Ventricular Fibrillation Arrest Research Articles

Beneficial effects of terlipressin in prolonged pediatric cardiopulmonary resuscitation: A case series

Arginine vasopressin was found in experimental and clinical studies to have a beneficial effect in cardiopulmonary resuscitation. The American Heart Association 2000 guidelines recommended its use for adult ventricular fibrillation arrest, and the American Heart Association 2005 guidelines noted that it may replace the first or second epinephrine dose. There is little reported experience with arginine vasopressin in cardiopulmonary resuscitation of children. Terlipressin, a long-acting analog of arginine vasopressin, has recently emerged as a treatment for vasodilatory shock in both adults and in children, but evidence of its effectiveness in the pediatric setting is sparse. The objective of this retrospective study is to describe our experience in adding terlipressin to the conventional protocol in children with cardiac arrest. Retrospective case series study. An 18-bed pediatric critical care department at a university-affiliated tertiary care children's hospital. Seven pediatric patients with asystole, aged 2 months to 5 yrs, who experienced eight episodes of refractory cardiac arrest and did not respond to conventional therapy. Addition of terlipressin to epinephrine during cardiopulmonary resuscitation of children. Return of spontaneous circulation was monitored and achieved in six out of eight episodes of cardiac arrest. One patient died 12 hrs after return of spontaneous circulation, and four patients survived to discharge with no neurologic sequelae. The combination of terlipressin to epinephrine during cardiopulmonary resuscitation may have a beneficial effect in children with cardiac arrest. More studies on this drug's safety and efficacy in this setting are mandated.

Myocardial ischemia prevention in swine with autologous ozoneized blood transfusion

Although ozone therapy has been widely used, no attempts have been made to evaluate its protective effects in acute myocardial ischemia. Because of this, a pilot study with a few number of animals was initiated. Under surgical conditions, 200 ml of autologous venous blood, enriched with 20 ml ozone (major autohemotransfusion—MAHT) were infused through the internal jugular vein of adult swines (n=3), 10 min before the proximal right coronary artery was occluded with a balloon for angioplasty. All animals were sacrificed immediately after having completed the sequence: ST segment elevation, ventricular fibrillation and cardiac arrest.

The susceptibility of ventricular arrhythmia to aconitine in conscious Lyon hypertensive rats

The present work was designed to investigate the relationship between hemodynamic parameters and the susceptibility of ventricular arrhythmia to aconitine in conscious Lyon hypertensive rats (LH). Male LH and Lyon low blood pressure rats (LL) were used. After the determination of baroreflex sensitivity (BRS), ventricular arrhythmia was induced by aconitine infusion in conscious rats. Blood pressure (BP) was recorded during the period of infusion. Compared with the LL rats, the LH rats possessed significantly higher BP, blood pressure variability and lower BRS. The threshold of aconitine required for ventricular fibrillation and cardiac arrest in the LH rats were significantly lower than those in the LL rats. It was found that all the hemodynamic parameters studied were not correlated with the threshold of aconitine required for arrhythmia, with the exception of BRS, which was positively related to the threshold of aconitine required for ventricular premature beat. The LH rats possessed greater susceptibility to aconitine-induced ventricular arrhythmias when compared to the LL rats. This greater susceptibility could not be attributed to any one of the hemodynamic parameters alone studied in the LH rats. It is proposed that various hypertension-associated abnormalities, including the abnormal hemodynamics, may co-contribute to this vulnerability to ventricular arrhythmias.

Decreasing CPR Interruptions in Out-of-Hospital VF Arrest

Survival after ventricular fibrillation (VF) arrest is usually less than 20%. Early cardiopulmonary resuscitation and early defibrillation are

