Outcome of early cardiopulmonary resuscitation in out-of-hospital cardiac arrest managed in Universiti Kebangsaan Malaysia Medical Centre

Out-of-hospital cardiac arrest (OHCA) patients require immediate cardiopulmonary resuscitation (CPR). Early initiation of CPR and defibrillation before arrival at Emergency Department (ED) increases the chance of survival from sudden cardiac arrest. The main objective of this study was to identify the factors that influenced the outcome of early cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA) patients managed at the ED of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). The second objective was to determine the incidence of CPR initiated by the public prior to ambulance arrival. The present study was a one-year cross-sectional study. The OHCA patients were identified from the ED resuscitation logbook. Patients’ medical records were used to obtain details of the resuscitation. Factors recorded included: aetiology of arrest, initiation of on-scene CPR, use of automated external defibrillators (AEDs), mode of transportation and the incidence of return of spontaneous circulation (ROSC) in the ED. Categorical data was analysed using chi-square and Fisher exact tests. Nine patients out of 98 had early CPR. Three patients achieved ROSC. Gender was significantly associated with ROSC (p-value=0.015). More patients who received early CPR achieved ROSC compared to those who received late CPR. The provision of early CPR and usage of AEDs by the public is still low. Female gender had a positive influence on ROSC. Efforts are required to increase the awareness and involvement of the public in initiating early CPR prior to the arrival of ambulance service

Диспетчерское сопровождение при угрозе внегоспитальной остановки кровообращения

Rapid recognition of cardiac arrest based on the data reported by a bystander, and delivering telephone cardiopulmonary resuscitation instructions by emergency medical services (EMS) dispatcher promote timely provision of frst aid by people who witness the emergency, and this may signifcantly influence the outcome of out-of-hospital cardiac arrest (OHCA). This review is aimed to analyze the up-to-date scientifc literature on EMS dispatcher recognition of OHCA. In particular, general concept and experience of algorithm-based diagnosis of cardiac arrest, diffculties of telephone OHCA recognition, approaches for dispatcher diagnosis quality evaluation and assurance are discussed herein. Based on the analysis results, recommendations on organizing and improving the effectiveness of EMS dispatcher recognition of cardiac arrest are formulated. The review is designed primarily for EMS and public health specialists.Быстрое выявление остановки сердца на основании сообщаемых очевидцами данных и предоставление инструкций по сердечно-легочной реанимации по телефону диспетчером службы скорой медицинской помощи (СМП) способствует своевременному оказанию первой помощи непосредственными свидетелями происшествия, что может существенно влиять на исход при внегоспитальной остановке кровообращения (ВГОК). Цель данного обзора состоит в анализе современной научной литературы, посвященной вопросам распознавания ВГОК диспетчером СМП. В частности, рассмотрены общие принципы и опыт алгоритмизированной диагностики остановки сердца, трудности распознавания ВГОК по телефону, подходы к оценке и обеспечению качества диспетчерской диагностики. На основании результатов анализа сформулированы рекомендации по организации и повышению эффективности распознавания остановки сердца диспетчером СМП. Обзор ориентирован, прежде всего, на аудиторию специалистов СМП и организаторов здравоохранения

Механизмы возникновения внезапной сердечной смерти

В обзоре рассмотрено понятие внезапной сердечной смерти, представлены основные теории патогенеза и факторы риска. Также проанализированы медикаментозные, интервенционные и хирургические методы первичной и вторичной профилактики. Основными механизмами развития ВСС являются фибрилляция желудочков, желудочковая тахикардия и асистолия. Профилактика ВСС - это, прежде всего, профилактика ИБС и ХСН. В настоящее время эффективным методом предотвращения ВСС и улучшения прогноза пациентов является имплантация ИКД. Однако ИКД на современном этапе часто недоступен в связи с высоким риском, поэтому лекарственная терапия остается главной в лечении этой группы пациентов. Среди всех препаратов БАБ обеспечивают наиболее значимый эффект и имеют наибольшую доказательную базу. Более того, назначение других препаратов в дополнение к БАБ еще больше снижает риск ВСС

Effects of a First Responders Automatic External Defibrillator (AED) program on patient Outcomes in a Rural Emergency Medical Service System

Background For patients in cardiac arrest the most important variable in survival is rapid activation of emergency medical services to provide early defibrillation. Previous studies have indicated that for the greatest chance of survival the patient must be defibrillated within six minutes of collapse. In September of 2002 the Fairmont police department placed AED\u27s in the medical kits of their officers in an effort to improve the chances of survival for the cardiac arrest patients in the city. This study is an attempt to gauge the success of this AED program by Iooking at multiple variables in the care of cardiac arrest patients. Methods A retrospective chart review study was undertaken and data was captured from patient care documents. An equal number of cardiac arrests (18) were taken from before and after the AED program was initiated for a total of 36 patients in the study. Results Statistical significant was found in the time from 911 dispatch to defibrillator placement and analysis,3.4 min in the pre-AED group vs. 5.2 min in the post AED group (P=0.03). No significance was found in patient outcomes in comparison to the pre-AED period Discussion Although there was no change in the patient outcomes after the AED program was initiated, a closer look at the data shows that a decrease in the amount of time it took to get to the patients side was accomplished, given more time and data points, it is possible that an increase in patient survival might be seen. Focus for the next study would be an attempt to decrease the time from collapse to patient defibrillation

