Mechanical Cardiopulmonary Resuscitation Research Articles

End-of-life in Hepatocellular Carcinoma: How Palliative Care and Social Factors Impact Care and Cost.

Investigate the impacts of palliative care consults, race, and socioeconomic status on the prevalence of invasive procedures in patients with hepatocellular carcinoma (HCC). Palliative care, race, and socioeconomic status can all influence end-of-life care preferences, but their roles in HCC have not been adequately explored. This is a cross-sectional study of patients with HCC from 2016 to 2019 using the National Inpatient Sample. Terminal and nonterminal hospitalizations were assessed with logistical regression evaluating associations between palliative care, race, income, and procedures along with do-not-resuscitate orders and cost. Procedures included mechanical ventilation, tracheostomy, and cardiopulmonary resuscitation (CPR) among others. A total of 217,060 hospitalizations in patients with HCC were included, 18.1% of which included a palliative care encounter. The mean age was 65.0 years (SD = 11.3y), 73.9% were males and 55.5% were white. Procedures were increased in terminal hospitalizations in black [CPR adjusted odds ratio (aOR) = 2.57, P < 0.001] and Hispanic patients (tracheostomy aOR = 3.64, P = 0.018) compared with white patients. Palliative care encounters were associated with reduced procedures during terminal hospitalizations (mechanical ventilation aOR = 0.47, P < 0.001, CPR aOR = 0.24, P < 0.001), but not in nonterminal hospitalizations. No association between income and end-of-life procedures was found. Palliative care was associated with decreased mean cost in terminal ($23,608 vs $31,756, P < 0.001) and nonterminal hospitalizations ($15,786 vs $19,914, P < 0.001). Palliative care is associated with less aggressive end-of-life care and decreased costs in patients with HCC. Black and Hispanic race were both associated with more aggressive end-of-life care.

Assessing the Impact of the Pandemic on Treatment Outcomes for Cardiac Arrest Patients Utilizing Mechanical CPR: A Nationwide Population-Based Observational Study in South Korea

Introduction: Cardiopulmonary resuscitation with mechanical devices (MCPR) was developed to provide high-quality cardiopulmonary resuscitation (CPR) for patients with cardiac arrest. However, the effect of this procedure on treatment outcomes remains controversial. Nevertheless, during the coronavirus disease-19 (COVID-19) pandemic, in-hospital MCPR gained attention, owing to its advantages such as saving medical staff and preventing infection. This study compared the treatment outcomes of in-hospital MCPR and manual CPR for out-of-hospital cardiac arrest (OHCA) patients during the COVID-19 pandemic. Materials and Methods: This retrospective nationwide population-based study was conducted in South Korea. Data were collected from the Out-of-Hospital Cardiac Arrest surveillance database managed by the Korea Disease Control and Prevention Agency. We included adult OHCA patients transported by emergency medical services from 2016 to 2021. The study compared outcomes during the COVID-19 pandemic years (2020–2021) with the preceding non-pandemic years (2018–2019). The primary outcome was survival to hospital discharge, and the secondary outcomes were good neurological outcome and sustained return of spontaneous circulation (ROSC). Results: The entire study included 72,050 patients with OHCA and, in the multivariable analyses, MCPR was associated with lower survival rates compared to manual CPR (AOR 0.63; 95% CI 0.51–0.77; p &lt; 0.001). Interestingly, during the COVID-19 pandemic, while MCPR use increased, the survival rate did not differ significantly between the MCPR and manual-CPR groups. Conclusion: Our study findings suggest that while MCPR may offer potential benefits, such as decreased infection risk for healthcare workers, it did not demonstrate superior outcomes compared to manual CPR in our study population.

Early prehospital mechanical cardiopulmonary resuscitation use for out-of-hospital cardiac arrest: an observational study

BackgroundThe use of mechanical cardiopulmonary resuscitation device has been very prevalent in out-of-hospital cardiac arrest rescue. This study aimed to investigate whether the timing of mechanical cardiopulmonary resuscitation device set-up correlated with the the outcome of cardiac arrest patients.MethodsWe retrospectively reviewed adult nontrauma cardiac arrest cases in New Taipei City, Taiwan, from January to December 2022. Demographic data, intervention-related factors, and the time variables of mechanical cardiopulmonary resuscitation were collected. The outcomes included the return of spontaneous circulation and 24-hour survival. We compared patients who achieved spontaneous circulation and those who did not with univariate and multivariable regression analyses.ResultsIn total, 1680 patients who received mechanical cardiopulmonary resuscitation were included in the analysis. Reducing the time interval from manual chest compression initiation to device setup was independently associated with the return of spontaneous circulation and 24-hour survival, especially in the subgroup of patients of initial shockable rhythm. Receiver operating characteristic analysis revealed that the outcome of patients with an initial shockable rhythm could be predicted by the mechanical cardiopulmonary resuscitation setup time, with areas under the curve of 60.8% and 63.9% for ROSC and 24-hour survival, respectively. The cutoff point was 395.5 s for patients with an initial shockable rhythm.ConclusionA positive correlation was found between early mechanical cardiopulmonary resuscitation intervention and the outcomes of out-of-hospital cardiac arrest patients. The time between manual chest compression and device setup could predict the return of spontaneous circulation and 24-hour survival in the subgroup of patients with initially shockable rhythm with the optimal cutoff point at 395.5 s.

