Heart And Stroke Foundation Of Canada Research Articles

Implementation of Chest Compression Feedback Technology to Improve the Quality of Cardiopulmonary Resuscitation in the Emergency Department: A Quality Initiative Test-of-change Study.

BackgroundCardiopulmonary resuscitation (CPR) metrics including compression rate and depth are associated with improved outcomes and the need for high-quality CPR is emphasized in both the American Heart Association (AHA) and Heart and Stroke Foundation of Canada (HSFC) guidelines. While these metrics can be utilized to assess the quality of CPR, they are infrequently measured in an objective fashion in the emergency department.ObjectivesAs part of an Emergency Department (ED) Quality Improvement (QI) project, we sought to determine the impact of real-time audio-visual (AV) feedback during CPR amongst ED healthcare providers.MethodsParticipants performed two minutes of uninterrupted CPR without AV feedback, followed by two minutes of CPR with AV feedback after a two-minute rest period in a simulated CPR setting. CPR metrics were captured by the defibrillator and uploaded to review software for analysis of each event.ResultsThe use of real-time AV feedback resulted in a significant improvement in the number of participants meeting AHA/HSFC recommended depth (38%, p = 0.0003) and rate (35%, p = 0.0002). Importantly, ‘compressions in target’, where participants met both rate and depth simultaneously, improved with AV feedback (19 vs 61%, p < 0.0001).ConclusionsWe found a significant improvement in compliance with CPR depth and rate targets as well as ‘compressions in target’ with the use of real-time AV feedback during simulation training. Future research is needed to ascertain whether these results would be replicated in other settings. Our findings do provide a robust argument for the implementation of real-time AV CPR feedback in Hamilton Emergency Departments.

A Reduction in Cardiac Function Precedes Structural Adaptations in Experimental Spinal Cord Injury

IntroductionChronic high‐thoracic spinal cord injury (SCI) is associated with systolic dysfunction, cardiomyocyte atrophy and the upregulation of major proteolytic pathways in the heart. How such dysfunction manifests with time is presently unknown.MethodsMale Wistar rats underwent complete SCI at the 3rd thoracic spinal level (T3‐SCI; n=10) or dorsal durotomy (SHAM; n=5). T3‐SCI rats were terminated at different time points: three days post‐SCI (3‐day SCI; n=5) or seven days post‐SCI (7‐day SCI; n=5). SHAM rats were terminated at seven days post‐durotomy. On termination day, prior to euthanasia, left‐ventricular (LV) catheterization was performed to assess cardiac function. Additionally, cardiac tissue was collected for histological analysis to quantify cardiomyocyte dimensions (standardized to femur length).ResultsRelative to SHAM, T3‐SCI rats at both 3‐day and 7‐day post‐SCI exhibited reduced stroke work (SW; p=0.036), load‐independent contractile function (inferred with end‐systolic pressure‐volume relationship, ESPVR; p=0.0013) and maximal rate of LV systolic pressure increment (dP/dtmax; p=0.0070). The maximal rate of LV relaxation (i.e. ‐dP/dtmin; p=0.019) was reduced at 3‐day and 7‐day post‐SCI vs. SHAM; however, tau (time constant of isovolumic relaxation) was not different (p=0.15). There were no differences for any functional indices between 3‐day vs. 7‐day SCI. Histological analysis of cardiomyocytes indicates no significant differences in length and width in SCI groups vs. SHAM (length p=0.20; width p=0.24).ConclusionSystolic cardiac function decreased significantly in both 3‐day and 7‐day SCI rats vs. SHAM. This indicates a rapid onset of cardiac dysfunction following T3‐SCI. Cardiomyocyte atrophy was not present in either 3‐day or 7‐day SCI rats, implying a reduction in cardiac function precedes structural remodeling.Support or Funding InformationHeart and Stroke Foundation of Canada (HSFC), International Collaboration on Repair Discoveries (ICORD) and Blusson Integrated Cure Partnership (BICP).This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

A Narrative Inquiry into Women’s Cardiovascular Health as Promoted by the Heart and Stroke Foundation of Canada (HSFC) to the Public Through Facebook.

