Automatic Defibrillator Research Articles

État de l'activité de rythmologie interventionnelle en France et conséquences des réformes des seuils sur les autorisations d'activité

BackgroundInterventional rhythmology activity (electrophysiology and pacing) has progressed in France during the last decade. The objective of this article is to assess the distribution of this activity depending on the type of centre (public, university or non-university, private). As the French government issued a new regulation regarding rhythmology activity in 2022, the impact of this regulation on activity distribution has been evaluated. MethodologyAll French data activity can be evaluated after accessing to a national database called PMSI [Programme de Médicalisation des Systèmes d'Information]. Based on data collected in year 2021, the level of activity of the different centres, and the impact of the new criteria of the French regulation regarding rhythmology activity have been analysed. ResultsAbout 200,000 arrhythmias interventions have been done in France in 2021 in 382 centres. According to the new criteria of the French regulation, 66% responded to level A (diagnostic electrophysiology, single- and dual-chamber pacing), 68% for level B (A+ right atrial ablation, implantable automatic defibrillator, cardiac resynchronisation therapy) and 70% for level C (B + left atrial and ventricular ablation). 1/4 of the centres do not meet criteria for level A activity, and 1/5 of them for levels B and C ConclusionsThis work showed that immediat and systematic application of new threshold could be threatening for 1/4 of A center and 1/5 of B or C center. The priority will be to reinforce existing centres before allowing new centres to perform arrhythmias management activity in France.

Primary prevention implantable cardioverter defibrillator in cardiac resynchronization therapy recipients with advanced chronic kidney disease.

The implantable cardioverter defibrillator (ICD) is effective for the prevention of sudden cardiac death (SCD) in patients with heart failure and a reduced ejection fraction (HFrEF). The benefit of the ICD in patients with advanced CKD, remains elusive. Moreover, the benefit of the ICD in patients with advanced chronic kidney disease (CKD) and HFrEF who are cardiac resynchronization therapy (CRT) recipients may be attenuated. We hypothesized that patients with CKD who are CRT recipients may derive less benefit from the ICD due to the competing risk of dying prior to experiencing an arrhythmia. The study population included 1,015 patients receiving CRT with defibrillator (CRT-D) device for primary prevention of SCD who were enrolled in either (Multicenter Automated Defibrillator Implantation Trial) MADIT-CRT trial or the Ranolazine in High-Risk Patients with Implanted Cardioverter Defibrillator (RAID) trial. The cohort was divided into two groups based on the stage of CKD: those with Stage 1 to 3a KD, labeled as (S1-S3a)KD. The second group included patients with Stage 3b to stage 5 kidney disease, labeled as (S3b-S5)KD. The primary endpoint was any ventricular tachycardia (VT) or ventricular fibrillation (VF) (Any VT/VF). The cumulative incidence of Any VT/VF was 23.5% in patients with (S1-S3a)KD and 12.6% in those with (S3b-S5)KD (p < 0.001) The incidence of Death without Any VT/VF was 6.6% in patients with (S1-S3a)KD and 21.6% in patients with (S3b-S5)KD (p < 0.001). A Fine and Gray multivariate competing risk regression model showed that Patients with (S3b-S5)KD had a 43% less risk of experiencing Any VT/VF when compared to those with (S1-S3a)KD (HR = 0.56, 95% CI [0.33-0.94] p = 0.03. After two years of follow up, there was almost a 5-fold increased risk of Death without Any VT/VF among patients with (S3b-S5)KD when compared to those with (S1-S3a)KD [HR = 4.63, 95% CI (2.46-8.72), p for interaction with time = 0.012]. Due to their lower incidence of arrhythmias and higher risk of dying prior to experiencing an arrhythmia, the benefit of the ICD may be attenuated in CRT recipients with advanced CKD. Future prospective trials should evaluate whether CRT without a defibrillator may be more appropriate for these patients.

Computed Tomography Tissue Characterization of Pediatric Cardiac Tumor

Little is known about tissue characterization of cardiac tumors by dedicated cardiac computed tomography (CT) protocols in pediatric patients. We report using arterial and delayed CT acquisitions to characterize a large left ventricular free wall tumor in a 12-year-old female with congenital mitral insufficiency and an automatic implantable cardioverter defibrillator. (Level of Difficulty: Intermediate.)

