Mechanical Cardiopulmonary Resuscitation In and On the Way to the Cardiac Catheterization Laboratory

William, Preethi; Rao, Prashant; Kanakadandi, Uday; Asencio, Alejandro; Kern, Karl B.

doi:10.1253/circj.cj-16-0330

Cited by 12 publications

(9 citation statements)

References 42 publications

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“…Many centres report on cardiac arrest during catheterisation procedures [104], but initiating coronary angiography when CPR is already ongoing is less well described [105][106][107].…”

Section: Coronary Angiography In Ohcamentioning

confidence: 99%

Passive leg raising in out-of-hospital cardiac arrest

et al. 2019

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Background: The chances of survival after an out-of-hospital cardiac arrest (OHCA) are one in ten. The majority of survivors have no or relatively mild neurological sequelae. Interventions are time critical and well-timed management is challenging. All aspects of resuscitation in an OHCA are based on knowledge of clinically important actions and their timing in OHCA management. Randomised trials face ethical and legal barriers. The victim is unable to give informed consent and obtaining consent from a legal surrogate delays resuscitation actions. This highlights the need for observational efforts in cardiac arrest research, together with the further exploration of clinically relevant factors and their importance to survival chances in OHCA. Methods: Study I describes the importance of the number of defibrillations in OHCA and their association with survival chances. It is based on data from the Swedish Registry of Cardiopulmonary Resuscitation (SRCR). Study II describes the implementation and feasibility of a direct pathway to immediate coronary angiography after OHCA and its outcome. Patients were screened in the field by ambulance crews and referred to the catheterisation laboratory after consultation with the interventionalist. Study III examines the effect of a basic manoeuvre (passive leg-raising, PLR) in cardiopulmonary resuscitation (CPR) in an observation comparing PLR with standard CPR. Study IV determines the association between ambulance response time and survival after an OHCA, based on data reported to the SRCR. Results: Study I: Between 1990 and 2015, 19,519 patients with a shockable rhythm were reported to the SRCR and included in the study. The chances of survival decreased as the number of defibrillations required increased. Among patients found in a shockable rhythm, 7.5% required more than 10 shocks. Among the witnessed cases, we identified 12 factors associated with survival to 30 days, one of which was the number of shocks that were delivered. Study II: Prehospital screening identified 86 OHCA patients, but only 58% fulfilled the given criteria for pathway activation. Among these, the angiography procedure was started within an hour after collapse in half the cases and the majority had a culprit lesion. Thirty per cent of the patients survived to 30 days and 92% of the survivors presented with a shockable rhythm. All survivors had a good cerebral performance or sufficient function to manage activities of daily life independently. Study III: The PLR manoeuvre was performed in 44% of the n=3,554 OHCA patients included in the study. Survival to 30 days was 7.9% among patients who received PLR and 13.5% among those who did not (OR 0.55; 95% CI 0.44-0.69; p < 0.0001). When matching 1:1 on a propensity score, the difference in 30-day survival between the two groups disappeared (OR 1.07; CI 0.80-1.44; p = 0.65). The matched comparison showed a 30-day survival rate of 8.6% in the PLR group versus 8.2% in the control group. Study IV: Survival chances after a witnessed OHCA decreased as ambulance respo...

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“…Many centres report on cardiac arrest during catheterisation procedures [104], but initiating coronary angiography when CPR is already ongoing is less well described [105][106][107].…”

Section: Coronary Angiography In Ohcamentioning

confidence: 99%

Passive leg raising in out-of-hospital cardiac arrest

et al. 2019

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“…[29, 30] Mechanical CPR devices can be used for maintaining systemic perfusion during percutaneous coronary intervention, pericardiocentesis, or extracorporeal membrane oxygenation in patients with circulatory collapse or cardiac arrest. [31, 32] In this respect, further study of clinical situations where mechanical CPR is effective is needed.…”

Section: Discussionmentioning

confidence: 99%

Comparison of hemodynamic effects and resuscitation outcomes between automatic simultaneous sterno-thoracic cardiopulmonary resuscitation device and LUCAS in a swine model of cardiac arrest

