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Michael Goldfarb, Bojan Cercek
There are over 300,000 out-of-hospital cardiac arrests (OOHCA) in the United States each year, and the long-term survival rate is less than 10%. Despite improvements in postarrest management, the greatest drop-off in survival occurs during hospitalization, mostly due to myocardial dysfunction and neurological injury. Coronary artery disease is common in postcardiac arrest patients, with an incidence of approximately 60-80%. In patients with a chest pain syndrome and an ST-segment-elevation myocardial infarction pattern evident on the presenting electrocardiogram, immediate revascularization is recommended by cardiovascular societies due to established mortality benefits...
November 2017: Cardiology in Review
M Bilal Iqbal, Abtehale Al-Hussaini, Gareth Rosser, Ramyah Rajakulasingam, Jayna Patel, Katharine Elliott, Poornima Mohan, Maria Phylactou, Rebecca Green, Mark Whitbread, Mark Mason, Richard Grocott-Mason, Robert Smith, Charles Ilsley
BACKGROUND: Despite advances in cardiopulmonary resuscitation, functional survival remains low after out-of-hospital cardiac arrest (OOHCA). Intra-aortic balloon pump (IABP) therapy has recently been shown to augment cerebral blood flow. Whether IABP therapy in the post-resuscitation period improves functional outcomes is unknown. METHODS: We analysed 174 consecutive patients who were successfully resuscitated from an OOHCA between 2011-2013 at Harefield Hospital, London...
December 2016: Heart, Lung & Circulation
Aaron Pulver, Ran Wei, Clay Mann
BACKGROUND: Out-of-hospital cardiac arrest (OOHCA) is prevalent in the United States. Each year between 180,000 and 400,000 people die due to cardiac arrest. The automated external defibrillator (AED) has greatly enhanced survival rates for OOHCA. However, one of the important components of successful cardiac arrest treatment is emergency medical services (EMS) response time (i.e., the time from EMS "wheels rolling" until arrival at the OOHCA scene). Unmanned Aerial Vehicles (UAV) have regularly been used for remote sensing and aerial imagery collection, but there are new opportunities to use drones for medical emergencies...
May 2016: Prehospital Emergency Care
Bernd W Böttiger, Michael Bernhard, Jürgen Knapp, Peter Nagele
BACKGROUND: Evidence suggests that EMS-physician-guided cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OOHCA) may be associated with improved outcomes, yet randomized controlled trials are not available. The goal of this meta-analysis was to determine the association between EMS-physician- versus paramedic-guided CPR and survival after OOHCA. METHODS AND RESULTS: Studies that compared EMS-physician- versus paramedic-guided CPR in OOHCA published until June 2014 were systematically searched in MEDLINE, EMBASE and Cochrane databases...
January 9, 2016: Critical Care: the Official Journal of the Critical Care Forum
Andy Hitt, Julia Williams, Tim Edwards
BACKGROUND: In the UK demand for emergency ambulances is increasing. To deal with this increase, Ambulance Service Trusts must use resources effectively and ensure that they are deployed appropriately. AIM: The aim of this study was to gain an understanding of factors influencing resource dispatchers' (RD) decision-making processes when managing ambulance resources attending out-of-hospital cardiac arrest (OOHCA) and how these decisions might impact on resource availability...
May 2015: Emergency Medicine Journal: EMJ
J Petrie, S Easton, V Naik, C Lockie, S J Brett, R Stümpfle
OBJECTIVES: There is a scarcity of literature reporting hospital costs for treating out of hospital cardiac arrest (OOHCA) survivors, especially within the UK. This is essential for assessment of cost-effectiveness of interventions necessary to allow just allocation of resources within the National Health Service. We set out primarily to calculate costs stratified against hospital survival and neurological outcomes. Secondarily, we estimated cost effectiveness based on estimates of survival and utility from previous studies to calculate costs per quality adjusted life year (QALY)...
April 2, 2015: BMJ Open
B Cardos, S Stipulante, A-S Delfosse, V D'Orio, A Ghuysen
Phone cardiopulmonary resuscitation (CPR) assists any cardiac arrest witness, previously trained or not, through standardized instructions given by phone. These instructions are intended to guide the bystander in checking for responsiveness, opening the airway and checking for adequate breathing, and to initiate chest compressions in case of apparent death. The "Algorithme Liégeois d'Encadrement à la Réanimation par Té1éphone" (ALERT) is an original phone CPR protocol helping the dispatchers to guide callers during the dispatcher's time window, between the beginning of the call and the Emergency Medical Services (EMS) arrival on scene...
