a repository of industry and patient/physician-reported medical device adverse events. A MAUDE database search was conducted on November 10, 2022, for reports received between January 1992 to October 2022 to capture all AE. A total of 32,557 AE were reported from 1992 to 2022. An increase in trends of AE was observed from 1992 to 2022 (0.1% to 7.3%), respectively. Among the 7 Lifepak models, Lifepak CR Plus (5.5%, 1177 events), Lifepak CR2 (5.7%, 1230 events), and Lifepak 20e (5.85%, 1260 events) had the three lowest reported AE while the Lifepak 15 (28.2%, 6073 events), Lifepak 20 (21.2%, 4561 events) and Lifepak 12 (23.6%, 5085 events) had the three highest reported AE (21,503 events). The most commonly reported AE was product malfunction (95.9%, 31,209 events) resulting in patient injury (0.9%, 289 events) and patient death (2.9%, 950 events). Correct utilization of AED is crucial during advanced cardiac life support. Appropriate selection of AED models with clinical situations and operators’ experience is essential.

The Effect of Simulation on Newly Licensed Nurses' Confidence in Initiating Cardiopulmonary Resuscitation: A Narrative Review.

Hospitalized patients experiencing cardiac arrest are more likely to receive resuscitative interventions such as cardiopulmonary resuscitation (CPR), advanced cardiac life support, and defibrillation, than patients who experience a cardiac arrest outside the hospital setting. Annually, there are nearly 290,000 inpatient cardiac arrests each year in the United States. These cardiac arrests are associated with a mean survival rate of only 25%. Increasing nurses' feelings of confidence in initiating CPR may lead to faster reaction times, shorter hospital stays, and improved patient outcomes. A narrative review of literature about the effectiveness of simulations on newly licensed nurses' perceived confidence in initiating CPR confidence levels yielded 16 articles.

Intraarrest transport, extracorporeal cardiopulmonary resuscitation, and early invasive management in refractory out-of-hospital cardiac arrest: an individual patient data pooled analysis of two randomised trials.

Refractory out-of-hospital cardiac arrest (OHCA) treated with standard advanced cardiac life support (ACLS) has poor outcomes. Transport to hospital followed by in-hospital extracorporeal cardiopulmonary resuscitation (ECPR) initiation may improve outcomes. We performed a pooled individual patient data analysis of two randomised controlled trials evaluating ECPR based approach in OHCA. The individual patient data from two published randomised controlled trials (RCTs) were pooled: ARREST (enrolled Aug 2019-June 2020; NCT03880565) and PRAGUE-OHCA (enrolled March 1, 2013-Oct 25, 2020; NCT01511666). Both trials enrolled patients with refractory OHCA and compared: intra-arrest transport with in-hospital ECPR initiation (invasive approach) versus continued standard ACLS. The primary outcome was 180-day survival with favourable neurological outcome (defined as Cerebral Performance Category 1-2). Secondary outcomes included: cumulative survival at 180 days, 30-day favourable neurological survival, and 30-day cardiac recovery. Risk of bias in each trial was assessed by two independent reviewers using the Cochrane risk-of-bias tool. Heterogeneity was assessed via Forest plots. The two RCTs included 286 patients. Of those randomised to the invasive (n=147) and standard (n=139) groups, respectively: the median age was 57 (IQR 47-65) and 58 years (IQR 48-66), and the median duration of resuscitation was 58 (IQR 43-69) and 49 (IQR 33-71) minutes (p=0.17). In a modified intention to treat analysis, 45 (32.4%) in the invasive and 29 (19.7%) patients in the standard arm survived to 180 days with a favourable neurological outcome [absolute difference (AD), 95% CI: 12.7%, 2.6-22.7%, p=0.015]. Forty-seven (33.8%) and 33 (22.4%) patients survived to 180 days [HR 0.59 (0.43-0.81); log rank test p=0.0009]. At 30 days, 44 (31.7%) and 24 (16.3%) patients had favourable neurological outcome (AD 15.4%, 5.6-25.1%, p=0.003), 60 (43.2%), and 46 (31.3%) patients had cardiac recovery (AD: 11.9%, 0.7-23%, p=0.05), in the invasive and standard arms, respectively. The effect was larger in patients presenting with shockable rhythms (AD 18.8%, 7.6-29.4; p=0.01; HR 2.26 [1.23-4.15]; p=0.009) and prolonged CPR (>45min; HR 3.99 (1.54-10.35); p=0.005). In patients with refractory OHCA, the invasive approach significantly improved 30- and 180-day neurologically favourable survival. None.