This Month in Anesthesiology

This Month in Anesthesiology

Issue Highlights

HomeCirculationVol. 114, No. 25Issue Highlights Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBIssue Highlights Originally published19 Dec 2006https://doi.org/10.1161/circ.114.25.2753Circulation. 2006;114:2753INCREASING USE OF CARDIOPULMONARY RESUSCITATION DURING OUT-OF-HOSPITAL VENTRICULAR FIBRILLATION ARREST: SURVIVAL IMPLICATIONS OF GUIDELINE CHANGES, by Rea et al.Even relatively brief interruptions of chest compressions, such as pauses required for assessment of the cardiac rhythm by an automatic external defibrillator, reduce survival in experimental models of cardiac arrest. American Heart Association guidelines for cardiopulmonary resuscitation have been revised accordingly to include a single shock, rather than stacked defibrillation shocks, followed by immediate resumption of cardiopulmonary resuscitation and delayed reassessment of cardiac rhythm. Do these changes improve patient outcomes? Rea and colleagues studied outcomes from out-of-hospital cardiac arrest before and after cardiopulmonary resuscitation protocol changes were implemented in King County, Washington. They observed an improvement in survival to hospital discharge. Recorded automatic external defibrillator data showed increased time spent with chest compressions. The findings provide support for minimizing interruptions in cardiopulmonary resuscitation. The study also illustrates how analysis of community data can provide reassurance that unanticipated adverse effects do not offset potential benefits when protocol changes supported by strong experimental evidence are applied to out-of-hospital cardiac arrest victims. See p 2760 (and editorial p 2754).ETHNIC AND GENDER DIFFERENCES IN AMBULATORY BLOOD PRESSURE TRAJECTORIES: RESULTS FROM A 15-YEAR LONGITUDINAL STUDY IN YOUTH AND YOUNG ADULTS, by Wang et al.In the United States, blacks experience a greater burden of hypertension and associated cardiovascular disease compared to whites. The reasons for these ethnic differences are incompletely understood. In this issue of Circulation, Wang and colleagues evaluated longitudinal trajectories of 24-hour ambulatory blood pressure (BP) using serial recordings obtained in black and white children over a 15-year period. The authors observed that black children had higher levels of both systolic and diastolic BP during day and night from early adolescence onwards. A striking finding was that black youth experienced a greater age-associated increase in nocturnal systolic and diastolic BP compared to whites. Black-white differences in age-associated changes in day-time BP were less striking. The authors conclude that a blunted nocturnal decline in BP that is more pronounced in adolescence may contribute to the greater burden of hypertension in blacks. If confirmed, these findings suggest the origins of adult hypertension (and ethnicity-related differences in hypertension burden) may lie in the patterns of 24-hour ambulatory BP in childhood. See p 2780.RISKS ASSOCIATED WITH STATIN THERAPY: A SYSTEMATIC OVERVIEW OF RANDOMIZED CLINICAL TRIALS, by Kashani et al.Statins, one of the most commonly prescribed drugs, reduce the risk of cardiovascular events, but there are concerns about their association with an increased risk of musculoskeletal, renal and hepatic complications. Clinical trials are the best source of unbiased information about the presence and magnitude of risk conferred by these medications. The study by Kashani et al in this issue of Circulation evaluated information about the adverse effects of statins based on 35 trials of statin monotherapy versus placebo, involving 74 102 patients. The investigators assessed the risk of myalgias, creatine kinase elevations, rhabdomyolysis, transaminase elevations, and discontinuation due to any adverse event. A caveat is that the experience in the clinical trials might underestimate risks of patients who are underrepresented in the trials, such as those who are older, have more comorbidity, or receive higher doses than specified in the trials. Nevertheless, the present study provides the best current unbiased estimates of the risks of statin therapy in the trial populations and can be used to support clinical decision making. See p 2788.Visit http://circ.ahajournals.org:Images in Cardiovascular MedicineA Quadricuspid Aortic Valve With Severe Aortic Regurgitation. See p e642. Download figureDownload PowerPointAcute Coronary Syndrome due to Intramural Hematoma. See p e644.Definitive Diagnosis of Obstructed Total Anomalous Pulmonary Venous Drainage in a Critically Ill Newborn With High-Resolution Computed Tomography. See p e646.CorrespondenceSee p e648. Previous Back to top Next FiguresReferencesRelatedDetails December 19, 2006Vol 114, Issue 25 Advertisement Article InformationMetrics https://doi.org/10.1161/circ.114.25.2753 Originally publishedDecember 19, 2006 PDF download Advertisement

Increasing Use of Cardiopulmonary Resuscitation During Out-of-Hospital Ventricular Fibrillation Arrest

