Successful Cardiac Resuscitation Research Articles

Comparison of the effects of using feedback devices for training or simulated cardiopulmonary arrest

BackgroundHigh-quality chest compression is essential for successful cardiac arrest resuscitation. High-quality cardiopulmonary resuscitation (CPR) can effectively improve the survival rate of patients with cardiopulmonary arrest. However, bystanders untrained in cardiopulmonary resuscitation may provide inadequate chest compressions. Previous studies have shown that the use of feedback devices in training alone or in simulated cardiopulmonary arrest alone can improve cardiopulmonary resuscitation. This study aims to determine whether using an audiovisual feedback (AVF) device during CPR training or a simulated cardiopulmonary arrest (CA) scenario would be more effective in improving the quality of chest compressions (CC).MethodsWe use a prospective, randomized, 2 × 2 factorial design trial. A total of 160 participants from Wuhan University and senior clinical medicine undergraduates who had not participated in any CPR training before and had no actual CPR experience are recruited. Each participant is randomized to 1 of 4 permutations, including AVF device vs. no AVF device during CPR training and AVF device vs. no AVF device during simulated CA. Main outcomes and measures are the depth, the percentage of CCs with correct depth (5–6 cm), the rate of CCs, and the percentage of CCs with the correct rate (100–120 cpm).ResultsThe use of the AVF device during simulated CA resulted in improved CC quality. In CA without AVF device, the average compression depth and the percentage of adequate depth with AVF device are 5.1 cm, 5.0 cm and 55.5%, 56.3%, respectively, which are higher than those without AVF device (4.5 cm, 4.7 cm and 32.8%, 33.6%). (p = 0.011, p = 0.000, both < 0.05).Compared with CA without AVF device, the average compression rate and the percentage of adequate rate with AVF device are 112.3 cpm, 111.2 cpm and 79.4%, 83.1%, respectively. The average compression rate and the percentage of adequate rate without using the AVF device are 112.4 cpm, 110.3 cpm and 71.5%, 68.5%, respectively. (p = 0.567 > 0.05, p = 0.017 < 0.05)Although the average compression rate in group D is slightly lower than that in group C, the percentage of suitable frequency with the feedback device is still higher than that without AVF device.ConclusionUsing a feedback device during simulated cardiopulmonary arrest is more effective in improving cardiopulmonary resuscitation than during training.

The “White Cerebellum Sign” after cardiac arrest

The white cerebellum sign, or reversal sign, is a rare radiological image in computed tomography of the head characterized by a hypodense image of the cerebral hemispheres with loss of white and gray matter differentiation and a relatively hyperdense image of infratentorial structures. It occurs in patients with severe, often irreversible, cerebral hypoxia. In the presented case of an 82-year-old patient with numerous comorbidities, the sign appeared about a week after successful cardiac arrest resuscitation. Despite intensive therapeutic management, the patient’s condition could not be improved, and palliative care was initiated.

Outcomes of cirrhotic patients admitted to the intensive care unit after a successful cardiac arrest resuscitation.

Objectives:To evaluate the outcomes of cirrhotic patients admitted to the intensive care unit (ICU) following cardiac arrest.Methods:This was a single centre retrospective study of all the cirrhotic patients, admitted to the ICU at King Abdulaziz Medical City, Riyadh, Saudi Arabia, after a successful cardiac arrest resuscitation, from 1999 to 2017. The characteristics of the hospital survivors and non-survivors were compared.Results:A total of 76 patients were admitted to the ICU during the study period, with a median age of 64 years. In addition to cirrhosis, the patients had other chronic comorbidities, including chronic renal disease (32.9%) and diabetes (47%). Of this group, 67 (88.2%) died in the hospital, and 54 (71%) died while in ICU. Compared to the group who survived, all non-survivors required mechanical ventilation and had a higher median APACHE II score of 38 (p=0.006), a lower median Glasgow coma score (GCS) of 3 (p=0.0003), and a higher median lactic acid of 6.4 mmol/L (p=0.032). On multivariable logistic regression analysis, the important predictors of hospital mortality were APACHE II score (p=0.006), bilirubin level (p=0.008) and GCS (p=0.005).Conclusion:Cirrhotic patients admitted to the ICU following cardiac arrest have high mortality. Patients with higher APACHE II scores, higher bilirubin and lower GCS have higher risk of in-hospital mortality.