Arrhythmia Evaluation in Wearable ECG Devices

This study evaluates four databases from PhysioNet: The American Heart Association database (AHADB), Creighton University Ventricular Tachyarrhythmia database (CUDB), MIT-BIH Arrhythmia database (MITDB), and MIT-BIH Noise Stress Test database (NSTDB). The ANSI/AAMI EC57:2012 is used for the evaluation of the algorithms for the supraventricular ectopic beat (SVEB), ventricular ectopic beat (VEB), atrial fibrillation (AF), and ventricular fibrillation (VF) via the evaluation of the sensitivity, positive predictivity and false positive rate. Sample entropy, fast Fourier transform (FFT), and multilayer perceptron neural network with backpropagation training algorithm are selected for the integrated detection algorithms. For this study, the result for SVEB has some improvements compared to a previous study that also utilized ANSI/AAMI EC57. In further, VEB sensitivity and positive predictivity gross evaluations have greater than 80%, except for the positive predictivity of the NSTDB database. For AF gross evaluation of MITDB database, the results show very good classification, excluding the episode sensitivity. In advanced, for VF gross evaluation, the episode sensitivity and positive predictivity for the AHADB, MITDB, and CUDB, have greater than 80%, except for MITDB episode positive predictivity, which is 75%. The achieved results show that the proposed integrated SVEB, VEB, AF, and VF detection algorithm has an accurate classification according to ANSI/AAMI EC57:2012. In conclusion, the proposed integrated detection algorithm can achieve good accuracy in comparison with other previous studies. Furthermore, more advanced algorithms and hardware devices should be performed in future for arrhythmia detection and evaluation.Cal-Comp Electronics & Communications Co., Ltd.; Kinpo Electronics, Inc. New Taipei City, Taiwan. Innovation Center for Big Data and Digital Convergence; Yuan Ze University, Taiwan

Pediatric cardiopulmonary resuscitation.

Outcomes following pediatric out-of-hospital arrests are much worse than in-hospital arrests. Survival to hospital discharge typically occurs in less than 10 % of these children, and many have severe neurological sequelae. These poor outcomes are in part because of prolonged periods of ‘no flow’ and in part because of specific diseases (e.g., traumatic cardiac arrest and sudden infant death syndrome [SIDS]). The major role of CPR is to supply vital organs and tissues with blood flow, oxygen and nutrients. Coronary perfusion pressure below 15 mmHg during CPR is a poor prognostic factor for a return of spontaneous circulation. The most critical elements are to “push hard” and “push fast”. Because there is no flow without chest compressions, it is important to minimize interruptions in chest compressions. The best ratio depends upon many factors including the compression rate, the tidal volume, the blood flow generated by compressions, and the time that compressions are interrupted to perform ventilations. A chest compression to ventilation ratio of 15:2 delivered the same minute ventilation as CPR with a chest compression to ventilation ratio of 5:1 in a manikin model of pediatric CPR, but the number of chest compressions delivered was 48 % higher with the 15:2 ratio. Intraosseous vascular access has largely replaced the need for endotracheal drug administration. Absorption of drugs into the circulation after endotracheal administration depends on dispersion over the respiratory mucosa, pulmonary blood fl ow, and the matching of the ventilation (drug dispersal) to perfusion. Myocardial dysfunction and vascular instability are common folowing resuscitation from cardiac arrest. Therefore in infants and children with cardiovascular dysfunction after cardiac arrest it is reasonable to administer vasoactive drugs (epinephrine, dopamine, dobutamine and norepinephrine) titrated to improve myocardial function and organ perfusion. VF is an uncommon, but not rare, EKG rhythm during out-of-hospital pediatric cardiac arrests. The incidence of VF varies by setting and age. In special circumstances, such as tricyclic antidepressant overdose, cardiomyopathy, post-cardiac surgery, and prolonged QT syndromes, VF is a more likely rhythm during cardiac arrest. Commotio cordis, or mechanically-initiated VF due to relatively low-energy chest wall impact during a narrow window of repolarization (10-30 msec before the T wave peak in swine models) is reported predominantly in children 4-16 years old. Defibrillation (defined as termination of VF), is necessary for successful resuscitation from VF cardiac arrest. The goal of defibrillation is return of an organized electrical rhythm with pulse. Provision of high quality CPR can improve outcome and save lives. Because pediatric cardiac arrests are commonly due to progressive asphyxia and/or shock, the initial treatment of choice is prompt CPR. The earlier that VF can be diagnosed, the more successfully we can treat it. ECMO is commonly used for circulatory support in pediatric cardiac surgical patients with refractory low cardiac output, persistent hypoxemia, arrhythmias, cardiac arrest, or failure to wean from CPB. CPR guidelines recommend target values for selected CPR parameters related to rate and depth of chest compressions and ventilations, avoidance of CPRfree intervals, and complete release of sternal pressure between compressions. An approach to “Push Hard, Push Fast, Minimize Interruptions, Allow Full Chest Recoil and Don’t Over-ventilate” can markedly improve myocardial, cerebral, and systemic perfusion, and will likely improve outcomes. Outcomes from pediatric cardiac arrest and CPR appear to be improving. The evolution of practice to understand the pathophysiology and timing, intensity, duration, and variability of the hypoxic-ischemic insult leads to goal directed therapy gated to the phase of cardiac arrest encountered