Resuscitation
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Randomized Controlled Trial Comparative Study
Outcome among VF/VT patients in the LINC (LUCAS IN Cardiac arrest) trial-A randomised, controlled trial.
The LINC trial evaluated two ALS-CPR algorithms for OHCA patients, consisting of 3min' mechanical chest compression (LUCAS) cycles with defibrillation attempt through compressions vs. 2min' manual compressions with compression pause for defibrillation. The PARAMEDIC trial, using 2min' algorithm found worse outcome for patients with initial VF/VT in the LUCAS group and they received more adrenalin compared to the manual group. We wanted to evaluate if these algorithms had any outcome effect for patients still in VF/VT after the initial defibrillation and how adrenalin timing impacted it. ⋯ No difference in short- or long-term outcomes was found between the 2 algorithms for patients still in VF/VT after the initial defibrillation. The time to the 1st defibrillation and the interval between defibrillations were longer in the mechanical CPR group without impacting the overall outcome. The number of defibrillations required to achieve ROSC or adrenalin doses did not differ between the groups.
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Observational Study
Relationship between age and outcomes of comatose cardiac arrest survivors in a setting without withdrawal of life support.
Previous studies on the relationship between age and outcomes after cardiac arrest were performed in settings where the majority of patients died after the withdrawal of life support (WLS). We examined the association between age and outcomes of comatose cardiac arrest survivors in a setting where WLS was not performed. ⋯ In a setting where WLS is not performed, we found that age was not associated with in-hospital mortality but was independently associated with neurologic outcome at hospital discharge and six-month mortality.
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Delivery room resuscitation of very low birth weight infants can involve use of endotracheal or intravenous epinephrine. Data of the past 19 years were reviewed to identify the usage of epinephrine in delivery room and identify characteristics of these babies. ⋯ Neonates with lower birth weight and younger gestational age were more likely to receive epinephrine during resuscitation at birth. Use of epinephrine in delivery room was associated with lower survival and severe intraventricular hemorrhage among very low birth weight infants.
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Performing advanced cardiac life support (ACLS) in the cardiac catheterization laboratory (CCL) is challenging. Mechanical chest compression (MCC) devices deliver compressions in a small space, allowing for simultaneous percutaneous coronary intervention and reduced radiation exposure to rescuers. In refractory cases, MCC devices allow rescuers to initiate percutaneous mechanical circulatory support (MCS) and extracorporeal life support (ECLS) during resuscitation. This study sought to assess the efficacy and safety of MCC when compared to manual compressions in the CCL. ⋯ Use of MCC during resuscitation of cardiac arrest in the CCL increases the rate of ROSC. Simultaneous implantation of MCS, including percutaneous ECLS, is feasible and safe during MCC-assisted resuscitation in the CCL.
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Regular physical activity is recommended to prevent cardiovascular disease including out-of-hospital cardiac arrest (OHCA). However, it is uncertain whether the intensity during physical activity is associated with better outcomes. We studied the effect of exercise at the time of arrest and the association between metabolic equivalent of task (MET) score and survival of OHCA patients of young and middle age. ⋯ Patients who had an OHCA during exercise were more likely to have neurologically intact survival compared to patients who had an OHCA during periods of non-exercise; however, only the moderate-intensity group was associated with a better neurological outcome.