Resuscitation after global brain ischemia-anoxia

Šafář, Peter; Bleyaert, Achiel L.; Nemoto, Edwin M.; Moossy, John; Snyder, James V.

doi:10.1097/00003246-197807000-00003

Cited by 96 publications

(42 citation statements)

References 44 publications

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“…FDMA databases include the following information recommended at the Utstein International Conference [18,19]: patient backgrounds, arrest witness, aetiology of OHCA (presumed cardiac or non-cardiac), type of BCPR (ventilation-only, compression-only or conventional), origin of BCPR (with or without DA-CPR instruction), initial cardiac rhythm, estimated time of collapse (obtained from the interviews to bystanders), time of bystander and EMT CPR initiation and EMT arrival, 1-month (1-M) survival, bystander group (family members and others) and 1-M cerebral performance category [19,20]. The time points of collapse and BCPR initiation were determined by EMT's interview with the bystander.…”

Section: Methods Of Measurementmentioning

confidence: 99%

Impact of bystander-performed ventilation on functional outcomes after cardiac arrest and factors associated with ventilation-only cardiopulmonary resuscitation: A large observational study

et al. 2015

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Aim: To determine the effectiveness of ventilations in bystander cardiopulmonary resuscitation (BCPR) and to identify the factors associated with ventilation-only BCPR.Methods: From out-of-hospital cardiac arrest (OHCA) data prospectively collected from 2005 to 2011 in Japan, we extracted data for 210,134 bystander-witnessed OHCAs with complete datasets but no prehospital involvement of physician [no BCPR, 115,733;2,093; 61,075; and conventional (compressions + ventilations) BCPR, 31,233] and determined the factors associated with 1-month neurologically favourable survival using simple and multivariable logistic regression analyses. In 91,885 patients with known BCPR durations, we determined the factors associated with ventilation-only BCPR.Results: The rate of survival in the no BCPR, ventilation-only, compression-only and conventional group was 2.8%, 3.9%, 4.5% and 5.0%, respectively. After adjustment for other factors associated with outcomes, the survival rate in the ventilation-only group was higher than that in the no BCPR group (adjusted OR; 95% CI, 1.29; 1.01-1.63), but lower than that in the compression-only (0.76; 0.59-0.96) or conventional groups (0.70; 0.55-0.89). Conventional CPR had the highest OR for survival in almost all OHCA subgroups. The adjusted OR (95% CI) for survival after dividing BCPR into ventilation and compression components were 1.19 (1.11-1.27) and 1.60 (1.51-1.69), respectively. Older guidelines, female sex, younger patient age, bystander-initiated CPR without instruction, early BCPR and short BCPR duration were associated with ventilation-only BCPR.Conclusions: Ventilation is a significant component of BCPR, but alone is less effective than compression in improving neurologically favourable survival after OHCAs.Word count: 247

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Section: Methods Of Measurementmentioning

confidence: 99%

Impact of bystander-performed ventilation on functional outcomes after cardiac arrest and factors associated with ventilation-only cardiopulmonary resuscitation: A large observational study

et al. 2015

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“…l Health-related quality of life (HRQL) at 3 and 12 months [Short Form questionnaire-12 items (SF-12) 43 and EuroQol-5 Dimensions (EQ-5D)]. 44 l Neurologically intact survival to 3 months [survival with a Cerebral Performance Category (CPC) 45 The outcomes defined by the Utstein convention 1 for reporting outcomes from cardiac arrest are reported, as well as long-term follow-up at 12 months. We did not measure the incidence of injuries resulting from CPR, for three reasons: first, they are of little importance unless they result in differences in more substantive outcomes such as survival or duration of hospitalisation; second, they are difficult to measure and classify and may not be detected reliably; and, third, organising injury data collection from a large number of hospitals was felt to add significant organisational complexity to the trial, for little benefit.…”

Section: Selection Of Trial Sitesmentioning

confidence: 99%

Prehospital randomised assessment of a mechanical compression device in out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised trial and economic evaluation