A multimodal characterization of cardiopulmonary resuscitation-associated lung edema

BackgroundCardiopulmonary resuscitation-associated lung edema (CRALE) is a phenomenon that has been recently reported in both experimental and out-of-hospital cardiac arrest patients.We aimed to explore the respiratory and cardiovascular pathophysiology of CRALE in an experimental model of cardiac arrest undergoing prolonged manual and mechanical chest compression (CC). Oxygen delivery achieved during mechanical or manual CC were also investigated as a secondary aim, to describe CRALE evolution under different hemodynamic supports generated during CPR.MethodsVentricular fibrillation (VF) was induced and left untreated for 5 min prior to begin cardiopulmonary resuscitation (CPR), including CC, ventilation with oxygen, epinephrine administration and defibrillation. Continuous mechanical and manual CC was performed alternating one of the two strategies every 5 min for a total of 25 min. Unsynchronized mechanical ventilation was resumed simultaneously to CC. A lung computed tomography (CT) was performed at baseline and 1 h after return of spontaneous circulation (ROSC) in surviving animals. Partitioned respiratory mechanics, gas exchange, hemodynamics, and oxygen delivery were evaluated during the experimental study at different timepoints. Lung histopathology was performed.ResultsAfter 25 min of CPR, a marked decrease of the respiratory system compliance with reduced oxygenation and CO2 elimination were observed in all animals. The worsening of the respiratory system compliance was driven by a significant decrease in lung compliance. The presence of CRALE was confirmed by an increased lung weight and a reduced lung aeration at the lung CT, together with a high lung wet-to-dry ratio and reduced airspace at histology. The average change in esophageal pressure during the 25-min CPR highly correlated with the severity of CRALE, i.e., lung weight increase.ConclusionsIn this porcine model of cardiac arrest followed by a 25-min interval of CPR with mechanical and manual CC, CRALE was consistently present and was characterized by lung inhomogeneity with alveolar tissue and hemorrhage replacing alveolar airspace. Despite mechanical CPR is associated with a more severe CRALE, the higher cardiac output generated by the mechanical compression ultimately accounted for a greater oxygen delivery. Whether specific ventilation strategies might prevent CRALE while preserving hemodynamics remains to be proved.

The association of time to key prehospital interventions recorded by EMT-worn video devices and sustained return of spontaneous circulation in out-of-hospital cardiac arrests

ABSTRACT OBJECTIVES The quality of prehospital resuscitation provided by emergency medical technicians (EMTs) is essential to ensure better outcomes following out-of-hospital cardiac arrests (OHCA). We assessed the quality of prehospital resuscitation by recording time to key prehospital interventions using EMT-worn video devices and investigated its association with outcomes of patients with OHCA. METHODS This retrospective, cross-sectional study included cases of non-traumatic OHCA in adults treated by EMS in Hsinchu City, Taiwan, during 2022 and 2023. We used data from high-resolution, chest-mounted wearable cameras to define and measure six Quality Indices (QIs) for prehospital resuscitation interventions (i.e., time spent recognizing OHCA). To evaluate the association between QI performance and sustained return of spontaneous circulation (ROSC), we used multivariable logistic regression. RESULTS Of 745 patients eligible for this study, 187 (25.1%) achieved sustained ROSC. Six core QIs were analyzed: recognition of OHCA (median time: 9.0 seconds), time from recognizing OHCA to initiating cardiopulmonary resuscitation (CPR; 9.0 seconds), automated external defibrillator setup (34.0 seconds), time from recognizing OHCA to beginning ventilation (160.0 seconds), advanced airway management (300 seconds), and deploying a mechanical CPR device (50 seconds). The performance of the six QIs were not associated with sustained ROSC (Adjusted odds ratio [95% confidence interval]: 1.00 [0.99-1.00], 0.99 [0.98-1.00], 1.00 [1.00-1.01], 1.00 [1.00-1.00], 1.00 [1.00-1.00] and 0.99 [0.99-1.00], respectively). CONCLUSIONS This study describes the rate of sustained ROSC and time to key interventions captured by EMT-worn video devices in non-traumatic OHCA patients. Although we found no direct link between QI performance and improved OHCA outcomes, this study highlights the potential of video-assisted QIs to enhance the documentation and understanding of prehospital resuscitation processes. These findings suggest that further refinement and application of these QIs could support more effective resuscitation strategies and training programs.

