2019 American Heart Association Focused Update on Systems of Care: Dispatcher-Assisted Cardiopulmonary Resuscitation and Cardiac Arrest Centers: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Panchal, Ashish R.; Berg, Katherine M.; Cabañas, José G.; Kurz, Michael C.; Link, Mark S.; Rios, Marina Del; Hirsch, Karen G.; Chan, Paul S.; Hazinski, Mary Fran; Morley, Peter; Donnino, Michael W.; Kudenchuk, Peter J.

doi:10.1161/cir.0000000000000733

Cited by 74 publications

(77 citation statements)

References 51 publications

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“…Epinephrine remains a mainstay in the treatment of cardiac arrest, but there continues to be debate on its safety and efficacy [1][2][3][4][5]. In various pediatric and adult studies of cardiac arrest, early epinephrine administration was associated with increased rates of return of spontaneous circulation (ROSC) and improved neurological outcomes when compared with late administration [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Epinephrine’s effects on cerebrovascular and systemic hemodynamics during cardiopulmonary resuscitation

Mavroudis

Morgan

et al. 2020

Crit Care

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Background Despite controversies, epinephrine remains a mainstay of cardiopulmonary resuscitation (CPR). Recent animal studies have suggested that epinephrine may decrease cerebral blood flow (CBF) and cerebral oxygenation, possibly potentiating neurological injury during CPR. We investigated the cerebrovascular effects of intravenous epinephrine in a swine model of pediatric in-hospital cardiac arrest. The primary objectives of this study were to determine if (1) epinephrine doses have a significant acute effect on CBF and cerebral tissue oxygenation during CPR and (2) if the effect of each subsequent dose of epinephrine differs significantly from that of the first. Methods One-month-old piglets (n = 20) underwent asphyxia for 7 min, ventricular fibrillation, and CPR for 10–20 min. Epinephrine (20 mcg/kg) was administered at 2, 6, 10, 14, and 18 min of CPR. Invasive (laser Doppler, brain tissue oxygen tension [PbtO2]) and noninvasive (diffuse correlation spectroscopy and diffuse optical spectroscopy) measurements of CBF and cerebral tissue oxygenation were simultaneously recorded. Effects of subsequent epinephrine doses were compared to the first. Results With the first epinephrine dose during CPR, CBF and cerebral tissue oxygenation increased by > 10%, as measured by each of the invasive and noninvasive measures (p < 0.001). The effects of epinephrine on CBF and cerebral tissue oxygenation decreased with subsequent doses. By the fifth dose of epinephrine, there were no demonstrable increases in CBF of cerebral tissue oxygenation. Invasive and noninvasive CBF measurements were highly correlated during asphyxia (slope effect 1.3, p < 0.001) and CPR (slope effect 0.20, p < 0.001). Conclusions This model suggests that epinephrine increases CBF and cerebral tissue oxygenation, but that effects wane following the third dose. Noninvasive measurements of neurological health parameters hold promise for developing and directing resuscitation strategies.

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Section: Introductionmentioning

confidence: 99%

Epinephrine’s effects on cerebrovascular and systemic hemodynamics during cardiopulmonary resuscitation

Mavroudis

Morgan

et al. 2020

Crit Care

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“…One of the aspects desirably included in the school environment is health education mediated by universities, services and health professionals. Studies ( 8 , 16 - 17 ) highlighted the central role of the professional nurse in educational practices in basic education, be they health promotion or disease prevention. This role is based mainly on sexual education, hygiene, food, immunization and mental health ( 8 , 17 - 18 ) .…”

Section: Discussionmentioning

confidence: 99%

“…This place was reserved with individual seats and tables: each student received a test notebook and pen, without the possibility of discussing the questions, and it was up to him to choose the answer he considered most appropriate. In the second season, a tutor (trained researcher) gave theoretical explanations about the care for an adult victim in a possible cardiac arrest, according to the American Heart Association protocol ( 8 , 15 ) .…”

Section: Methodsmentioning

confidence: 99%

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Teaching Basic Life Support to schoolchildren: quasi-experimental study

