Duration Of Cardiopulmonary Resuscitation Research Articles

Explorative study on lower inflection point dynamics during cardiopulmonary resuscitation: Potential implications for airway management

IntroductionIn patients undergoing cardiopulmonary resuscitation (CPR) after an Out-of-Hospital Cardiac Arrest (OHCA), intrathoracic airway closure can impede ventilation, adversely affecting patient outcomes. This explorative study investigates the evolution of intrathoracic airway closure by analyzing the lower inflection point (LIP) during the inspiration phase of CPR, aiming to identify the potential thresholds for alveolar recruitment. Methods and materialsEleven OHCA patients undergoing CPR with endotracheal intubation and manual bag ventilation were included. Flow and pressure measurements were obtained using Sensirion SFM3200AW and Wika CPT2500 sensors attached to the endotracheal tube, connected to a Surface Go Tablet for data collection. Flow data was analyzed in Microsoft Excel, while pressure data was processed using the Wika USBsoft2500 application. Analysis focused on the inspiration phase of the first 6–8 breaths, with an additional 2 breaths recorded and analyzed at the end of CPR. ResultsAcross the cohort, the median tidal volume was 870.00 ml (mL), average flow was 31.90 standard liters per minute (slm), and average pressure was 17.21 cmH2O. The calculated average LIP was 31.47 cmH2O. Most cases (72.7%) exhibited a negative trajectory in LIP evolution during CPR, with 2 cases (18.2%) showing a positive trajectory and 1 case remaining inconclusive. The average LIP in the first 8 breaths was significantly higher than in the last 2 breaths (p = 0.018). No significant correlation was found between average LIP and return of spontaneous circulation (ROSC), compression depth, frequency, or end-tidal CO2 (EtCO2). However, a significant negative correlation was observed between the average LIP of the last 2 breaths and CPR duration (p = 0.023). Validation: LIP calculation in low-flow ventilations using the novel mathematical method yielded values consistent with those reported in the literature. Discussion/conclusionThese explorative data demonstrate a predominantly negative trajectory in LIP evolution during CPR, suggesting potential challenges in maintaining airway patency. Limitations include a small sample size and sensor recording issues. Further research is warranted to explore the evolution of LIP and its implications for personalized ventilation strategies in CPR.

Development and validation of a clinico-biological score to predict outcomes in patients with drowning-associated cardiac arrest

BackgroundWhile several scoring systems have been developed to predict short-term outcome in out-of-hospital cardiac arrest patients, there is currently no dedicated prognostic tool for drowning-associated cardiac arrest (DACA) patients. MethodsPatients experiencing DACA from two retrospective multicenter cohorts of drowning patients were included in the present study. Among the patients from the development cohort, risk-factors for day-28 mortality were assessed by logistic regression. A prediction score was conceived and assessed in patients from the validation cohort. ResultsAmong the 103 included patients from the development cohort, the day-28 mortality rate reached 51% (53/103). Identified independent early risk-factors for day-28 mortality included cardiopulmonary resuscitation duration longer than 20 min (OR 6.40 [95% CI 1.88–23.32]; p = 0.003), temperature at Intensive Care Unit admission <34 °C (OR 8.84 [95% CI 2.66–32.92]; p < 0.001), need for invasive mechanical ventilation (OR 6.83 [95% CI 1.47–40.87]; p = 0.02) and lactate concentration > 7 mmol/L (OR 3.56 [95% CI 1.01–13.07]; p = 0.04). The Area Under the ROC Curve (AUC) of the developed score based on those variables reached 0.91 (95% CI, 0.86–0.97). The optimal cut-off for predicting poor outcomes was 4 points with a sensitivity of 92% (95% CI, 82–98%), a specificity of 82% (95% CI, 67–91%), a positive predictive value (PPV) of 84% (95% CI, 72–95%) and a negative predictive value (NPV) of 91% (95% CI, 79–96%). The assessment of this score on the validation cohort of 81 patients exhibited an AUC of 0.82. Using the same 4 points threshold, sensitivity, specificity, PPV and NPV values of the validation cohort were: 81%, 67%, 72% and 77%, respectively. ConclusionIn patients suffering from drowning induced initial cardiac arrest admitted to ICU with a DACA score ≥ 4, the likelihood of survival at day-28 is significantly lower. Prospective validation of the DACA score and assessment of its usefulness are warranted in the future.

Duration of cardiopulmonary resuscitation and outcomes for adults with in-hospital cardiac arrest: retrospective cohort study.

Duration of cardiopulmonary resuscitation and outcomes for adults with in-hospital cardiac arrest: retrospective cohort study.

