Treatment Of Sudden Cardiac Arrest Research Articles

Changes in public interest in sudden cardiac arrest: a big data analysis

Abstract Background Search engine queries (SEQ) are considered a surrogate for public interest, with the most popular global search engine processing ~ 1.2 trillion online queries annually and >1 billion health-related queries daily.1 Big data from SEQ trends have been used for disease surveillance and may be able to offer insights for public health interventions, such as detecting respiratory illness outbreaks and understanding cardiac disease patterns.2-4 Sudden cardiac arrest (SCA) occurs in ~5 million people annually worldwide; October is internationally designated for SCA awareness, with public health campaigns aimed to improve early recognition of and early defibrillation for SCA. Use of big data from SEQ as a public health tool to assess changes in public interest surrounding SCA campaigns has not been explored. Purpose To characterize changes in public interest in SCA via analysis of internet SEQ trends. Methods Google Trends was queried for the terms "cardiac arrest", "cardiopulmonary resuscitation" (CPR), "automated external defibrillation" (AED) and "myocardial infarction" (MI) worldwide for the past 5 years (11/2018 – 11/2023). Relative search volumes (RSV, expressed in scale from 0-100) and related queries were analyzed. Baseline RSV for each term was defined as 2 weeks pre-peak. Numerical percentage and Chi square tests were used for statistical comparison. Results Compared to baseline, RSV for "cardiac arrest" significantly increased in correlation with the SCA of 2 professional athletes: Christian Eriksen (football, Denmark) on 6/12/2021 (+321%, p<0.001), Damar Hamlin (American football, United States) on 1/2/2023 (+653%, p<0.001) and collegiate athlete Bronny James (basketball, United States) on 7/24/2023 (+164%, p<0.001). (Figure) RSV significantly increased for "cardiopulmonary resuscitation" (+61% and +170% respectively, p<0.001 for both) and "Automated external defibrillator" (+141% and +192% p<0.001 and p=0.003, respectively) during the same period for pro-athletes but not for the college athlete (p=1.0 and p= 0.84 respectively). While none of the athletes had MI, RSV for "myocardial infarction" also had correlating increases over baseline for all 3 athletes (+35%, p<0.001 +30%, p<0.001 and +22%, p=0.027, respectively). RSV did not significantly change for any search terms during October SCA awareness months during the study period (all p>0.05). Conclusions Public interest in SCA, CPR and AED surge when SCA occurs in well-known individuals such as athletes, rather than with scheduled public health campaigns; co-surge in MI interest likely indicates on-going public confusion between SCA and MI. Analyses of big data from SEQ could assist cardiovascular societies in planning targeted SCA educational campaigns by building upon periodic natural surges in public interest in SCA, CPR and AED; this should include continued education on the differences in recognition and treatment of SCA and MI.

The development of the extravascular defibrillator with substernal lead placement: A new Frontier for device-based treatment of sudden cardiac arrest.

IntroductionThe extravascular implantable cardioverter‐defibrillator (EV ICD) system with substernal lead placement is a novel nontransvenous alternative to current commercially available ICD systems. The EV ICD provides defibrillation and pacing therapies without the potential long‐term complications of endovascular lead placement but requires a new procedure for implantation with a safety profile under evaluation.MethodsThis paper summarizes the development of the EV ICD, including the preclinical and clinical evaluations that have contributed to the system and procedural refinements to date.ResultsExtensive preclinical research evaluations and four human clinical studies with >140 combined acute and chronic implants have enabled the development and refinement of the EV ICD system, currently in worldwide pivotal study.ConclusionThe EV ICD may represent a clinically valuable solution in protecting patients from sudden cardiac death while avoiding the long‐term consequences of transvenous hardware. The EV ICD offers advantages over transvenous and subcutaneous systems by avoiding placement in the heart and vasculature; relative to subcutaneous systems, EV ICD requires less energy for defibrillation, enabling a smaller device, and provides pacing features such as antitachycardia and asystole pacing in a single system.

Estimation of Health and Economic Benefits of a Small Automatic External Defibrillator for Rapid Treatment of Sudden Cardiac Arrest (SMART): A Cost-Effectiveness Analysis.