The most recent resuscitation guidelines have sought to improve the interface between defibrillation and cardiopulmonary resuscitation; the survival impact of these changes is unknown, however. A year before issuance of the most recent guidelines, we implemented protocol changes that provided a single shock without rhythm reanalysis, stacked shocks, or postdefibrillation pulse check, and extended the period of cardiopulmonary resuscitation from 1 to 2 minutes. We hypothesized that survival would be better with the new protocol. The present study took place in a community with a 2-tiered emergency medical services response and an established system of cardiac arrest surveillance, training, and review. The investigation was a cohort study of persons who had bystander-witnessed out-of-hospital ventricular fibrillation arrest because of heart disease, comparing a prospectively defined intervention group (January 1, 2005, to January 31, 2006) with a historical control group that was treated according to previous guidelines of rhythm reanalysis, stacked shocks, and postdefibrillation pulse checks (January 1, 2002, to December 31, 2004). The primary outcome was survival to hospital discharge. The proportion of treated arrests that met inclusion criteria was similar for intervention and control periods (15.4% [134/869] versus 16.6% [374/2255]). Survival to hospital discharge was significantly greater during the intervention period compared with the control period (46% [61/134] versus 33% [122/374], P=0.008) and corresponded to a decrease in the interval from shock to start of chest compressions (28 versus 7 seconds). Adjustment for covariates did not alter the survival association. These results suggest the new resuscitation guidelines will alter the interface between defibrillation and cardiopulmonary resuscitation and in turn may improve outcomes.

Epicardial Left Ventricular Lead Placement for Cardiac Resynchronization Therapy Following Failed Coronary Sinus Approach

Outcomes of surgical left ventricular (LV) lead placement in patients with failing percutaneous cardiac resynchronization therapy (CRT) are not well defined. The authors reviewed all primary epicardial LV lead placements at their institution to identify patient population, perioperative course, and structural and functional outcomes, and compared this group with patients who had successful percutaneous CRT. Fourteen patients (11%) required epicardial LV lead placement via left thoracotomy or thoracoscopy with mean intensive care unit stay of 2.1 days and inotrope use in 38%. Complications included ventricular fibrillatory arrest, stroke, hypotension, and major bleeding, but there was no difference in 90-day survival between epicardial and percutaneous CRT lead placement. In survivors, New York Heart Association class improved from 3.0 to 2.3 (P=.008) without a change in ejection fraction or severity of mitral regurgitation. Thus, in patients with unsuccessful percutaneous CRT, epicardial LV lead placement is associated with perioperative morbidity, but with subsequent improvement in functional status without excess mortality.

Adenosine A 1 receptor antagonism hastens the decay in ventricular fibrillation waveform morphology during porcine cardiac arrest

Endogenous adenosine (ADO) is known to be cardioprotective during acute myocardial ischemia. Coronary sinus ADO concentration has recently been shown to increase nearly 13-fold over baseline levels after 5 min of untreated ventricular fibrillation (VF). The role of ADO in VF has never been previously examined. The objective of this study was to determine the effect of ADO receptor antagonism, as measured by the scaling exponent (ScE), on the degeneration of VF over time during the circulatory phase of cardiac arrest. A well-established swine model of prolonged VF arrest was used for this experiment. Eighteen domestic mixed-breed swine were assigned by block randomization to receive either DTI-0017 (5mg/kg), a potent ADO A(1) receptor antagonist or placebo in a double-blind fashion. The animals were instrumented under general anesthesia and acclimatized. The assigned solution was infused over 5 min. One minute after the infusion was completed, VF was induced with a 3s, 60 Hz, 100 mA transthoracic shock and left untreated. Lead II ECG was monitored continuously and recorded at 1000 samples/s. It was determined a priori that evaluation of the plots would be limited to a previously observed plateau phase historically occurring between 5 and 8 min corresponding to the circulatory phase of cardiac arrest. The scaling exponent values over this period were calculated for each of the 18 recordings using custom MATLAB routines. Using the Wald statistic to produce the Chi square distributions the null hypothesis, that there was no difference between the two groups, was tested. The Wald statistic calculation based on eight epochs from 300 to 475 s in placebo and DTI groups was significant to reject the null hypothesis of no difference in the groupxtime interaction at the 0.015 level (Chi square distribution for Wald=17.49, d.f.=7). In this swine model, adenosine A(1) receptor antagonism accelerated the natural decay in the ECG VF waveform during the circulatory phase of cardiac arrest. Our findings would suggest that endogenous adenosine has cardioprotective effects during sudden cardiac arrest by slowing the time-dependent degeneration of VF.