What factors are effective on the CPR duration of patients under extracorporeal cardiopulmonary resuscitation: a single-center retrospective study

BackgroundExtracorporeal cardiopulmonary resuscitation (ECPR) is an alternative method for patients with reversible causes of cardiac arrest (CA) after conventional cardiopulmonary resuscitation (CCPR). However, cardiopulmonary resuscitation (CPR) duration during ECPR can vary due to multiple factors. Healthcare providers need to understand these factors to optimize the resuscitation process and improve outcomes. The aim of this study was to examine the different variables impacting the duration of CPR in patients undergoing ECPR.MethodsThis retrospective, single-center, observational study was conducted on adult patients who underwent ECPR due to in-hospital CA (IHCA) or out-of-hospital CA (OHCA) at Hamad General Hospital (HGH), the tertiary governmental hospital of Qatar, between February 2016 and March 2020. Univariate and multivariate binary logistic regression analyses were performed to identify the prognostic factors associated with CPR duration, including demographic and clinical variables, as well as laboratory tests.ResultsThe mean ± standard division age of the 48 participants who underwent ECPR was 41.50 ± 13.15 years, and 75% being male. OHCA and IHCA were reported in 77.1% and 22.9% of the cases, respectively. The multivariate analysis revealed that several factors were significantly associated with an increased CPR duration: higher age (OR: 1.981, 95%CI: 1.021–3.364, P = 0.025), SOFA score (OR: 3.389, 95%CI: 1.289–4.911, P = 0.013), presence of comorbidities (OR: 3.715, 95%CI: 1.907–5.219, P = 0.026), OHCA (OR: 3.715, 95%CI: 1.907–5.219, P = 0.026), and prolonged collapse-to-CPR time (OR: 1.446, 95%CI:1.092–3.014, P = 0.001). Additionally, the study found that the initial shockable rhythm was inversely associated with the duration of CPR (OR: 0.271, 95%CI: 0.161–0.922, P = 0.045). However, no significant associations were found between laboratory tests and CPR duration.ConclusionThese findings suggest that age, SOFA score, comorbidities, OHCA, collapse-to-CPR time, and initial shockable rhythm are important factors influencing the duration of CPR in patients undergoing ECPR. Understanding these factors can help healthcare providers better predict and manage CPR duration, potentially improving patient outcomes. Further research is warranted to validate these findings and explore additional factors that may impact CPR duration in this population.

Eastern Association for the Surgery of Trauma (EAST) vs Western Trauma Association (WTA): How a Level 1 Trauma Center Splits the Difference in Resuscitative Thoracotomy.

Background Resuscitative thoracotomy (RT) is performed in severe trauma cases as a final lifesaving effort. Prominent, yet differing, practice management guidelines exist from Eastern Association for the Surgery of Trauma (EAST) and Western Trauma Association (WTA). This study evaluates all RTs performed from 2012 to 2019 at an urban Level 1 trauma center for management guideline indication and subsequent outcomes. Methods Our trauma registry was queried to identify RT cases from 2012 to 2019. Data was collected on patient demographics, prehospital presentation, cardiopulmonary resuscitation (CPR) requirements, and resuscitation provided. Survival to the operating room, intensive care unit, and overall were recorded. Information was compared with regard to EAST and WTA criteria. Results Eighty-seven patients who underwent RTs were included. WTA guidelines were met in 78/87 (89.7%) of cases, comparatively EAST guidelines were met in every case. Within the EAST criteria, conditional and strong recommendations were met in 70/87 (80.4%) and 17/87 (19.5%) of cases, respectively. In nine cases (10.3%) indications were discordant, each meeting conditional indication by EAST and no indication by WTA. All patients that survived to the operating room (OR), ICU admission, and overall met EAST criteria. Conclusion All RTs performed at our Level 1 trauma center met indications provided by EAST criteria. WTA guidelines were not applicable in nine salvaging encounters due to the protracted duration of CPR before proceeding to RT. Furthermore, more patients that survived to OR and ICU admission met EAST guidelines suggesting an improved potential for patient survivability. As increased data is derived, management guidelines will likely be re-established for optimized patient outcomes.