Dispatcher-assisted BLS for lay bystanders: A pilot study comparing video streaming via smart glasses and telephone instructions

ObjectiveTo determine whether dispatcher assistance via smart glasses improves bystander basic life support (BLS) performance compared with standard telephone assistance in a simulated out-of-hospital cardiac arrest (OHCA) scenario. MethodsPilot study in which 28 lay people randomly assigned to a smart glasses-video assistance (SG-VA) intervention group or a smartphone-audio assistance (SP-AA) control group received dispatcher guidance from a dispatcher to provide BLS in an OHCA simulation. SG-VA rescuers received assistance via a video call with smart glasses (Vuzix, Blade) connected to a wireless network, while SP-AA rescuers received instructions over a smartphone with the speaker function activated. BLS protocol steps, quality of chest compressions, and performance times were compared. ResultsNine of the 14 SG-VA rescuers correctly completed the BLS protocol compared with none of the SP-AA rescuers (p = 0.01). A significantly higher number of SG-VA rescuers successfully opened the airway (13 vs. 5, p = 0.002), checked breathing (13 vs. 8, p = 0.03), correctly positioned the automatic external defibrillator pads (14 vs.6, p = 0.001), and warned bystanders to stay clear before delivering the shock (12 vs. 0, p < 0.001). No significant differences were observed for performance times or chest compression quality. The mean compression rate was 104 compressions per minute in the SG-VA group and 98 compressions per minute in the SP-AA group (p = 0.46); mean depth of compression was 4.5 cm and 4.4 cm (p = 0.49), respectively. ConclusionsSmart glasses could significantly improve dispatcher-assisted bystander performance in an OHCA event. Their potential in real-life situations should be evaluated.

A combined impedance compensation strategy applied to external automatic defibrillators.

Transthoracic impedance is one of the key factors affecting the success of defibrillation. Impedance compensation technique is used to adjust defibrillation parameters according to the transthoracic impedance of the defibrillator. In this paper, a combined impedance compensation strategy is proposed to address the shortcomings of existing compensation strategies. In order to evaluate the performance of thecombined compensation strategy, this paper uses the prototype as the experimental machine, and uses two AED with representative impedance compensation strategies asthe control machine, and the simulated defibrillation method is used for comparative testing. The results show that the combined impedance compensation has a more steadier distribution over the defibrillation energy and current: compared with the energy-based impedance compensation strategy, this strategy can significantly reduce the peak current (25 Ω: 27.8 vs. 54.7 A; 50 Ω: 20.7 vs. 32.3 A) and average current (25 Ω: 24.8 vs. 37.5 A) of defibrillation at low impedance, and compared with the current impedance compensation strategy, it can significantly reduce the defibrillation energy (150 Ω: 8.6 vs. 1.7 %, 175 Ω: 15.6 vs. 4.9 %, 200 Ω: 21.9 vs. 8.5 %) at high impedance. Impedance compensation is more precise and the current passing during defibrillation is steadier.

The Effects of the Attitude and Knowledge of Automatic Defibrillator on the Performance of Automatic Defibrillator and Cardiopulmonary Resuscitation

연구목적: 본 연구는 보건계열 대학생의 자동제세동기의 태도와 지식이 자동제세동기와 심폐소생술 수행능력에 미치는 영향요인을 확인하고자 하는 탐색적 조사연구이다. 연구방법: 보건계열 대학생 3학년 315명을 대상으로 SPSS 23.0 프로그램을 이용하여 t-test, One-way ANOVA, 상관관계 및 회귀분석 하였다. 연구결과: 대학생의 자동제세동기의 태도와 지식이 자동제세동기와 심폐소생술 수행능력 정도는 4.21점, 2.65점, 4.01점이고, 자동제세동기와 심폐소생술 수행능력에 가장 영향을 미치는 요인은 자동제세동기에 대한 태도이고 다음으로 자동제세동기에 대한 지식이었다. 종속변수를 설명하는 설명력은 45.0%이었다. 결론: 본 연구를 통해 보건계열 대학생의 자동제세동기와 심폐소생술 수행능력을 높이기 위해 매년 BLS provider 프로그램 참여 등 지식과 태도를 높일 수 있도록 교육과정 개발과 지속적인 교육이 이뤄질 수 있도록 제언한다.Objective : The purpose of this study was to investigate the perception, attitude, and knowledge of AEDs and their effects on AEDs and cardiopulmonary resuscitation (CPR) performance of college health students Methods : t-test, one-way ANOVA, correlation, and regression analysis were conducted using the SPSS 23.0 program for 315 third-year college students in the health students Results : The degree of attitude and knowledge of AEDs and CPR performance of college health students was 4.21, 2.65, and 4.01 points, and the most influential factor on AED and CPR performance was attitude toward AED, followed by AED. It was the knowledge of an automated external defibrillator. The explanatory power to explain the dependent variable was 45.0%. Conclusion : Through this study, it is proposed to develop a curriculum and continue education to improve knowledge and attitude, such as participating in the BLS provider program every year, in order to improve the AED and CPR performance of health-related college students.

