Cardiopulmonary Resuscitation In Patients Research Articles

Outcomes and potential for improvement in the prehospital treatment of penetrating chest injuries in a European metropolitan area: A retrospective analysis of 2009 – 2017

BackgroundTrauma is the leading cause of death in patients <45 years living in high-resource settings. However, penetrating chest injuries are still relatively rare in Europe – with an upwards trend. These cases are of particular interest to emergency medical services (EMS) due to available invasive treatment options like chest tube placement or resuscitative thoracotomy. To date, there is no sufficient data from Austria regarding penetrating chest trauma in a metropolitan area, and no reliable source to base decisions regarding further skill proficiency training on. MethodsFor this retrospective observational study, we screened all trauma emergency responses of the Viennese EMS between 01/2009 and 12/2017 and included all those with a National Advisory Committee for Aeronautics (NACA) score ≥ IV (= potentially life-threatening). Data were derived from EMS mission documentations and hospital files, and for those cases with the injuries leading to cardiopulmonary resuscitation (CPR), we assessed the EMS cardiac arrest registry and consulted a forensic physician. ResultsWe included 480 cases of penetrating chest injuries of NACA IV-VII (83% male, 64% > 30 years old, 74% stab wounds, 16% cuts, 8% gunshot wounds, 56% inflicted by another party, 26% self-inflicted, 18% unknown). In the study period, the incidence rose from 1.4/100,000 to 3.5/100,000 capita, and overall, about one case was treated per week. In the cases with especially severe injury patterns (= NACA V-VII, 43% of total), (tension-)pneumothorax was the most common injury (29%). The highest mortality was seen in injuries to pulmonary vessels (100%) or the heart (94%). Fifty-eight patients (12% of total) deceased, whereas in 15 cases, the forensic physician stated survival could theoretically have been possible. However, only five of these CPR patients received at least unilateral thoracostomy. Regarding all penetrating chest injuries, thoracostomy had only been performed in eight patients. ConclusionsSevere cases of penetrating chest trauma are rare in Vienna and happened about once a week between 2009 and 2017. Both incidence and case load increased over the years, and potentially life-saving invasive procedures were only reluctantly applied. Therefore, a structured educational and skill retention approach aimed at both paramedics and emergency physicians should be implemented. Trial registrationRetrospective analysis without intervention.

Intensive Care Admissions and Outcome of Cardiac Arrests; A National Cohort Study From the United States.

Outcomes of cardiac arrest among patients who had cardiopulmonary resuscitation (CPR) in intensive care units (ICU) has limited data on the national level basis in the United States. We aimed to study the outcomes of ICU CPRs. Data from the national readmissions database (NRD) sample that constitutes 49.1% of the stratified sample of all hospitals in the United States were analyzed for ICU-related hospitalizations for the years 2016 to 2019. ICU CPR was defined by procedure codes. A total of 4,610,154 ICU encounters were reported for the years 2016 to 2019 in the NRD. Of these patients, 426,729 (9.26%) had CPR procedure recorded during the hospital encounter (mean age 65 ± 17.81; female 42.4%). And 167,597 (39.29%) patients had CPR on the day of admission, of which 63.16% died; while 64,752 (15.18%) patients had CPR on the day of ICU admission, of which 72.85% died. And 36,002 (8.44%) had CPR among patients with length of stay 2 days, of which 73.34% died. A total of 1,222,799 (26.5%) admitted to ICU died, and patients who had ICU CPR had higher mortality, 291,391(68.3%). Higher complication rates were observed among ICU CPR patients, especially who died. Over the years from 2016 to 2019, ICU CPR rates increased from 8.18% (2016) to 8.66% (2019); p-trend = 0.001. The mortality rates among patients admitted to ICU increased from 22.1% (2016) to 24.1% (2019); p-trend = 0.005. The majority of ICU CPRs were done on the first day of ICU admission. The trend for ICU CPR was increasing. The mortality trend for overall ICU admissions has increased, which is concerning and would suggest further research to improve the high mortality rates in the CPR group.

Clinical characteristics of in-hospital cardiac arrest in emergency patients in Kashgar area and analysis of influencing factors on success rate of cardiopulmonary resuscitation