Risk factors for neurological disability outcomes in patients under extracorporeal membrane oxygenation following cardiac arrest: An observational study

ObjectivesThis study aimed to identify factors associated with neurological and disability outcomes in patients who underwent ECMO following cardiac arrest. MethodsThis retrospective, single-center, observational study included adult patients who received ECMO treatment for in-hospital cardiac arrest (IHCA) or out-of-hospital cardiac arrest (OHCA) between February 2016 and March 2020. Factors associated with neurological and disability outcomes in these patients who underwent ECMO were assessed. SettingHamad General Hospital, Qatar. Main outcome measuresNeurological disability outcomes were assessed using the Modified Rankin Scale (mRS) and the Cerebral Performance Category (CPC) scale. ResultsAmong the 48 patients included, 37 (77 %) experienced OHCA, and 11 (23 %) had IHCA. The 28-day survival rate was 14 (29.2 %). Of the survivors, 9 (64.3 %) achieved a good neurological outcome, while 5 (35.7 %) experienced poor neurological outcomes. Regarding disability, 5 (35.7 %) of survivors had no disability, while 9 (64.3 %) had some form of disability. The results showed significantly shorter median time intervals in minutes, including collapse to cardiopulmonary resuscitation (CPR) (3 vs. 6, P = 0.001), CPR duration (12 vs. 35, P = 0.001), CPR to extracorporeal cardiopulmonary resuscitation (ECPR) (20 vs. 40, P = 0.001), and collapse-to-ECPR (23 vs. 45, P = 0.001), in the good outcome group compared to the poor outcome group. ConclusionThis study emphasizes the importance of minimizing the time between collapse and CPR/ECMO initiation to improve neurological outcomes and reduce disability in cardiac arrest patients. However, no significant associations were found between outcomes and other demographic or clinical variables in this study. Further research with a larger sample size is needed to validate these findings. Implications for clinical practiceThe study underscores the significance of reducing the time between collapse and the initiation of CPR and ECMO. Shorter time intervals were associated with improved neurological outcomes and reduced disability in cardiac arrest patients.

Prognostic effects of cardiopulmonary resuscitation (CPR) start time and the interval between CPR to extracorporeal cardiopulmonary resuscitation (ECPR) on patient outcomes under extracorporeal membrane oxygenation (ECMO): a single-center, retrospective observational study

BackgroundThe impact of the chronological sequence of events, including cardiac arrest (CA), initial cardiopulmonary resuscitation (CPR), return of spontaneous circulation (ROSC), and extracorporeal cardiopulmonary resuscitation (ECPR) implementation, on clinical outcomes in patients with both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA), is still not clear. The aim of this study was to investigate the prognostic effects of the time interval from collapse to start of CPR (no-flow time, NFT) and the time interval from start of CPR to implementation of ECPR (low-flow time, LFT) on patient outcomes under Extracorporeal Membrane Oxygenation (ECMO).MethodsThis single-center, retrospective observational study was conducted on 48 patients with OHCA or IHCA who underwent ECMO at Hamad General Hospital (HGH), the tertiary governmental hospital of Qatar, between February 2016 and March 2020. We investigated the impact of prognostic factors such as NFT and LFT on various clinical outcomes following cardiac arrest, including 24-hour survival, 28-day survival, CPR duration, ECMO length of stay (LOS), ICU LOS, hospital LOS, disability (assessed using the modified Rankin Scale, mRS), and neurological status (evaluated based on the Cerebral Performance Category, CPC) at 28 days after the CA.ResultsThe results of the adjusted logistic regression analysis showed that a longer NFT was associated with unfavorable clinical outcomes. These outcomes included longer CPR duration (OR: 1.779, 95%CI: 1.218–2.605, P = 0.034) and decreased survival rates for ECMO at 24 h (OR: 0.561, 95%CI: 0.183–0.903, P = 0.009) and 28 days (OR: 0.498, 95%CI: 0.106–0.802, P = 0.011). Additionally, a longer LFT was found to be associated only with a higher probability of prolonged CPR (OR: 1.818, 95%CI: 1.332–3.312, P = 0.006). However, there was no statistically significant connection between either the NFT or the LFT and the improvement of disability or neurologically favorable survival after 28 days of cardiac arrest.ConclusionsBased on our findings, it has been determined that the NFT is a more effective predictor than the LFT in assessing clinical outcomes for patients with OHCA or IHCA who underwent ECMO. This understanding of their distinct predictive abilities enables medical professionals to identify high-risk patients more accurately and customize their interventions accordingly.

Extracorporeal Versus Conventional Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest: A Propensity Score Matching Cohort Study.