A Scientometric Analysis of Mechanical Cardiopulmonary Resuscitiation Device Publications

Aim: Today, the use of automatic chest compression devices is increasing. The aim of this study is to identify popular publications about chest compression devices, save time for researchers, and summarize the important points of chest compression devices using the scientometric analysis method. Material and Methods: All data were collected using the Web of Science Core Collection between July 1-8, 2023. Articles related to the topic were selected using the keywords "automated chest compression device" or "mechanical chest compression device". All articles in the database were manually scanned and analyzed. The distribution of relevant articles in the database was analysed according to scientific journals. Global research productivity, international collaborations, and research themes were analyzed using the scientometric method. Results: A total of 589 articles were identified in the WoS. Out of these, 439 (74.407%) were original articles, followed by 63 (10.678%) review articles and 30 (5.085%) editorial materials. When examining the distribution of research articles by country, the United States (US) topped the list with 171 articles, followed by Germany (n=77). Although the UK ranked third in terms of the number of publications with 53 articles, it ranked first in terms of the number of citations. (n=3465). An assessment of the top 20 publishing journals revealed that the Resuscitation Journal led in terms of publication count (n=133), citation count (n=5906), and average citations per publication (n=44.41). Conclusion: Our bibliometric study analyzed 589 articles on mechanical cardiopulmonary resuscitation. This can help researchers identify trending topics and areas of interest more quickly. More research is needed to fully understand the effectiveness and best tools for saving lives in emergency situations.

Design and validation of an In Vitro test bench for the investigation of cardiopulmonary resuscitation procedure

Despite recent clinical and technological advancements, the cardiac arrest survival rate remains as low as 10%. To enhance patient outcomes, it is crucial to deepen the understanding of cardiopulmonary resuscitation (CPR) at a fundamental level. Currently, there is a lack of knowledge on the physiological effects of CPR, in particular on the hemodynamics in the heart and the great vessels. The design and validation of a dedicated in vitro heart simulator, capable of replicating the physiological response to CPR, holds the potential to provide valuable insights into the fluid dynamics in the heart during CPR but also to be used as a platform for the development and testing of mechanical CPR machines. The main objective of this study is to design and validate the first in vitro heart simulator that can replicate the physiological response during CPR. For that, a custom-made heart simulator is designed consisting of an elastic model of the complete heart and a controllable linear actuator. The heart model is positioned in an anatomical position, and the linear actuator compresses the model at specific rates and depths. Flow and pressure waveforms are recorded on the newly developed simulator at 60 contractions per minute and results are validated against reported in vivo data in the literature. Finally, the system’s capabilities are evaluated by considering several combinations of compression rates and depths.

Out-of-Hospital Cardiac Arrest Outcomes After Ventricular Fibrillation.

This study is a retrospective review ofpatients who sustained out-of-hospital cardiac arrest due to ventricular fibrillation.The data were analyzed to decipher predictors of good outcomes as the overall survival rate in the county is significantly higher than the national average. The inclusion criteria for the study comprised all patients over the age of 18 for whom a call was made for unresponsiveness. Data for this project included all cardiac arrests due to ventricular fibrillation in the calendar year 2022. Results: A total of 80 patients sustained cardiac arrest due to ventricular fibrillation. The age range was 27-80 years old. The study has 71% White, 19% African American, 8.7% Hispanic, and 1% other populations. Ninety-five percent received epinephrine, 89% utilized an advanced airway, 60% underwent hypothermia protocol, 24% utilized an AED device, and 14% used a mechanical CPR device. Seventy-six percent were pronounced dead in the ER or the hospital, and 19% survived to discharge. In the survivor population, CPR was initiated in 13 minutes or less and defibrillation occurred in 23 minutes or less. While none of the variables achieved statistical significance, epinephrine use showed a trend toward statistical significance for the outcome of sustained return of spontaneous circulation (ROSC) with a p-value of 0.05346. Nineteen percent of patients survived out-of-hospital cardiac arrests in the Polk County hospital system. This is significantly higher than the national average. This likely reflects the emphasis on high-quality CPR and active on-scene management, as no individual variable was statistically significant.

Outcome-Orientated Organ Allocation-A Composite Risk Model for Pancreas Graft Evaluation and Acceptance.