Noninvasive risk stratification prevents sudden death due to paroxysmal atrial fibrillation in hypertrophic cardiomyopathy

Sudden death is a tragic complication of hypertrophic cardiomyopathy. We report the case of a young patient with hypertrophic cardiomyopathy in whom an episode of atrial fibrillation triggered ventricular fibrillation and cardiac arrest. A 21-year-old man with nonobstructive hypertrophic cardiomyopathy underwent cardioverter-defibrillator implantation for primary prevention of sudden death, after risk stratification with noninvasive strategies. After 6 weeks, during a moderate effort, the patient had a syncopal episode, preceded by palpitations and dizziness, and terminated by the cardioverter-defibrillator. Device interrogation revealed an episode of atrial fibrillation with high ventricular response, spontaneously followed by ventricular tachycardia/fibrillation. Atrial fibrillation is a potential trigger of life-threatening arrhythmias and sudden death in patients with hypertrophic cardiomyopathy. Clinical investigation of risk markers for sudden death should be encouraged to identify high-risk patients who may benefit from a prophylactic therapy with an implantable cardioverter-defibrillator.

The natural biochemical changes during ventricular fibrillation with cardiopulmonary resuscitation and the onset of postdefibrillation pulseless electrical activity

Objective The objective of this study was to document the biochemical changes during ventricular fibrillation (VF) with cardiopulmonary resuscitation (CPR), and to identify factors associated with postdefibrillation pulseless electrical activity (PD-PEA). Background It has been reliably estimated that as much as 60% of out-of-hospital sudden cardiac death can be attributed to the onset of PD-PEA (Niemann JT, Cruz B, Garner D et al. Immediate countershock versus CPR before countershock in a 5-minute swine model of ventricular fibrillation arrest. Ann Emerg Med 2000;36:543-6). Previous attempts to treat reversible causes of pulseless electrical activity have not been successful clinically (Niemann JT, Stratton SJ, Cruz B, Lewis RJ. Outcome of out-of-hospital postcountershock asystole and pulseless electrical activity versus primary asystole and pulseless electrical activity. Crit Care Med 2001;29:2366-70). Methods This investigation used 22 studies on 14 anesthetized pigs breathing 100% oxygen. Ventricular fibrillation was induced with a right ventricular catheter electrode, and the chest was compressed with a pneumatically driven Chest Thumper (Michigan Instruments) (80-100 lb at 60/min). The electrocardiogram and aortic pressure were recorded continuously. Arterial pH, P o 2, P co 2, Na +, K +, Ca 2+, Cl −, SaO 2, glucose, hematocrit, and hemoglobin level were measured at selected times. Ventricular defibrillation was achieved with transchest electrodes. Results Typically, during VF with CPR, mean aortic pressure was 20 to 25 mm Hg. In all cases aortic P o 2 decreased to about 20% of the initial value in 10 minutes, and aortic blood K + increased by 50% in 6 minutes. By 5 to 8 minutes, the incidence of PD-PEA was 50%. Conclusion Ventricular fibrillation duration, arterial K +, and arterial P co 2 were statistically correlated with the onset of PD-PEA in this study. In addition, trends suggest an association of mean arterial blood pressure and arterial P o 2 with the onset of PD-PEA.

Coronary vasospasm-induced acute coronary syndrome complicated by life-threatening cardiac arrhythmias in patients without hemodynamically significant coronary artery disease