Sudden death in sports. 2018-2020. Argentine Registry

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The prevalence of Sudden Death in Sports (SDS) is low in relation to other forms of death in the general population. There is little current data about this problem in Argentina. Objectives Obtain information about the characteristics of these events in order to recommend effective prevention measures. Methods A specific mailbox was created to receive SDS case reports. The study was presented in academic, health and social media institutions. The information received was analyzed and investigated with direct contact with professionals or people related to the event. Results From January 2018 to February 2020, 26 months, 35 cases of SDS were surveyed. 89% of the male sex pts, 68% over 35 years. SDS occurred mainly in: Football, 11 pts, Gymnastics, 10 pts and marathon 9 pts. 68% of the athletes were amateurs and 52% during high performance practices. Assistance received: 29 athletes received assistance, 19 pts Basic Cardiopulmonary Resuscitation (CPR) and 10 pts advanced CPR with automatic or manual defibrillation in 9 cases. Of the 21 pts that were transferred, 9 pts entered and 8 exited alive. The survival rate was 23% and all graduated in functional class I. A forensic autopsy was performed in only 8 cases. Associated pathologies: 8 pts with coronary heart disease, 7 pts dilated cardiomyopathy, 3 pts, unspecified heart disease, 1 pt with toxic medication, 1 pt died from commotio cordis and 15 pts without diagnosis. Conclusions The number of reported cases of SDS was low, with an approximate incidence of 0.25% / 100,000.hab / year, 1 to 2 cases per month. SDS episodes occurred mainly in football, gymnasia and marathon, with an adequate level of on-site assistance and greater use of defibrillation therapy compared to previous reports. High mortality persists (77%). The use of autopsy is low showing cardiomyopathy or unknown origin in young people and coronary disease in adults

Automatic subcutaneous defibrillator screening in patients with intracardiac devices: comparative study depending on the point of pacing

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Subcutaneous defibrillator (S-ICD) has been shown to be effective in the prevention of sudden cardiac death with the advantage of avoiding intravascular access. Although it should not be indicated when pacing indications exists, the need for pacing may arise in the course of underlying heart disease. Before implantation, it is necessary to screen the surface electrocardiogram (ECG) to avoid inappropriate shocks due to overdetection. Published studies so far show a drastic reduction in the percentage of patients eligible for screening with conventional pacing techniques (right ventricular apex, right ventricular outflow tract or resynchronisation with coronary sinus pacing). Purpose The change in screening signal produced by cardiac pacing during is unknown. So far, no studies have been published comparing the outcome of S-ICD screening between different pacing sites, including conduction system pacing (CSP, his and left bundle branch pacing). Our aim is to analyse the success rate of screening and its predictors in patients with cardiac pacing according to the pacing point. Methods A total of 102 patients were screened for S-ICD and divided into 5 groups according to pacing type: His bundle pacing (HBP), left bundle pacing (LBP), right ventricular apex (RVA), right ventricular outflow tract (RVOT) and biventricular cardiac resynchronisation (CRT). There were no significant differences in any variable between the HBP and LBP group, so they were unified as the CSP group. We used a control group of 10 healthy patients with no implantable devices or ECG abnormalities. All patients underwent automatic screening with paced rhythm using the automatic algorithm (Boston Scientific). We considered a suitable screening when at least one vector (primary, secondary or alternative) was positive in both decubitus and standing position, in left or right parasternal position. Results Baseline characteristics by group are summarised in table1. Paced QRS width was lower in the CSP group (135 [120-160] vs 120 [106-120] p=0,001). All healthy controls passed the screening (100%). 39 (97.5%) CSP patients passed the screening, compared to 15 (71.4%) CRT, 14 (70%) RVOT and 4 (19%) RVA. The differences were statistically significant, p &amp;lt; 0.001 (image 1 A &amp; B). In multivariate analysis, only pacing type was shown to be a predictor of positive screening (p 0.001), independent of paced QRS width. Conclusions In our experience, the probability of obtaining a positive screening of the S-ICD is higher with conduction system stimulation than with the other pacing points (AVD, RVOT or CRT).