Comparing the effects of extracorporeal cardiopulmonary resuscitation (ECPR) and conventional cardiopulmonary resuscitation (CCPR) on outcomes in patients with in-hospital cardiac arrest (IHCA) in China. The benefits of ECPR over CCPR in patients with IHCA remain controversial. This article analyzed data from the BASeline Investigation of In-hospital Cardiac Arrest (BASIC-IHCA) study, which consecutively enrolled patients with IHCA from July 1, 2019, to December 31, 2020. Patients who received ECPR were selected as the case group and matched with patients who received CCPR as the control group by propensity score at a ratio of 1:4. A parallel questionnaire survey of participating hospitals was conducted, to collect data on ECPR cases from January 1, 2021 to November 30, 2021. The primary outcome was survival to discharge or 30-day survival. We included 39 hospitals across 31 provinces in China. Patients receiving cardiopulmonary resuscitation and without contraindications to ECPR were selected from the BASIC-IHCA database. Patients older than 75 years, not witnessed, or with cardiopulmonary resuscitation duration less than 10 min were excluded. None. A total of 4853 patients met the inclusion criteria before matching, with 34 undergoing ECPR (median age, 56.5 yr; 67.65% male) and 4819 underwent CCPR (median age, 59 yr; 64.52% male). There were 132 patients receiving CCPR and 33 patients receiving ECPR who were eventually matched. The ECPR group had significantly higher survival rates at discharge or 30-day survival (21.21% vs. 7.58%, p = 0.048). The ECPR group had significantly lower mortality rates (hazard ratio 0.57; 95% CI, 0.38-0.91) than the CCPR group at discharge or 30 days. Besides the BASIC-IHCA study, the volume of ECPR implementations and the survival rate of patients with ECPR (29.4% vs. 10.4%. p = 0.004) in participating hospitals significantly improved. ECPR may be beneficial compared with CCPR for patient survival after IHCA and should be considered for eligible patients with IHCA.

Duration of cardiopulmonary resuscitation and outcomes for adults with in-hospital cardiac arrest: retrospective cohort study

ObjectiveTo quantify time dependent probabilities of outcomes in patients after in-hospital cardiac arrest as a function of duration of cardiopulmonary resuscitation, defined as the interval between start of chest compression...

The Rate of Success of CPR in Patients Suffering from Cardiac Arrest in Patients Admitted in CCU in Cardiology Department Ayub Medical Teaching Institute

Cardiopulmonary resuscitation (CPR) is an essential procedure used to treat patients who are in cardiac arrest, particularly in the Critical Care Unit (CCU). Objective: To assess the success rate of CPR admitted to the CCU, revealing insight on the effectiveness of current resuscitation techniques. Methods: This retrospective study was conducted at Department of Cardiology Ayub Medical Teaching Institute, Abbottabad, between 13th April 2023 to 30th November 2023, 110 patients had cardiac arrest while in the intensive care unit. Data were gathered and examined on patient demographics, pre-existing comorbidities, time to start CPR, duration of CPR, and results. CPR success was defined as a sustained restoration of spontaneous circulation (ROSC) for at least 20 minutes. Results: This study included 110 cardiac patients. Most patients (68.18%) were male. Hypertension was the most common comorbidity at 72.7%. CPR started on average 4.8 minutes late, with a 1.2-minute standard deviation. The average CPR time was 18.2 minutes, with a 5.6-minute SD. After cardiac arrest, 60 (54.5%) patients began CPR within 5 minutes. Another subgroup found 96.0% CPR success in 25 (22.7%) ventricular fibrillation patients. Then occurred ventricular tachycardia (80.0%), pulseless electrical activity (76.0%), and asystole (68.9%). These data suggest that CPR works better in ventricular fibrillation patients. Conclusions: This research sheds light on cardiac arrest CCU patients' demographics, care, and outcomes. The data show that early CPR and ventricular fibrillation detection and treatment improve outcomes for these individuals.

High Variability in the Duration of Chest Compression Interruption is Associated With Poor Outcomes in Pediatric Extracorporeal Cardiopulmonary Resuscitation.

To determine the association between chest compression interruption (CCI) patterns and outcomes in pediatric patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR). Cardiopulmonary resuscitation (CPR) data were collected using defibrillator-electrode and bedside monitor waveforms from pediatric ECPR cases between 2013 and 2021. Duration and variability of CCI during cannulation for ECPR was determined and compared with survival to discharge using Fishers exact test and logistic regressions with cluster-robust se s for adjusted analyses. Quaternary care children's hospital. Pediatric patients undergoing ECPR. None. Of 41 ECPR events, median age was 0.7 years (Q1, Q3: 0.1, 5.4), 37% (15/41) survived to hospital discharge with 73% (11/15) of survivors having a favorable neurologic outcome. Median duration of CPR from start of ECPR cannulation procedure to initiation of extracorporeal membrane oxygenation (ECMO) flow was 21 minutes (18, 30). Median duration of no-flow times associated with CCI during ECMO cannulation was 11 seconds (5, 28). Following planned adjustment for known confounders, survival to discharge was inversely associated with maximum duration of CCI (odds ratio [OR] 0.91 [0.86-0.95], p = 0.04) as well as the variability in the CCI duration (OR 0.96 [0.93-0.99], p = 0.04). Cases with both above-average CCI duration and higher CCI variability ( sd > 30 s) were associated with lowest survival (12% vs. 54%, p = 0.009). Interaction modeling suggests that lower variability in CCI is associated with improved survival, especially in cases where average CCI durations are higher. Shorter duration of CCI and lower variability in CCI during cannulation for ECPR were associated with survival following refractory pediatric cardiac arrest.