BackgroundSudden cardiac arrest (SCA) occurs in 0.4% of the general population and up to 6% or more of at-risk groups each year. Early CPR and defibrillation improves SCA outcomes but access to automatic external defibrillators (AEDs) remains limited.MethodsMarkov models were used to evaluate the cost-effectiveness of a portable SMART (SMall AED for Rapid Treatment of SCA) approach to early SCA management over a life-time horizon in at-risk and not at-risk populations. Simulated patients (n = 600,000) who had not received an implantable cardioverter defibrillator (ICD) were randomized to a SMART device with CPR prompts or non-SMART approaches. Annual SCA risk was varied from 0.2 to 3.5%. Analysis was performed in a US economy from both societal (SP) and healthcare (HP) perspectives to evaluate the number of SCA fatalities prevented by SMART, and SMART cost-effectiveness at a threshold of $100,000/Quality Adjusted Life Year (QALY).ResultsA SMART approach was cost-effective when annual SCA risk exceeded 1.51% (SP) and 1.62% (HP). The incremental cost-effectiveness ratios (ICER) were $95,251/QALY (SP) and $100,797/QALY (HP) at a 1.60% SCA annual risk. At a 3.5% annual SCA risk, SMART was highly cost-effective from both SP and HP [ICER: $53,925/QALY (SP), $59,672/QALY (HP)]. In microsimulation, SMART prevented 1,762 fatalities across risk strata (1.59% fatality relative risk reduction across groups). From a population perspective, SMART could prevent at least 109,839 SCA deaths in persons 45 years and older in the United States.Conclusions and RelevanceA SMART approach to SCA prophylaxis prevents fatalities and is cost-effective in patients at elevated SCA risk. The availability of a smart-phone enabled pocket-sized AED with CPR prompts has the potential to greatly improve population health and economic outcomes.

The cardiac arrest centre for the treatment of sudden cardiac arrest due to presumed cardiac cause: aims, function, and structure: position paper of the ACVC association of the ESC, EAPCI, EHRA, ERC, EUSEM, and ESICM

Approximately 10% of patients resuscitated from out-of-hospital cardiac arrest (OHCA) survive to hospital discharge. Improved management to improve outcomes are required, and it is proposed that such patients should be preferentially treated in cardiac arrest centres (CACs). The minimum requirements of therapy modalities for the CAC are 24/7 availability of an on-site coronary angiography laboratory, an emergency department, an intensive care unit, imaging facilities, such as echocardiography, computed tomography, and magnetic resonance imaging, and a protocol outlining transfer of selected patients to CACs with additional resources (OHCA hub hospitals). These hub hospitals are regularly treating a high volume of patients and offer further treatment modalities. This consensus document describes the aims, the minimal requirements for therapeutic modalities and expertise, and the structure, of a CAC. It represents a consensus among the major European medical associations and societies involved in the treatment of OHCA patients.

The cardiac arrest centre for the treatment of sudden cardiac arrest due to presumed cardiac cause - aims, function and structure: Position paper of the Association for Acute CardioVascular Care of the European Society of Cardiology (AVCV), European Association of Percutaneous Coronary Interventions (EAPCI), European Heart Rhythm Association (EHRA), European Resuscitation Council (ERC), European Society for Emergency Medicine (EUSEM) and

Approximately 10% of patients resuscitated from out-of-hospital cardiac arrest survive to hospital discharge. Improved management to improve outcomes is required, and it is proposed that such patients should be preferentially treated in cardiac arrest centres. The minimum requirements of therapy modalities for the cardiac arrest centre are 24/7 availability of an on-site coronary angiography laboratory, an emergency department, an intensive care unit, imaging facilities such as echocardiography, computed tomography and magnetic resonance imaging, and a protocol outlining transfer of selected patients to cardiac arrest centres with additional resources (out-of-hospital cardiac arrest hub hospitals). These hub hospitals are regularly treating a high volume of patients and offer further treatment modalities. This consensus document describes the aims, the minimal requirements for therapeutic modalities and expertise, and the structure, of a cardiac arrest centre. It represents a consensus among the major European medical associations and societies involved in the treatment of out-of-hospital cardiac arrest patients.