The effect of interprofessional simulations on pharmacy and physician assistant students' learning of advanced cardiac life support concepts

BackgroundThe Interprofessional Education Collaborative (IPEC) defined core competencies for IPE in 2011, and use of simulation in interprofessional education (IPE) continues to be developed in prelicensure health education programs. Interprofessional education activityIn this prospective, observational study, interprofessional student teams addressed reversible causes of cardiac arrest in weekly simulations during an Emergency Medicine course. Each simulation was followed by sequential team debriefs, first regarding the IPEC core competencies of interprofessional communication, teamwork, and roles and responsibilities, and second regarding the patient-related content of the case. DiscussionTwenty-eight pharmacy students and 60 physician assistant students completed the course. A didactic knowledge exam was administered before, immediately after, and 150 days after the course. Both disciplines' exam scores significantly increased from baseline to the end of the course and from baseline to the 150-day follow-up. Students also completed the validated Interprofessional Perceptions Survey before and after the course. Both disciplines demonstrated significant increases in Team Value, Efficiency and Interprofessional Accommodation components. ImplicationsParticipation in this simulation-based course resulted in 150-day retention of advanced cardiovascular life support knowledge and improved interprofessional perceptions in both pharmacy and physician assistant students.

Sudden Cardiac Death: An Update on Commotio Cordis.

Sudden cardiac death (SCD) is one of the leading causes of cardiovascular mortality, and it is caused by a diverse array of conditions. Among these is commotio cordis, a relatively infrequent but still significant cause, often seen in young athletes involved in competitive or recreational sports. It is known to be caused by blunt trauma to the chest wall resulting in life-threatening arrhythmia (typically ventricular fibrillation). The current understanding pertains to blunt trauma to the precordium, with an outcome depending on factors such as the type of stimulus, the force of impact, the qualities of the projectile (shape, size, and density), the site of impact, and the timing of impact in relation to the cardiac cycle. In the management of commotio cordis,a history of preceding blunt chest trauma is usually encountered. Imaging is mostly unremarkable except for ECG, which may show malignant ventricular arrhythmias. Treatment is focused on emergent resuscitation with the advanced cardiac life support protocol algorithm, with extensive workup following the return of spontaneous circulation. In the absence of underlying cardiovascular pathologies, implantable cardiac defibrillator insertion is not beneficial, and patients can even resume physical activity if the workup is unremarkable. Proper follow-up is also key in the management and monitoring of re-entrant ventricular arrhythmias, which are amenable to ablative therapy. Prevention of this condition involves protecting the chest wall against blunt trauma, especially with the use of safety balls and chest protectors in certain high-risk sporting activities. This study aims to elucidate the current epidemiology and clinical management of SCD with a particular focus on a rarely explored etiology, commotio cordis.

Diagnostic Value of Serum Lactate Dehydrogenase Level Measured in the Emergency Department in Predicting Clinical Outcome in Out-of-Hospital Cardiac Arrest: A Multicenter, Observational Study.