Incidence, characteristics and outcomes of out-of-hospital cardiac arrest due to ventricular fibrillation in the general population: data from a single-center long-term registry

Abstract Funding Acknowledgements: Type of funding sources: None. Out-of-hospital cardiac arrest (OHCA) is a major public health problem and ventricular fibrillation (VF) is the most common initial rhythm when cardiac disease is the cause of arrest. It can be favorably treated with defibrillation but rapidly tends to deteriorate to non-shockable rhythms over time, so that reported survival rates vary from 3% to 10%. Early defibrillation strategy has led to a considerable survival improvement; however, automated external defibrillators are still used in &amp;lt;3% of episodes of OHCA. Here, we analyze data from a single-center emergency-medical-service (EMS) registry, involving all consecutive OHCA occurring from January 2013 to June 2022 in whom resuscitation or defibrillation has been attempted. The "Progetto Vita" initiative has been developed in our province since 1999 with the aim of improving deployment of automated external defibrillators into the public space so that the first line involved in the chain of survival (laic bystander or policemen/health care staff) and the use of automatic external defibrillators (AED) by policemen/citizens before the arrival of the EMS personnel are crucial indicators involved in the registry. Patients presenting with OHCA due to VF were considered eligible for this analysis. During the 10-year period of examination, 3,124 patients received medical care for OHCA; 323 of them presented VF and were considered for subsequent analysis. VF occurred prevalently at home (73%), in men (75%); mean age was 70. Bystander or laic citizen CPR was performed in 35 cases (11%) with a survival rate of 63%. AED used by either laic bystander or police was used in 30 cases (9%) with a success rate of 77%. Cardiac comorbidities were noted in 67 patients (21%), predominantly males, and CAD was the most common disease. Main historical, clinical, ECG, instrumental features and therapeutic management and differences in sex groups are listed in Table 1. As expected, incidence increased with age; male predominance was observed in all age subgroups although we observed a different distribution between sexes in age subgroups (Table 1). There were 237 deaths (mortality rate 73%), 41 (17%) of them occurring after arrival at Emergency Service.Among successfully admitted patients, VF was mostly related to coronary artery disease (70%) and STEMI was the most frequent manifestation of acute ischemic heart disease, both in males and females. Overall, 87 (27%) patients survived and were successfully admitted to intensive care unit (57%) or coronary care unit (43%). Multivariate logistic regression analysis showed that laic-performed CPR (OR 2.52, 95% CI 1.04, 6.1, p=0.04) and use of AED (OR 7.15; 95% CI 2.66, 19.19, p&amp;lt;0.001) were both independent predictors of survival. VF in the general population is still poorly predictable and mortality remains high: implementation of community involvement in early-defibrillation through publicly available AEDs appears effective in improving survival. Study population Population characteristics

Left-to-right atrioventricular activation delay, a novel measure of AV-conduction, predicts clinical outcomes in non-LBBB patients