Cha

Kim

et al. 2019

PLoS ONE

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Introduction Mechanical cardiopulmonary resuscitation (CPR) devices are widely used to rescue patients from cardiac arrest. This study aimed to compare hemodynamic effects and resuscitation outcomes between a motor-driven, automatic simultaneous sterno-thoracic cardiopulmonary resuscitation device and the Lund University cardiac arrest system (LUCAS). Material and methods After 2 minutes of electrically induced ventricular fibrillation (VF), Yorkshire pigs (weight 35–60 kg) received CPR with an automatic simultaneous sterno-thoracic CPR device (X-CPR group, n = 13) or the Lund University cardiac arrest system (LUCAS group, n = 12). Basic life support for 6 minutes and advanced cardiovascular life support for 12 minutes, including defibrillation and epinephrine administration, were provided. Hemodynamic parameters and resuscitation outcomes, including return of spontaneous circulation (ROSC), 24-hour survival, and cerebral performance category (CPC) at 24 hours, were evaluated. Results Hemodynamic parameters, including aortic pressures, coronary perfusion pressure, carotid blood flow, and end-tidal carbon dioxide pressure were not significantly different between the two groups. Resuscitation outcomes were also not significantly different between the groups (X-CPR vs. LUCAS; rate of ROSC: 31% vs 25%, p = 1.000; 24-hour survival rate: 31% vs 17%, p = 0.645; neurological outcome with CPC ≤2: 31% vs 17%, p = 0.645). Also no significant difference in incidence complications associated with resuscitation was found between the groups. Conclusions CPR with a motor-driven X-CPR and CPR with the LUCAS produced similar hemodynamic effects and resuscitation outcomes in a swine model of cardiac arrest.

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“…1 genannten Kriterien zur Prognoseeinschätzung in einer solchen Situation anzuwenden. Es ist auch zu berücksichtigen, dass sowohl während eines Krankentransports als auch im Katheterlabor die Effektivität einer kardiopulmonalen Reanimation mit manuellen Thoraxkompressionen herabgesetzt sein kann, sodass möglicherweise kein ausreichender Minimalkreislauf erzeugt wird [10]. Abhilfe können hier theoretisch mechanische Thoraxkompressionssysteme (z.…”

Section: Invasive Diagnostik Unter Laufender Reanimation?unclassified

“…B. Lucas ® , Autopulse ® ) bieten. In größeren Studien ließ sich insgesamt jedoch kein Vorteil einer mechanischen Thoraxkompression bei OHCA nachweisen [10]. Allerdings haben einzelne Fallserien gezeigt, dass bei einem im Katheterlabor aufgetretenen Herzstillstand eine mechanische Thoraxkompression mit sehr guten Erfolgsraten eingesetzt werden kann [11], sodass die aktuellen AHA-Reanimationsleitlinien unter solchen Bedingungen durchaus eine eingeschränkte Bedeutung im Sinne einer Klasse-IIb-Empfehlung sehen [12].…”

Section: Invasive Diagnostik Unter Laufender Reanimation?unclassified

“…Ein ganz aktueller Ansatz ist die frühzeitige Implantation eines Herzunterstützungssystems bei therapierefraktärem Herz-Kreislauf-Stillstand ("Hyperinvasive Approach"). Erste kleinere, nicht randomisierte Fallserien hierzu sind schon veröffentlicht, die Überlebensraten von 31-45 % gezeigt haben [10,13,14]. Bei einem solchen aufwendigen Behandlungsansatz ist es jedoch von besonderer Bedeutung, dass Kriterien zur Patientenselektion und der Effekt auf die Prognose möglichst in großen randomisierten Studien überprüft werden, bevor ein breiter Einsatz in der Routine erfolgt [7].…”

Section: Invasive Diagnostik Unter Laufender Reanimation?unclassified

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Invasive Koronardiagnostik im Rahmen einer Postreanimationsbehandlung nach außerklinischem Herzstillstand

2017

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Zusammenfassung Ein akutes Koronarsyndrom ist die h?ufigste Ursache f?r einen au?erklinischen Herzstillstand. In den letzten Jahren sind einige Empfehlungen und Leitlinien zum Einsatz einer invasiven kardiologischen Diagnostik und einer perkutanen Koronarintervention unter diesen Bedingungen ver?ffentlicht worden. Danach ist es Konsens, dass Patienten, bei denen im Rahmen einer strukturierten Initialdiagnostik und Risikostratifikation ein akutes Koronarsyndrom als gesicherte oder wahrscheinliche Ursache f?r den Herzstillstand angenommen wird, prognostisch von einer perkutanen Koronarintervention profitieren k?nnen. Die initiale Evaluation und interdisziplin?re Festlegung der Behandlungsstrategie muss jedoch die Abkl?rung nicht kardialer Ursachen ebenso wie Kriterien f?r eine sehr ung?nstige Prognose beinhalten.

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Mechanical Cardiopulmonary Resuscitation In and On the Way to the Cardiac Catheterization Laboratory

Cited by 12 publications

References 42 publications

Passive leg raising in out-of-hospital cardiac arrest

Passive leg raising in out-of-hospital cardiac arrest

Comparison of hemodynamic effects and resuscitation outcomes between automatic simultaneous sterno-thoracic cardiopulmonary resuscitation device and LUCAS in a swine model of cardiac arrest

Invasive Koronardiagnostik im Rahmen einer Postreanimationsbehandlung nach außerklinischem Herzstillstand

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