Is enteral feeding tolerated during therapeutic hypothermia?

Objective To determine whether patients undergoing therapeutic hypothermia following cardiac arrest tolerate early enteral nutrition. Methods We undertook a single-centre longitudinal cohort analysis of the tolerance of enteral feeding by 55 patients treated with therapeutic hypothermia following resuscitation from cardiac arrest. The observation period was divided into three phases: (1) 24 h at target temperature (32–34 °C); (2) 24 h rewarming to 36.5 °C; and (3) 24 h maintained at a core temperature below 37.5 °C. Results During period 1, patients tolerated a median of 72% (interquartile range (IQR) 68.7%; range 31.3–100%) of administered feed. During period 2 (rewarming phase), a median of 95% (IQR 66.2%; range 33.77–100%) of administered feed was tolerated. During period 3 (normothermia) a median of 100% (IQR 4.75%; range 95.25–100%) of administered feed was tolerated. The highest incidence of vomiting or regurgitation of feed (19% of patients) occurred between 24 and 48 h of therapy. Conclusions Patients undergoing therapeutic hypothermia following cardiac arrest may be able to tolerate a substantial proportion of their daily nutritional requirements. It is possible that routine use of prokinetic drugs during this period may increase the success of feed delivery enterally and this could usefully be explored

Improving outcome in out-of-hospital cardiac arrest: impact of bystander cardiopulmonary resuscitation and prehospital physician care

Evidence for the impact of prehospital, physician-delivered advanced cardiac life support (ACLS) on survival from out-of-hospital cardiac arrest is conflicting. The prospective observational study by Yasunaga and co-workers demonstrates an improved survival at 1 month associated with prehospital physician-delivered ACLS over emergency life-saving technician-delivered ACLS. These effects are additive to the survival benefit seen with bystander-initiated cardiopulmonary resuscitation (BCPR) compared with no BCPR. The present commentary places these findings in the context of the existing literature and discusses some of the unresolved controversies

Cardiac arrest outcomes in the United Kingdom

This thesis includes six papers that are related to the incidence and outcome from cardiac arrest in the United Kingdom. The Utstein-style template for reporting in-hospital cardiac arrest defines the data elements of the epidemiology and outcome of cardiac arrest that should be collected so that valid comparisons can be made between emergency medical services (EMS) systems, countries, and regions. Much of this reporting template concerns the documentation of data relating to the post-resuscitation care phase of patient management and links well the papers in this thesis that describe the characteristics and outcome of patients admitted to intensive care units (ICUs) after cardiac arrest. The first report from the UK National Cardiac Arrest Audit (NCAA) documented the incidence and outcome from in-hospital cardiac arrest in 144 acute hospitals in 2011–2013. Although the incidence overall was 1.6 cardiac arrests per 1000 hospital admissions, there was considerable seasonal variation. The rate of survival to hospital discharge was 18.4 %. Analysis of the Intensive Care National Audit and Research Centre (ICNARC) case mix programme database (CMPD) provides valuable insights into the increasing numbers of patients admitted to ICUs comatose after resuscitation from cardiac arrest. During the period 1995–2005, mechanically ventilated post-cardiac arrest patients accounted for 5.8% of all ICU admissions; 42.9% survived to leave ICU and 28.6% survived to hospital discharge. A later analysis of the ICNARC CMPD showed that cardiac arrest survivors represented a steadily increasing proportion of mechanically ventilated admissions during 2004 to 2014. Their hospital mortality decreased during the study period. A third analysis of the ICNARC CMPD showed a significant change in temperature management strategy (indicated by a change in the lowest body temperature in the first 24 h of admission) following publication of the Targeted Temperature Management Trial (TTM) trial in December 2013; this change was not associated with a change in the mortality rate. The final paper in this thesis, a secondary analysis of the PARAMEDIC-2 study showed that the treatment effect of adrenaline on return of spontaneous circulation (ROSC) at hospital admission was the same when given by the intravenous (IV) and intraosseous (IO) routes

The impact of COVID-19 on the epidemiology, outcome and management of cardiac arrest