Abstract Funding Acknowledgements Type of funding sources: None. Background The PR-interval reflects atrial and atrioventricular activation. A prolonged PR has been linked to heart failure (HF), atrial fibrillation and mortality. This might at least in part be the consequence of compromised cardiac performance (e.g. left ventricular filling). On the other hand, very long PR may just be a marker of advanced heart disease. Alternative measures that account for atrial and ventricular activation might better predict adverse hemodynamic consequences of delayed atrioventricular conduction. The DEEPER-PR mechanistic pilot study suggested that various novel measures of AV conduction are associated with Doppler-derived cardiac performance. However, the clinical significance of these novel parameters is unknown. Study objective: To examine the association of novel measures of AV conduction with clinical outcomes in a HFrEF population with non-LBBB and a wide QRS (non-LBBB ICD-only MADIT-CRT subset). Methods Time intervals from anonymized scanned baseline 12-lead ECGs from the Multicenter Automatic Defibrillator Implantation Trial – Cardiac Resynchronization Therapy (MADIT-CRT), non-LBBB patients (n=537) were assessed in detail using ImageJ (public domain software provided by NIH). The primary endpoint of the study was the combined endpoint of heart failure (HF) or death events. The earliest onset of atrial activation (P wave onset), zero crossing of the P wave in lead V1, earliest onset of the QRS complex, time interval to the first peak of the R wave in V1 and V6, and QRS width were determined. The PR interval and 8 novel parameters (see figure 1) were measured and calculated accordingly. Bivariate non-parametric correlations were calculated to ascertain the associations between these covariates. In addition, Kaplan-Meier analyses by quintiles of all AV delay measures, and multivariable Cox regression analyses were performed among ICD-only patients (n=209) to determine the associated risk regarding of the combined MADIT-CRT clinical outcome of HF events or death. Results Weak correlations were found between the AV delay variables (figure 2). Four of the variables (P0PV1, P0R, PePV6, PR) were significantly associated to the risk of HF or death with the upper quintile defining a high-risk HF population, as compared to quintiles 1 to 4 (see figure 3). This indicated a threshold behavior of the associations. P0PV1 was the most powerful risk predictor (Chi-square=16.31, HR for Q5 vs. Q1-4=3.12, CI=1.80-5.41, p&amp;lt;0.001), followed by PRmax (Chi-square=13.19, HR for Q5 vs. Q1-4=2.81, CI=1.61-4.92, p&amp;lt;0.001), P0R (Chi-square=10.42, HR=2.54, CI=1.44-4.48, p=0.001), and PePV6 (Chi-square=7.96, HR for Q5 vs. Q1-4=2.2, CI=1.29-4.07, p=0.005). Conclusion This post-hoc ECG-based study identified in MADIT-CRT non-LBBB patients the left-to-right atrioventricular activation delay (P0PV1) as the most powerful risk predictor of HF or death. Prospective evaluation of this measure is warranted.

P261 OUT–OF–HOSPITAL CARDIAC ARREST (OHCA): TWO–YEAR OBSERVATIONAL STUDY

Abstract Background Cardiac arrest is the third cause of death in Europe. It is a medical emergency characterized by high mortality and morbidity. Myocardial infarction is the leading cause of cardiac arrest. Data collection through national and international registries is essential to advance knowledge and improve diagnostic and therapeutic practices. Purpose: we assess the epidemiological impact of OHCA within a territory of approximately 300.000 inhabitants and follow patients’ intrahospital clinical pathway with the aim to identify possible predictors of survival and neurological outcome. Methods an electronic database is used to collect and share data across the Emergency Medical Services (EMS) and reference Cardiologists. Respectively, the EMS collects out–of–hospital patient data, whereas Cardiologists collect all information about intrahospital progress. Results during an observation period of two years, 100 patients with OHCA were enrolled. The majority were male and the average age was 65 years old. The first rhythm identified was shockable in 41% of the cases. Witnesses performed cardiopulmonary resuscitation and used automatic external defibrillator respectively in 57% and 10% of the cases. Only 34% of the victims obtained ROSC and were admitted into the cardiac intensive care unit and half of them died before discharge. Within this group, cardiac arrest was caused by myocardial infarction in 46% of the cases. Of these, culprit lesion was located in the left anterior descending artery in 46,2 % of the cases. It appears that a blood pH value below 7,04 – measured at the arrival in Emergency Department – is a poor prognostic predictor of ROSC, with a 79% sensitivity and 86% specificity (AUC 0,81, 95% CI 0,644 – 0,977). On the other hand, a plasma level of lactic acid expresses multiorgan damage secondary to cardiac arrest and therefore represents a predictor of survival and neurological outcomes, but not ROSC. Conclusion during the two years of observation, the incidence of OHCA turned out to be slightly lower compared to the data available in the literature. Mortality remains extremely high: only 12% of the population survives, of which 16% with poor neurological outcome. Blood gas analysis, if correctly interpreted, could be an optimal tool to target therapeutic choices for cardiac arrest victims. Further studies with a higher sample size will be needed to validate this data.

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.

