Resuscitation
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Donation after brain death (DBD) is current praxis in Sweden. Circulatory death is far more common. Donation from patients suffering Out-of-Hospital Cardiac Arrest (OHCA) may have the potential to increase the organ-donor pool. The aim of this study was to describe the potential donor pool and its characteristics if uncontrolled donation after circulatory death (uDCD) were to be implemented in the metropolitan area of Stockholm, Sweden. ⋯ Although not taking important real-life limitations into account, our results indicate that implementation of a uDCD programme may substantially increase the number of potential organ donors in Stockholm.
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The out-of-hospital cardiac arrest (OHCA) and cardiac arrest hospital prognosis (CAHP) scores were developed for early neuroprognostication after OHCA. Calculation of both scores requires estimation of the no-flow interval, which may be imprecise. We aimed to validate simplified OHCA and CAHP scores, which exclude the no-flow interval, in an East Asian cohort. ⋯ The simplified OHCA and CAHP scores predicted neurological outcomes in successfully resuscitated East Asian OHCA patients with similar and excellent accuracy. The simplified OHCA and CAHP scores could potentially serve alongside the original scores as risk-adjustment tools for comparison of outcomes between regional OHCA registries worldwide.
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Observational Study
Evaluation of Out-of-Hospital Cardiac Arrest using Transesophageal Echocardiography in the Emergency Department.
Transesophageal echocardiography (TEE) has been proposed as a modality to assess patients in the setting of cardiac arrest, both during resuscitation care and following return of spontaneous circulation (ROSC). In this study we aimed to assess the feasibility and clinical impact of TEE during the emergency department (ED) evaluation during out-of-hospital cardiac arrest (OHCA). ⋯ TEE is feasible and clinically impactful during OHCA management. Resuscitative TEE may allow for characterization of cardiac activity, including identification of pseudo-PEA and fine VF, determination of reversible pathology, and optimization of CPR quality.
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Quantitative waveform measures are a surrogate of the acute physiological status of the myocardium and predict survival following ventricular fibrillation out-of-hospital cardiac arrest (OHCA). We investigated whether the amplitude spectrum area (AMSA) waveform measure mediates the adverse relationship between increasing burden of chronic health conditions and lower likelihood of survival. ⋯ The waveform measure AMSA - a surrogate for the physiological status of the myocardium - mediated only a modest portion of the association between increasing burden of chronic health conditions and lower likelihood of survival following ventricular fibrillation OHCA.
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Implantable cardioverter-defibrillators (ICDs) are a well-established therapy for patients at risk of life-threatening ventricular arrhythmias. With rising implant rates, the risk of a rescuer performing chest compressions during discharge is increasing, leading to concerns over rescuer safety from the resultant leakage current. More recently, subcutaneous ICDs (S-ICD) have been developed, which utilise a higher energy and more superficial electrodes compared with transvenous ICDs (T-ICD), raising safety concerns further. ⋯ Rescuers performing chest compressions on ICD patients are at risk from leakage current, particularly from S-ICDs. Chest compressions should be performed from the opposite side to the ICD to reduce rescuer risk.