A Narrative Inquiry into Women’s Cardiovascular Health as Promoted by the Heart and Stroke Foundation of Canada (HSFC) to the Public Through Facebook.

Pediatric Basic and Advanced Life Support: An Update on Practice and Education

This review aims to summarize the major changes in the 2010 Heart and Stroke foundation of Canada (HSFC) and the American Heart Association (AHA) Pediatric Basic and Advanced Life Support Guidelines. The Guidelines were based on the International Liaison Committee on Resuscitation's (ILCOR) comprehensive, evidence-based review of the resuscitation literature. The key recommendations from the Guidelines include: the removal of "look, listen and feel" and a de-emphasis on the use of the pulse check by healthcare providers to diagnose cardiac arrest; a change in the sequence of resuscitation for patients in cardiac arrest from the previously well-known "A-B-C" i.e. Airway, Breathing, and Chest Compressions to "C-A-B" i.e. Chest Compressions first; modification to the appropriate depth of compression (at least 1/3 of the anterior-posterior depth of the chest wall or about 4 cm in infants and 5 cm in children); end-tidal CO(2) monitoring (in intubated patients) to assess the quality of chest compressions and optimize cardiopulmonary resuscitation (CPR); and titrating Fi0O2 once "Return of Spontaneous Circulation" (ROSC) is achieved to maintain an oxygen saturation between 94-99%. Overall, pediatricians, family and community physicians who may care for acutely ill children should be aware of these updated guidelines in order to provide the best possible care to their patients.

Stayin’ alive: The 2010 Heart and Stroke Foundation of Canada/American Heart Association resuscitation guidelines for newborns and older children

Five years have transpired since the most recent set of paediatric and neonatal resuscitation guidelines were jointly released by the Heart and Stroke Foundation of Canada (HSFC) and the American Heart Association. The recent publication of the 2010 resuscitation guidelines (1–3) prompts the following questions: What process led to the creation of the guidelines? What is new since 2005? What is our role in implementation? Guideline development has evolved from using consensus of experts, to the use of an evidence-based approach. Starting in 2000, the International Liaison Committee on Resuscitation (ILCOR), consisting of resuscitation councils from around the world (including the HSFC), has conducted regular systematic reviews of the resuscitation literature. These reviews resulted in the Consensus on Science and Treatment Recommendations (CoSTR). After the release of ILCOR’s 2005 CoSTR document, the paediatric and neonatal task forces reconvened, with international (including Canadian) representation. Each task force identified key questions requiring evidence evaluation, and assigned each question to two or more international resuscitation experts. After a rigorous literature search, relevant articles were independently identified, analyzed and graded by each worksheet author. With the assistance of an evidence evaluation expert, the scientific information surrounding a specific question was summarized and treatment recommendations were drafted based on this summary. The worksheet summaries (without treatment recommendations) were made available to the wider scientific community through the ILCOR website. Each worksheet author then presented his/her findings one final time to the paediatric or neonatal task forces, who debated and finalized the CoSTR statements (published in October 2010 [4,5]). Since that time, regional resuscitation councils (such as the HSFC and American Heart Association) have released their own resuscitation guidelines that have contextualized the CoSTR documents for their respective health care systems. A significant challenge for the world’s paediatric and neonatal resuscitation community continues to be the paucity of high-quality studies in the basic science, clinical and educational domains. Many resuscitation science recommendations are based on extrapolation from adult (human) studies or even animal data, whereas educational science largely consists of low-level studies of learner outcomes rather than patient outcomes. There is a pressing need for further study regarding how best to translate resuscitation science into practice, and how best to improve knowledge acquisition and retention by both lay rescuers and health care professionals over time. Studies are needed to compare traditional instructor-led courses with newer innovative approaches to teaching including Internet- and computer-based training, and low- or high-fidelity simulation. The rapid attrition of cognitive and technical skills within months of initial instruction suggests that we need to consider other approaches to continuing education, potentially including more frequent refresher courses, training sessions or simulations. The introduction of simulation and debriefing to neonatal resuscitation training will result in substantial changes to Neonatal Resuscitation Program (NRP) courses, presenting new challenges for our instructors and learners. These new methodologies will help us recognize the importance of teamwork competencies, and individual knowledge, skills and behaviours. Fortunately, the clinical science recommendations reinforce and build on practices introduced to Canada in 2006 (6), and will require relatively minor modifications. Outside the newborn population, clearer, simpler and more consistent messaging to the public regarding how to provide cardiopulmonary resuscitation (CPR) to individuals of all ages will hopefully ensure that bystanders act promptly, in contrast to the majority of out-of-hospital cardiac arrests in Canada, where no intervention is provided by lay rescuers. Starting the first cycle of CPR with chest compressions (chest compressions, airway, breathing), as opposed to the traditional order (airway, breathing, chest compressions) will ensure that rescuers immediately ‘do something (ie, at least chest compressions) as opposed to doing nothing’ for all cardiac arrest victims. This will maximize coronary perfusion and delay the provision of rescue breaths by only a few seconds. The challenge for paediatric and neonatal health care providers is to recognize our collective role and responsibility in optimizing resuscitative care for Canada’s infants and children. Although maintaining up-to-date CPR certification and/or NRP registration is an essential first step, our role extends to advocating CPR education for our own children and families, and getting the “stayin’ alive” message out to the public through our patients, their families and the community. It is time for us, as paediatricians, to approach paediatric cardiac arrest as a preventable disease, in the same way that we successfully advanced seatbelt and bicycle helmet education programs. Similarly, perinatal teams should view newborn compromise as predictable in many circumstances and, therefore, assess risk and prepare for resuscitation before every delivery. Finally, it is incumbent on us to cultivate resuscitation-based scientific research to fill the knowledge gaps in basic, clinical and educational science, and inform future CoSTR cycles.