Survey on Applications of Emergency Medical Drones

Introduction:Traditionally, helicopters or special types of airplanes have been used to transport emergency patients when an aeromedical transport is necessary. However, despite its excellent utility, the cost of each flight is relatively expensive and has many limitations. So as an alternative to traditional aircrafts, there has been a movement to overcome the limitations of traditional air transport through the development and application of emergency medical drones. In this study, practical applications of emergency medical drones were investigated.Method:As a first step, through literature and internet searches, the current state of development, field of use, results, and problems of emergency medical drones were investigated. Based on this first investigation, a second Delphi survey of experts was conducted to investigate the appropriate fields for the use of emergency medical drones and the expected future applications.Results:Currently, emergency patient support drones are being used to transport first aid equipment including an automatic external defibrillator, manage emergency patient status and on-site remote evaluation, and transport human organs during organ transplantation. Emergency medical drones for emergency patients are being developed, including systems that manage the patient's condition by applying additional advanced technologies.Conclusion:Emergency medical drones were classified into drones for transporting emergency patients and drones for emergency medical support according to whether emergency patients were on board. Drones for emergency patient support were being used to transport first aid equipment, manage emergency patient status and on-site remote evaluation, and transport organs during organ transplantation. The trend of air transport in the future is expected to change to a futuristic means of transportation in the form of emergency medical drones.

PO-04-053 OUT-OF-HOSPITAL CARDIAC ARREST ASSOCIATED WITH EARLY REPOLARIZATION

Early repolarization syndrome (ERS) is characterized by J-point elevation presenting as slurring or notching of the terminal part of the QRS complex. Of the several congenital and acquired disorders that encompass J-wave syndromes, ERS has been linked to increased risk of developing polymorphic VT and idiopathic VF that can lead to sudden cardiac death. To describe a patient who presented after a cardiac arrest with initial ECG criteria consistent with Type III ERS who recieved a dual-chamber ICD. n/a We present a case of a 42-year-old man without any prior history that presented to the emergency room after successful resuscitation from out-of-hospital cardiac arrest due to VF. After noticing agonal respiration during early morning hours, his wife called emergency medical services (EMS) and promptly performed cardiopulmonary resuscitation. Upon arrival, EMS found the patient to be in VF. He was shocked once by an automatic external defibrillation leading to ROSC with restoration of sinus rhythm. In the ED, his initial vitals were 122/93 mmHg, 104 bpm, 95% oxygen saturation on room air, and temperature of 36.4 °C. He denied any family history of sudden cardiac death. Wife reported prior history of nocturnal agonal respirations. Initial diagnostic work-up was significant for a leukocytosis of 19,000 and serial high-sensitivity cardiac troponins of 130, 305, and 364 with a 0/3-hour delta change of 234. A12-lead ECG upon presentation is shown in Figure 1 without previous ECGs available for comparison. An emergent coronary angiography was performed which revealed no significant coronary obstruction or anomaly. With both his ECG findings and a Shanghai Score of 7, a diagnosis of Type III ERS was highly suspected. Further diagnostic testing included a TTE showing left ventricular dysfunction with an ejection fraction of 40-45%. CMR showed no delayed gadolinium enhancement. Ultimately, a dual-chamber ICD was implanted during the admission. Follow-up ECGs revealed resolution of slurred terminal QRS complexes. He was discharged on beta blocker and low-dose losartan with close outpatient follow-up with electrophysiology. ECG changes of ERS can be dynamic and may sometimes be concealed, particularly in the setting of an out-of-hospital cardiac arrest. It is important to identify early repolarization patterns due to the adverse prognostic significance especially of Type III ERS which is associated with the highest level of risk for development of malignant arrhythmia.

Out-of-hospital cardiac arrest: University of Trieste students' skills on resuscitative maneuvers and automated external defibrillator