Out-of-hospital cardiac arrest (OHCA) is complex, and risk stratification tools have the potential to include components other than clinical risk indicators, thus requiring extensive studies. Simple and accurate biomarkers for OHCA patients with poor prognoses are still needed. Serum lactate dehydrogenase (LDH) has been identified as a risk factor in patients with various diseases, such as cancer, liver disease, severe infections, and sepsis. The primary aim of this study was to assess the accuracy of LDH values at initial presentation in the emergency department (ED) in predicting the clinical outcome in OHCA. This retrospective multicenter observational study was performed in the ED of two tertiary university hospitals and one general hospital between January 2015 and December 2021. All patients with OHCA who visited the ED were included. The primary outcome was the sustained return of spontaneous circulation (ROSC; >20 min) after advanced cardiac life support (ACLS). The secondary outcome was survival to discharge (including home care and nursing care discharge) among patients with ROSC. The neurological prognosis was considered a tertiary outcome in patients who survived to discharge. In total, 759 patients were enrolled in the final analysis. The median LDH level in the ROSC group was 448 U/L (range: 112-4500), which was significantly lower than that in the no-ROSC group (p < 0.001). The median LDH level in the survival-to-discharge group was 376 U/L (range: 171-1620), which was significantly lower than that in the death group (p < 0.001). Using the adjusted model, the odds ratio of the LDH value (≤634 U/L) for primary outcomes was 2.418 (1.665-3.513) and the odds ratio of LDH value (≤553 U/L) for secondary outcomes was 4.961 (2.184-11.269). In conclusion, the serum LDH levels of patients with OHCA measured in the ED can potentially serve as a predictive marker for clinical outcomes such as ROSC and survival to discharge, although it may be difficult to predict neurological outcomes.

Extracorporeal cardiopulmonary resuscitation: A primer for pharmacists.

To describe the use of mechanical circulatory support in the setting of cardiac arrest and summarize pharmacists' role in extracorporeal cardiopulmonary resuscitation (ECPR). ECPR is increasingly used to reduce morbidity and improve mortality after cardiac arrest. ECPR employs venoarterial ECMO, which provides full circulatory perfusion and gas exchange in both adult and pediatric patients in cardiac arrest. After the emergency medicine team identifies potential candidates for ECPR, the ECMO team is consulted. If deemed a candidate for ECPR by the ECMO team, the patient is cannulated during ongoing standard cardiopulmonary resuscitation. A multidisciplinary team of physicians, nurses, perfusionists, pharmacists, and support staff is needed for successful ECPR. Pharmacists play a vital role in advanced cardiac life support (ACLS) prior to cannulation. Pharmacists intervene to make pharmacotherapy recommendations during ACLS, prepare medications, and administer medications as allowed by institutional and state regulations. Pharmacists also provide pharmacotherapy support in the selection of anticoagulation agents, ongoing vasopressor administration during ECMO cannulation, and the optimization of medication selection in the peri-ECPR period. With the growing use of ECPR, pharmacists should be aware of their role in medication optimization during ECPR.

Electrocardiogram Interpretation Competency of Medical Interns in Saudi Arabia: A Cross-Sectional Study.

Objective To determine the competence of medical interns in Saudi Arabia in interpreting common ECG abnormalities, explore limitations, and facilitate solutions to the development of ECG interpretation skills in Saudi Arabia. Methods This cross-sectional study was conducted from 11 June 2022 to 3 November 2022 using the convenience stratified sampling technique among 373medical interns (54.4% male and 45.6% female) in 15 medical colleges within Saudi Arabia. Results Almost all (91.7%) of the participants recognized the basic ECG elements, as they correctly identified normal ECG patterns. The mostwell-understood ECG pathologies were ventricular fibrillation, atrial fibrillation, and acute myocardial infarction, which were accurately interpreted by 69.2%, 67.8%, and 61.9% of the participants, respectively. The least understood ECG result was a pathological Q wave, which only 20.9% recognized. Most (63.5%) participants attributed their challenges in ECG interpretation to their inadequate training in college, and 57.4% of them stated that practical case-based training could best facilitate the improvement of their skills in ECG interpretation. Conclusion Most of the participants showed unsatisfactory performance in ECG interpretation. Despite their completion ofadvanced cardiac life support courses, their overall performance did not improve significantly. Most of them believed that their colleges did not adequately train them to read ECGs. Thus, a majority think case-based training is a key strategy for improving their ECG interpretation skills.