Tony

Carbogim

Motta

et al. 2020

Rev. Latino-Am. Enfermagem

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Objective: to evaluate the knowledge of basic education students before and after educational intervention on Basic Life Support in a situation of adult cardiorespiratory arrest. Method: quasi-experimental study conducted with 335 students from three elementary schools. Data was collected using an instrument that captured sociodemographic data and knowledge about Basic Life Support. Subsequently, they were analyzed by descriptive and analytical statistics. Results: students’ knowledge in the post-test (p <0.05) was significantly higher than in the pre-test. The average of the pre-test scores was 4.12 ± 1.7 and, in the post-test it was 6.53 ± 1.9 (p = 0.00). Conclusion: the results demonstrated effectiveness of the intervention with the expansion of knowledge about Basic Life Support in cardiorespiratory arrest. The results reinforce the importance of Nursing in health education actions in elementary schools.

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“…Cardiac arrest was diagnosed based on the updated de nition issued by the American Heart Association and the International Consensus Conference on Cardiopulmonary Resuscitation [16]. The term 'bacteremia' is generally understood to mean the bacterial growth of blood cultures obtained from central or peripheral venipuncture, after the exclusion of contaminant sampling.…”

Section: De Nitionsmentioning

confidence: 99%

Blood Cultures and Broad-Spectrum Antimicrobials are Essential for Patients with Out-of-Hospital Cardiac Arrest

Lee

Chen

Hong

et al. 2020

Preprint

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Background: Etiologies of out-of-hospital cardiac arrest (OHCA) have been majorly focused on cardiac origins. Little is known regarding the role of bloodstream infections (BSIs) in OHCA episodes. Our aim was to disclose clinical features and incidences of BSIs and the survival benefit of prompt administration of appropriate antimicrobial therapy (AAT) in adults with OHCA.Methods: In the 10-year multicenter cohort, clinical information was retrospectively collected and causative microorganisms were prospectively stored for species identification and susceptibilities. The effect of delayed AAT administration on 30-day mortality was examined after adjustment for independent predictors of mortality, recognized by a multivariate regression analysis.Results: Of 1,021,177 emergency department encounters, OHCA visits had a higher BSI incidence than non-OHCA visits (413/3,429, 12.0% vs. 7,429/242,302, 3.1%; P<0.001). Compared with the matched non-OHCA (2,478) patients, OHCA (413) patients experienced more bacteremic episodes due to lower respiratory tract infections, fewer urosepsis events, fewer Escherichia coli bacteremia, and more streptococcal and anaerobes bacteremia. More antimicrobial-resistant organisms, such as methicillin-resistant Staphylococcus aureus and extended-spectrum beta-lactamase-producing Enterobacteriaceae, were evident in OHCA patients. Notably, each hour delay in AAT administration was associated with an average increase of 0.8% in crude 30-day mortality rates (adjusted odds ratio [AOR], 1.008; P = 0.04) in OHCA patients, 7% (AOR, 1.007; P < 0.001) in critically ill patients without OHCA, and 3% (AOR, 1.003; P < 0.001) in less critically ill patients.Conclusions: BSIs should be considered in patients experiencing OHCA; bacteremia sources, causative microorganisms, and antimicrobial susceptibilities differed between the OHCA and non-OHCA patients. The incorporation of blood culture samplings and rapid initiation of broad-spectrum antimicrobial therapy as the first-aids is essential for OHCA patients.

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2019 American Heart Association Focused Update on Systems of Care: Dispatcher-Assisted Cardiopulmonary Resuscitation and Cardiac Arrest Centers: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Cited by 74 publications

References 51 publications

Epinephrine’s effects on cerebrovascular and systemic hemodynamics during cardiopulmonary resuscitation

Epinephrine’s effects on cerebrovascular and systemic hemodynamics during cardiopulmonary resuscitation

Teaching Basic Life Support to schoolchildren: quasi-experimental study

Blood Cultures and Broad-Spectrum Antimicrobials are Essential for Patients with Out-of-Hospital Cardiac Arrest

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