Cardiac hydatid cyst presenting as ventricular arrhythmia: a case report

BackgroundHydatid disease caused by Echinococcus granulosus commonly involves the liver followed by lungs. Cardiac involvement is a rare occurrence and presents a challenging scenario.Case presentationOur case describes a middle-aged gentleman who presented to the emergency room with an episode of sudden loss of consciousness resulting from ventricular tachycardia. After successful cardiac resuscitation, the patient underwent imaging that showed a lesion compatible with hydatid cyst. Surgical treatment with pharmacologic coverage was provided which resulted in good clinical outcome.ConclusionsThe case highlights rare occurrence of isolated cardiac hydatid disease presenting as cardiac arrhythmia in contrast to its common routine outpatient presentation involving the liver and lungs. Good knowledge of the unusual presentations and its epidemiology is essential to the proper management of such patients.

Factors Associated with Successful Resuscitation during Out-of-Hospital Cardiac Arrest Performed By Surgico Medical Ambulance and Rescue Team (S.M.A.R.T), Division of Emergency Medical Service and Disaster, Faculty of Medicine Vajira Hospital, Navamindrad

Objective: To explore factors associated with successful on-scene cardiac resuscitation and to identify the number of patients with return of spontaneous circulation (ROSC). Materials and Methods: The present study was a retrospective descriptive study. Data were collected from the Surgico Medical Ambulance and Rescue Team at the Emergency Medicine Service and Disaster Division, Navamindradhiraj University. Data were recorded by using the overall operation reports of the Bangkok Emergency Medical Service Centre (Erawan Centre) about advanced life support. The reports used the code followed by the Emergency Medical Triage Protocol and Criteria Based Dispatch (CBD), CBD6 Red1, or followed by Response Code (RC) RC6 Red1, between May 2019 and April 2020. Results: Two hundred seventy-three patients with out-of-hospital cardiac arrest (OHCA) were included in the present study. Seventy (25.6%) patients were successfully on-scene resuscitated, of which, 65.7% were male patients with an average age of 57.87 (standard deviation [SD] 21.6) years. However, 203 (74.4%) patients that received appropriated advanced resuscitation (non-ROSC) died on scene. Among patients in the successful resuscitation group and those in the deceased group, 65.7% and 61.6% were male, respectively (p=0.537). The mean age was 57.87 (SD 21.6) years and 65.8 (SD 20.21) years, respectively (p=0.006). In the multivariate analysis controlled for confounders, a significant association (p&lt;0.05) was found between successful pre-hospital cardiac resuscitation on scene with the following four factors, traumatic cardiac arrest (adjusted odds ratio [OR] 4.18, 95% confidence interval [CI] 1.60 to 10.93, p=0.004), response time within eight minutes (adjusted OR 2.07, 95% CI 1.03 to 4.14, p=0.041), initial electrocardiogram with ventricular fibrillation (adjusted OR 2.63, 95% CI 1.13 to 6.12, p=0.025, and pulseless electrical activity (adjusted OR 2.89, 95% CI 1.26 to 6.64, p=0.012), and administration of resuscitation drug with epinephrine (adjusted OR 13.62, 95% CI 4.72 to 39.31, p&lt;0.001). Conclusion: In the present study, four factors were found to have a significant association with successful prehospital cardiac resuscitation on scene. Based on the knowledge discovered, these factors will develop on-scene CPR guidelines for the care of patients with OHCA for the authors’ emergency medical service personals. Keywords: Success; Resuscitation; Prehospital cardiac arrest

Gastric Mallory–Weiss tear after cardiopulmonary resuscitation

Abstract Mallory–Weiss tear is a rare complication that could result following cardiopulmonary resuscitation, leading to vigorous upper gastrointestinal bleeding. We illustrate a case of an 84-year-old male patient, admitted to the hospital for investigation of lung nodules and bilateral pleural effusion. The patient developed cardiac arrest during pleural aspiration, and cardiopulmonary resuscitation was done, which was followed shortly by an attack of acute upper gastrointestinal bleeding. Urgent upper endoscopy revealed a mucosal tear with submucosal oozing of blood and two large vessels in its floor, which were successfully managed endoscopically with both injection and hemoclips. This case report emphasizes the importance of considering this potential complication, especially after performing a successful cardiac resuscitation.