Association between prehospital advanced life support by emergency medical services personnel and neurological outcomes among adult out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation: A secondary analysis of the SAVE-J II study.

Early deployment of extracorporeal cardiopulmonary resuscitation (ECPR) is critical in treating refractory out-of-hospital cardiac arrest (OHCA) patients who are potential candidates for ECPR. The effect of prehospital advanced life support (ALS), including epinephrine administration or advanced airway, compared with no ALS in this setting remains unclear. This study's objective was to determine the association between any prehospital ALS care and outcomes of patients who received ECPR with emergency medical services-treated OHCA. This was a secondary analysis of data from the Study of Advanced Cardiac Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan (SAVE-J) II study. Patients were separated into 2 groups-those who received prehospital ALS (ALS group) and those did not receive prehospital ALS (no ALS group). Multiple logistic regression analysis was used to investigate the association between prehospital ALS and favorable neurological outcomes (defined as Cerebral Performance Category scores 1-2) at hospital discharge. A total of 1289 patients were included, with 644 patients in the ALS group and 645 patients in the no ALS group. There were fewer favorable neurological outcomes at hospital discharge in the ALS group compared with the no ALS group (10.4vs 19.8%, p<0.001). A multiple logistic regression analysis revealed that any prehospital ALS care (adjusted odds ratios 0.47; 95% confidence interval 0.34-0.66; p<0.001) was associated with unfavorable neurological outcomes at hospital discharge. Prehospital ALS was associated with worse neurological outcomes at hospital discharge in patients treated with ECPR for OHCA. Further prospective studies are required to determine the clinical implications of these findings.

A National Survey Assessing the Variability in the Management of Traumatic Cardiac Arrest.

Resuscitation of traumatic cardiac arrest (TCA) is variable, with approaches that overlap Advanced Trauma Life Support (ATLS) and Advanced Cardiac Life Support (ACLS) algorithms. There is no standard algorithm for TCA, with some withholding ACLS protocols given abysmal outcomes. This study aims to assess surgeon practices and attitudes toward resuscitation practices in TCA. A 16-question web-based survey was distributed to the membership of a national trauma association. Respondent demographics and management of TCA were analyzed. Chi-squared tests determined statistical significance. Open-ended responses were coded and analyzed inductively. Two hundred and three surveys were completed. 73.4% of respondents reported utilizing ACLS, while 26.6% reported they never utilized ACLS. A statistically significant difference in the performance of ACLS was found based on number of years in practice (P = .025) and the state of practice (P = .006). There was no significant difference in self-reported survival rates or legal, ethical, or interpersonal conflicts. Qualitative data highlighted themes of interpersonal conflict and futility. This study shows that one-quarter of respondents never utilize ACLS in TCA. Of those that utilize ACLS, there was variability in the technique, indication, and duration of resuscitation. Despite significant variability in technique, there appears to be similar survival rates and incidence of conflict. The association between years in practice and ACLS use suggests this may represent an emerging change in practice. The low response rate limits generalizability; however, there is significant variability in practice, highlighting a need for evidence-based guidelines.

Cardiopulmonary Arrest During Pregnancy: A Review Article.

Massive pulmonary embolism (PE) is an uncommon but severe complication of pregnancy or during the first few weeks after giving birth. Our intention was to thoroughly analyze the information available to its management methods.Significant bleeding of mother survival and early deliveries in fetal survivals were having hemorrhage andwerehaving key outcomes. We found 127 severe PE cases that have had at least one form of treatment (at least 83% big; 23% with cardiac arrest). The 83 women who received thrombolysis had a 94% (95%) survival rate. Cardiac arrest in pregnancy is uncommon, although maintaining current competency can be challenging. While maternal mortality rates have decreased globally over the past 25 years, they have increased in the United States. The intricacy of the maternal mortality issue is a result of a number of clinical and socioeconomic problems such as unequal healthcare access, racial and ethnic disparities, maternal comorbidities, and bias in epidemiologic ascertainment. The importance of doctors being prepared to react to a potential maternal cardiac arrest in any situation where they are providing treatment for pregnant women is highlighted by the rise in maternal mortality. For the treatment of maternal cardiac arrest, an interdisciplinary team with expertise in both the maternal resuscitation procedure and the physiological changes that take place during pregnancy is necessary. Additionally offered are basic and advanced cardiac life support protocols. Techniques to remove obstacles like aortocaval compression that could impair the effectiveness of resuscitation should be used.