Peer reviewe

In-hospital cardiac arrest : the state of the art

In-hospital cardiac arrest (IHCA) is associated with a high risk of death, but mortality rates are decreasing. The latest epidemiological and outcome data from several cardiac arrest registries are helping to shape our understanding of IHCA. The introduction of rapid response teams has been associated with a downward trend in hospital mortality. Technology and access to defibrillators continues to progress. The optimal method of airway management during IHCA remains uncertain, but there is a trend for decreasing use of tracheal intubation and increased use of supraglottic airway devices. The first randomised clinical trial of airway management during IHCA is ongoing in the UK. Retrospective and observational studies have shown that several pre-arrest factors are strongly associated with outcome after IHCA, but the risk of bias in such studies makes prognostication of individual cases potentially unreliable. Shared decision making and advanced care planning will increase application of appropriate DNACPR decisions and decrease rates of resuscitation attempts following IHCA

The presence of psychological trauma symptoms in resuscitation providers and an exploration of debriefing practices

Introduction Witnessing traumatic experiences can cause post-traumatic stress disorder (PTSD). The true impact on healthcare staff of attending in-hospital cardiac arrests (IHCAs) has not been studied. This cross-sectional study examined cardiac arrest debriefing practices and the burden of attending IHCAs on nursing and medical staff. Methods A 33-item questionnaire-survey was sent to 517 doctors (of all grades), nurses and health-care assistants (HCAs) working in the emergency department, the acute medical unit and the intensive care unit of a district general hospital between April and August 2018. There were three sections: demographics; cardiac arrest and debriefing practices; trauma-screening questionnaire (TSQ). Results The response rate was 414/517 (80.1%); 312/414 (75.4%) were involved with IHCAs. Out of 1463 arrests, 258 (17.6%) were debriefed. Twenty-nine of 302 (9.6%) staff screened positively for PTSD. Healthcare assistants and Foundation Year 1 doctors had higher TSQ scores than nurses or more senior doctors (p = 0.02, p = 0.02, respectively). Debriefing was not associated with PTSD risk (p = 0.98). Only 8/67 (11.9%) of resuscitation leaders had prior debriefing training. Conclusions Nearly 10% of acute care staff screened positively for PTSD as a result of attending an IHCA, with junior staff being most at risk of developing trauma symptoms. Very few debriefs occurred, possibly because of a lack of debrief training amongst cardiac arrest team leaders. More support is required for acute care nursing and medical staff following an IHCA

Cluster randomised comparison of the effectiveness of 100% oxygen versus titrated oxygen in patients with a sustained return of spontaneous circulation following out of hospital cardiac arrest: A feasibility study. PROXY: Post ROSC OXYgenation study

Background: Hyperoxia following out of hospital cardiac arrest (OHCA) is associated with a poor outcome. Animal data suggest the first hour post resuscitation may be the most important. In the UK the first hour usually occurs in the prehospital environment. Methods: A prospective controlled trial, cluster randomised by paramedic, comparing titrated oxygen with 100% oxygen for the first hour after return of spontaneous circulation (ROSC) following OHCA. The trial was done in a single emergency medical services (EMS) system in the United Kingdom (UK) admitting patients to three emergency departments. This was a feasibility trial to determine whether EMS staff (UK paramedics) can be successfully recruited and deliver the intervention. Results: One hundred and fifty seven paramedics were approached and 46 (29%) were consented, randomised and trained. During the study period 624 patients received a resuscitation attempt. A study paramedic was in attendance at 73 (12%) of these active resuscitations. Thirty-five patients were recruited to the trial, 32 (91%) were transported to hospital and 13 (37%) survived to 90days. The intervention was initiated in 27/35 (77%) of enrolled patients. A reliable oxygen saturation trace was obtained in 22/35 (69%) of patients. Data collection was complete in 33/35 (94%) of patients. Conclusions: It may be feasible to complete a randomised trial of titrated versus unrestricted oxygen in the first hour after ROSC following OHCA in the UK. However, the relatively few eligible patients and incomplete initiation of the allocated intervention are challenges to future research. Trial registration: ISRCTN 49548506 retrospectively registered on 24.11.2016

The role of adrenaline in cardiopulmonary resuscitation

Abstract Adrenaline has been used in the treatment of cardiac arrest for many years. It increases the likelihood of return of spontaneous circulation (ROSC), but some studies have shown that it impairs cerebral microcirculatory flow. It is possible that better short-term survival comes at the cost of worse long-term outcomes. This narrative review summarises the rationale for using adrenaline, significant studies to date, and ongoing research

Implementing a standard internal telephone number 2222 for cardiac arrest calls in all hospitals in Europe

Non peer reviewe