Life Support For Cardiac Arrest Research Articles

Cardiopulmonary resuscitation: the power to save lives

Cardiopulmonary arrest (CPA) is understood as the sudden, unexpected and catastrophic cessation of systemic circulation, useful ventricular and ventilatory activity. It is essential that any individual is aware of the risk factors, epidemiology, has minimal knowledge to recognize a CPA early and can proceed appropriately to provide quality support to the victim. The advances in terms of technology, treatment and prevention are notorious, however, many lives are still lost due to the poor quality of a first care. The study aimed to understand the level of knowledge and train the population about risk factors, epidemiology, early recognition, correct initial approach, cardiac compressions and quality ventilation, in order to reduce the incidence of mortality and improve the prognosis of patients in cardiac arrest. An exploratory intervention was used, bringing knowledge objectively, through banners, folders and lectures in easy-to-understand language, providing quality and relevant information so that listeners could acquire indispensable skills and actually change lives. The actions took place in a Basic Health Unit (BHU), on previously established days and times, always striving to reach as many people as possible. Recognizing early and knowing how to conduct a CPA until specialized help arrives is of fundamental importance, but unfortunately the largest part of the population approached demonstrated to be unaware of the basics on the subject. Unpreparedness regarding risk factors, initial signs and symptoms and, mainly, regarding the initial approach and effective cardiac compressions, was present in most of the target audience. Urgent and emergency situations can result in serious clinical outcomes, sequels and even death of the victims. A trained layperson, capable of identifying and carrying out the necessary actions, can considerably improve the prognosis of victims who are in an urgent or emergency situation in society. It is important to provide quality and effective care, so that the victims do not have sequelae or, if they do, that these are minimal. Fast and efficient help is essential to avoid irreversible neurological damage, in addition to the risk of death that increases every minute. For this, it is necessary to start Cardiopulmonary Resuscitation (CPR) maneuvers as early as possible, even by a person who is not in the health area until specialized help arrives. In view of the results obtained, it is concluded that training on basic life support in cardiac arrest is still a little-known topic among the public addressed, which reflects a common scenario among the lay population and reinforces the importance of carrying out studies such as this in society, in order to disseminate basic knowledge that saves lives. It is essential that cardiopulmonary resuscitation training is not something exclusive to health professionals, the lay population needs to be guided so that they know how to act correctly in critical moments. The activities carried out spread health knowledge and provided subsidy so that the part of the contemplated population can also act as health educators.

Extracorporeal Life Support for Cardiac Arrest and Cardiogenic Shock

The rising incidence and recognition of cardiogenic shock has led to an increase in the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). As clinical experience with this therapy has increased, there has also been a rapid growth in the body of observational and randomized data describing the clinical and logistical considerations required to institute a VA-ECMO program with successful clinical outcomes. The aim of this review is to summarize this contemporary data in the context of four key themes that pertain to VA-ECMO programs: the principles of patient selection; basic hemodynamic and technical principles underlying VA-ECMO; contraindications to VA-ECMO therapy; and common complications and intensive care considerations that are encountered in the setting of VA-ECMO therapy.

ExtraCorporeal life support for Cardiac ARrest in patients with post cardiac arrest syndrome: The ECCAR study

Post cardiac arrest shock (PCAS) occurring after resuscitated cardiac arrest (CA) is a main cause of early death. Extracorporeal life support (ECLS) could be useful pending recovery from myocardial failure. To describe our PCAS population, and the factors associated with initiation of ECLS. This analysis included 921 patients admitted to two intensive care units between 2005 and 2014 for CA and PCAS; 43 of these patients had ECLS initiated. Neurological and ECLS-related outcomes were gathered retrospectively. The 43 patients treated with ECLS were predominantly (70%) young males with evidence of myocardial infarction on coronary angiography. ECLS was initiated in patients with severe cardiovascular dysfunction (median left ventricular ejection fraction 15% [interquartile range 10-25%]), a median of 9hours [interquartile range 6-16hours] after the CA. At 1 year, eight patients (19%) had survived without neurological disability. Blood lactate and coronary aetiology were associated with neurological outcomes. Logistic regression conducted using 878 controls with PCAS identified age>62 years, location of CA, use of a high dose of adrenaline (>3mg) and blood lactate and serum creatinine concentrations (>5mmol/L and>109μmol/L, respectively) as risk factors for initiation of ECLS. ECLS, as a salvage therapy for PCAS, could be an acceptable alternative for highly-selected patients.