Part 1: Executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

The International Liaison Committee on Resuscitation (ILCOR) was founded on November 22, 1992, and currently includes representatives from the American Heart Association (AHA), the European Resuscitation Council (ERC), the Heart and Stroke Foundation of Canada (HSFC), the Australian and New Zealand Committee on Resuscitation (ANZCOR), Resuscitation Council of Southern Africa (RCSA), the InterAmerican Heart Foundation (IAHF), and the Resuscitation Council of Asia (RCA). Its mission is to identify and review international science and knowledge relevant to cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) and when there is consensus to offer treatment recommendations.

Does chronic stimulation of both nicotinic and opioid receptors contribute to the loss of O2 and CO2 sensitivity in perinatal adrenomedullary chromaffin cells?

Adaptation of the neonate to extrauterine life depends critically on catecholamine secretion (CAT) from adrenomedullary chromaffin cells (AMC). This CAT secretion is triggered by asphyxial stressors (e.g. hypoxia and hypercapnia) associated with the birthing process and these act directly on AMC, prior to functional splanchnic innervation. These sensing mechanisms are lost postnatally along a time course correlating roughly with innervation of AMC. Thus, the majority of juvenile AMC (&gt;14 days) are unable to sense directly hypoxia and hypercapnia, although there is evidence that these properties may return following denervation. The splanchnic nerve releases various neurotransmitters including acetylcholine (ACh) which activate nicotinic ACh receptors (nAChR) and enkephalins which activate opioid receptors on AMC. Here, we test the hypothesis that activation of these receptors may initiate a signaling cascade leading to the loss of O2 and/or CO2 sensitivity. Recently, we showed that chronic stimulation of nAChR on AMC with nicotine, results in the loss of hypoxic, but not hypercapnic, sensitivity (Buttigieg et al. FASEB J 2007, in press). This loss of hypoxic sensitivity appears to be mediated by up‐regulation of KATP channels, which are activated by low PO2. Preliminary studies based on exposure of AMC to chronic opioid receptor stimulation suggest that this treatment leads to loss of both hypercapnic and hypoxic sensitivity. Thus, synaptic stimulation of opioid and nACh receptors on AMC may contribute to the normal developmental loss of O2 and CO2 sensitivity. Funded by: The Heart and Stroke Foundation (HSF) of Ontario. JB and SB were funded by a Focus on Stroke award from HSF of Canada.