2014: Revue Médicale de Liège
Christian Vaillancourt, Manya Charette, Ann Kasaboski, Marianne Hoad, Vivianne Larocque, Denis Crête, Stephanie Logan, Patrick Lamoureux, Jeff McBride, Sheldon Cheskes, George A Wells, Ian G Stiell
INTRODUCTION: We sought to determine the ability of 9-1-1 dispatchers to accurately determine the presence of out-of-hospital cardiac arrest (OOHCA) over the telephone, and to determine the frequency with which CPR instructions are initiated and chest compressions delivered in patients not in cardiac arrest. METHODS: We conducted a multi-center, prospective cohort study of adult OOHCA patients not witnessed by EMS for which resuscitation was attempted. Dispatchers were not health care professionals and received 6 weeks of training followed by a 6-month preceptorship...
May 2015: Resuscitation
M Bilal Iqbal, Abtehale Al-Hussaini, Gareth Rosser, Saleem Salehi, Maria Phylactou, Ramyah Rajakulasingham, Jayna Patel, Katharine Elliott, Poornima Mohan, Rebecca Green, Mark Whitbread, Robert Smith, Charles Ilsley
Despite advances in cardiopulmonary resuscitation (CPR), survival remains low after out-of-hospital cardiac arrest (OOHCA). Acute coronary ischemia is the predominating precipitant, and prompt delivery of patients to dedicated facilities may improve outcomes. Since 2011, all patients experiencing OOHCA in London, where a cardiac etiology is suspected, are systematically brought to heart attack centers (HACs). We determined the predictors for survival and favorable functional outcomes in this setting. We analyzed 174 consecutive patients experiencing OOHCA from 2011 to 2013 brought to Harefield Hospital-a designated HAC in London...
March 15, 2015: American Journal of Cardiology
Ashwin Subramaniam, Ravindranath Tiruvoipati, John Botha
Therapeutic hypothermia (TH), where patients are cooled to between 32°C and 36°C for a period of 12-24 hours and then gradually rewarmed, may reduce the risk of ischemic injury to cerebral tissue following a period of insufficient blood flow. This strategy of TH could improve mortality and neurological function in patients who have experienced out-of-hospital cardiac arrest (OOHCA). The necessity of TH in OOHCA was challenged in late 2013 by a fascinating and potentially practice changing publication, which found that targeting a temperature of 36°C had similar outcomes to cooling patients to 33°C...
March 2015: Therapeutic Hypothermia and Temperature Management
José G Cabañas, J Brent Myers, Jefferson G Williams, Valerie J De Maio, Michael W Bachman
Abstract Background. Ventricular fibrillation (VF) is considered the out-of-hospital cardiac arrest (OOHCA) rhythm with the highest likelihood of neurologically intact survival. Unfortunately, there are occasions when VF does not respond to standard defibrillatory shocks. Current American Heart Association (AHA) guidelines acknowledge that the data are insufficient in determining the optimal pad placement, waveform, or energy level that produce the best conversion rates from OOHCA with VF. Objective. To describe a technique of double sequential external defibrillation (DSED) for cases of refractory VF (RVF) during OOHCA resuscitation...
January 2015: Prehospital Emergency Care
Hassan Soleimanpour, Farzad Rahmani, Samad Ej Golzari, Saeid Safari
The aim of the present study is to assess the complications of mild induced hypothermia (MIH) in patients with cardiac arrest. Presently, based on the guidelines of the American heart Association, MIH following successful cardiopulmonary resuscitation (CPR) in unconscious adult patients due to ventricular fibrillation (VF) with out-of-hospital cardiac arrest (OOHCA) is essential and required. However, MIH could be associated with complications in Patients with cardiac arrest. Studies conducted on the precautions and care following cardiac arrest and MIH were included...
2014: Journal of Cardiovascular and Thoracic Research
Nichole Bosson, Amy H Kaji, William Koenig, Paula Rashi, Richard Tadeo, Deidre Gorospe, James T Niemann
BACKGROUND: Dismal prognosis after failed out-of-hospital resuscitation has previously been demonstrated. Changes in resuscitation and post-resuscitation care may affect patient outcomes. We describe characteristics and outcomes of patients with out-of-hospital cardiac arrest (OOHCA) transported to specialty cardiac centers after failure of out-of-hospital interventions. METHODS: In Los Angeles (LA) County, patients with non-traumatic OOHCA with return of spontaneous circulation (ROSC) are transported to specialized cardiac care centers...