Background: Pancreas transplantation (PTX) remains the most effective treatment to prevent long-term complications and provide consistent euglycemia in patients with endocrine pancreatic insufficiency, mainly in type I diabetic patients. Considering early graft loss (EGL) and the perioperative complication rate, an optimal risk stratification based on donor risk factors is paramount. Methods: In our single-center study, we retrospectively assessed the risk factors for EGL and reduced graft survival in 97 PTXs (82 simultaneous pancreas and kidney [SPK], 11 pancreases transplanted after kidney [PAK] and 4 pancreases transplanted alone [PTA]) between 2010 and 2021. By statistically analyzing the incorporation of different donor risk factors using the Kaplan-Meier method and a log-rank test, we introduced a composite risk model for the evaluation of offered pancreas grafts. Results: The overall EGL rate was 6.5%. In the univariate analysis of donor characteristics, age > 45 years, BMI > 25 kg/m2, lipase > 60 U/L, cerebrovascular accident (CVA) as the cause of death, mechanical cardiopulmonary resuscitation (mCPR), cold ischemia time (CIT) > 600 min and retrieval by another center were identified as potential risk factors; however, they lacked statistical significance. In a multivariate model, age > 45 years (HR 2.05, p = 0.355), BMI > 25 kg/m2 (HR 3.18, p = 0.051), lipase > 60 U/L (HR 2.32, p = 0.148), mCPR (HR 8.62, p < 0.0001) and CIT > 600 min (HR 1.89, p = 0.142) had the greatest impact on pancreas graft survival. We subsumed these factors in a composite risk model. The combination of three risk factors increased the rate of EGL significantly (p = 0.003). Comparing the pancreas graft survival curves for ≥3 risk factors to <3 risk factors in a Kaplan-Meier model revealed significant inferiority in the pancreas graft survival rate (p = 0.029). Conclusions: When evaluating a potential donor organ, grafts with a combination of three or more risk factors should only be accepted after careful consideration to reduce the risk of EGL and to significantly improve outcomes after PTX.

Mild (34 °C) versus moderate hypothermia (24 °C) in a swine model of extracorporeal cardiopulmonary resuscitation

BackgroundThe role of hypothermia in post-arrest neuroprotection is controversial. Animal studies suggest potential benefits with lower temperatures, but high-fidelity ECPR models evaluating temperatures below 30 °C are lacking. ObjectivesTo determine whether rapid cooling to 24 °C initiated upon reperfusion reduces brain injury compared to 34 °C in a swine model of ECPR. MethodsTwenty-four female pigs had electrically induced VF and mechanical CPR for 30 min. Animals were cannulated for VA-ECMO and cooled to either 34 °C for 4 h (n = 8), 24 °C for 1 h with rewarming to 34 °C over 3 h (n = 7), or 24 °C for 4 h without rewarming (n = 9). Cooling was initiated upon VA-ECMO reperfusion by circulating ice water through the oxygenator. Brain temperature and cerebral and systemic hemodynamics were continuously monitored. After four hours on VA-ECMO, brain tissue was obtained for examination. ResultsTarget brain temperature was achieved within 30 min of reperfusion (p = 0.74). Carotid blood flow was higher in the 24 °C without rewarming group throughout the VA-ECMO period compared to 34 °C and 24 °C with rewarming (p < 0.001). Vasopressin requirement was higher in animals treated with 24 °C without rewarming (p = 0.07). Compared to 34 °C, animals treated with 24 °C with rewarming were less coagulopathic and had less immunohistochemistry-detected neurologic injury. There were no differences in global brain injury score. ConclusionsDespite improvement in carotid blood flow and immunohistochemistry detected neurologic injury, reperfusion at 24 °C with or without rewarming did not reduce early global brain injury compared to 34 °C in a swine model of ECPR.

Feasibility of a 4 French resuscitative endovascular balloon occlusion of the aorta (REBOA) device for nontraumatic cardiac arrest in a randomized controlled study using a large porcine model

AimThe objectives of this study were to assess the return of spontaneous circulation rates and hemodynamic response of large swine (>65Kg) during cardiopulmonary resuscitation after nontraumatic cardiac arrest using the COBRA-OS® aortic occlusion balloon and to address limitations of large swine closed-chest cardiopulmonary resuscitation by comparing closed-chest vs. open-chest cardiopulmonary resuscitation. MethodsYorkshire pigs (n = 10) weighing >65 kg were anesthetized and ventilated. After 7 min of untreated ventricular fibrillation (VF), animals were randomized to receive mechanical closed-chest cardiopulmonary resuscitation or open-chest cardiac massage. Following a 5-minute low-flow state, advanced cardiac life support algorithms were started and the COBRA-OS® was inflated in the thoracic aorta. Animals that achieved return of spontaneous circulation were re-started on mechanical ventilation and medications, CPR, defibrillation, and aortic occlusion were discontinued. The primary outcome was return of spontaneous circulation and secondary outcomes were mean arterial pressures generated in the low flow and aortic occlusion states before return of spontaneous circulation. Groups were compared with a t-test or Mann-Whitney U test for normal and non-parametric data, respectively, while categorical data was compared with the chi square test. ResultsReturn of spontaneous circulation was obtained in 4 animals (80%) in the open cardiac massage group and none in the mechanical closed-chest CPR group (p < 0.05). The COBRA-OS® successfully occluded all aortas and animals experienced higher mean arterial pressures in both groups with aortic occlusion (median 15 mm Hg, IQR 13–23 mm Hg), but with a higher MAP difference in the open cardiac massage group (−12.2 mm Hg, [−2.581, −21.819]). ConclusionsConsideration should be given to intra-thoracic cardiac massage to increase cardiopulmonary resuscitation effectiveness and therefore return of spontaneous circulation rates in large (>65 kg) swine models of nontraumatic cardiac arrest. The COBRA-OS® demonstrated feasibility for use in this model.The Keenan Research Center, Li Ka Shing Knowledge Institute of St. Michael’s Hospital Animal Care Committee: ACC Protocol #726.