Challenges for the Canadian Cardiovascular Society in the 1990s

During the 1990s, under the leadership of Dr Eldon R Smith, the first five-year strategic plan was created. Partly as a result of this plan, a review of the annual meeting of the Canadian Cardiovascular Society (CCS) was undertaken. I was fortunate enough to have been chosen to chair this review and the subsequent Annual Meeting Committee. The initial review revealed significant areas for improvement, including finances, location, partners, sponsors, threats and opportunities. Each issue was tackled systematically, with an emphasis on producing a high-quality learning and networking experience, eventually resulting in a joint partnership with the Heart and Stroke Foundation of Canada (HSFC) in creating the Canadian Cardiovascular Congress, which has since become the largest medical meeting in Canada. The success of the CCS annual general meeting and the Canadian Cardiovascular Congress resulted in significant revenue for the Society in the early years. Because of tax constraints, these residuals were placed in a separate charitable account, eventually morphing into the CCS Academy, and most recently, the CCS Foundation, whose focus is on recruiting and retaining outstanding young people into the clinical, teaching and research aspects of cardiovascular sciences. Bursaries are provided to support a number of young people each year to attend the Canadian Cardiovascular Congress and to support some other specific learning or research projects for the Society. During the 1990s, there was also an increasing emphasis on the need for evidence-based guidelines. The consensus conferences, ever-popular with members and nonmembers alike, became more focused on the evidence available for recommendations, and the consensus conferences became a regular feature of The Canadian Journal of Cardiology. For the first time in Canada, the issue of prevention and the role of the cardiovascular specialist in prevention were identified. The Harold N Segall Award of Merit was created and focused on prevention. Guidelines were created for adult congenital heart disease, as well as women and cardiovascular disease. Issues such as heart failure, atrial fibrillation, implantable cardiac defibrillators (and others) were analyzed from the Canadian perspective, and Canadian guidelines were created and disseminated. Also during this time, The Royal College of Physicians and Surgeons of Canada devolved specialty continuing professional development (CPD) to the specialty professional associations, and created CPD accreditation guidelines. The Society, which had always been strong in CPD, was the first of any specialty groups to be given accreditation assessor status, and created within the CCS a separate committee and staff position to further develop learning and knowledge translation capacity and opportunities for the Society. This too has spawned a trainee day at the congress, further support for adult cardiology and, now, pediatric cardiology fellowship examination review symposia on an annual basis. An award for the distinguished teacher was created to honour outstanding teachers in cardiovascular sciences and to complement the existing awards for research achievement and annual achievement awards. In addition, a new award for the paper with maximum impact for the preceding year was created: the Dr Robert E Beamish Award, which is supported by the Journal. Because of the focus on excellence and the recognition of excellence among the members of the cardiovascular community, the CCS partnered with the HSFC to create an awards reception. Others followed, including the Anemia Institute for Research and Education Award (supported by the Canadian Anesthesiologists’ Society), the Richard Rowe Research Prize (supported by the Canadian Pediatric Cardiology Association), the Dr Paul Cartier Cardiac Surgery Resident Research Award (supported by the Canadian Society of Cardiac Surgeons) and, of course, the many research awards sponsored by both the HSFC and Canadian Institutes of Health Research. The increasing activities of the Society have resulted in a more complex organization with an increasing staff, but also increasing membership and increasing visibility and political influence. The headquarters was relocated to Ottawa, Ontario, during this decade, and a full-time executive director was hired. There is no doubt that the CCS is viewed by other specialty associations as one of the premier professional specialty organizations in the country. Closer links were established with the American College of Cardiology, and the CCS began to play a more significant role in the InterAmerican Society of Cardiology, culminating in the InterAmerican Congress of Cardiology being held in Toronto, Ontario, hosted jointly by the CCS and the HSFC in 2001. In summary, the 1990s were, for the CCS, a ‘decade of doing’, and tribute should be given to the many members who freely gave their time and expertise to individual projects, manuscripts, research and organizational support and leadership. Without them, the Society would not be able to continue to focus on what members need to better serve their patients and on excellence in teaching and research.