Impact of prolonged cardiopulmonary resuscitation on outcomes in heart transplantation with higher risk donor heart.

To evaluate the influence of prolonged cardiopulmonary resuscitation (CPR) on outcomes in heart transplantation with higher risk donor hearts (HRDHs). Patients transplanted in our hospital between May 2006 and December 2019 were divided into 2 groups, HRDH recipients and non HRDH recipients. HRDH was defined as meeting at least one of the following criteria: (1) donor left ventricular ejection fraction ≤ 50%, (2) donor-recipient predicted heart mass ratio < 0.8 or > 1.2, (3) donor age ≥ 55years, (4) ischemic time > 4h and (5) catecholamine index > 20. Recipients of HRDHs were divided into 3 groups according to the time of CPR (Group1: non-CPR, Group 2: less than 30min-CPR, and Group 3: longer than 30min CPR). A total of 125 recipients were enrolled in this study, composing of HRDH recipients (n = 97, 78%) and non HRDH recipients (n = 28, 22%). Overall survival and the rate of freedom from cardiac events at 10years after heart transplantation were comparable between two groups. Of 97 HRDH recipients, 54 (56%) without CPR, 22 (23%) with CPR < 30min, and 21 (22%) with CPR ≥ 30min were identified. One-year survival rates were not significantly different among three groups. The 1-year rate of freedom from cardiac events was not also statistically different, excluding the patients with coronary artery disease found in early postoperative period, which was thought to be donor-transmitted disease. Multivariate logistics regression for cardiac events identified that the CPR duration was not a risk factor even in HRDH-recipients. The CPR duration did not affect the outcomes after heart transplantation in HRDH recipients.

Characteristics and outcomes of cardiac arrest patients with prolonged resuscitation

Background: There is lack of uniformity and consensus amongst the emergency physicians about an appropriate duration of cardiopulmonary resuscitation (CPR) and resuscitative efforts before deciding about termination of resuscitation (TOR) in patients with either out-of-hospital or in the emergency department (ED) non-traumatic cardiac arrests. An ideal duration of resuscitation for those with persistent cardiac arrest has not been determined yet. This study aims to evaluate the resuscitative interventions, patient factors and outcomes associated with prolonged duration of resuscitation in these patients. Methods: A retrospective study conducted in the Emergency Department (ED) of Changi General Hospital, Singapore and included 15 non-consecutive and randomly selected adult patients who either had an out-hospital cardiac arrest (OHCA) or suffered a witnessed cardiac arrest soon after arrival in the ED and were resuscitated further. Results: The median age was 58 years (IQR 51.5–70.5 years), and the median total CPR and resuscitation duration was 46 min (IQR 40–62.5 min). 12 patients sustained ROSC and one had transient ROSC. Ten (10) patients survived to hospital admission from ED and 5 of them underwent emergency angiography from ED. Three patients were discharged from hospital eventually with mRS scores of 0–1. Conclusion: Patients with sustained ROSC were older, had more prevalence of co-morbidities and lesser prevalence of shockable rhythms, received bystander CPR and pre-hospital adrenaline more frequently, had longer total duration of CPR and a larger proportion were administered intravenous calcium gluconate during ED resuscitation.

Predictors and Outcomes of Acute Brain Injury in Patients on Venoarterial Extracorporeal Membrane Oxygenation after Cardiopulmonary Resuscitation.