European Resuscitation Council Guidelines for Resuscitation: 2018 Update – Antiarrhythmic drugs for cardiac arrest

This European Resuscitation Council (ERC) Guidelines for Resuscitation 2018 update is focused on the role of antiarrhythmic drugs during advanced life support for cardiac arrest with shock refractory ventricular fibrillation/pulseless ventricular tachycardia in adults, children and infants. This update follows the publication of the International Liaison Committee on Resuscitation (ILCOR) 2018 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR). The ILCOR CoSTR suggests that any beneficial effects of amiodarone or lidocaine are similar. This ERC update does not make any major changes to the recommendations for the use of antiarrhythmic drugs during advanced life support for shock refractory cardiac arrest.

Advanced Life Support in Cardiac Arrest — Current Guidelines and Outstanding Investigations

The current review highlights the European Resuscitation Council 2015 and the Russian National Resuscitation Council 2015 guidelines on advanced life support. The review reflects the key elements of the in-hospital advanced life support algorithm, results of the largest modern studies and outlines promising areas of scientific development.

Is it the time to integrate "sono cardiopulmonary resuscitation" in cardiopulmonary resuscitation algorithm of traumatic cardiac arrest?

Sir, American Heart Association 2010 advanced cardiac arrest life support (ACLS) guidelines have stressed on the quality of cardiopulmonary resuscitation (CPR) by monitoring various physiological parameters such as end-tidal CO2. However, there is a paucity of literature about how to early and effectively identify and manage the potentially treatable causes of cardiac arrest (5 “H” and 5 “T”) as per ACLS algorithm.[1] The term “sono CPR” refers to applications of ultrasonography (USG) while performing CPR. The point of care USG may be performed during the brief pauses taken for pulse and rhythm check, after every 2 min of a CPR cycle. Hence, chest compressions are not interrupted nor there is any deviation from the standard ACLS guidelines. Authors practice AIIMS-CLIP, a protocol which refers to sequential scanning of cardiac (C) and lung (L) windows followed by an assessment of inferior vena cava (IVC) diameter using USG. Using “sono CPR,” approximately 40% of the potentially treatable causes (5 “H” and 5 “T”) of cardiac arrest may be assessed and managed in time. In traumatic cardiac arrest (TCA), cardiac scan can detect tamponade (T) and pulmonary thromboembolism (T), lung scan can detect tension pneumothorax (T), and IVC scan can detect hypovolemia (H). From the prognostic point of view, a cardiac scan showing the absence of cardiac motion during resuscitation of patients in cardiac arrest would be highly predictive of inability to achieve a return of spontaneous circulation and a poor prognosis.[2,3,4,5] Ultrasound evaluation of cardiac contractility increases the success rate of accomplished CPR.[5] In the light of above knowledge, would it be right to keep ourselves blind regarding detectable and treatable causes of cardiac arrest while performing CPR and awaiting for the cardiac activity to return or to actively use “sono CPR” and search for treatable causes so that timely intervention could be done? Future research may explore the integration of point of care sonography as an adjunct to CPR in TCA. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Basic life support for cardiac arrest: where every second counts

A cardiac arrest happens when the heart stops pumping blood around the body. All staff could be required to perform cardiopulmonary resuscitation (CPR) if this emergency occurs and so must be aware of the principles of basic life support, as AJ Stewart explains

Extracorporeal life support for cardiac arrest in a paediatric emergency department

The initiation of extracorporeal membrane oxygenation (ECMO) in the emergency department (ED) is a rare event. Herein, we report a case of acute fulminant myocarditis in a nine-year-old girl who was successfully resuscitated by early initiation of ECMO support in the paediatric ED of KK Women's and Children's Hospital, Singapore. The patient had rapidly progressed into a witnessed pulseless ventricular tachycardia on presentation, and ECMO was started in the ED following the failure of standard resuscitation measures to establish spontaneous circulation. ECMO was continued for nine days. The patient recovered well with normal neurocognitive function. The initiation of ECMO in the ED is potentially life-saving in the resuscitation of children with witnessed in-hospital cardiac arrest due to a reversible cause.