Background Coronary vasospasm-induced electrical and mechanical complications in patients with acute coronary syndrome and no hemodynamically significant coronary artery disease are rarely reported. Methods A total of 733 consecutive patients with acute coronary syndrome admitted to our hospital who subsequently underwent coronary angiography at our institution were enrolled. Patients who had documented complete atrioventricular block or ventricular fibrillation, no evidence of hemodynamically significant coronary artery disease on coronary angiogram, and no other (non-coronary) cardiac abnormalities were included. Patients were followed for subsequent cardiac events and mortality. Results Over a 6-year period at our institution, acute coronary syndrome complicated by life-threatening cardiac arrhythmias developed in six patients who had no hemodynamically significant coronary artery disease with corresponding intra-coronary ergonovine provocative coronary vasospasm. Acute myocardial infarction was diagnosed in five of these patients and variant angina pectoris in one. Complete atrioventricular block was the most common complication in these cases, followed by cardiogenic shock with or without right ventricular infarction, ventricular fibrillation, and severe sinus arrest. These complications were corrected with intravenous fluid, intravenous atropine or cardiac defibrillation. During a median follow-up period of 26 months, none of the patients expired or suffered nonfatal reinfarction. Two individuals who did not stop smoking during follow-up developed recurrent angina after self-discontinuation of calcium antagonists. Conclusions Coronary vasospasm can be a cause of life-threatening cardiac arrhythmias in patients with acute coronary syndrome and no hemodynamically significant coronary artery disease. Coronary angiography with/without intra-coronary ergonovine testing is necessary in acute coronary syndrome patients to identify the underlying pathology and establish appropriate treatment in these cases.

Three-Phase Model of Cardiac Arrest: Time-Dependent Benefit of Bystander Cardiopulmonary Resuscitation

Evidence has suggested that the pathophysiology of ventricular fibrillation cardiac arrest may consist of 3 time-sensitive phases: electrical, circulatory, and metabolic. We performed a retrospective cohort study of adults in a metropolitan county who had had witnessed ventricular fibrillation arrest before emergency medical services were undertaken to investigate this 3-phase model with regard to bystander cardiopulmonary resuscitation (CPR). We hypothesized that the survival benefit from bystander CPR depends on the collapse-to-shock interval, with the highest benefit occurring during the circulatory phase. The collapse-to-shock interval was a priori grouped into 4 categories: 1 to 5, 6 to 7, 8 to 10, and > or = 11 minutes. We used logistic regression analysis to assess whether the association between CPR and survival to hospital discharge depended on the collapse-to-shock interval category. Of the 2,193 events meeting the inclusion criteria, 67.0% had received bystander CPR. The average collapse-to-shock interval was 8.2 +/- 2.8 minutes. The survival rate was 33.4%. A higher likelihood of survival was associated with bystander CPR (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.15 to 1.73) and a shorter collapse-to-shock interval (OR -1.84, 95% CI 1.62 to 2.10, for each additional SD of 2.8 minutes less) after adjustment. The beneficial association of CPR increased as the collapse-to-shock interval increased (p = 0.05 for interaction). The bystander CPR was associated with an OR of survival of 0.96 (95% CI 0.64 to 1.46) for a 1- to 5-minute collapse-to shock interval, OR of 1.25 (95% CI 1.00 to 1.58) for a 6- to 7-minute interval, OR of 1.62 (95% CI 1.25 to 2.11) for an 8- to 10-minute interval, and OR of 2.11 (95% CI 1.32 to 3.37) for an > or = 11-minute interval. The results of this investigation support a phased model of ventricular fibrillation arrest. The findings suggest that the transition from the electrical to circulatory phase may occur at about 5 minutes, and the circulatory phase may extend to 15 minutes.

Suicide due to oral ingestion of lidocaine: a case report and review of the literature

The Authors describe a rare case of suicide in a 31-year-old woman, due to oral ingestion of lidocaine; the histological and toxicological findings are discussed to provide useful information to the present experience with this particular modality of death. Histological examination revealed generalized stasis. In the myocardium we observed segmentation of the myocardial cells and/or widening of intercalated discs and associated group of hypercontracted myocardial cells with “square” nuclei in line with hyperdistended ones. Non-eosinophilic bands of hypercontracted sarcomeres alternating with stretched, often apparently separated sarcomeres, small foci of paradiscal contraction band necrosis, and perivascular fibrosis were observed too. Lidocaine was detected in the subject's urine through immunoenzymatic screening. Toxicological analysis by solid–liquid extraction and gas chromatography–mass spectrometry (GC–MS) analysis, was carried out to identify and quantify the individual substances present in the biological fluids and organs. Lidocaine concentrations were as follows: blood 31 μg/mL, gastric content 2.5 g, liver 10 μg/g, kidney 12 μg/g, brain 9 μg/g, spleen 24 μg/g, lung 84 μg/g, heart 9 μg/g, urine 9 μg/mL, and bile 6 μg/mL. No other drugs or alcohol were detected. When blood lidocaine reaches toxic levels, serious toxic symptoms associated with the central nervous system and cardiac system are noted. The overdose of lidocaine produces death from ventricular fibrillation or cardiac arrest. In this case, according to macroscopic and microscopic findings, the cause of death was most likely cardiac and possibly related to ventricular fibrillation.