Aterosclerose coronariana obstrutiva fatal em criança de 9 anos: relato de caso

This article is about a 9-year-old male child with chest pain and clinical signs of hypercholesterolemia. During medical investigation we confirmed primary hypercholesterolemia and diagnosed bicuspid aortic valve and severe coronary disease, this being the cause of chest pain. Unfortunately, the patient evolved to death during the procedure, despite a successful coronary stent implantation and cardiac resuscitation. Atherosclerotic disease is rare among children, being commonly associated to familial forms of hypercholesterolemia. Bicuspid aortic valve, on the other hand, is a common congenital heart disease, but the association between both is rarely described. Chest pain is a common cause of complaint, and although in the vast majority of cases it is not associated with cardiac etiology, in the setup of hypercholesterolemia, especially familial forms, it should prompt the pediatrician attention to threatening etiology.

MP55: Reducing barriers to successful cardiac resuscitation: intervention in elementary schools

Introduction: The incidence of out-of-hospital cardiac arrest (OHCA) in school is approximately 2.1 for 100,000 per year. Although rare, it is a devastating event for the local community. Schools with public access to automated external defibrillators (AED) and an emergency response plan have demonstrated increased survival rates of up to 70% for students who suffer cardiac arrest. Previous studies identified numerous barriers to successful cardiac resuscitation in public school systems. The main objectives of this study were to identify those barriers in the Quebec region elementary school system and to assess the impacts of an AED focused training session. Methods: A previously validated survey focused on the potential barriers to successful defibrillation in OHCA and on demographic variables was sent to 139 elementary schools. Later, 92 employees within three elementary schools who responded to the survey were evaluated before and after receiving training on the use of AED in a mock cardiac arrest scenario. The primary outcome was the time to first shock and the secondary outcomes included correct AED pad placement and safety of the procedure. Results: Survey response rate was 53%, which is comparable to previous studies assaying barriers to cardiac resuscitation in public school systems. 95% of school respondents reported the presence of an AED on the school premises but 46% stated that no formal AED training course was provided to employees. Out of the four schools who reported a previous OHCA, only one had access to an AED at the time of the event. Following focused AED training, 92% of school workers successfully completed a defibrillation sequence in a mock scenario, from 53% before (p &lt; 0.001, McNemar test). The time to first shock went from 66 seconds (95% CI 63-70) to 47 seconds (95% CI 45-49; -29%, p &lt; 0.001). Proper pad placement was the most problematic step for participants and personnel who reported previous training had better performance (OR 3.15, 95% CI 1.33-7.42, p = 0.009). Conclusion: Most elementary schools in the Quebec region have access to AEDs. However, inadequate AED training represents a significant barrier to successful defibrillation in the event of an OHCA. Our results showed that a simple focused AED training could improve the performance of school workers and optimize the chain of survival.

English

English

Real-Time Cardiopulmonary Resuscitation Feedback and Targeted Training Improve Chest Compression Performance in a Cohort of International Healthcare Providers.

Optimal cardiopulmonary resuscitation (CPR) performance is the foundation of successful cardiac arrest resuscitation. However, health care providers perform inadequate compressions. Better training techniques and real-time CPR feedback may improve compression performance. We sought to evaluate the impact of a targeted training program combined with real-time defibrillator CPR feedback on chest compression performance in an international cohort of health care providers. Physicians, nurses, respiratory therapists, and technicians from 6 hospitals in 5 countries (Taiwan, Singapore, China, Bahrain, and Kuwait) participated in a standardized resuscitation workshop. Chest compression was measured before and after didactics and activation of CPR feedback. Compressions were performed for 1min on standard CPR manikins placed on a hospital bed and backboard and measured using ZOLL R Series defibrillators. The percentage of compressions meeting target values for depth and rate were compared before and after the workshop and activation of real-time CPR feedback. No depth maximum was defined to allow for mattress compression. Chest compressions were more likely to meet targets for depth (71-95%, odds ratio [OR] 8.61 [95% confidence interval {CI} 4.42-16.77], p<0.001), rate (41-81%, OR 6.4 [95% CI 4.2-9.8], p<0.001), and both depth and rate (5-42%, OR 2.4 [95% CI 6.7-22.9], p<0.001) after the workshop and activation of real-time CPR feedback. A targeted training intervention combined with real-time CPR feedback improved chest compression performance among health care providers from various countries.