2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.

This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.

Early Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest

BackgroundExtracorporeal cardiopulmonary resuscitation (CPR) restores perfusion and oxygenation in a patient who does not have spontaneous circulation. The evidence with regard to the effect of extracorporeal CPR on survival with a favorable neurologic outcome in refractory out-of-hospital cardiac arrest is inconclusive.MethodsIn this multicenter, randomized, controlled trial conducted in the Netherlands, we assigned patients with an out-of-hospital cardiac arrest to receive extracorporeal CPR or conventional CPR (standard advanced cardiac life support). Eligible patients were between 18 and 70 years of age, had received bystander CPR, had an initial ventricular arrhythmia, and did not have a return of spontaneous circulation within 15 minutes after CPR had been initiated. The primary outcome was survival with a favorable neurologic outcome, defined as a Cerebral Performance Category score of 1 or 2 (range, 1 to 5, with higher scores indicating more severe disability) at 30 days. Analyses were performed on an intention-to-treat basis.ResultsOf the 160 patients who underwent randomization, 70 were assigned to receive extracorporeal CPR and 64 to receive conventional CPR; 26 patients who did not meet the inclusion criteria at hospital admission were excluded. At 30 days, 14 patients (20%) in the extracorporeal-CPR group were alive with a favorable neurologic outcome, as compared with 10 patients (16%) in the conventional-CPR group (odds ratio, 1.4; 95% confidence interval, 0.5 to 3.5; P=0.52). The number of serious adverse events per patient was similar in the two groups.ConclusionsIn patients with refractory out-of-hospital cardiac arrest, extracorporeal CPR and conventional CPR had similar effects on survival with a favorable neurologic outcome. (Funded by the Netherlands Organization for Health Research and Development and Maquet Cardiopulmonary [Getinge]; INCEPTION ClinicalTrials.gov number, NCT03101787.)

Indications for hand and glove disinfection in Advanced Cardiovascular Life Support: A manikin simulation study.

There are no investigations on hand hygiene during cardiopulmonary resuscitation (CPR), even though these patients are at high risk for healthcare-associated infections. We aimed to evaluate the number of indicated hand hygiene per CPR case in general and the fraction that could be accomplished without delay for other life-saving techniques through standardized observations. In 2022, we conducted Advanced Cardiovascular Life Support (ACLS) courses over 4 days, practicing 33 ACLS case vignettes with standard measurements of chest compression fractions and hand hygiene indications. A total of nine healthcare workers (six nurses and three physicians) participated. A total of 33 training scenarios resulted in 613 indications for hand disinfection. Of these, 150 (24%) occurred before patient contact and 310 (51%) before aseptic activities. In 282 out of 310 (91%) indications, which have the highest impact on patient safety, the medication administrator was responsible; in 28 out of 310 (9%) indications, the airway manager was responsible. Depending on the scenario and assuming 15 s to be sufficient for alcoholic disinfection, 56-100% (mean 84.1%, SD ± 13.1%) of all indications could have been accomplished without delaying patient resuscitation. Percentages were lower for 30-s of exposure time. To the best of our knowledge, this is the first study investigating the feasibility of hand hygiene in a manikin CPR study. Even if the feasibility is overestimated due to the study setup, the fundamental conclusion is that a relevant part of the WHO indications for hand disinfection can be implemented without compromising quality in acute care, thus increasing the overall quality of patient care.