2005 emergency cardiovascular care guidelines

Creating the 2005 ECC guidelines The comprehensive guidelines creation process followed in 2005 has evolved significantly beyond the process used to create previous guidelines. In 1992, the Heart and Stroke Foundation of Canada (HSFC) participated in the American Heart Association’s (AHA) guideline process and then adapted the AHA guidelines for Canada. In 2000, the HSFC partnered with the AHA and other members of the International Liaison Committee on Resuscitation (ILCOR)* to develop the first international ECC guidelines. Consensus on some issues was difficult or impossible to reach because of differences in resources and medical practice in different parts of the world. Even after the guidelines were agreed upon, each of the international participants then altered the guidelines for their home countries. In 2005, rather than try to reach an international consensus on guidelines, ILCOR agreed to develop an international consensus on science and also on treatment recommendations where possible, but to leave the establishment of guidelines to each of its members. The HSFC decided that, rather than “Canadianize” the AHA guidelines as it had done before 2000, HSFC would work with the AHA to develop a single set of guidelines that would be acceptable in both Canada and the United States. This 2005 guideline revision is the result of a process that began 5 years ago, immediately following the completion of the 2000 guidelines. The process has involved thousands of volunteer hours by hundreds of resuscitation experts and researchers from around the world, who reviewed 276 topics and completed more than 400 worksheets. In January 2005, 380 experts from around the world met in Dallas under the auspices of ILCOR to examine the evidence on resuscitation and to develop a consensus on science and on treatment recommendations. This international consensus forms the basis for the new guidelines. The guidelines themselves are a result of a collaboration between the AHA and the HSFC. Previous guidelines have been criticized for reflecting the influence of pharmaceutical companies and other special interests. For the 2005 guidelines, ILCOR and the AHA went to great lengths to ensure full disclosure of potential conflicts and to manage conflict of interest when it existed. Details of the conflict of interest policy have been published along with the consensus document.

Part 11: Neonatal Resuscitation

Part 11: Neonatal Resuscitation

Adult resuscitation guidelines

In April of this year at the international meeting in Brighton, the Resuscitation Council of the United Kingdom presented changes to its guidelines for resuscitation. The original guidelines, published in 1992 by the European Resuscitation Council ( ERC ), were the result of a consensus view from international groups of experts based on the most up to date information. The International Liaison Committee on Resuscitation (ILCOR) comprises the ERC, the American Heart Association (AHA), the Australian Resuscitation Council (ARC), the Resuscitation Council of Southern Africa (RCSA), the Heart and Stroke Foundation of Canada (HSFC). and the Cosejo Latinoamericano de Resuscitation (CLAR).

Paediatric life support: An advisory statement by the Paediatric Life Support Working Group of the International Liaison Committee on Resuscitation

This document reflects the deliberations of ILCOR. The epidemiology and outcome of paediatric cardiopulmonary arrest and the priorities, techniques and sequence of paediatric resuscitation assessments and interventions differ from those of adults. The working group identified areas of conflict and controversy in current paediatric basic and advanced life support guidelines, outlined solutions considered and made recommendations by consensus. The working group was surprised by the degree of conformity already existing in current guidelines advocated by the American Heart Association (AHA), the Heart and Stroke Foundation of Canada (HSFC), the European Resuscitation Council (ERC), the Australian Resuscitation Council (ARC), and the Resuscitation Council of Southern Africa (RCSA). Differences are currently based upon local and regional preferences, training networks and customs, rather than scientific controversy. Unresolved issues with potential for future universal application are highlighted. This document does not include a complete list of guidelines for which there is no perceived controversy and the algorithm/decision tree figures presented attempt to follow a common flow of assessments and interventions, in coordination with their adult counterparts. Survival following paediatric prehospital cardiopulmonary arrest occurs in only approximately 3–17% and survivors are often neurologically devastated. Most paediatric resuscitation reports have been retrospective in design and plagued with inconsistent resuscitation definitions and patient inclusion criteria. Careful and thoughtful application of uniform guidelines for reporting outcomes of advanced life support interventions using large, randomized, multicenter and multinational clinical trials are clearly needed. Paediatric advisory statements from ILCOR will, by necessity, be vibrant and evolving guidelines fostered by national and international organizations intent on improving the outcome of resuscitation for infants and children worldwide.