Disparities Regarding Inadequate Automated External Defibrillator Training and Potential Barriers to Successful Cardiac Resuscitation in Public School Systems

Installation of automated external defibrillators (AEDs) in public schools has been shown to improve outcomes for children with sudden cardiac arrest (SCA). However, the adequacy of faculty AED training and potential barriers to successful cardiac resuscitation remain unknown. A questionnaire was mailed to all public schools in the state of Illinois (n = 3796). The survey focused on the demographic variables of each school as well as the confidence of the responder regarding effectiveness of AED training. 2,192 surveys were included in this study (58% response rate). Independent variables for perceived inadequate AED training were schools that were predominantly black (odds ratio [OR] 3.93; 3.01 to 5.13) or Hispanic (OR 2.75; 2.11 to 3.58), elementary schools (OR 2.05; 1.69 to 2.50), schools with <250 students (OR 1.69; 1.19 to 2.40) and <25 faculty (OR 1.54; 1.10 to 2.15). Eighty-eight percent of responders cited at least one barrier to successful AED utilization. Location in a town setting (OR 9.34; 4.73 to 18.44) or rural setting (OR 3.18; 2.47 to 4.10) as well as upper socioeconomic status (OR 3.85; 2.04 to 7.29) were found to be predictors of schools with no barriers to AED utilization.

O19-4 - Efficacy of Long-term Dobutamine Infusion Overlapping with Carvedilol Introduction for a Patient with Refractory Heart Failure due to OMI

An 83 year-old female with clinical scenario type 4 refractory heart failure (HF) was transferred to our ICU. In the previous hospital, she underwent primary PCI for extensive anterior AMI and subsequently developed low output syndrome. Therefore, she was treated with dobutamine and then during tapering dobutamine LOS relapsed. Therefore, she was transferred to our hospital to manage the HF on day 21. Because the symptom was stable but tachycardia was observed, we introduced very small amount of carvedilol(1.25 mg). Once the symptom of LOS seemed to be getting better, but sudden bradycardia and PEA was developed on day 40. A successful cardiac resuscitation was carried out and then dose of dobutamine was increased and carvedilol was discontinued. At that time we planned long-term low-dose dobutamine infusion until complete recovering from the HF and re-introduce carvedilol at the appropriate timing. On day 74, we successfully re-introduced carvedilol(0.625 mg) and could increased the dose of carvedilol (1.25 mg)on day 90 because of good clinical course. Eventually we succeeded to discontinue dobutamine on day 119 and she left our hospital on her own foot. The use of dobutamine is controversial, because it facilitates cardiac remodeling. However, low-dose and long-term dobutamine infusion overlapping with carvedilol introduction is sometimes necessary for a patient with refractory LOS like the present case.

Circulation: Clinical Summaries

<i>Circulation:</i> Clinical Summaries

Transient severe aortic regurgitation and left ventricular dysfunction due to a stuck leaflet in a patient undergoing percutaneous transcatheter aortic valve implantation

We report the case of a 78-year-old patient who underwent transcatheter aortic valve implantation. During the deployment, the leaflets of the implanted valve appeared to be stuck in calcium protruding from the native aortic leaflets, resulting in transient severe aortic regurgitation leading to cardiac arrest with successful cardiac resuscitation. Transient severe aortic regurgitation secondary to the mechanical failure of the deployed valve can lead to serious clinical consequences.