Recovery of arterial blood pressure after chest compression pauses in patients with out-of-hospital cardiac arrest

Background and aimsChest compressions generating good perfusion during cardiopulmonary resuscitation (CPR) in cardiac arrest patients are critical for positive patient outcomes. Conventional wisdom advises minimizing compression pauses because several compressions are required to recover arterial blood pressure (ABP) back to pre-pause values. Our study examines how compression pauses influence ABP recovery post-pause in out-of-hospital cardiac arrest. MethodsWe analyzed data from a subset of a prospective, randomized LUCAS 2 Active Decompression trial. Patients were treated by an anesthesiologist-staffed rapid response car program in Oslo, Norway (2015–2017) with mechanical chest compressions using the LUCAS device at 102 compressions/min. Patients with an ABP signal during CPR and at least one compression pause >2 sec were included. Arterial cannulation, compression pauses, and ECG during the pause were verified by physician review of patient records and physiological signals. Pauses were excluded if return of spontaneous circulation occurred during the pause (pressure pulses associated with ECG complexes). Compression, mean, and decompression ABP for 10 compressions before/after each pause and the mean ABP during the pause were measured with custom MATLAB code. The relationship between pause duration and ABP recovery was investigated using linear regression. ResultsWe included 56 patients with a total of 271 pauses (pause duration: median = 11 sec, Q1 = 7 sec, Q3 = 18 sec). Mean ABP dropped from 53 ± 10 mmHg for the last pre-pause compression to 33 ± 7 mmHg during the pause. Compression and mean ABP recovered to >90% of pre-pause pressure within 2 compressions, or 1.7 sec. Pause duration did not affect the recovery of ABP post-pause (R2: 0.05, 0.03, 0.01 for compression, mean, and decompression ABP, respectively). ConclusionsABP generated by mechanical CPR recovered quickly after pauses. Recovery of ABP after a pause was independent of pause duration.

Leukocyte filtration and leukocyte modulation therapy during extracorporeal cardiopulmonary resuscitation in a porcine model of prolonged cardiac arrest

Extracorporeal cardiopulmonary resuscitation (ECPR) is emerging as a feasible and effective rescue strategy for prolonged cardiac arrest (CA). However, prolonged total body ischemia and reperfusion can cause microvascular occlusion that prevents organ reperfusion and recovery of function. One hypothesized mechanism of microvascular “no-reflow” is leukocyte adhesion and formation of neutrophil extracellular traps. In this study we tested the hypothesis that a leukocyte filter (LF) or leukocyte modulation device (L-MOD) could reduce NETosis and improve recovery of heart and brain function in a swine model of prolonged cardiac arrest treated with ECPR. Thirty-six swine (45.5 ± 2.5 kg, evenly distributed sex) underwent 8 min of untreated ventricular fibrillation CA followed by 30 min of mechanical CPR with subsequent 8 h of ECPR. Two females were later excluded from analysis due to CPR complications. Swine were randomized to standard care (Control group), LF, or L-MOD at the onset of CPR. NET formation was quantified by serum dsDNA and citrullinated histone as well as immunofluorescence staining of the heart and brain for citrullinated histone in the microvasculature. Primary outcomes included recovery of cardiac function based on cardiac resuscitability score (CRS) and recovery of neurologic function based on the somatosensory evoked potential (SSEP) N20 cortical response. In this model of prolonged CA treated with ECPR we observed significant increases in serum biomarkers of NETosis and immunohistochemical evidence of microvascular NET formation in the heart and brain that were not reduced by LF or L-MOD therapy. Correspondingly, there were no significant differences in CRS and SSEP recovery between Control, LF, and L-MOD groups 8 h after ECPR onset (CRS = 3.1 ± 2.7, 3.7 ± 2.6, and 2.6 ± 2.6 respectively; p = 0.606; and SSEP = 27.9 ± 13.0%, 36.7 ± 10.5%, and 31.2 ± 9.8% respectively, p = 0.194). In this model of prolonged CA treated with ECPR, the use of LF or L-MOD therapy during ECPR did not reduce microvascular NETosis or improve recovery of myocardial or brain function. The causal relationship between microvascular NETosis, no-reflow, and recovery of organ function after prolonged cardiac arrest treated with ECPR requires further investigation.

