Vasopresin and its analogues in treatment of cardiac arrest

Vasopressin and its analogues in treatment of cardiac arrest Introduction: Recent guidelines for cardiopulmonary resuscitation (CPR) recommend use of drugs as an integral part of treatment. Vasoactive drugs have been used in resuscitation to increase myocardial and cerebral perfusion during chest compressions. Resuscitation research is trying to find alternative vasopressors to adrenaline, for which the long-term survival benefit has not been proven. Successful use of terlipressin in cardiac arrest (CA) was documented in small studies in children and some rare case reports. Terlipressin has never been tested in CA of cardiac aetiology in any clinical or experimental study. Objectives: We aimed to evaluate the role of catecholamines and non-adrenergic vasopressors, vasopressin and terlipressin, during CPR based on review of selected trials. Introduction of a standardized experimental porcine model of ventricular fibrillation (VF) was done for research of therapeutic interventions during CPR. We aimed to evaluate the effects of terlipressin with adrenaline on perfusion of vital organs during prolonged CPR compared to placebo with adrenaline. We tested our hypothesis that terlipressin, if given simultaneously with the first dose of epinephrine during CPR for VF, increases CorPP (coronary perfusion pressure) or..

Cross-sectional investigation of HEMS activities in Europe:a feasibility study

Objectives. To gather information on helicopter emergency medical services (HEMSs) activities across Europe. Methods. Cross-sectional data-collection on daily (15 November 2013) activities of a sample of European HEMSs. A web-based questionnaire with both open and closed questions was used, developed by experts of the European Prehospital Research Alliance (EUPHOREA). Results. We invited 143 bases from 11 countries; 85 (60%) reported base characteristics only and 73 (51%) sample-day data too. The variety of base characteristics was enormous; that is, the target population ranged from 94.000 to 4.500.000. Of 158 requested primary missions, 62 (0.82 per base) resulted in landing. Cardiac aetiology (36%) and trauma (36%) prevailed, mostly of life-threatening severity (43%, 0.64 per mission). Had HEMS been not dispatched, patients would have been attended by another physician in 67% of cases, by paramedics in 24%, and by nurses in 9%. On-board physicians estimated to have caused a major decrease of death risk in 47% of missions, possible decrease in 22%, minor benefit in 17%, no benefit in 11%, and damage in 3%. Earlier treatment and faster transport to hospital were the main reasons for benefit. The most frequent therapeutic procedure was drug administration (78% of missions); endotracheal intubation occurred in 25% of missions and was an option hardly offered by ground crews. Conclusions. The study proved feasible, establishing an embryonic network of European HEMS. The participation rate was low and limits the generalizability of the results. Fortunately, because of its cross-sectional characteristics and the handy availability of the web platform, the study is easily repeatable with an enhanced network

Prediction of pre-hospital blood transfusion in trauma patients based on scoring systems

Abstract Background Pre-hospital blood transfusion (PHBT) is a safe and gradually expanding procedure applied to trauma patients. A proper decision to activate PHBT with the presently limited diagnostic options at the site of an incident poses a challenge for pre-hospital crews. The purpose of this study was to compare the selected scoring systems and to determine whether they can be used as valid tools in identifying patients with PHBT requirements. Methods A retrospective single-center study was conducted between June 2018 and December 2020. Overall, 385 patients (aged [median; IQR]: 44; 24–60; 73% males) were included in this study. The values of five selected scoring systems were calculated in all patients. To determine the accuracy of each score for the prediction of PHBT, the Receiver Operating Characteristic (ROC) analysis was used and to measure the association, the odds ratio with 95% confidence intervals was counted (Fig. 1). Results Regarding the proper indication of PHBT, shock index (SI) and pulse pressure (PP) revealed the highest value of AUC and sensitivity/specificity ratio (SI: AUC 0.88; 95% CI 0.82–0.93; PP: AUC 0.85 with 95% CI 0.79–0.91). Conclusion Shock index and pulse pressure are suitable tools for predicting PHBT in trauma patients

European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances.

These European Resuscitation Council (ERC) Cardiac Arrest in Special Circumstances guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the modifications required to basic and advanced life support for the prevention and treatment of cardiac arrest in special circumstances; specifically special causes (hypoxia, trauma, anaphylaxis, sepsis, hypo/hyperkalaemia and other electrolyte disorders, hypothermia, avalanche, hyperthermia and malignant hyperthermia, pulmonary embolism, coronary thrombosis, cardiac tamponade, tension pneumothorax, toxic agents), special settings (operating room, cardiac surgery, catheter laboratory, dialysis unit, dental clinics, transportation (in-flight, cruise ships), sport, drowning, mass casualty incidents), and special patient groups (asthma and COPD, neurological disease, obesity, pregnancy)

Corrigendum to "European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances" [Resuscitation 161 (2021) 152-219].

Lott C, Truhlar A, Alfonzo A, et al. Corrigendum to "European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances" [Resuscitation 161 (2021) 152-219]. Resuscitation. 2021;167:91-92

[Cardiac arrest under special circumstances].

These guidelines of the European Resuscitation Council (ERC) Cardiac Arrest under Special Circumstances are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the modifications required for basic and advanced life support for the prevention and treatment of cardiac arrest under special circumstances; in particular, specific causes (hypoxia, trauma, anaphylaxis, sepsis, hypo-/hyperkalaemia and other electrolyte disorders, hypothermia, avalanche, hyperthermia and malignant hyperthermia, pulmonary embolism, coronary thrombosis, cardiac tamponade, tension pneumothorax, toxic agents), specific settings (operating room, cardiac surgery, cardiac catheterization laboratory, dialysis unit, dental clinics, transportation [in-flight, cruise ships], sport, drowning, mass casualty incidents), and specific patient groups (asthma and chronic obstructive pulmonary disease, neurological disease, morbid obesity, pregnancy)

European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary

This executive summary provides the essential treatment algorithms for the resuscitation of children and adults and highlights the main guideline changes since 2010. Detailed guidance is provided in each of the ten sections, which are published as individual papers within this issue of Resuscitation. The sections of the ERC Guidelines 2015 are