To analyze the clinical characteristics of patients with emergency in-hospital cardiac arrest (IHCA) in Kashgar, Xinjiang Uygur Autonomous Region and the factors affecting the success rate of cardiopulmonary resuscitation. Retrospectively selected patients who had cardiac arrest and cardiopulmonary resuscitation in the emergency department of the People's Hospital of 6 counties and cities in Kashgar area from January 2019 to January 2022. The clinical data of all patients were collected, including gender, age, major underlying diseases, the beginning and duration of resuscitation, the number of electric defibrillation acute physiology and chronic health evaluation II (APACHE II). According to whether the resuscitation was successful, all patients were divided into successful resuscitation group and failed resuscitation group. The clinical characteristics of the two groups were compared. Then, the influencing factors of the success rate of cardiopulmonary resuscitation in IHCA patients were analyzed by binary Logistic regression. A total of 1 376 patients were enrolled, including 1 117 cases of failed resuscitation and 259 cases of successful resuscitation. The success rate of resuscitation was 18.82%. Compared with the resuscitation failure group, the patients in the successful resuscitation group were younger (age: 49.10±20.99 vs. 58.44±18.32), the resuscitation start time was earlier [resuscitation start time ≤ 5 minutes: 76.45% (198/259) vs. 66.61% (744/1 117)], the proportion of cardiovascular and cerebrovascular diseases was lower [cardiovascular disease: 49.42% (128/259) vs. 58.19% (650/1 117), cerebrovascular disease: 17.37% (45/259) vs. 21.58% (241/1 117)], the number of electric defibrillation was lower [times: 0 (0, 2) vs. 1 (0, 1)], the proportion of endotracheal intubation was more [80.31% (208/259) vs. 55.60% (621/1 117)], APACHE II score was lower (13.75±8.03 vs. 17.90±4.63), and the difference was statistically significant (all P < 0.01). Binary Logistic regression analysis showed that age, start time of resuscitation, ventilation mode and APACHE II score were protective factors affecting the success rate of cardiopulmonary resuscitation in patients with emergency IHCA [age: odds ratio (OR) = 0.982, 95% confidence interval (95%CI) was 0.973-0.991, P < 0.001; resuscitation start time ≤ 5 minutes: OR = 0.629, 95%CI was 0.409-0.966, P = 0.034; tracheal intubation assisted ventilation: OR = 0.243, 95%CI was 0.149-0.397, P < 0.001; low APACHE II score: OR = 0.871, 95%CI was 0.836-0.907, P < 0.001], while underlying diseases (cardiovascular diseases) are a risk factor affecting the success rate of cardiopulmonary resuscitation (OR = 1.190, 95%CI was 1.015-1.395, P = 0.036). Age, resuscitation start time, ventilation mode, APACHE II score and major underlying diseases (cardiovascular diseases) have a greater impact on the success rate of resuscitation in IHCA patients. The above factors are conducive to improving or formulating more effective rescue strategies for IHCA patients, so as to achieve the purpose of improving the success rate of clinical treatment.

Effects of personal protective equipment on cardiopulmonary resuscitation quality and outcomes: A systematic review

BackgroundThe impact of wearing personal protective equipment (PPE) during cardiopulmonary resuscitation (CPR) on CPR quality and patient outcomes is unclear. This systematic review aimed to examine whether wearing PPE during resuscitation affects patient outcomes, CPR quality and rescuer fatigue. MethodsIn this review registered in PROSPERO (CRD42022347746), we searched Medline, EMBASE and Cochrane library between 2000 and 2022. The inclusion criteria were studies: in actual or simulated cardiac arrest; comparing PPE with no PPE; and randomised controlled trials and observational studies with a English abstract. Risk of bias was assessed using Cochrane's Risk of Bias-2 and ROBINS-I tools and outcomes assessed with GRADE. We conducted a meta-analysis according to the study design. Quantitative data synthesis was done using a random-effect model incorporating the potential heterogeneity. ResultsA total of 17 simulation-based studies and 1 clinical study were included. All outcomes were judged to be very low certainty of evidence, subject to high risk of bias. The clinical study showed no difference in survival comparing enhanced and conventional PPE. Meta-analysis of 11 RCTs and 6 observational studies found no difference in CPR quality in rescuers wearing PPE compared with no PPE. Pooled rescuer fatigue was significantly worse in the PPE group (mean difference, 2.7 VAS score out of 10; 95% CI, 1.4–4.0). ConclusionsPPE was not associated with reduced CPR quality or lower cardiac arrest survival. Rescuers wearing PPE may report more fatigue. This finding was mainly derived from simulation studies, additional clinical studies are needed.

Extracorporeal CPR after the INCEPTION trial: No one steps twice into the same river.

The use of veno-arterial extracorporeal membrane oxygenation as extracorporeal cardiopulmonary resuscitation in patients suffering out-of-hospital cardiac arrest, largely increased in the last decade despite evidence supporting this practice being limited to non-randomized studies. However, between 2020 and 2023, four randomized studies were published comparing extracorporeal cardiopulmonary resuscitation to conventional cardiopulmonary resuscitation with controversial findings that triggered great debates. In this controversy, we discuss merits and pitfalls, and provide a critical interpretation of the available evidence from randomized trials on the use of extracorporeal cardiopulmonary resuscitation, with a particular focus on the recent multi-center INCEPTION trial.