Venoarterial (V-A) extracorporeal membrane oxygenation (ECMO) after cardiac arrest often predisposes patients to acute brain injury (ABI), which affects survival and neurological performance. The investigation of the predictors of ABI will be beneficial for further management. To explore the predictors and outcomes of ABI and intracerebral hemorrhage (ICH) in patients experiencing cardiac arrest and cardiopulmonary resuscitation (CPR) with V-A ECMO support. We retrospectively analyzed 150 patients who successfully weaned from V-A ECMO support after pre-ECMO CPR at our institution from January 2009 to December 2021. Short-term and long-term outcomes were evaluated. Characteristics before and during ECMO were analyzed for determining the predictors of ABI and ICH. Of the 150 patients, 66 (44.0%) had ABI. ABI was associated with higher in-hospital mortality (62.1% vs. 21.4%, p < 0.0001) and poorer long-term survival after discharge (p = 0.002). Patients who survived to discharge with ABI had significantly more severe neurological deficits at discharge (84.0% vs. 42.4%, p < 0.0001) and improved little at one year after discharge (33.3% vs. 11.4%, p = 0.027). We found that CPR duration [odds ratio (OR) = 1.04, p = 0.003] was the independent risk factor for ABI, whereas lower platelet counts was the independent risk factor for ICH (OR = 0.96, p = 0.019). After CPR, development of ABI during V-A ECMO support impacted survival and further neurological outcome. Longer CPR duration before ECMO set up significantly increases the occurrence of ABI. Besides, severe thrombocytopenia during ECMO support increases the possibility of ICH.

“Application of Transitions Nursing Theory among Patients with Cardiac Arrests to Assess the Impact of Cardiopulmonary Resuscitation Duration on Functional Outcome—A Conceptual Framework”

Background: Change is the only constant in life, and humans continuously strive to cope and adapt based on the changes in their health (physical and mental) status. Cardiovascular diseases (CVD’s) are the leading cause of cardiac emergencies that cause enormous impact on patients, families, and health systems prompting processes and strategies for coping with their health status changes and their aftermath effect. Aim: A discussion of the conceptual framework of transition theory applicable to the study to assess the impact of the cardiopulmonary resuscitation (CPR) duration on the functional outcome among patients with in-hospital cardiac arrest (IHCA). Methodology: The transition theory, a middle-range and situation specific theory is applied to the prospective study conducted at a tertiary care hospital in South India. The outcomes were measured using the cerebral performance category (CPC). Results: The theory identifies that cardiac arrest is a situational transition affected by the chronicity of the disease as described with unfavorable outcome with CPC score of 3–5. The fear of death, dependency state of the patient in an unfavorable outcome based on CPC, and caregiver burden on family due to the prolonged duration of acuity of the disease or death of the patient are identified as properties in this theory. Based on the study, the personal meaning includes lifestyle modifications, the impact of spiritualism, financial stability, and the educational qualifications of the patient and family identified as personal meanings that play a major role as facilitators and inhibitors. The patterns and responses in this study identified with follow-up appointments, confidence in caring for themselves, and coping for themselves among the survived cardiac arrest patients. The nursing therapeutics identified from the study are risks identified from the comprehensive assessment, readiness to intervene and implement nursing actions, educating the patient and family based on the transition, and enhancing the creation of a healthy environment. Conclusions: The transition theory is holistically applicable for patients with cardiac arrest, identifying the process and changes adapted by the patient and family with the progression of the disease and the roles adapted by the family members in the event of the patient’s death.

Clinical Implications of the Lung Ultrasound Score in Patients after Cardiopulmonary Resuscitation.

Lung ultrasound score (LUS) is a clinical index used to measure lung injury, but its clinical value in patients after cardiopulmonary resuscitation (CPR) remains relatively unknown. The purpose of this study was to investigate the clinical value of LUS in patients after CPR. This retrospective study included a total of 34 patients older than 18 years with a nontraumatic cause of in-hospital cardiac arrest, who received standard resuscitation and achieved return of spontaneous circulation (ROSC). All patients underwent bedside lung ultrasound examination within half an hour once ROSC was achieved, and LUSs were calculated. The study included patient death as the endpoint event. Compared with the group with lower LUSs, the patients with higher LUSs had a lower oxygenation index, longer duration of CPR, and lower 72 h survival rate. The initial LUS had good clinical value in predicting the secondary outcomes of CPR (adjusted odds ratio (aOR): 1.353, 95% confidence interval (CI): 1.018-1.797, and P = 0.037) and 72 h survival rate of patients who underwent CPR (aOR: 1.145, 95% CI: 1.014-1.294, and P = 0.029). LUS was shown to be helpful and had a prognostic value in patients after CPR.