A Report of the Vancouver Forum on the Care of the Live Organ Donor: Lung, Liver, Pancreas, and Intestine Data and Medical Guidelines

An international conference of transplant physicians, surgeons, and allied health professionals was held in Vancouver, Canada, on September 15 and 16, 2005 to address the care of the live lung, liver, pancreas, and intestine organ donor. The Vancouver Forum was convened under the auspices of the Ethics Committee of The Transplantation Society. Forum participants included over 100 leaders in organ transplantation, representing many countries from around the world, including participants from the following continents: Africa, Asia, Australia, Europe, North and South America. The objective of the Vancouver Forum was to develop an international standard of care for the live lung, liver, pancreas and intestinal organ donor. This Vancouver Forum followed a conference convened in Amsterdam on the care of the live kidney donor (1, 2). There were four organ specific work groups at the Vancouver Forum: lung, liver, pancreas and intestine. Each organ work group addressed the following topics in concert and reported their findings in a plenary presentation to all participants:

Problems and Complications With Cold-Water Rescue

A case description is presented of a 9-member rowing team whose scull swamped on a small lake in Victoria, Canada, because of a sudden winter storm, which immersed them in 4 degrees C water for 50 minutes until a small rescue boat found them in darkness. Another 13 minutes of cold exposure in 6.7 degrees C air occurred during boat transport to waiting ambulance paramedics. Two rowers died, one from severe hypothermia and the other from drowning as a consequence of cold incapacitation and hypothermia. The 2 coldest rowers, who were transported 8 km to a major hospital, arrived with rectal temperatures of 23.4 degrees C and 25 degrees C; the first was asystolic and the second was unconscious and in sinus bradycardia. Analysis of all the circumstances of this incident provided an opportunity to observe a continuum of responses in a heterogeneous group of rowers at risk of severe hypothermia. Several practical lessons concerning cold-water survival, rescue, and treatment can be learned. The effects of low body mass were associated with greater cooling rate. Diminished neuromuscular performance in the periphery appeared to be independent of body mass. Rough handling during moving of patients with marked hypothermia introduces the risk of producing ventricular fibrillation or cardiac arrest. Unconscious, nonshivering hypothermia victims who are rescued and insulated from cold could have a further afterdrop of 3 degrees C to 4 degrees C. During transport to a hospital, the use of heating devices concentrating on core regions may increase the chance of successful treatment in the hospital. Cardiopulmonary bypass may be indicated for severely hypothermic patients in asystole.

Therapeutic cooling in cardiac arrest of noncardiac origin

On the basis of previous published data, the Interliaison Committee on Resuscitation has advised that unconscious adults with spontaneous circulation after out-of-hospital cardiac arrest should be cooled to 33°C during 24 hours when the initial rhythm was ventricular fibrillation (VF) and the cause of the cardiac arrest is of cardiac origin. We postulate that other rhythms might beneficiate from cooling as well as cardiac arrest of noncardiac origin. We therefore started a prospective study, and we compare the effect of cooling on long-term outcome in patients resuscitated after cardiac arrest of noncardiac origin or having rhythms other than VF. Twenty-eight patients were included, 14 of them were subjected to hypothermia after achieving return of spontaneous circulation (ROSC) (hypothermia group), the remaining other 14 patients were subjected to normothermia (normothermia group). The cause of cardiac arrest was near asphyxia after strangulation or secondary to choking. Other patients had asystole or pulseless electrical activity (PEA) at the first rhythm assessment. The postresuscitation phase was similar in both groups. In the hypothermia group, the cooling was initiated either by surface or intravenous cooling. The patient was cooled to 33°C as soon as possible in the Emergency Department, and the temperature was maintained for 24 hours. The re-warming phase was slowly started 24 hours later by increasing the body temperature by 1°C each 4 hours. No difference in complications was observed in the both groups. Good neurological outcome was highly significant in the hypothermia group (Table ​(Table11). Table 1 In conclusion, cooling seems to improve the neurological outcome after cardiac arrest even in rhythms other than VF and cardiac arrest of noncardiac origin. Surprisingly cooling also mitigates the brain damage associated with asphyxial cardiac arrest in humans.