Place of magnesium sulfate in cardiopulmonary resuscitation. A systematic review and meta-analysis

INTRODUCTION: Sudden cardiac arrest treatment is challenging, And the effectiveness of resuscitation procedures — especially in pre-hospital conditions — is low. The purpose of this meta-analysis is to investigate the effects of magnesium sulfate (MgSO4) in cardiac arrest on the return of spontaneous circulation (ROSC) and survival to hospital discharge. MATERIAL AND METHODS: We searched in MEDLINE, EMBASE, Scopus, and ClinicalTrials.gov, Web of Science up to May 25, 2020, and we conducted a systematic review and meta-analysis. We synthesized results by using mean differences, and odds ratios. The overall incidence and outcome of cardiac arrest were assessed using a random-effects meta-analysis. RESULTS: A total of 5 eligible studies were included in this meta-analysis. Survival to discharge was higher in magnesium sulfate group compared to placebo group (9,5% vs. 8.2% respectively; OR = 1.17; 95% CI: 0.61, 2.23; p = 0.64). Higher survival rate to hospital admission was observed in the placebo group — 26.9% compared to the group where magnesium was administered — 25.7% (OR = 0.93; 95% CI: 0.59, 1.47; p = 0.77. CONCLUSIONS: In conclusion, this meta-analysis indicates no statistically significant benefit of resuscitation with magnesium sulfate compared to the placebo. Thus, due to the low number of studies we recommend future randomized controlled trials to identify which anti-arrhythmic drug we should use on shock-refractory cardiac arrest.

Impact of Application of Multifunction Electrode (MFE) Pads on Cardiopulmonary Resuscitation Quality.

Background Early defibrillation and high-quality chest compressions are crucial in treatment of sudden cardiac arrest (SCA) subjects. The aim of this study was to assess an impact of defibrillation methods on cardiopulmonary resuscitation (CPR) quality. Methods A randomized simulation cross-study was designed, in which 100 two-person paramedical teams participated. Two 10-minute scenarios of SCA in the mechanism of ventricular fibrillation were analysed. In the first one, teams had at their disposal defibrillator with hard paddles (group C), whereas in the second one, adhesive electrodes were used (group MFE). The CPR quality was evaluated on the basis of the chest compression parameters (rate, depth, recoil, compression fraction (CCF), and no-flow time), airways patency achievement, and successful emergency drug administration. Results Substituting standard hard paddles with adhesive electrodes led to an increase in CCF (77% vs 73%; p < 0.05), higher rate of complete chest recoil, and a decrease in no-flow time (6.0 ± 1.1 vs. 7.3 ± 1.1; p < 0.001). The airway patency was ensured sooner in group MFE (271 ± 118 s vs. 322 ± 106 s in group C; p < 0.001). All teams in scenario with adhesive electrodes were able to administer two doses of adrenaline, meanwhile only 74% of them in group C (p < 0.001). Moreover, in 8% of group C scenarios, paramedics did not have enough time to administer amiodarone. Conclusion Our simulation-based analysis revealed that use of adhesive electrodes during defibrillation instead of standard hard paddles may improve the quality of CPR performed by two-person emergency team.

Kendo Protective Equipment Prevents Quick Access for Resuscitation During Sudden Cardiac Arrest: A Cross-Over Manikin Study

Protective equipment in sports can be a barrier to sudden cardiac arrest (SCA) treatment, but no Kendo-related data are available. In order to enhance the SCA survival rate, we aimed to determine whether Kendo protective equipment should be removed before or after an automated external defibrillator (AED) has arrived by measuring the quality and timeframe of cardiopulmonary resuscitation administration. Eighteen collegiate female Kendo players were instructed to treat the patient with SCA under two conditions: (a) equipment removal [ER] condition; (b) no equipment removal [NER] condition. Chest compression initiation was delayed during simulated cardiac arrest situations in Kendo, but the SCA quality was much better without protective equipment. When a layperson is only a nonhealthcare professional female, Kendo protective equipment becomes a barrier for quick access during SCA treatment of Kendo players.