Real-world comparison between mechanical and manual cardiopulmonary resuscitation during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic has posed significant challenges to healthcare systems worldwide, including an increase in out-of-hospital cardiac arrests (OHCA). Healthcare providers are now required to use personal protective equipment (PPE) during cardiopulmonary resuscitation (CPR). Additionally, mechanical CPR devices have been introduced to reduce the number of personnel required for resuscitation. This study aimed to compare the outcomes of CPR performed with a mechanical device and the outcomes of manual CPR performed by personnel wearing PPE. MethodsThis multicenter observational study utilized data from the Korean Cardiac Arrest Research Consortium registry. The study population consisted of OHCA patients who underwent CPR in emergency departments (EDs) between March 2020 and June 2021. Patients were divided into two equal propensity score matched groups: mechanical CPR group (n = 421) and PPE-equipped manual CPR group (n = 421). Primary outcomes included survival rates and favorable neurological outcomes at discharge. Total CPR duration in the ED was also assessed. ResultsThere were no significant between-group differences with respect to survival rate at discharge (mechanical CPR: 7.4% vs PPE-equipped manual CPR: 8.3%) or favorable neurological outcomes (3.3% vs. 3.8%, respectively). However, the mechanical CPR group had a longer duration of CPR in the ED compared to the manual CPR group. ConclusionThis study found no significant differences in survival rates and neurological outcomes between mechanical CPR and PPE-equipped manual CPR in the ED setting. However, a longer total CPR duration was observed in the mechanical CPR group. Further research is required to explore the impact of PPE on healthcare providers' performance and fatigue during CPR in the context of the pandemic and beyond.

Improving outcomes from paediatric cardiac arrest in low resource setting

Abstract Introduction Both out of (OHCA) and in hospital (IHCA) pediatric cardiac arrest has traditionally been considered a futile medical condition with dismal outcomes. This is further magnified by resuscitation protocols are typically articulated from the perspective of ideal resource environment without consideration of applicability in district hospitals or non-tertiary centres. Purpose To determine clinical outcomes from both paediatric OHCA and IHCA in low-resource setting and to identify shortcomings in relation to resuscitation in these areas, possible solutions and to suggest future research priorities. Methods This was a multicenter retrospective study in a middle sized city (estimated population 390000) served by a single Emergency Medical Services (EMS) system. All records of OHCA and IHCA under 16 years old were reviewed from the Cardiac Arrest Registry from 2017 to 2022. Data collected included demographic profiles, etiology of cardiac arrest, initial cardiac rhythm, time of initiation of cardiopulmonary resuscitation (CPR) and adrenaline administration by EMS team and duration of CPR. Outcomes of interest included return of spontaneous circulation (ROSC) and survival to hospital discharge (STHD). Results From the 5-year study period, 68 children (mean age of 5.8±1.2 yrs) were included in this study. 22 (32.4%) were infants (&amp;lt;1 year old) and 7 (10.3%) were neonates (&amp;lt;28 days old). Total mortality was observed at 63.2% (n=43). Return of spontaneous circulation (ROSC) was achieved in 40 (58.8%) patients and 33.8% (n=23) survived to hospital discharge. OHCA was witnessed in 52 (83.8%) children from total OHCA and bystander CPR was delivered only in 19 (30.6%) cases. All IHCA were witnessed. Asystole was the most common (n=39) initial rhythm. A delay in initiating cardiopulmonary resuscitation (CPR) and adrenaline administration was observed in 49 cases of OHCA and 1 in IHCA. The median time from emergency call to CPR and from CPR to first adrenaline administration was 20.9±1.2 min and 2.9±1.3 min for OHCA and 0.4±0.2 min and 1.5±0.7min for IHCA [Table 1]. Longer time to CPR and adrenaline administration was associated with lower chance of achieving ROSC and STHD. Using multivariate analyses, fewer adrenaline doses (p&amp;lt;0.05), witnessed cardiac arrest (p=0.001), initial rhythm of ventricular fibrillation (p&amp;lt;0.05) and shorter CPR duration (p=0.007) were good prognostic factors for ROSC and STHD. Conclusion Outcomes from OHCA and IHCA in low resource settings are poor. Unwitnessed arrest, delays in initiation of CPR and adrenaline administration were associated with poor survival. Recognition and identification of at-risk patients, early high-quality CPR and adrenaline administration are imperative to improve mortality. Early recognition and effective resuscitation protocols for children in the community and encouraging bystander CPR should be developed collaboratively with local experts and the EMS team.