Emergency Medical Service Agency Practices and Cardiac Arrest Survival

Survival for out-of-hospital cardiac arrest (OHCA) varies widely across emergency medical service (EMS) agencies in the US. However, little is known about which EMS practices are associated with higher agency-level survival. To identify resuscitation practices associated with favorable neurological survival for OHCA at EMS agencies. This cohort study surveyed EMS agencies participating in the Cardiac Arrest Registry to Enhance Survival (CARES) with 10 or more OHCAs annually during January 2015 to December 2019; data analyses were performed from April to October 2023. Survey of resuscitation practices at EMS agencies. Risk-standardized rates of favorable neurological survival for OHCA at each EMS agency were estimated using hierarchical logistic regression. Multivariable linear regression then examined the association of EMS practices with rates of risk-standardized favorable neurological survival. Of 577 eligible EMS agencies, 470 agencies (81.5%) completed the survey. The mean (SD) rate of risk-standardized favorable neurological survival was 8.1% (1.8%). A total of 7 EMS practices across 3 domains (training, cardiopulmonary resuscitation [CPR], and transport) were associated with higher rates of risk-standardized favorable neurological survival. EMS agencies with higher favorable neurological survival rates were more likely to use simulation to assess CPR competency (β = 0.54; P = .05), perform frequent reassessment (at least once every 6 months) of CPR competency in new staff (β = 0.51; P = .04), use full multiperson scenario simulation for ongoing skills training (β = 0.48; P = .01), perform simulation training at least every 6 months (β = 0.63; P < .001), and conduct training in the use of mechanical CPR devices at least once annually (β = 0.43; P = .04). EMS agencies with higher risk-standardized favorable neurological survival were also more likely to use CPR feedback devices (β = 0.58; P = .007) and to transport patients to a designated cardiac arrest or ST-segment elevation myocardial infarction receiving center (β = 0.57; P = .003). Adoption of more than half (≥4) of the 7 practices was more common at EMS agencies in the highest quartile of favorable neurological survival rates (70 of 118 agencies [59.3%]) vs the lowest quartile (42 of 118 agencies [35.6%]) (P < .001). In a national registry for OHCA, 7 practices associated with higher rates of favorable neurological survival were identified at EMS agencies. Given wide variability in neurological survival across EMS agencies, these findings provide initial insights into EMS practices associated with top-performing EMS agencies in OHCA survival. Future studies are needed to validate these findings and identify best practices for EMS agencies.

The impact of specialized pediatric palliative care on advance care planning and healthcare utilization in children and young adults: a retrospective analysis of medical records of in-hospital deaths.

Pediatric palliative care supports children and young adults with life-limiting conditions and their families, seeking to minimize suffering and enhance quality of life. This study evaluates the impact of specialized palliative care (SPC) on advance care planning (ACP) and patterns of end-of-life care for patients who died in the hospital. This is a retrospective cohort study of medical records extracted from a clinical data warehouse, covering patients who died aged 0-24 in an academic tertiary children's hospital in South Korea. Participants were categorized into before (2011-2013; pre-period) and after (2017-2019; post-period) the introduction of an SPC service. Within the post-period, patients were further categorized into SPC recipients and non-recipients. We identified 274 and 205 patients in the pre-period and post-period, respectively. ACP was conducted more and earlier in the post-period than in the pre-period, and in patients who received palliative care than in those who did not. Patients who received SPC were likely to receive less mechanical ventilation or cardiopulmonary resuscitation and more opioids. A multivariable regression model showed that earlier ACP was associated with not being an infant, receiving SPC, and having a neurological or neuromuscular disease. SPC involvement was associated with more and earlier ACP and less intense end-of-life care for children and young adults who died in the hospital. Integrating palliative care into routine care can improve the quality of end-of-life care by reflecting patients' and their families' values and preferences.