Effectiveness, efficacy, and safety of wearable cardioverter-defibrillators in the treatment of sudden cardiac arrest - Results from a health technology assessment.

To assess the effectiveness, efficacy, and safety of a wearable cardioverter-defibrillator (WCD) in adult persons with high risk for sudden cardiac arrest and for which an implantable cardioverter is currently not applicable. We performed a systematic literature search in Medline, Embase, Cochrane Library, and CRD-databases. Study selection was performed by two reviewers independently. Data were presented quantitatively; due to heterogeneity of studies no meta-analysis was performed. One randomized-controlled trial (RCT), one non-randomized comparative trial, and forty-four non-comparative trials were included. The RCT reported an overall mortality of 3.1 percent in the WCD group versus 4.9 percent in controls (relative risk [RR]: .64; 95 percent confidence interval [CI], .43-.98, p = .04), but no significant effect on arrhythmia-related mortality. The RR for arrhythmia-related mortality amounted to .67 (95 percent CI, .37-1.21, p = .18) as assessed in the RCT. Appropriate shocks were observed in 1.3 percent of patients in both comparative studies, and inappropriate shocks in .6 percent of patients in the RCT. Termination of ventricular tachycardia (VT) or ventricular fibrillation (VF) was successful in 75 to 100 percent of appropriate shocks in all studies. Adverse events assessed in the RCT showed a lower incidence of shortness of breath (38.8 percent vs. 45.3 percent; p = .004), higher incidence of rash at any location (15.3 percent vs. 7.1 percent; p < .001), and higher incidence of itching at any location (17.2 percent vs. 6.4 percent; p < .001) for WCD. Available evidence demonstrates that the WCD detects and terminates VT/VF events reliably and shows a high rate of appropriate shocks in mixed patient populations. Data of large registries confirm that the WCD is a safe intervention.

School Nurses’ Perceived Barriers and Perceptual Influences When Implementing AED Programs

School nurses' experienced barriers and benefits with perceptions of self-efficacy are important factors to consider for program implementation in the school setting. Little research has been done in the area of automated external defibrillator (AED) program implementation by the school nurse for the treatment of sudden cardiac arrest. The purpose of this study was to identify benefits of and barriers to AED program implementation in public schools and measure school nurses' self-efficacy related to their role as a change agent in program implementation. Results revealed that school nurses are functioning with a high level of self-efficacy in their ability to influence major health-care decisions in the school setting, and despite barriers, AED program implementation is considered beneficial and a necessary component of emergency care.

The effectiveness of modified basic life support module on knowledge, attitude, and performance of cardiopulmonary resuscitation among university students

Introduction: Cardiopulmonary resuscitation is a primary method used in the treatment of sudden cardiac arrest. It is a crucial skill that a healthcare provider and a lay rescuer should acquire to improve the survival and the neurological outcome of out-of-hospital cardiac arrest. Several modules were used to teach cardiopulmonary resuscitation for the healthcare provider and lay rescuer, but no module been developed that could be utilised in both population. Thus, this study aims to investigate the effectiveness of modified cardiopulmonary resuscitation training to knowledge (K), attitude (A), and performance (P) between medical and non-medical university students. Methods: This research was a single experimental study involving a total number of 125 students: 58 for a medical group and 67 for a non-medical group. A modified basic life support module, based on American Heart Association guideline 2015 was delivered to both groups under the same study setting. Pre and post KA scores were assessed using Res-Q questionnaire. The performance was evaluated by resuscitation feedback machine. The KA scores were analysed using repeated measure analysis of variance, and performance was examined using Pearson chi-square. Results: The study showed 64.8% of the participants were able to perform high-quality chest compression. Despite significant differences of sociodemographic background, there was no significant difference on effective chest compression between two groups (p = 0.200). There were also significant improvements in KA scores in both groups after intervention (p &lt; 0.001). Conclusion: The knowledge of cardiopulmonary resuscitation can be delivered to everyone as aspired by our stakeholder to have one qualified cardiopulmonary resuscitation provider in a family. This modified basic life support module is reliably applicable to both healthcare and lay rescuer cardiopulmonary resuscitation training. All rescuers will perform in a similar manner, and this will tremendously reduce the discrepancy in the cardiopulmonary resuscitation qualities. Ultimately, this will improve an out-of-hospital return of spontaneous circulation rate.

