Resuscitation
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Randomized Controlled Trial
Extracorporeal Cardiopulmonary Resuscitation-Based Approach to Refractory Out-of-Hospital Cardiac Arrest: a Focus on Organ Donation, a Secondary Analysis of a Prague OHCA Randomized Study.
Refractory out-of-hospital cardiac arrest (OHCA) has a poor outcome. In patients, who cannot be rescued despite using advanced techniques like extracorporeal cardiopulmonary resuscitation (ECPR), organ donation may be considered. This study aims to evaluate, in refractory OHCA, how ECPR versus a standard-based approach allows organ donorship. ⋯ The ECPR-based approach in the refractory OHCA trial is associated with increased organ donorship and an excellent outcome of transplanted organs.
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Randomized Controlled Trial
Cardiovascular changes induced by targeted mild hypercapnia after out of hospital cardiac arrest. A sub-study of the TAME cardiac arrest trial.
Hypercapnia may elicit detrimental haemodynamic effects in critically ill patients. We aimed to investigate the consequences of targeted mild hypercapnia versus targeted normocapnia on pulmonary vascular resistance and right ventricular function in patients resuscitated from out-of-hospital cardiac arrest (OHCA). ⋯ In resuscitated OHCA patients, targeting mild hypercapnia did not increase PVRI or worsen right ventricular function compared to normocapnia. Mild hypercapnia comparatively improved cardiac performance and mixed venous oxygen saturation.
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Randomized Controlled Trial
The Effects of Mechanical Versus Bag-Valve Ventilation on Gas Exchange During Cardiopulmonary Resuscitation in Emergency Department Patients: A Randomized Controlled Trial (CPR-VENT).
Effective ventilation is crucial for successful cardiopulmonary resuscitation (CPR). Previous studies indicate that higher arterial oxygen levels (PaO2) during CPR increase the chances of successful resuscitation. However, the advantages of mechanical ventilators over bag-valve ventilation for achieving optimal PaO2 during CPR remain uncertain. ⋯ In ED patients with refractory cardiac arrest, arterial oxygen levels during CPR were comparable between patients ventilated with MV and BV. Mechanical ventilation is at least feasible and safe during CPR in intubated cardiac arrest patients.
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Gastric inflation caused by excessive ventilation is a common complication of cardiopulmonary resuscitation. Gastric inflation may further compromise ventilation via increases in intrathoracic pressure, leading to decreased venous return and cardiac output, which may impair out-of-hospital cardiac arrest (OHCA) outcomes. The purpose of this study was to measure the gastric volume of OHCA patients using computed tomography (CT) scan images and evaluate the effect of gastric inflation on return of spontaneous circulation (ROSC). ⋯ We observed a median gastric volume of 400 ml in patients after OHCA resuscitation. In our setting, gastric distention did not prevent ROSC.
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Advances in vertical take-off and landing (VTOL) technologies may enable drone-like crewed air ambulances to rapidly respond to out-of-hospital cardiac arrest (OHCA) in urban areas. We estimated the impact of incorporating VTOL air ambulances on OHCA response intervals in two large urban centres in France and Canada. ⋯ VTOL air ambulances dedicated to OHCA response may improve EMS response intervals, with substantial improvements in ALS response metrics.