Favourable outcome in survivors of CPR-related chest wall injuries

BackgroundThere is a lack of studies focusing on long-term chest function after chest wall injury due to cardiopulmonary resuscitation (CPR). The purpose of this cross-sectional study was to investigate long-term pain, lung function, physical function, and fracture healing after manual or mechanical CPR and in patients with and without flail chest. MethodsPatients experiencing out-of-hospital cardiac arrest between 2013 and 2020 and transported to Sahlgrenska University Hospital were identified. Survivors who had undergone a computed tomography (CT) showing chest wall injury were contacted. Thirty-five patients answered a questionnaire regarding pain, physical function, and quality of life and 25 also attended a clinical examination to measure the respiratory and physical functions 3.9 (SD 1.7, min 2-max 8) years after the CPR. In addition, 22 patients underwent an additional CT scan to evaluate fracture healing. ResultsThe initial CT showed bilateral rib fractures in all but one patient and sternum fracture in 69 %. At the time of the follow-up none of the patients had persistent pain, however, two patients were experiencing local discomfort in the chest wall. Lung function and thoracic expansion were significantly lower compared to reference values (FVC 14 %, FEV1 18 %, PEF 10 % and thoracic expansion 63 %) (p < 0.05). Three of the patients had remaining unhealed injuries. Patients who had received mechanical CPR in additional to manual CPR had a lower peak expiratory flow (80 vs 98 % of predicted values) (p=0.030) =0.030) and those having flail chest had less range of motion in the thoracic spine (84 vs 127 % of predicted) (p = 0.019) otherwise the results were similar between the groups. ConclusionNone of the survivors had long-term pain after CPR-related chest wall injuries. Despite decreased lower lung function and thoracic expansion, most patients had no limitations in physical mobility. Only minor differences were seen after manual vs. mechanical CPR or with and without flail chest.

Splenic Modulation of Early Post-Resuscitation Inflammation in a Porcine Model of Sudden Cardiac Arrest

Objective: The spleen has been implicated as a potential therapeutic target for acute anti-inflammatory intervention via modulation of splenic nerve activity, but the translational viability of this approach is unclear due to limited mechanistic understanding of splenic leukocyte mobilization in clinically relevant models. In contrast to prior rodent studies, we recently demonstrated that the spleen is not required for leukocyte mobilization after focal myocardial ischemia/reperfusion in swine. However, the spleen's role in the early inflammatory response to whole-body ischemia/reperfusion following resuscitation from sudden cardiac arrest (SCA) remains unexplored. Therefore, we used a surgical approach to investigate the spleen's contribution to early post-resuscitation inflammation in a porcine model of SCA. Methods: Eighteen swine were randomized to splenectomy (SPLX; n=9) or sham surgery (SHAM; n=9), and subsequently underwent 8 minutes of electrically-induced ventricular fibrillation SCA one week later. Mechanical CPR with defibrillation and intravenous epinephrine (EPI; 0.015 mg/kg) was performed to achieve return of spontaneous circulation (ROSC; defined as sustained MAP&gt;60mmHg). Hemodynamic parameters, cardiac function, circulating biomarkers of injury (cTnI) and inflammation (IL-6, TNF-⍺), and blood leukocyte levels were assessed for 4 hours post-ROSC, at which time the heart and brain were collected for post-mortem analysis of leukocyte infiltration via flow cytometry. Results: SPLX and SHAM animals were resuscitated at a similar rate (SHAM vs SPLX: 56% vs. 44%) and required a similar number of defibrillation attempts (4.3±0.8 vs. 5.2±1.3), but SPLX required more EPI boluses during CPR (3.3±1.3 vs. 1.4±0.2; p&lt;0.05) and took longer to achieve ROSC (779±196 vs. 455±37 sec; p&lt;0.05). After ROSC, SPLX animals required more EPI (43±10 vs. 13±10 μg/kg; p&lt;0.05) to maintain MAP &gt;60mmHg and tended to have higher circulating cTnI levels compared to SHAM (19.5±4.4 vs. 5.8±4.4 ng/mL; p=0.07). A significant elevation in circulating leukocytes was observed from pre-SCA to 4-hours post-ROSC in both SPLX (19.5±1.3 to 32.0±2.6 103/μl; p&lt;0.05) and SHAM (from 15.1±1.3 to 23.7±2.9 103/μl; p&lt;0.05), along with an increase in circulating IL-6 and TNF-α vs. pre-SCA values that tended to be higher in SPLX. Flow cytometry revealed post-ROSC leukocyte infiltration that was particularly evident in the brain, with an increased number of inflammatory granulocytes (CD172+CD163-) and dendritic cells (CD172+CD16+) in multiple brain regions of SPLX and SHAM animals compared with healthy controls. Conclusion: These results demonstrate that, in swine, the spleen is not required for the robust early inflammatory response to resuscitation from SCA. This observation provides further evidence that, in contrast to rodents, the spleen is not a primary contributor to sterile inflammation following ischemia/reperfusion injury in large animals. This translational study suggests that neuromodulation of splenic leukocyte mobilization may not be a viable therapeutic strategy for mitigating acute inflammation in clinical post-cardiac arrest syndrome. Supported by funding from the NIH and US Department of Veteran's Affairs. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Mechanical Cardiopulmonary Resuscitation (CPR) Is Better Than Manual CPR? Literature Study