Out-of-hospital cardiac arrest is the third leading cause of death in industrialized countries. Although most cardiac arrests are witnessed, survival is only 2-10%, since bystanders are often unable to correctly perform cardiopulmonary resuscitation (CPR). This study aims to assess the theoretical and practical knowledge of CPR and the use of the automatic external defibrillator in university students. The study involved a total of 1686 students from 21 different faculties of the University of Trieste, 662 students from healthcare faculties and 1024 from non-healthcare faculties. Basic life support and early defibrillation (BLS-D) courses and retrainings after 2 years are mandatory for students in their final 2-year healthcare faculties at the University of Trieste. Through the platform "EUSurvey" from March to June 2021, they were given an online questionnaire of 25 multiple choice questions to investigate the performance of BLS-D. In the overall population, 68.7% knew how to diagnose a cardiac arrest and 47.5% knew the time frame after which irreversible brain damage occurs. Practical knowledge was analyzed by evaluating the correct answers to all four questions on performing CPR (i.e. hand position during compressions, frequency of compressions, depth of compressions, and ventilation-compression ratio). Health faculties students have better theoretical and practical knowledge of CPR than their colleagues of non-healthcare faculties, with better overall knowledge on the all four practical questions (11.2% vs 4.3%; p<0.001). Final-year medical students of the University of Trieste, who attended the BLS-D course and underwent retraining after 2 years, have achieved better results than first year medical students (without BLS-D training) (38.1% vs 2.7%; p<0.001). Mandatory BLS-D training and retraining leads to a better knowledge of cardiac arrest management and consequently a better patient outcome. In order to improve patient survival, heartsaver (BLS-D for laics) training should be extended as obligatory in all university courses.

Automatic Implantable Cardioverter Defibrillator Lead-related Endocarditis due to Staphylococcus lugdunensis

Staphylococcus lugdunensis is a coagulase-negative staphylococcus (CoNS) that constitutes normal skin flora and is often read as a contaminant when isolated in blood cultures. In recent years S. lugdunensis has been increasingly recognized as a true pathogen causing a spectrum of infections from benign skin and soft tissue infections to bacteremia, bone and joint infections, and endocarditis. A significant role in the pathogenesis of infections is played by the ability of the organism to form biofilms that allow it to attach itself to foreign objects such as pacemakers, prosthetic valves, and orthopedic implants. The mortality rate in infective endocarditis caused by S. lugdunensis has been as high as 38.8 % making it as virulent as Staphylococcus aureus reported in the literature. It requires aggressive antibiotics and optimal source control, including surgical debridement and valve replacement if indicated. We present a case of S.lugdunensis infective endocarditis in a patient with an automatic implantable cardioverter defibrillator (AICD). The patient presented with lower back pain for three weeks and was found to have a right psoas abscess and S.lugdunensis bacteremia, with a vegetation on the right ventricular defibrillator wire requiring device explantation and prolonged antibiotic treatment.

Pengaruh Pemberian Video Animasi Mengenai Prosedur Operasional Alat Automatic External Defibrillator (AED) Terhadap Tingkat Pengetahuan Mahasiswa Keperawatan Poltekkes Kemenkes Pangkalpinang

Cases of sudden cardiac arrest can occur anywhere and anytime beyond the hospital. The American Heart Association advocates using Automatic External Defibrillators as a tool to help the sudden cardiac arrest survivor. However, the previous study showed health workers have less knowledge of tool utilization. The study aimed to determine the influence of animated videos regarding the operational procedures on the level of knowledge of the Polytechnic Pangkalpinang Ministry of Health nursing students. The queasy experimental was used with a non-equivalent control group pre-test and post-test design approach. The total of 140 participants divided into intervention groups received animated videos while the control groups received guide book only. The questionnaires used have a validity value of each question item 0.05 and reliability showed by Cronbach alpha value of 0.732. Data were analyzed using Wilcoxon Test and The Mann-Whitney test to see the comparison between the groups. The results showed an increase in the average knowledge before and after being given the intervention. However, there was no significant effect of providing animated video on the level of knowledge of nursing students (p=0.055 ≥ 0.05), and there was no significant difference between groups (p=0.889 ≥ 0.05). The development of an easy-to-access application and various learning media for introducing other medical devices is recommended for further studies.