Higher mean cerebral oxygen saturation shortly after extracorporeal cardiopulmonary resuscitation in patients who regain consciousness.

In cardiac arrest, cerebral ischemia and reperfusion injury mainly determine the neurological outcome. The aim of this study was to investigate the relation between the course of cerebral oxygenation and regain of consciousness in patients treated with extracorporeal cardiopulmonary resuscitation (ECPR). We hypothesized that rapid cerebral oxygenation increase causes unfavorable outcomes. This prospective observational study was conducted in three European hospitals. We included adult ECPR patients between October 2018 and March 2020, in whom cerebral regional oxygen saturation (rSO2 ) measurements were started minutes before ECPR initiation until 3 h after. The primary outcome was regain of consciousness, defined as following commands, analyzed using binary logistic regression. The sample consisted of 26 ECPR patients (23% women, Agemean 46 years). We found no significant differences in rSO2 values at baseline (49.1% versus 49.3% for regain versus no regain of consciousness). Mean cerebral rSO2 values in the first 30 min after ECPR initiation were higher in patients who regained consciousness (38%) than in patients who did not regain consciousness (62%, odds ratio 1.23, 95% confidence interval 1.01-1.50). Higher mean cerebral rSO2 values in the first 30 min after initiation of ECPR were found in patients who regained consciousness.

The value of a machine learning algorithm to predict adverse short-term outcome during resuscitation of patients with in-hospital cardiac arrest: a retrospective study.

Background and importance Guidelines recommend that hospital emergency teams locally validate criteria for termination of cardiopulmonary resuscitation in patients with in-hospital cardiac arrest (IHCA). Objective To determine the value of a machine learning algorithm to predict failure to achieve return of spontaneous circulation (ROSC) and unfavourable functional outcome from IHCA using only data readily available at emergency team arrival. Design Retrospective cohort study. Setting and participants Adults who experienced an IHCA were attended to by the emergency team. Outcome measures and analysis Demographic and clinical data typically available at the arrival of the emergency team were extracted from the institutional IHCA database. In addition, outcome data including the Cerebral Performance Category (CPC) score count at hospital discharge were collected. A model selection procedure for random forests with a hyperparameter search was employed to develop two classification algorithms to predict failure to achieve ROSC and unfavourable (CPC 3-5) functional outcomes. Main results Six hundred thirty patients were included, of which 390 failed to achieve ROSC (61.9%). The final classification model to predict failure to achieve ROSC had an area under the receiver operating characteristic curve of 0.9 [95% confidence interval (CI), 0.89-0.9], a balanced accuracy of 0.77 (95% CI, 0.75-0.79), an F1-score of 0.78 (95% CI, 0.76-0.79), a positive predictive value of 0.88 (0.86-0.91), a negative predictive value of 0.61 (0.6-0.63), a sensitivity of 0.69 (0.66-0.72), and a specificity of 0.84 (0.8-0.88). Five hundred fifty-nine subjects experienced an unfavourable outcome (88.7%). The final classification model to predict unfavourable functional outcomes from IHCA at hospital discharge had an area under the receiver operating characteristic curve of 0.93 (95% CI, 0.92-0.93), a balanced accuracy of 0.59 (95% CI, 0.57-0.61), an F1-score of 0.94 (95% CI, 0.94-0.95), a positive predictive value of 0.91 (0.9-0.91), a negative predictive value of 0.57 (0.48-0.66), a sensitivity of 0.98 (0.97-0.99), and a specificity of 0.2 (0.16-0.24). Conclusion Using data readily available at emergency team arrival, machine learning algorithms had a high predictive power to forecast failure to achieve ROSC and unfavourable functional outcomes from IHCA while cardiopulmonary resuscitation was still ongoing; however, the positive predictive value of both models was not high enough to allow for early termination of resuscitation efforts.

The Effectiveness of Cardiopulmonary Resuscitation (CPR) Training of patients with covid- 19 Using the Flipped Classroom and the Jigsaw Method on the Level of Nursing Students` Knowledge of Bushehr University of Medical Sciences

