Resuscitation
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Multicenter Study Comparative Study
Kinetics of manual and automated mechanical chest compressions.
Early onset of adequate chest compression is mandatory for cardiopulmonary resuscitation (CPR) following cardiac arrest. Transmission of forces from chest strain to the heart may be variable between manual and mechanical chest compressions. Furthermore, automated mechanical chest devices can deliver an active decompression, thus improving the venous return to the heart. This pilot study investigated the kinetics of cardiac deformation during these two CPR methods. ⋯ Mechanical compared to manual chest compression delivered a more rapid compression and decompression of the cardiac structures at an adequate rate, with broader inward-outward movement of the ventricular walls suggesting greater emptying and filling of the ventricles. Transesophageal echocardiography may be a useful tool to assess the adequacy of chest compression without CPR interruption.
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Observational Study
Cardiac arrest in the intensive care unit: An assessment of preventability.
Cardiac arrest in the intensive care unit (ICU-CA) is a common and highly morbid event. We investigated the preventability of ICU-CAs and identified targets for future intervention. ⋯ ICU-CAs may have preventable elements. Themes of preventability were identified and addressing these themes through data-driven quality improvement initiatives could potentially reduce CA incidence in critically-ill patients.
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Gray-white-matter ratio (GWR) calculated from head CT is a radiologic index of tissue changes associated with hypoxic-ischemic encephalopathy after cardiac arrest (CA). Evidence from previous studies indicates high specificity for poor outcome prediction at GWR thresholds of 1.10-1.20. We aimed to determine the relationship between accuracy of neurologic prognostication by GWR and timing of CT. ⋯ A GWR below 1.10 predicts poor outcome (CPC4-5) in patients after CA with high specificity irrespective of time of acquisition of CT. Because GWR decreases over time in patients with severe HIE, sensitivity for prediction of poor outcome is higher for late CTs (>24 h after CA) as compared to early CTs (<6 h after CA).
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Comparative Study Observational Study
The effects of route of admission to a percutaneous coronary intervention centre among patients with out-of-hospital cardiac arrest.
Patients with OHCA who are not transported directly to a percutaneous coronary intervention (PCI)-capable hospital may eventually undergo an inter-hospital transfer (IHT). The aim of the present study was to investigate the effects of route of admission to a PCI centre among patients with OHCA. ⋯ The route of admission to a PCI centre is associated with neurological recovery among resuscitated patients with OHCA of presumed cardiac aetiology. This has implications for regionalized EMS transport and IHT protocols for patients with OHCA.