Future Directions: Management of Sudden Cardiac Death.

There will always be a need to optimize early recognition and treatment of sudden cardiac arrest. For out-of-hospital cardiac arrest, this requires a complex system of care involving bystanders, 911 dispatchers, and emergency medical service and hospital-based providers. Optimizing this system is fundamental to improving outcomes. In addition, personnel and resources are needed to develop and sustain a research pipeline that will bring new scientific discoveries and technologies to the field. The 2015 Institute of Medicine report, "Strategies to Improve Cardiac Arrest Survival: A Time to Act," provides a roadmap.

Blinded Evaluation of Combination Drug Therapy for Prolonged Ventricular Fibrillation Using a Swine Model of Sudden Cardiac Arrest

ABSTRACTDespite experimental evidence supporting the use of resuscitation drugs in the treatment of sudden cardiac arrest (CA), there are no good human clinical data to support the decades-old practice of giving these medications during out-of-hospital CA resuscitation. We hypothesized that the lack of efficacy in clinical practice in ventricular fibrillation (VF) is the failure-based manner in which resuscitation drugs have historically been administered (one at a time interspersed with chest compressions and a defibrillation attempt, giving the next only if the previous one was ineffective). The aim of this study was to determine if giving and circulating a combination of commonly available, historically used resuscitation drugs together, prior to the first defibrillation attempt after prolonged VF, might improve short-term outcomes compared with the failure-based serial drug approach used in the past. We used a well-established swine model of sudden prolonged untreated VF. Animals were randomized to receive epinephrine (0.01 mg/kg), vasopressin (0.5 U/kg), amiodarone (4 mg/kg), and sodium bicarbonate (1.0 mEq/kg) in series (SERIES group [n = 53]) or a combination of epinephrine (0.01 mg/kg), vasopressin (0.5 U/kg), amiodarone (4 mg/kg), sodium bicarbonate (1.0 mEq/kg), and metoprolol (0.2 mg/kg) (COCKTAIL group) delivered in rapid succession at the beginning of the attempted resuscitation (n = 27). Data were analyzed descriptively. Baseline characteristics and chemistries between the two groups were the same. Termination of VF was statistically similar in the two groups: 88.7% (47/53) versus 85.2% (23/27) p = 0.66, with an adjusted relative risk ratio (RRR) of 0.94 (0.37, 1.15). However, ROSC was higher in the SERIES group (56.6% [30/53] versus 22.2% [6/27], adjusted RRR = 2.83; [1.16, 3.84] p = 0.029) as was 20-minute survival (52.8% [28/53] versus 18.5% [5/27], adjusted RRR = 3.15 [1.14, 4.54] p = 0.032). The combination of drugs studied, at these dosages, inexplicably worsened short-term outcomes after prolonged untreated VF.

Cardiopulmonary resuscitation using electrically driven devices: a review.

In the treatment of sudden cardiac arrest (SCA) immediate resuscitation with chest compressions and ventilation is crucial for survival. As manual resuscitation is associated with several drawbacks, mechanical resuscitation devices have been developed to support resuscitation teams. These devices are able to achieve better perfusion of heart and brain in laboratory settings, but real world experience showed no significant improved survival in comparison to manual resuscitation. This review will focus on two mechanical resuscitation devices, the Lund University Cardiac Assist System (LUCAS) and AutoPulse devices and the actual literature available. In conclusion, the general use of mechanical resuscitation devices cannot be recommended at the moment.

Factors Affecting the Occurrence of Out-of-Hospital Sudden Cardiac Arrest.