Factors Complicating Interpretation of Capnography during Advanced Life Support in Cardiac Arrest—A Clinical Retrospective Study in 575 Patients: Heradstveit BE, Sunde K, Sunde GA, Wentzel-Larsen T, Heltne JK. Resuscitation 2012;83:813–8.

This study from Norway evaluated the levels of end-tidal carbon dioxide (ETCO2) capnography in patients with out-of-hospital cardiac arrest (OHCA), and its interpretation limitations based on initial heart rhythm, cause of the arrest, presence of bystander cardiopulmonary resuscitation (CPR), and time dependency on a retrospective study. Capnography data were available for 575 non-traumatic OHCA patients that were intubated and treated by the Helicopter Emergency Medical Service at Haukelend University Hospital over a period of 6 years.

Factors complicating interpretation of capnography during advanced life support in cardiac arrest—A clinical retrospective study in 575 patients

BackgroundEnd tidal carbon dioxide (ETCO2) monitoring during advanced life support (ALS) using capnography, is recommended in the latest international guidelines. However, several factors might complicate capnography interpretation during ALS. How the cause of cardiac arrest, initial rhythm, bystander cardiopulmonary resuscitation (CPR) and time impact on the ETCO2 values are not completely clear. Thus, we wanted to explore this in out-of-hospital cardiac arrested (OHCA) patients. MethodsThe study was carried out by the Emergency Medical Service of Haukeland University Hospital, Bergen, Norway. All non-traumatic OHCAs treated by our service between January 2004 and December 2009 were included. Capnography was routinely used in the study, and these data were retrospectively reviewed together with Utstein data and other clinical information. ResultsOur service treated 918 OHCA patients, and capnography data were present in 575 patients. Capnography distinguished well between patients with or without return of spontaneous circulation (ROSC) for any initial rhythm and cause of the arrest (p<0.001). Cardiac arrests with a respiratory cause had significantly higher levels of ETCO2 compared to primary cardiac causes (p<0.001). Bystander CPR affected ETCO2-recordings, and the ETCO2 levels declined with time. ConclusionsCapnography is a useful tool to optimise and individualise ALS in cardiac arrested patients. Confounding factors including cause of cardiac arrest, initial rhythm, bystander CPR and time from cardiac arrest until quantitative capnography had an impact on the ETCO2 values, thereby complicating and limiting prognostic interpretation of capnography during ALS.

Out-of-hospital extracorporeal life support for cardiac arrest—A case report

We report the use of out-of-hospital extracorporeal life support (ECLS) in cardiac arrest. We treated a 9-year-old girl with cardiac arrest after warm-water drowning with percutaneous venoarterial extracorporeal membrane oxygenation (ECMO) using a new portable Mini-ECMO system. A beating-heart circulation was reestablished on ECMO, but, unfortunately, our patient did not survive. This case shows that Mini-ECMO support can be used to restore an effective circulation and gas exchange in the out-of-hospital setting.

Successful extracorporeal life support in cardiac arrest with recurrent ventricular fibrillation unresponsive to standard cardiopulmonary resuscitation

Extracorporeal life support has been used as an extension of conventional cardiopulmonary resuscitation (CPR). However, the appropriate indications for extracorporeal CPR (ECPR) including the duration of CPR are unknown. We present a case of a male, 37-year-old out-of-hospital cardiac arrest patient who received prolonged CPR followed by ECPR. Despite advanced cardiac life support, he did not regain a sustained spontaneous circulation and had recurrent ventricular fibrillation (VF) during the prolonged CPR. VF was unresponsive to CPR, defibrillation, adrenaline (epinephrine), and antiarrhythmics. The CPR time before ECPR was approximately 2h. During extracorporeal life support, the VF did not recur and percutaneous coronary angioplasty was achieved. Ultimately, the patient was discharged without neurological complications. Although cardiac arrest occurred out-of-hospital and CPR was performed for a long time, a patient might be a candidate for ECPR if perfusing rhythms are restored transiently but not successfully maintained due to recurrent VF. ECPR may be used for VF unresponsive to standard CPR techniques.