July 2014: Resuscitation
Paul MacConachie Middleton, Paul Michael Simpson, Richard E Thomas, Jason Charles Bendall
BACKGROUND: Since their emergence from the operating theatre over a decade ago, supra-glottic airways (SGA) have become increasingly common in the management of out-of-hospital cardiac arrest (OOHCA) with laryngeal masks (LM) the most common SGA. The proliferation of LMs in the prehospital setting has occurred despite lower than expected rates of successful insertion being reported. METHODS: We conducted a single-centre, prospective parallel-group, 'open label' randomised controlled trial in subjects with OOHCA (aged greater than or equal to 12 years of age; weighing greater than or equal to 30 kg) were allocated to either the i-gel supraglottic airway (IG-SGA) or the Portex Soft Seal Laryngeal Mask (PSS-LM) within a large Australian ambulance service...
July 2014: Resuscitation
Vishva A Wijesekera, Daniel V Mullany, Catherina A Tjahjadi, Darren L Walters
BACKGROUND: Coronary revascularization in resuscitated out of hospital cardiac arrest (OOHCA) patients has been associated with improved survival. METHODS: This was a retrospective review of patients with OOHCA between 01/07/2007 and 31/03/2009 surviving to hospital admission. Cardiac risk factors, demographics, treatment times, electrocardiogram (ECG), angiographic findings and in-hospital outcomes were recorded. RESULTS: Of the 78 patients, 63 underwent coronary angiography...
March 3, 2014: BMC Cardiovascular Disorders
Nichole Bosson, Amy H Kaji, James T Niemann, Marc Eckstein, Paula Rashi, Richard Tadeo, Deidre Gorospe, Gene Sung, William J French, David Shavelle, Joseph L Thomas, William Koenig
BACKGROUND: Post-resuscitation care of cardiac arrest patients at specialized centers may improve outcome after out-of-hospital cardiac arrest (OOHCA). This study describes experience with regionalized care of resuscitated patients. METHODS: Los Angeles (LA) County established regionalized cardiac care in 2006. Since 2010, protocols mandate transport of nontraumatic OOHCA patients with field return of spontaneous circulation (ROSC) to a STEMI Receiving Center (SRC) with a hypothermia protocol...
April 2014: Prehospital Emergency Care
Xiaobo Wu, Joe Bisera, Wanchun Tang
OBJECTIVE: The possibility of successful defibrillation decreases with an increased duration of ventricular fibrillation (VF). Futile electrical shocks are inversely correlated with myocardial contractile function and long-term survival. Previous studies have demonstrated that various ECG waveform analyses predict the success of defibrillation. This study investigated whether the absolute amplitude of pre-shock VF waveform is likely to predict the success of defibrillation. METHODS: ECG recordings of 350 out-of-hospital cardiac arrest (OOHCA) patients were obtained from the automated external defibrillator (AED) and analyzed by the method of signal integral...
December 2013: Resuscitation
Daniel P Davis, Rebecca E Sell, Nathan Wilkes, Renee Sarno, Ruchika D Husa, Edward M Castillo, Brenna Lawrence, Roger Fisher, Criss Brainard, James V Dunford
BACKGROUND: Compression pauses may be particularly harmful following the electrical recovery but prior to the mechanical recovery from cardiopulmonary arrest. METHODS AND RESULTS: A convenience sample of patients with out-of-hospital cardiac arrest (OOHCA) were identified. Data were exported from defibrillators to define compression pauses, electrocardiogram rhythm, PetCO2, and the presence of palpable pulses. Pulse-check episodes were randomly assigned to a derivation set (one-third) and a validation set (two-thirds)...
January 2013: Resuscitation
George L Foltin, Neal Richmond, Marsha Treiber, Andrew Skomorowsky, Sandro Galea, David Vlahov, Shannon Blaney, Monique Kusick, Robert Silverman, Michael G Tunik
OBJECTIVES: The objective of this study was to describe the demographics of out-of-hospital cardiac arrests (OOHCAs) in children younger than 18 years and characteristics associated with survival among these children in New York City (NYC). METHODS: A prospective observational cohort of all children younger than 18 years with OOHCA in NYC between April 1, 2002, and March 31, 2003. Data were collected from prehospital providers by trained paramedics utilizing a previously validated telephone interview process...
September 2012: Pediatric Emergency Care
Keval S V Shah, Anoop S V Shah, Raj Bhopal
BACKGROUND: Several studies have reported racial/ethnic variation in out-of-hospital cardiac arrest (OOHCA) characteristics, which engendered varying conclusions. We performed a systematic review and meta-analysed the evidence for differences in OOHCA survival when considering the patient's race and/or ethnicity. METHODS: We searched Medline and EMBASE databases up to and including 1 Oct 2011 for studies investigating racial/ethnic differences in OOHCA characteristics, supplemented by manual searches of bibliographies of relevant studies...
May 2014: European Journal of Preventive Cardiology
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