Training in Basic Life Support and Bystander-Performed Cardiopulmonary Resuscitation and Survival in Out-of-Hospital Cardiac Arrests in Denmark, 2005 to 2019

Strategies to improve survival from out-of-hospital cardiac arrest (OHCA) include mass education of laypersons with no official duty to respond to OHCA. In Denmark, basic life support (BLS) course attendance has been mandated by law in October 2006 for obtaining a driver's license for all vehicles and in vocational education programs. To examine the association between yearly BLS course participation rate and bystander cardiopulmonary resuscitation (CPR) and 30-day survival from OHCA and to examine if bystander CPR rate acted as a mediator on the association between mass education of laypersons in BLS and survival from OHCA. This cohort study included outcomes for all OHCA incidents from the Danish Cardiac Arrest Register between 2005 and 2019. Data concerning BLS course participation were supplied by the major Danish BLS course providers. The main outcome was 30-day survival of patients who experienced OHCA. Logistic regression analysis was used to examine the association between BLS training rate, bystander CPR rate, and survival, and a bayesian mediation analysis was conducted to examine mediation. A total of 51 057 OHCA incidents and 2 717 933 course certificates were included. The study showed that the annual 30-day survival from OHCA increased by 14% (odds ratio [OR], 1.14; 95% CI, 1.10-1.18; P < .001) when BLS course participation rate increased by 5% in analysis adjusted for initial rhythm, automatic external defibrillator use, and mean age. An average mediated proportion of 0.39 (95% QBCI, 0.049-0.818; P = .01). In other words, the last result indicated that 39% of the association between mass educating laypersons in BLS and survival was mediated through an increased bystander CPR rate. In this cohort study of Danish BLS course participation and survival, a positive association was found between annual rate of mass education in BLS and 30-day survival from OHCA. The association of BLS course participation rate on 30-day survival was mediated by the bystander CPR rate; approximately 60% of the association of BLS course participation rate on 30-day survival was based on factors other than increased CPR rates.

Diferencias entre comunidades autónomas de España en la dotación de desfibriladores externos semiautomáticos fuera del ámbito sanitario

BackgroundEarly defibrillation is one of the interventions that can most influence the prognosis of cardiac arrest. The objectives of this study were to determine the number of automatic external defibrillators outside the healthcare setting in each autonomous community in Spain and to compare the legislation of each autonomous community on the mandatory installation of defibrillators outside the healthcare setting. MethodsA cross-sectional observational study was carried out between December 2021 and January 2022 by consulting official data in the 17 Spanish autonomous communities. ResultsComplete data on the number of registered defibrillators were obtained from 15 autonomous communities. The number of defibrillators ranged from 35 to 126 per 100,000 inhabitants. At the global level, differences were observed between communities with mandatory defibrillator installation and those without (92.1 vs. 57.8 defibrillators/100,000 inhabitants). ConclusionsThere is heterogeneity in the provision of defibrillators outside the health care setting, which seems to be related to the diversity of legislation on the mandatory installation of defibrillators.

Study of the Variables of Local Healthcare Personnel Linked to Becoming a Formal Public CPR Instructor in Baoan, Shenzhen, China

BackgroundPublic Cardiopulmonary resuscitation (CPR) education is important to increase the survival rate of out-of-hospital cardiac arrest (OHCA). In this study, we survey local healthcare personnel in China who met the requirements of becoming public CPR instructors to assess their level of knowledge and attitudes toward teaching CPR.Materials and MethodsTo find qualified public CPR instructors among the local healthcare personnel, we ran three training sessions between March 2018 and December 2018. We held three courses on selecting public CPR instructors from the local healthcare personnel (n = 496). We also surveyed candidates for public CPR instructors before making our final choice. The selected instructors were retrained for a single day in December 2021. The necessary information was exchanged with the members of the passing group, and the maintained valuables were investigated.ResultsPublic CPR instructors certified 428 cases (86.49%) after the final exam. The results showed that the emergency group had a higher success rate than the non-emergency group (control group) (175, 90.7% vs. 253, 83.8%; P = 0.042). Here, we conducted a binary logistic regression analysis to determine the relationship between 15 survey variables and the passing rate. The variables, such as financial incentives, prior automatic external defibrillator (AED) training, and younger age were independently affected by being public CPR instructors. Despite this, 246 instructors (57.9%) still attended the retraining courses in 2021, with significantly more instructors in the emergency group than those in the non-emergency group (111, 64.5% vs. 135, 53.4%; P = 0.022). Furthermore, the instructors who were not incentivized financially were less likely to switch between the emergency and non-emergency groups (96, 79.33% vs. 116, 86.56%; P = 0.990).ConclusionThe Chinese emergency team can serve as a model for the local healthcare personnel by training and leading a group of volunteer CPR instructors. Our research has practical implications for China's national CPR education policy by informing the scheduling of regional public CPR education programs.