Introduction: Mechanical CPR mitigate rescuer fatigue and ensure adherence to guidelines, potentially enhancing overall survival rates. Contrarily, manual CPR relies on human skill, presenting challenges in maintaining uniformity and endurance. Unveiling the complexities within this juxtaposition becomes imperative in shaping future resuscitative paradigms. The purposeof studi is to determine the effectiveness of mechanical CPR in cardiac arrest management compared to manual CPRMethods: Database used were Pubmed and Proquest using the keywords "Mechanical CPR", "Automatic CPR Device" and "Cardiac Arrest". The inclusion criteria were last 5 years published, analyzing the effect of automatic CPR devices on cardiac arrest management, as well as full text articles. The inclusion criteria are literature review, systematic review or is not original research. The number of articles eligible for review is 10 journal articlesResults: The use of automatic CPR equipment is still inferior compared to manual CPR during cardiac arrest with the use value being 4-5% of all cardiac arrest patients. There are 4 journals that state that ROSC in cardiac arrest management using automatic CPR devices is higher than manual, but there are 2 journal articles that report the opposite. Automatic CPR device is very vulnerable to injury with fractures reaching 85.5% of total injuries compared to manual CPR which does not experience injury.Conclusion: The use of automatic CPR device does not produce better results than manual CPR overall for ROSC, but is very useful and meaningful in certain conditions such as during the transportation process, therefore, the automatic CPR device is more meaningful for pre-hospital useKeywords: Manual CPR; Mechanical CPR; CPR; OHCA

Critical care management of acute intoxications, dynamics and changes over time: a cohort study

Acute intoxications and poisonings are a relevant cause for ICU admission of critically ill patients. This study aimed to determine the characteristics of intoxicated patients in a tertiary center medical ICU in Austria over time and to investigate parameters associated with ICU mortality. This study was a retrospective data analysis including adult ICU patients from the years 2007 to 2021. In addition to ICU documentation, pre-hospital, and emergency department documents as well as autopsy reports were utilized. In an exploratory subanalysis, we compared these findings to a historical dataset from our facility from 1992 to 1996. We identified 581 cases admitted to the medical ICU because of acute poisoning (2007–2021), of which 45% were female and 46.6% were mixed intoxications. Suicidal intent was the primary cause of intoxication (48.2%) and ICU length of stay was median 1.2 days. The majority of deceased patients received pre-hospital mechanical CPR. Primary and secondary poison/toxin removal modalities were used in 29.9% and 11.7% of cases, whereas antidotes were administered in 54.4%. Comparing the data with a historical cohort (n = 168), we found a shift in primary detoxification away from gastric lavage and an increase in alternative secondary poison/toxin removal techniques. The ICU mortality was 4.1% and 4.2% in the present and historic cohort, respectively. Pre-existing psychiatric illnesses increased from 49% in the historic to 69% in the present cohort. Psychiatric illness predisposes patients to severe intoxications necessitating ICU care, thus increasing prevention measures seems warranted. Females did present with a different spectrum of intoxications compared to males. ICU mortality remained low over time and most deceased patients had a grim prognosis already on ICU arrival.

A remote-controlled automatic chest compression device capable of moving compression position during CPR: A pilot study in a mannequin and a swine model of cardiac arrest.

Recently, we developed a chest compression device that can move the chest compression position without interruption during CPR and be remotely controlled to minimize rescuer exposure to infectious diseases. The purpose of this study was to compare its performance with conventional mechanical CPR device in a mannequin and a swine model of cardiac arrest. A prototype of a remote-controlled automatic chest compression device (ROSCER) that can change the chest compression position without interruption during CPR was developed, and its performance was compared with LUCAS 3 in a mannequin and a swine model of cardiac arrest. In a swine model of cardiac arrest, 16 male pigs were randomly assigned into the two groups, ROSCER CPR (n = 8) and LUCAS 3 CPR (n = 8), respectively. During 5 minutes of CPR, hemodynamic parameters including aortic pressure, right atrial pressure, coronary perfusion pressure, common carotid blood flow, and end-tidal carbon dioxide partial pressure were measured. In the compression performance test using a mannequin, compression depth, compression time, decompression time, and plateau time were almost equal between ROSCER and LUCAS 3. In a swine model of cardiac arrest, coronary perfusion pressure showed no difference between the two groups (p = 0.409). Systolic aortic pressure and carotid blood flow were higher in the LUCAS 3 group than in the ROSCER group during 5 minutes of CPR (p < 0.001, p = 0.008, respectively). End-tidal CO2 level of the ROSCER group was initially lower than that of the LUCAS 3 group, but was higher over time (p = 0.022). A Kaplan-Meier survival analysis for ROSC also showed no difference between the two groups (p = 0.46). The prototype of a remote-controlled automated chest compression device can move the chest compression position without interruption during CPR. In a mannequin and a swine model of cardiac arrest, the device showed no inferior performance to a conventional mechanical CPR device.