Introduction:The nature of education in universities of medical sciences is such that teaching in these universities is a matter of peculiar importance. Therefore, revision of traditional teaching methods and usage of contemporary, effective and student- oriented methods is inevitable and also acceptable by educational systems. Therefore, the present study was conducted with the aim of the Effectiveness of Cardiopulmonary Resuscitation (CPR) Training of patients with covid- 19 Using the Flipped Classroom and the Jigsaw Method on the Level of Nursing Students Knowledge of Bushehr University of Medical Sciences. Method:This two- group semi-experimental study with a pre- test- post- test design was conducted on 41 7th semester undergraduate nursing students in the topic of cardiopulmonary resuscitation of covid- 19 patients. Students were randomly divided into two groups: jigsaw (20 people) and flipped classroom (21 people). After teaching the topic in the above two methods, the knowledge of cardiopulmonary resuscitation of the two groups was measured with researcher- made questionnaire. Data were analyzed using mean, standard deviation, independent and paired t- tests with a significance level of 0.05 through SPSS. Findings: The results showed that the knowledge score of both groups increased significantly (P &lt; 0.001) after the intervention, so that the average score of cardiopulmonary resuscitation knowledge in the flipped class from 13.62 ± 3.56 before the intervention has increased to 20.71 ± 5.41 after the intervention and also in the jigsaw class, from 14.65 ± 3.17before the intervention, has increased to 26.20 ± 2.63 after the intervention. The comparison of the average changes of these two active educational methods showed that in the jigsaw class group, the average increase in knowledge score is higher than the flipped class, which is statistically significant (P&lt;0.001). Conclusion: Overall, the results of this study show that the flipped classroom and the jigsaw teaching methods can improve and enrich nursing student's knowledge about cardiopulmonary resuscitation in patients with COVID- 19. it is recommended that nursing instructors use these methods, especially the jigsaw method, which in this study improved the learning of nursing students, in teaching students more.

Did lockdown influence bystanders’ willingness to perform cardiopulmonary resuscitation? A worldwide registry-based perspective

AimBystander cardiopulmonary resuscitation (CPR) significantly increases the survival rate after out-of-hospital cardiac arrest. Using population-based registries, we investigated the impact of lockdown due to Covid-19 on the provision of bystander CPR, taking background changes over time into consideration. MethodsUsing a registry network, we invited all registries capable of delivering data from 1. January 2017 to 31. December 2020 to participate in this study. We used negative binominal regression for the analysis of the overall results. We also calculated the rates for bystander CPR. For every participating registry, we analysed the incidence per 100000 inhabitants of bystander CPR and EMS-treated patients using Poisson regression, including time trends. ResultsTwenty-six established OHCA registries reported 742 923 cardiac arrest patients over a four-year period covering 1.3 billion person-years. We found large variations in the reported incidence between and within continents. There was an increase in the incidence of bystander CPR of almost 5% per year. The lockdown in March/April 2020 did not impact this trend. The increase in the rate of bystander CPR was also seen when analysing data on a continental level. We found large variations in incidence of bystander CPR before and after lockdown when analysing data on a registry level. ConclusionThere was a steady increase in bystander CPR from 2017 to 2020, not associated with an increase in the number of ambulance-treated cardiac arrest patients. We did not find an association between lockdown and bystanders’ willingness to start CPR before ambulance arrival, but we found inconsistent patterns of changes between registries.

Heparin Loading Dose in Patients Undergoing Extracorporeal Cardiopulmonary Resuscitation

To study the differences in hemorrhagic and embolic complications among extracorporeal cardiopulmonary resuscitation (ECPR) patients who received and did not receive a loading dose of heparin. This study is a controlled before-after monocentric retrospective study. The emergency department of the Aerospace Center Hospital (ASCH). The authors studied a total of 28 patients who, after a cardiac arrest, underwent ECPR in the emergency department of the ASCH from January 2018 to May 2022. The authors compared the hemorrhagic and embolic complications and prognosis of the 2 groups based on whether they received a loading dose of heparin anticoagulation therapy before catheterization (a loading-dose group and a non-loading dose- group). There were 12 patients in the loading-dose group and 16 in the nonloading-dose group. There was no statistically significant difference in age, sex, underlying diseases, causes of cardiac arrest, and hypoperfusion time between the 2 groups. The incidence of hemorrhagic complications was 75% in the loading-dose group and 67.5% in the nonloading-dose group. The difference between the 2 groups was not statistically significant (p > 0.05). The incidence of life-threatening massive hemorrhage in the loading-dose group was 50%, and in the nonloading-dose group, it was 12.5%. The difference between the 2 groups was statistically significant (p=0.03). The incidence of embolic complications in the loading-dose group and nonloading-dose group was 8.3% and 12.5%, respectively, and the difference between the 2 groups was not statistically significant (p > 0.05). The survival rates of the 2 groups were 8.3% v 18.8%, respectively, and the difference between the 2 groups was not statistically significant (p > 0.05). In conclusion, in the authors' study of patients undergoing ECPR, administering a loading dose of heparin was associated with an increased risk of early fatal hemorrhage. However, stopping this loading dose did not raise the risk of embolic complications. It also did not lower the risk of total hemorrhage and transfusion.