Continuous renal replacement therapy may aid recovery after cardiac arrest

We report on the case of a patient who suffered a cardiac arrest in ventricular fibrillation (VF), leading to a decerebrate state, who made a rapid complete neuronal recovery following the institution of continuous renal replacement therapy (CRRT). Continuous veno-venous haemodiafiltration (CVVHDF) was used; the patient remained haemodynamically stable. Flexor responses were seen after 1 1/2 h and the patient regained consciousness within 3 h. There were no complications associated with the procedure except some minor gastric bleeding, which did not need any specific therapy.

Major Changes in the 2005 AHA Guidelines for CPR and ECC

The emergency cardiovascular care (ECC) scientists involved in the 2005 evidence evaluation process and the revision of the 2005 AHA Guidelines for CPR and ECC began and ended the process aware of the limitations of the resuscitation scientific evidence, optimistic about emerging data that documents the benefits of high-quality cardiopulmonary resuscitation (CPR), and determined to make recommendations that would increase survival from cardiac arrest and life-threatening emergencies. This editorial summarizes the factors that contributed to the tipping point, the point at which information and discussion either triggered support for major changes in the guidelines or reaffirmed existing recommendations. The scientists critically reviewed the sequence and priorities of the steps of CPR to identify those factors with the greatest potential impact on survival. They then developed recommendations to support those interventions that should be performed frequently and well. There was unanimous support for increased emphasis on ensuring that rescuers deliver high-quality CPR: rescuers need to provide an adequate number and depth of compressions, allow complete chest recoil after each compression, and minimize interruptions in chest compressions. The 2005 AHA Guidelines for CPR and ECC are based on the most comprehensive review of resuscitation literature ever published.1 The evidence evaluation process incorporated the input of 281 international resuscitation experts who evaluated research, topics, and hypotheses over a 36-month period before the 2005 Consensus Conference. The process included structured evidence evaluation, analysis, and documentation of the literature.2 It also included rigorous disclosure and management of potential conflicts of interest, a process summarized in two editorials.3,4 Cardiopulmonary resuscitation and emergency cardiovascular care is a relatively new field. The epidemiologic data is incomplete, and high-level evidence is insufficient to support many recommendations. Although sudden cardiac arrest (SCA) is responsible for an estimated 250 000 deaths out of the hospital in the United …

Part 7.2: Management of Cardiac Arrest

Four rhythms produce pulseless cardiac arrest: ventricular fibrillation (VF), rapid ventricular tachycardia (VT), pulseless electrical activity (PEA), and asystole. Survival from these arrest rhythms requires both basic life support (BLS) and advanced cardiovascular life support (ACLS). The foundation of ACLS care is good BLS care, beginning with prompt high-quality bystander CPR and, for VF/pulseless VT, attempted defibrillation within minutes of collapse. For victims of witnessed VF arrest, prompt bystander CPR and early defibrillation can significantly increase the chance for survival to hospital discharge. In comparison, typical ACLS therapies, such as insertion of advanced airways and pharmacologic support of the circulation, have not been shown to increase rate of survival to hospital discharge. This section details the general care of a patient in cardiac arrest and provides an overview of the ACLS Pulseless Arrest Algorithm. During cardiac arrest, basic CPR and early defibrillation are of primary importance, and drug administration is of secondary importance. Few drugs used in the treatment of cardiac arrest are supported by strong evidence. After beginning CPR and attempting defibrillation, rescuers can establish intravenous (IV) access, consider drug therapy, and insert an advanced airway. ### Central Versus Peripheral Infusions Central line access is not needed in most resuscitation attempts. If IV access has not been established, the provider should insert a large peripheral venous catheter. Although in adults peak drug concentrations are lower and circulation times longer when drugs are administered via peripheral sites rather than central sites, the establishment of peripheral access does not require interruption of CPR.1,2 Drugs typically require 1 to 2 minutes to reach the central circulation when given via a peripheral vein but require less time when given via central venous access. If a resuscitation drug is administered by a peripheral venous route, administer the drug by bolus injection and follow with a 20-mL bolus of …