Objective. This paper aims to discover the risk factors for sudden cardiac arrest (out-of-hospital sudden cardiac arrest (OHSCA)) which significantly affect the decision about prioritizing emergency interventions before dispatching medical emergency teams, risk of deterioration of the patient's condition at the scene, and emergency procedures. Methods. A retrospective study taking into account the international classification of diseases ICD-10 based on an analysis of medical records of Emergency Medical Service in Wroclaw (Poland). Results. The main risk factor of OHSCA is coexistence of external cause leading to illness or death (ICD Group V-10) as well as the occurrence of diseases from the group of endocrine disorders (group E), in particular diabetes. The increase in the risk of OHSCA incidence is affected by nervous system diseases (group G), especially epilepsy of various etiologies, respiratory diseases (group J), mainly COPD, and bronchial asthma or mental and behavioral disorders (group F), with particular emphasis on the drugs issue. The procedure for receiving calls for Emergency Notification Centre does not take into account clinical risk factors for sudden cardiac arrest (SCA). Conclusion. Having knowledge of OHSCA risk factors can increase the efficiency of rescue operations from rapid assessment and provision of appropriate medical team, through effective performance of medical emergency treatment and prevention of SCA or finally reducing the costs.

Catecholaminergic polymorphic ventricular tachycardia (CPVT) initially diagnosed as idiopathic ventricular fibrillation: The importance of thorough diagnostic work-up and follow-up

Catecholaminergic polymorphic ventricular tachycardia (CPVT) characteristically presents with exercise- or emotion-induced syncope during childhood. In 30% of patients, sudden cardiac arrest (SCA) is the first presentation of the disorder [1]. It has been suggested that CPVT is the underlying disease in 56% of cases of unexplained SCA [2]. Diagnosis is based on (family) history of adrenergically induced syncope, response to stress testing and genetic analysis. Delayed diagnosis leads to suboptimal treatment and unnecessary risk of SCA.

Optimal Single-Pulse for Pacemakers Based on a Sinoatrial Model

This study designs an optimal single-pulse stimulus in pacemakers to treat sudden cardiac arrest, while minimizing the pulse amplitude and reducing the delivered energy. Based on the Yanagihara, Noma, and Irisawa (YNI) model that describes the potential behavior of a sinoatrial node in a heart, it develops the frequency entrainment between irregular YNI-response and optimal single-pulse. This study derives the minimum amplitude of the optimal single-pulse for successful entrainment. Simulation results confirm that the proposed optimal single pulse is effective to induce rapid response of sudden cardiac arrest for heartbeat recovery, while a reduction in delivered energy of 91%, comparing with conventional pulse. This study will be helpful not only for the treatment of sudden cardiac arrest but also for prolonging battery longevity and reducing the stimuli pain on patients with implantable medical devices.

AP090 Cerebral flow improvement during CPR with LUCAS measured by Doppler

Great quality chest compressions are the most important maneouvers together with prompt defibrillation to guarantee critical flow to heart and brain in a sudden cardiac arrest treatment. Cerebral flow can be measured by trans-cranial doppler; normal rates for a healthy person are 60–80 cm/s. LUCAS® devices performs 5 cm depth chest compressions at a rate of 100 per minute, becoming immune to tiredness. Aim: To compare the middle cerebral artery flow measured by doppler, with or without LUCAS® chest compressor during cardio-pulmonary resuscitation. Methods: Prospective study from January 2011 to June 2011, where one prehospital advanced life support unit (ALSU) from the city of Barcelona was provided with the Toshiba Viamo portable ultrasound scanner and one physician was trained in cerebrovascular ultrasound during 1 month previously to the beggining of the study. Cerebral middle artery flow at 5–6 cm was mesured in all the sudden cardiac arrest (SCA) assisted by this trained unit in the study period, previously and after the LUCAS® device was placed. Results: 6 patients with SCA were assisted, 3 of them males (66±10.53 years old) and 3 females (48.33±22.67 years old). 1 patient with a SCA caused by a STEMI recovered spontaneous circulation (ROSC) before the ultrasound scan could be performed and his flow after ROSC was 96 cm/s. 2 young females suffered SCA as a consequence of a spontaneous subarachnoid haemorrhage (SSH) and no flow was observed with manual chest compressions nor with LUCAS®, but one of them ROSC. In the other 3 patients the median flow was 31.6±8.32 cm/s in the manual group in front of 50.6±27.12 cm/s in LUCAS® group. Conclusions: Patients with SCA due to SSH seem not to receive cerebral flow during resuscitation with manual chest compressions nor with LUCAS®. LUCAS seems to improve cerebral flow compared with manual CPR during the resuscitation of patients with a non-SSH SCA.