Penilaian Kualitas Hidup Pasien Post CPR : Studi Literatur

Improving the quality of life of post-CPR (Cardiopulmonary resuscitation) patients can be judged from the results of the outcomes, namely the return of spontaneous circulation and the success of being discharged from the hospital. The research method stirred up the literature review using the Joana Briggs Institute's exclusionary criteria. Five databases with high and medium-quality standards, namely Springer Link, Science Direct, Plos One, Pubmed, and Proquest for the 2017-2022 article, were selected by Prisma 2020 flow chart for systematic review. A total of 10 articles were established in the study. The factor that improves patients' quality of life after CPR is the results of the patient's neurological quality assessment; the better the results of the patient's neurological quality assessment, the more life expectancy by more than five years. Through the results of this literature review, it is hoped that there will be an increase in attention to cardiac arrest patients, not only assessing the success of post-CPR but also must continue to be controlled using instruments, namely ROSC, STD, SF-12, GOS, temperature management, CPC SCORE, GO-FAR SCORE, Blood PH, PCO2, HCO3 to improve the quality of life of post-CPR patients.

Reanimação cardiopulmonar em posição prona: uma revisão sistemática de séries/relatos de casos

Abstract Introduction The prone position is frequently adopted for surgical or critically ill patients in intensive care. Cardiorespiratory arrest in these patients may pose an operational challenge, in which delays resulting from mobilization to the supine position culminate in worse outcomes. Objective To provide clinical insight based on the synthesis of evidence from reports or case series on reverse cardiopulmonary resuscitation (reverse CPR) in surgical patients or invasive ventilatory support in severe acute respiratory distress syndrome. Methods This is a systematic review of reports or case series in PubMed, Scopus, Embase, and Google Scholar databases, in addition to a search of the gray literature. Case reports published in any language, reporting at least one case of prone cardiopulmonary resuscitation in patients of any age and in any care context, were considered eligible. Results Thirteen studies of fourteen cases of successful reverse resuscitation were retrieved. Three patients died within 30 days, while the others survived without complications or neurological sequelae. Conclusion Despite limited evidence to support clinical decision-making, prone resuscitation appears to be a feasible alternative in exceptional circumstances, where patient mobilization may result in additional harm, delay or interrupt advanced life support (compressions, high-quality early chest surgery, and defibrillation) or incur occupational risks to the health team.

The Aassociation between Pre-Cardiac Arrest Comorbidity and Unsuccessful Cardiopulmonary Resuscitation in Patients with Cardiac Arrest

The Aassociation between Pre-Cardiac Arrest Comorbidity and Unsuccessful Cardiopulmonary Resuscitation in Patients with Cardiac Arrest

Knowledge of Pharmacists about Cardiopulmonary Resuscitation Medications in Saudi Arabia