Invited Commentary

Invited Commentary

Left atrial wall dissection, mitral valve prosthesis dehiscence and pericardial hematoma: complex findings after successful cardiac resuscitation

Left atrial wall dissection, mitral valve prosthesis dehiscence and pericardial hematoma: complex findings after successful cardiac resuscitation

Initial defibrillation versus initial chest compression in a 4-minute ventricular fibrillation canine model of cardiac arrest*

Previous laboratory and clinical studies have demonstrated that chest compression preceding defibrillation in prolonged ventricular fibrillation (VF) increases the likelihood of successful cardiac resuscitation. The lower limit of VF duration when preshock chest compression provides no benefit has not been specifically studied. We aimed to study the effect of order of defibrillation and chest compression on defibrillation and cardiac resuscitation in a 4-minute VF canine model of cardiac arrest. Prospective, randomized animal study. Key Laboratory of Cardiovascular Remodeling and Function Research and Department of Cardiology, QiLu Hospital. Twenty-four domestic dogs. VF was induced in anesthetized and ventilated canines. After 4 minutes of untreated VF, animals were randomly assigned to receive shock first or chest compression first. Animals in the shock-first group received an immediate single countershock of 360 J for <10 seconds, then 200 immediate compressions before pulse check or rhythm reanalysis. The ratio of compression to ventilation was 30:2. Interruptions to deliver rescue breaths were eliminated in this study. Animals in the chest compression-first group received 200 chest compressions before a single countershock; the other interventions were the same as for the shock-first group. End points were restoration of spontaneous circulation (ROSC), defined as spontaneous systolic arterial pressure >50 mm Hg, when epinephrine (0.02 mg/kg intravenously) was given, and resuscitation, defined as maintaining systolic arterial pressure >50 mm Hg at the 24-hour study end point. In the shock-first group, all animals achieved ROSC, and ten of 12 survived at the 24-hour study end point. In the chest compression-first group, 11 of 12 animals achieved ROSC, and nine of 12 survived at the 24-hour study end point. In this 4-minute VF canine model of cardiac arrest, the order of initial defibrillation or initial chest compression does not affect cardiac resuscitation.

Cardiac Recovery in a Human Non–Heart-beating Donor After Extracorporeal Perfusion: Source for Human Heart Donation?

Successful renal, liver and more recently lung transplantation using organs from non-heart-beating donors (NHBDs) has been reported. Regarding the heart, it has generally been assumed that warm ischemic insult would result in overwhelming and irreversible myocardial damage. We report recovery of cardiac function in a human NHBD by using extracorporeal perfusion 23 minutes after cardiorespiratory arrest. Successful cardiac resuscitation in the NHBD represents a potential source of increased donor organ supply for clinical heart transplantation.

143: The Non-Heart Beating Donor for Heart Transplantation: A New and Evolving Source of Organs

The non-heart beating donor (NHBD) is an increasing source of organs for transplantation. Cardiac donation from NHBD has been considered unsuitable due to concerns over irreversible myocardial damage resulting from warm ischemia. We describe successful cardiac resuscitation in a NHBD with extracorporeal perfusion. Furthermore, we review this donor source to estimate what proportion would be suitable for cardiac donation.

Long-term survival after successful inhospital cardiac arrest resuscitation

Little is known about long-term outcomes of patients who survive inhospital cardiac arrest. We examined long-term survival after inhospital cardiac arrest and whether procedural changes that improved survival to discharge impacted long-term survival. Consecutive inhospital arrests in the Atlanta Veterans Affairs Medical Center (Atlanta, GA) from 1995 to 2004 (n = 732) were retrospectively analyzed. Data regarding the arrest was obtained, including age, left ventricular ejection fraction, medications, and comorbidities, presenting rhythm, location of arrest, code duration, and outcomes. Long-term mortality data was obtained based on chart and Social Security Death Index reviews. Further data was gathered on internal cardioverter-defibrillator presence and use in survivors. Overall, 49 subjects (6.6%) survived to discharge. Univariate analysis found that ventricular tachycardia/ventricular fibrillation and the use of beta-blockers, angiotensin-converting enzyme inhibitors, and antiarrhythmics at the time of arrest were associated with increased survival, whereas advancing age and comorbidities were associated with a higher risk of mortality. Multivariate analysis determined that age, rhythm, and comorbidities independently affected survival. Implementation of a resuscitation program previously documented to improve survival to discharge did not translate to durable long-term survival. Three-year survival rate after discharge was only 41%. Alternatively, subjects with internal cardioverter-defibrillator showed a 36% improvement in 3-year survival rate to 77% (P = .001). Subjects with inhospital cardiac arrest have poor long-term prognoses. A strategy that improved inhospital survival did not alter long-term mortality rate. Thus, survival to discharge may not be a sufficient end point for future resuscitation trials.