Feasibility of initiating extracorporeal life support during mechanical chest compression CPR: A porcine pilot study

BackgroundRecently, portable extracorporeal membrane oxygenation (ECMO) machines have become commercially available. This creates the potential to utilize extracorporeal life support (ECLS) for the treatment of sudden cardiac arrest in the emergency department, and potentially in the out-of-hospital setting. ObjectiveWe sought to determine the feasibility of installing the ECMO circuit during delivery of mechanical chest compression CPR. MethodsWe used 5 mixed-breed domestic swine with a mean mass of 26.0kg. After induction of anesthesia, animals were instrumented with micromanometer-tipped transducers placed in the aorta and right atrium via the left femoral artery and vein. Ventricular fibrillation (VF) was induced electrically with a transthoracic shock and left untreated for 8min. Then, mechanical chest compressions were begun (LUCAS, Jolife, Lund, Sweden) and manual ventilations were performed to maintain ETCO2 between 35 and 45Torr. Compressions continued until ECMO flow was started. Ten minutes after induction of VF, drugs were given (epinephrine, vasopressin, and propranolol). ECMO installation was started via cutdown on the right external jugular vein and right femoral artery for placement of venous and arterial catheters while chest compressions continued. ECMO installation start time varied from 17 to 30min after start of compressions and continued until ECG indicated a shockable rhythm. First rescue shocks were given at 22, 32, 35, 44, and 65min. ResultsECMO was successfully installed in all five animals without incident. It was necessary to briefly discontinue chest compressions during the most delicate part of inserting the catheters into the vessels. ECMO also allowed for very rapid cooling of the animals and facilitated post-resuscitation hemodynamic support. Only the 65-min animal did not attain return of spontaneous circulation (ROSC). ConclusionMechanical chest compression may be a suitable therapeutic bridge to the installation of ECMO and does not interfere with ECMO catheter placement.

Public claims about automatic external defibrillators: an online consumer opinions study.

BackgroundPatients are no longer passive recipients of health care, and increasingly engage in health communications outside of the traditional patient and health care professional relationship. As a result, patient opinions and health related judgements are now being informed by a wide range of social, media, and online information sources. Government initiatives recognise self-delivery of health care as a valuable means of responding to the anticipated increased global demand for health resources. Automated External Defibrillators (AEDs), designed for the treatment of Sudden Cardiac Arrest (SCA), have recently become available for 'over the counter' purchase with no need for a prescription. This paper explores the claims and argumentation of lay persons and health care practitioners and professionals relating to these, and how these may impact on the acceptance, adoption and use of these devices within the home context.MethodsWe carry out a thematic content analysis of a novel form of Internet-based data: online consumer opinions of AED devices posted on Amazon.com, the world's largest online retailer. A total of #83 online consumer reviews of home AEDs are analysed. The analysis is both inductive, identifying themes that emerged from the data, exploring the parameters of public debate relating to these devices, and also driven by theory, centring around the parameters that may impact upon the acceptance, adoption and use of these devices within the home as indicated by the Technology Acceptance Model (TAM).ResultsFive high-level themes around which arguments for and against the adoption of home AEDs are identified and considered in the context of TAM. These include opinions relating to device usability, usefulness, cost, emotional implications of device ownership, and individual patient risk status. Emotional implications associated with AED acceptance, adoption and use emerged as a notable factor that is not currently reflected within the existing TAM.ConclusionsThe value, credibility and implications of the findings of this study are considered within the context of existing AED research, and related to technology acceptance theory. From a methodological perspective, this study demonstrates the potential value of online consumer reviews as a novel data source for exploring the parameters of public debate relating to emerging health care technologies.