International Journal of Pharmacology and Clinical Sciences,2022,11,3,82-91.DOI:10.5530/ijpcs.2022.11.15Published:December 2022Type:Research Article Authors:Yousef Ahmed Alomi, Rola AL Kenani, Samah Mukhlef Alzaid, Wafa Hussain Alshehre, and Khawlah Ibrahim Alshahrani Author(s) affiliations:Yousef Ahmed Alomi*, BSc. Pharm, MSc. Clin Pharm, BCPS, BCNSP, DiBA, CDE, Critical care clinical pharmacists TPN clinical pharmacist Freelancer Business Planner, Content Editor, and Data Analyst,Riyadh, SAUDI ARABIA. Rola AL Kenani, BSc. Pharm, SSC-PhP, Nephrology Pharmacotherapy Specialist, Riyadh, SAUDI ARABIA Samah Mukhlef Alzaid, Bsc.Pharm, Clin. Pharm, Clinical Pharmacy Services, Gurayat General Hospital, Ministry of Health, Gurayat, SAUDI ARABIA Wafa Hussain Alshehre, Pharm.D, BCSP, Drug information clinical pharmacy specialist, Pharmacy Department, Aliman Hospital, Ministry of Health, Riyadh, SAUDI ARABIA. Khawlah Ibrahim Alshahrani, Pharm D, College of Pharmacy, Taif University, Taif, SAUDI ARABIA. Abstract:Objectives: To illustrate the knowledge of pharmacists about CPR medications services in Saudi Arabia. Materials and Methods: The study analyzed a cross-sectional survey that discussed pharmacist’s knowledge of Cardiopulmonary Resuscitation (CPR) medications in Saudi Arabia. The survey consisted of respondents’ demographic information about pharmacists and Cardiopulmonary Resuscitation (CPR) drugs, assessment of primary and advanced knowledge, and the resources used for Cardiopulmonary Resuscitation (CPR) medications. The 5-point Likert response scale system was used with closed-ended questions. The survey was validated through the revision of expert reviewers and pilot testing. Besides, various tests of the reliability of McDonald’s ω, Cronbach alpha, Gutmann’s λ2, and Gutmann’s λ6 were carried out with the study. The data analysis of the Pharmacist practice of Cardiopulmonary Resuscitation (CPR) medications is done through the survey monkey system. Besides, the statistical package of social sciences (SPSS), Jeffery’s Amazing Statistics Program (JASP), and Microsoft Excel sheet version 16 were implemented. Results: A total number of 439 pharmacists responded to the questionnaire. Of them, more than onethird responded from the Central region (122 (31.69%)), one Quarter responded from the Eastern region (91 (23.64%)), and one-fifth responded from the southern part (79 (20.52%)). Males responded more than females (203 (53.14%)) versus 179 (46.86%)), with statistically non-significant differences between all levels (p=0.219). Most of the responders were in the age group of 36-45 years (152 (39.48%)) and 46-55 years (134 (34.81%)), with statistically significant differences between all age groups (p=0.000). The majority of pharmacists had training courses in Basic Life Support (BLS) (293 ((77.11%)), Advance Cardiac Life Support (ACLS) (289 ((76.05%)), Pediatric Cardiac Life Support (PCLS) (287((75.53%)), and Neonatal Cardiac Life Support (NCLS) (203 ((53.42%)), with statistically significant differences between all levels (p=0.000). The average score of basic knowledge of pharmacists about Cardiopulmonary Resuscitation (CPR) medications was (1.67). The element “know how to prepare and dispense ACLS medications list” obtained the highest score (2.04). The aspect “there is an official standardized NCLS medications list” (1.94), and The element “there is an official standardized PCLS medications list” (1.93). The average score of advanced knowledge of pharmacists about Cardiopulmonary Resuscitation (CPR) medications was (1.86). The element “know the compatibility of ACLS medications” obtained the highest score (2.31). The aspect “know the drug - interactions with NCLS medications” (2.27), and The element “know the drug - interactions with PCLS medications” (2.17). The resources used most about the CPR medications were Medical association literature/guidelines/recommendations 307 (76.56%), Peer discussions 298 (74.31%), and Scientific literature 293 (73.07%). Conclusion: The pharmacists’ knowledge of CPR medication was inappropriate. Therefore, undergraduate education and training of CPR medication is high recommended. Besides, involvement training for postgraduate studies is required to improve pharmacy staff knowledge of CPR services and patient outcomes in Saudi Arabia. Keywords:Cardiopulmonary Resuscitation, Knowledge, Medications, PharmacistsView:PDF (346.17 KB) PDFClick here to download the PDF file. Images Knowledge of Pharmacists about Cardiopulmonary Resuscitation Medications in Saudi Arabia

Abstract 180: Impact Of Hot Debriefing Programs On Pediatric Cardiopulmonary Resuscitation Quality And Outcomes

Introduction: Successful cardiopulmonary resuscitation (CPR) outcomes rely on AHA guideline compliant chest compressions (CC). Resuscitation teams struggle to achieve these CPR metrics. Cold debriefing has led to higher quality CPR and improved patient outcomes. The impact of hot debriefing (HD) on CPR quality and patient outcomes is unknown. We sought to evaluate the association of HD on CPR quality and patient outcomes. Methods: Retrospective cohort of in-hospital cardiac arrests (IHCA), 0 to 18yo with complete quantitative CC metrics in the pediRES-Q database (1/2018 - 3/2021). We investigated exposure to HD, defined as hospital HD rate &gt;50% in the 12 months prior to the CPR event, with AHA compliant CPR (CC fraction (CCF) ≥0.80, CC rate (CCR) 100-120/min, and CC depth (CCD) &lt;1yo ≥3.4 cm, 1-8yo ≥4.4 cm, &gt;8yo 4.5≥6.6 cm). HD vs. non-HD events by CPR quality were compared via Chi-square or Wilcoxon rank sum tests and stratified by age. For index events, we evaluated return of circulation (ROC), survival to hospital discharge (SHD) and favorable neurologic outcome (Pediatric Cerebral Performance Category score of 1, 2, or no change from baseline). Multivariable logistic regressions with a Generalized Estimating Equation method, adjusted for age group, arrest duration, initial rhythm, illness category, and site clustering. Results: We evaluated 515 IHCA events stratified by HD exposure (221 w and 294 wo) and age. Across age ranges, there was no difference in CCD or CCF between groups. Median CCR was lower in HD exposure groups: &lt;1yo, 110 vs 117 (p &lt;0.001), 1-8yo, 110 vs 117 (p &lt;0.001) and 8-&lt;18yo, 110 vs 115 (p =0.003). There was no difference in compliance with a composite of CCF + CCR + CCD. The composite CCR + CCF had increased compliance in the HD exposure groups: &lt;1yo, 37% (34 of 92) vs 21% (21 of 102) (p = 0.02), 1-8yo, 38% (27 of 72) vs 23% (26 of 111) (p = 0.05) and 8-&lt;18yo, 42% (24 of 57) vs 25% (20 of 81) (p = 0.04). To assess patient outcomes, we evaluated 917 index arrests (255 w HD exposure and 662 wo). On multivariable analysis, no significant difference was found for ROC, SHD or favorable neurologic outcome by HD exposure. Conclusion: Pediatric IHCA events with HD exposure demonstrated improved CPR metrics for CCR and CCF. No association was identified for patient level outcomes.