Gates

Lall

Quinn

et al. 2017

Health Technol Assess

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BackgroundMechanical chest compression devices may help to maintain high-quality cardiopulmonary resuscitation (CPR), but little evidence exists for their effectiveness. We evaluated whether or not the introduction of Lund University Cardiopulmonary Assistance System-2 (LUCAS-2; Jolife AB, Lund, Sweden) mechanical CPR into front-line emergency response vehicles would improve survival from out-of-hospital cardiac arrest (OHCA).ObjectiveEvaluation of the LUCAS-2 device as a routine ambulance service treatment for OHCA.DesignPragmatic, cluster randomised trial including adults with non-traumatic OHCA. Ambulance dispatch staff and those collecting the primary outcome were blind to treatment allocation. Blinding of the ambulance staff who delivered the interventions and reported initial response to treatment was not possible. We also conducted a health economic evaluation and a systematic review of all trials of out-of-hospital mechanical chest compression.SettingFour UK ambulance services (West Midlands, North East England, Wales and South Central), comprising 91 urban and semiurban ambulance stations. Clusters were ambulance service vehicles, which were randomly assigned (approximately 1 : 2) to the LUCAS-2 device or manual CPR.ParticipantsPatients were included if they were in cardiac arrest in the out-of-hospital environment. Exclusions were patients with cardiac arrest as a result of trauma, with known or clinically apparent pregnancy, or aged < 18 years.InterventionsPatients received LUCAS-2 mechanical chest compression or manual chest compressions according to the first trial vehicle to arrive on scene.Main outcome measuresSurvival at 30 days following cardiac arrest; survival without significant neurological impairment [Cerebral Performance Category (CPC) score of 1 or 2].ResultsWe enrolled 4471 eligible patients (1652 assigned to the LUCAS-2 device and 2819 assigned to control) between 15 April 2010 and 10 June 2013. A total of 985 (60%) patients in the LUCAS-2 group received mechanical chest compression and 11 (< 1%) patients in the control group received LUCAS-2. In the intention-to-treat analysis, 30-day survival was similar in the LUCAS-2 (104/1652, 6.3%) and manual CPR groups [193/2819, 6.8%; adjusted odds ratio (OR) 0.86, 95% confidence interval (CI) 0.64 to 1.15]. Survival with a CPC score of 1 or 2 may have been worse in the LUCAS-2 group (adjusted OR 0.72, 95% CI 0.52 to 0.99). No serious adverse events were noted. The systematic review found no evidence of a survival advantage if mechanical chest compression was used. The health economic analysis showed that LUCAS-2 was dominated by manual chest compression.LimitationsThere was substantial non-compliance in the LUCAS-2 arm. For 272 out of 1652 patients (16.5%), mechanical chest compression was not used for reasons that would not occur in clinical practice. We addressed this issue by using complier average causal effect analyses. We attempted to measure CPR quality during the resuscitation attempts of trial participants, but were unable to do so.ConclusionsThere was no evidence of improvement in 30-day survival with LUCAS-2 compared with manual compressions. Our systematic review of recent randomised trials did not suggest that survival or survival without significant disability may be improved by the use of mechanical chest compression.Future workThe use of mechanical chest compression for in-hospital cardiac arrest, and in specific circumstances (e.g. transport), has not yet been evaluated.TriaI registrationCurrent Controlled Trials ISRCTN08233942.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 11. See the NIHR Journals Library website for further project information.

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“…Neurologic outcome was coded by the CARES hospital contact with the use of a cerebral-performance category (CPC) scale ranging from 1 to 5, with 1 indicating conscious with normal function or only slight disability, 2 conscious with moderate disability, 3 conscious with severe disability, 4 comatose or in a vegetative state, and 5 brain-dead or dead. [22][23][24] We geocoded the CARES data set on the basis of the address of the cardiac arrest, using the Centrus Desktop geocoder, version 4.0 (Pitney Bowes). We used census tracts as proxies for neighborhoods, because they represent socially and economically homogeneous groups of approximately 4000 to 7000 people.…”

Section: Data Collection and Processingmentioning

confidence: 99%