Termination-of-resuscitation rule in the emergency department for patients with initial pulseless electrical activity after out-of-hospital cardiac arrest

Abstract Background/Introduction In several Asian countries including Japan, emergency medical service (EMS) providers are prohibited from performing field termination-of-resuscitation (TOR) in patients with refractory out-of-hospital cardiac arrest (OHCA). In 2022, we developed a TOR rule in the emergency department for patients with initial asystole after refractory OHCA, which includes three criteria: unwitnessed arrest, EMS-initiated cardiopulmonary resuscitation (CPR) duration was more than 20 min, and there was no prehospital return of spontaneous circulation (ROSC). However, until now a TOR rule in the emergency department for patients with initial pulseless electrical activity (PEA) has not been developed. Purpose This study aimed to develop and validate a TOR rule in the emergency department for patients with initial PEA after refractory OHCA. Methods We analysed the records of 137,230 adult patients (≥18 years-old) with initial PEA from the nationwide all-Japan Utstein registry from 2016 to 2020. Patients were divided into two groups: development (n=109,642, 2016 to 2019) and validation (n=27,588, 2020). The primary outcome measures were specificity, false positive rate (FPR), and positive predictive value (PPV) of the TOR rule for patients with initial PEA in the emergency department for predicting 1-month mortality. Using recursive partitioning analysis, we developed a new TOR rule for patients with initial PEA after OHCA. Results The overall 1-month survival rate of the participants was 7.4% (95% confidence interval [CI], 7.2–7.5%). Recursive partitioning analysis for the development group in predicting 1-month mortality revealed that a TOR rule for patients with PEA could be defined if patients with OHCA met all the following four criteria immediately after hospital arrival: (1) unwitnessed arrest by any laypersons, (2) EMS-initiated CPR duration more than 20 min, (3) no prehospital ROSC, and (4) age greater than or equal to 80 years. The specificity, FPR, and PPV of the rule for predicting 1-month mortality were 99.1% (95% CI, 98.9–99.3%), 0.87% (95% CI, 0.69–1.09%), and 99.2% (95% CI, 98.9–99.3%), respectively. The proportion of patients who fulfilled the rule and the area under the receiver operating curve (AUC) was 7.8% (95% CI, 7.7–8.0%), and 0.80 (95% CI, 0.79–0.80), respectively. In the validation group, the specificity, FPR, PPV, proportion of patients who met the rule, and AUC were 99.1% (95% CI, 98.5–99.4%), 0.93% (95% CI, 0.58–1.49%), 99.3% (95% CI, 98.8–99.5%), 8.3% (95% CI, 8.0–8.6%), and 0.789 (95% CI, 0.775–0.797), respectively. Conclusions We developed and validated a TOR rule in the emergency department for patients with initial PEA after OHCA. The rule includes four criteria (unwitnessed arrest, EMS-initiated CPR duration was more than 20 min, no prehospital ROSC, and age was greater than or equal to 80 years) with a more than 99% predictor of 1-month mortality.

Higher Survival With the Use of Extracorporeal Cardiopulmonary Resuscitation Compared With Conventional Cardiopulmonary Resuscitation in Children Following Cardiac Surgery: Results of an Analysis of the Get With The Guidelines-Resuscitation Registry.

Extracorporeal membrane oxygenation to support cardiopulmonary resuscitation (CPR) is increasingly used in children suffering cardiac arrest after cardiac surgery. However, its efficacy in promoting survival has not been evaluated. We compared survival of pediatric cardiac surgery patients suffering in-hospital cardiac arrest who were resuscitated with extracorporeal CPR (E-CPR) to those resuscitated with conventional CPR (C-CPR) using propensity matching. Retrospective study using multicenter data from the American Heart Association Get With The Guidelines-Resuscitation registry (2008-2020). Multicenter cardiac arrest database containing cardiac arrest and CPR data from U.S. hospitals. Cardiac surgical patients younger than 18 years old who suffered in-hospital cardiac arrest and received greater than or equal to 10 minutes of CPR. None. Among 1223 patients, 741 (60.6%) received C-CPR and 482 (39.4%) received E-CPR. E-CPR utilization increased over the study period ( p < 0.001). Duration of CPR was longer in E-CPR compared with C-CPR recipients (42 vs. 26 min; p < 0.001). In a propensity score matched cohort (382 E-CPR recipients, 382 C-CPR recipients), E-CPR recipients had survival to discharge (odds ratio [OR], 2.22; 95% CI, 1.7-2.9; p < 0.001). E-CPR survival was only higher when CPR duration was greater than 18 minutes. Propensity matched analysis using patients from institutions contributing at least one E-CPR case ( n = 35 centers; 353 E-CPR recipients, 353 C-CPR recipients) similarly demonstrated improved survival in E-CPR recipients compared with those who received C-CPR alone (OR, 2.08; 95% CI, 1.6-2.8; p < 0.001). E-CPR compared with C-CPR improved survival in children suffering cardiac arrest after cardiac surgery requiring CPR greater than or equal to 10 minutes.