Abstract 9761: Risk Factors for Cardiopulmonary Resuscitation Among Acute Ischemic Stroke Admissions in the United States; An Overview From the National Inpatient Sample

Introduction: Recent studies have shown an improvement in survival among Cardiopulmonary resuscitation (CPR) cases in several situations. However, risk factors of CPR among patients admitted for Acute Ischemic Stroke (AIS) remain uncertain. Methods: Our analysis used the most extensive US inpatient database, the 2019 National Inpatient Sample, to identify patients diagnosed with CPR among adults of ages 40 and more admitted with a principal diagnosis of AIS. We also queried the different cardiac arrhythmias seen in these patients. Multivariable analysis was used to find the adjusted odds ratio(aOR) of requiring cardiopulmonary resuscitation. Results: Our study found 1425 AIS patients requiring cardiopulmonary resuscitation, which was also more common in patients of ages 40-60 (aOR 1.168), diabetics (aOR 1.160), with heart failure (aOR 1.130), hypotension (aOR 1.932), hepatic failure (aOR 3.317), renal failure (aOR 1.856), respiratory failure (aOR 18.223), gastrointestinal hemorrhage (aOR 1.960), hyperkalemia (aOR 2.258), and hypokalemia (aOR 1.265). Smokers (aOR 0.663), Females (aOR 0.878), and those with hyperlipidemia (aOR 0.689) were less likely to need CPR. Several cardiac arrhythmias were noted among those who needed CPR, such as supraventricular tachycardia (6.0% vs. 1.4%), and ventricular tachycardia (19.6% vs. 1.6%), paroxysmal atrial fibrillation (11.9% vs. 9.7%), and ventricular fibrillation (13.3% vs. 0.1%). Finally, CPR patients were slightly younger (mean age 69.82 vs. 70.89) with a longer (mean length of stay 11.48 vs. 5.01 days) hospitalization. A higher mortality rate was also found as 1030 patients died (72.3% vs. 3.6%). Conclusions: We observed several significant potential risk factors for CPR among AIS patients. Further studies, strategies, and changes in protocols among AIS admissions may benefit the long-term prognosis.

Arterial oxygen and carbon dioxide tension and acute brain injury in extracorporeal cardiopulmonary resuscitation patients: Analysis of the extracorporeal life support organization registry

Acute brain injury (ABI) remains common after extracorporeal cardiopulmonary resuscitation (ECPR). Using a large international multicenter cohort, we investigated the impact of peri-cannulation arterial oxygen (PaO2) and carbon dioxide (PaCO2) on ABI occurrence. We retrospectively analyzed adult (≥18 years old) ECPR patients in the Extracorporeal Life Support Organization registry from 1/2009 through 12/2020. Composite ABI included ischemic stroke, intracranial hemorrhage (ICH), seizures, and brain death. The registry collects 2 blood gas data pre- (6 hours) and post- (24 hours) cannulation. Blood gas parameters were classified as: hypoxia (<60mm Hg), normoxia (60-119mm Hg), and mild (120-199mm Hg), moderate (200-299mm Hg), and severe hyperoxia (≥300mm Hg); hypocarbia (<35mm Hg), normocarbia (35-44mm Hg), mild (45-54mm Hg) and severe hypercarbia (≥55mm Hg). Missing values were handled using multiple imputation. Multivariable logistic regression analysis was used to assess the relationship of PaO2 and PaCO2 with ABI. Of 3,125 patients with ECPR intervention (median age=58, 69% male), 488 (16%) experienced ABI (7% ischemic stroke; 3% ICH). In multivariable analysis, on-ECMO moderate (aOR=1.42, 95%CI: 1.02-1.97) and severe hyperoxia (aOR=1.59, 95%CI: 1.20-2.10) were associated with composite ABI. Additionally, severe hyperoxia was associated with ischemic stroke (aOR=1.63, 95%CI: 1.11-2.40), ICH (aOR=1.92, 95%CI: 1.08-3.40), and in-hospital mortality (aOR=1.58, 95%CI: 1.21-2.06). Mild hypercarbia pre-ECMO was protective of composite ABI (aOR=0.61, 95%CI: 0.44-0.84) and ischemic stroke (aOR=0.56, 95%CI: 0.35-0.89). Early severe hyperoxia (≥300mm Hg) on ECMO was a significant risk factor for ABI and mortality. Careful consideration should be given in early oxygen delivery in ECPR patients who are at risk of reperfusion injury.

Long-Term Survival and Quality of Life in Non-Surgical Adult Patients Supported with Veno-Arterial Extracorporeal Oxygenation.

The use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) for hemodynamic support is on the rise. Not much is known about the impact of extracorporeal membrane oxygenation (ECMO) and its complications on long-term survival and quality of life. In this single-center, cross-sectional study, we evaluated the survival and quality of life in patients treated with VA ECMO between May 2009 and July 2019. Follow-up was conducted between November 2019 and January 2020. Overall, 118 patients were evaluated in this study. Of the 37 patients who were alive at hospital discharge, 32 answered the EuroQol-5 dimensional-5-level questionnaire (EQ-5D-5L). For patients discharged alive from the hospital, mean survival was 8.1 years, 8.4 years for cardiogenic shock, and 5.0 years for patients with refractory cardiac arrest. EQ-5D-5L index value of ECMO survivors was not significantly different from the general age-matched population. Neurologic complications and major bleeding during index hospitalization limit long-term quality of life. Patients treated with VA ECMO have high in-hospital mortality, with extracorporeal membrane oxygenation cardio-pulmonary resuscitation patients being at higher risk of early death. However, once discharged from the hospital, most patients remain alive with a reasonable quality of life.

Resuscitative endovascular occlusion of the aorta (REBOA) as a mechanical method for increasing the coronary perfusion pressure in non-traumatic out-of-hospital cardiac arrest patients

Aim of the studyResuscitative endovascular balloon occlusion of the aorta (REBOA), originally designed to block blood flow to the distal part of the aorta by placing a balloon in trauma patients, has recently been shown to increase coronary perfusion in cardiac arrest patients. This study evaluated the effect of REBOA on aortic pressure and coronary perfusion pressure (CPP) in non-traumatic out of-hospital cardiac arrest (OHCA) patients. MethodsAdult OHCA patients with cerebral performance category 1 or 2 prior to cardiac arrest, and without evidence of aortic disease, were enrolled from January to December 2021. Aortic pressure and right atrial pressure were measured before and after balloon occlusion. The CPP was calculated using the measured aortic and right atrial pressures, and the values before and after the balloon occlusion were compared. ResultsFifteen non-traumatic OHCA patients were enrolled in the study. The median call to balloon time was 46.0 (IQR, 38.0–54.5) min. The median CPP before and after balloon occlusion was 13.5 (IQR, 5.8–25.0) and 25.2 (IQR, 12.0–44.6) mmHg, respectively (P = 0.001). The median increase in the estimated CPP after balloon occlusion was 86.7%. ConclusionsThe results of this study suggest that REBOA may increase the CPP during cardiopulmonary resuscitation in patients with non-traumatic OHCA. Additional studies are needed to investigate the effect on clinical outcomes.

Outcomes and Characteristics of Patients with Intraprocedural Cardiopulmonary Resuscitation during TAVR.

Transcatheter aortic valve replacement (TAVR) has become an established alternative to surgical aortic valve replacement (AVR) for higher risk patients. Periprocedural TAVR complications decreased with a growing expertise of implanters. Yet, TAVR can be accompanied by life-threatening adverse events such as intraprocedural cardiopulmonary resuscitation (CPR). This study retrospectively analyzed predictors and outcomes in a cohort of patients from a high-volume center undergoing periprocedural CPR during TAVR. A total of 729 patients undergoing TAVR, including 59 with intraprocedural CPR, were analyzed with respect to peri- and postprocedural outcomes. Patients undergoing CPR showed a significantly lower left ventricular ejection fraction (LVEF) and lower baseline transvalvular mean and peak pressure gradients. The systolic blood pressure measured directly preoperatively was significantly lower in the CPR cohort. CPR patients were in a higher need for intraprocedural defibrillation, heart-lung circulatory support, and conversion to open heart surgery. Further, they showed a higher incidence of atrioventricular block grade III , valve malpositioning, and pericardial tamponade. The in-hospital mortality was significantly higher after intraprocedural CPR, accompanied by a higher incidence of disabling stroke, new pacemaker implantation, more red blood cell transfusion, and longer stay in intensive care unit. Impaired preoperative LVEF and instable hemodynamics before valve deployment are independent risk factors for CPR and are associated with compromised outcomes. Heart rhythm disturbances, malpositioning of the prosthesis, and pericardial tamponade are main causes of the high mortality of 17% reported in the CPR group. Nevertheless, mechanical circulatory support and conversion to open heart surgery reduce mortality rates of CPR patients.