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This article explores the use of transesophageal echocardiography (TEE) during advanced cardiac life support (ACLS) to enhance the effectiveness of cardiopulmonary resuscitation (CPR). TEE allows for continuous monitoring and improved imaging during CPR, potentially optimizing chest compression quality. However, there is limited evidence on the impact of TEE on patient outcomes. A recent study suggests that avoiding aortic valve compression during CPR may improve the likelihood of achieving and sustaining return of spontaneous circulation (ROSC). Further research is needed to determine long-term outcomes and potential biases in evaluating TEE findings. The article proposes that incorporating TEE as a surrogate for chest compression performance could be beneficial, but more rigorous studies are necessary to demonstrate its effectiveness in improving survival and neurological outcomes. The text also briefly touches on the management of aneurysmal subarachnoid hemorrhage, highlighting the variability in thresholds and triggers for fluid loading and blood transfusions. [Extracted from the article]

This article explores the ethical considerations surrounding the use of CPR for organ preservation after brain death. It identifies two main barriers to accepting CPR for this purpose: misunderstanding of organ donation authorization and moral concerns. The author argues that requiring explicit consent for CPR during donor management in the ICU can address these barriers and help maintain public trust. The article emphasizes the importance of transparency and understanding in organ donation processes, and suggests that obtaining consent can address moral concerns, respect cultural and religious needs, and prevent misunderstandings and feelings of distrust. [Extracted from the article]

BACKGROUND: Bystander cardiopulmonary resuscitation (CPR) is associated with higher survival for out-of-hospital cardiac arrest, but whether its association with survival differs by patients' sex and race and ethnicity is less clear. METHODS: Within a large US registry, we identified 623 342 nontraumatic out-of-hospital cardiac arrests during 2013 to 2022 for this observational cohort study. Using hierarchical logistic regression, we examined whether there was a differential association between bystander CPR and survival outcomes by patients' sex and race and ethnicity, overall and by neighborhood strata. RESULTS: Mean age was 62.1±17.1 years, and 35.9% were women. Nearly half of patients (49.8%) were non-Hispanic White; 20.6% were non-Hispanic Black; 7.3% were Hispanic; 2.9% were Asian; and 0.4% were Native American. Overall, 58 098 (9.3%) survived to hospital discharge. Although bystander CPR was associated with higher survival in each race and ethnicity group, the association of bystander CPR compared with patients without bystander CPR in each racial and ethnic group was highest in individuals who were White (adjusted odds ratio [OR], 1.33 [95% CI, 1.30--1.37]) and Native American (adjusted OR, 1.40 [95% CI, 1.02--1.90]) and lowest in individuals who were Black (adjusted OR, 1.09 [95% CI, 1.04--1.14]; Pinteraction<0.001). The adjusted OR for bystander CPR compared with those without bystander CPR for Hispanic patients was 1.29 (95% CI, 1.20--1.139), for Asian patients, it was 1.27 (95% CI, 1.12--1.42), and for those of unknown race, it was 1.31 (95% CI, 1.25--1.36). Similarly, bystander CPR was associated with higher survival in both sexes, but its association with survival was higher in men (adjusted OR, 1.35 [95% CI, 1.31--1.38]) than women (adjusted OR, 1.15 [95% CI, 1.12--1.19]; Pinteraction<0.001). The weaker association of bystander CPR in Black individuals and women was consistent across neighborhood race and ethnicity and income strata. Similar results were observed for the outcome of survival without severe neurological deficits. CONCLUSIONS: Although bystander CPR was associated with higher survival in all patients, its association with survival was weakest for Black individuals and women with out-of-hospital cardiac arrest. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Serial evaluations of lactate concentration may be more useful in predicting outcomes in patients with out-of-hospital cardiac arrest (OHCA) than a single measurement. This study aimed to evaluate the impact of lactate clearance (LC) on clinical and neurologic outcomes in patients with OHCA who underwent extracorporeal cardiopulmonary resuscitation (ECPR). DESIGN: Retrospective multicenter observational study. SETTING: Patients with OHCA receiving ECPR at 36 hospitals in Japan between January 1, 2013, and December 31, 2018. PATIENTS: This study evaluated 1227 patients, with lactateinitial assessed upon emergency department admission and lactatesecond measured subsequently. To adjust for the disparity in the time between lactate measurements, the modified 6-hour LC was defined as follows: ([lactateinitial--lactatesecond]/lactateinitial) x 100 x (6/the duration between the initial and second measurements [hr]). The patients were divided into four groups according to the modified 6-hour LC with an equivalent number of patients among LC quartiles: Q1 (LC < 18.8), Q2 (18.8 < LC < 59.9), Q3 (60.0 < LC < 101.2), and Q4 (101.2 < LC). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The 30-day survival rates increased as the 6-hour LC increased (Q1, 21.2%; Q2, 36.8%; Q3, 41.4%; Q4, 53.6%; p for trend < 0.001). In the multivariate analysis, the modified 6-hour LC was significantly associated with a 30-day survival rate (adjusted odds ratio [AOR], 1.003; 95% CI, 1.001-1.005; p < 0.001) and favorable neurologic outcome (AOR, 1.002; 95% CI, 1.000-1.004; p = 0.027). CONCLUSIONS: In patients with OHCA who underwent ECPR, an increase in the modified 6-hour LC was associated with favorable clinical and neurologic outcome. Thus, LC can be a criterion to assess whether ECPR should be continued. [ABSTRACT FROM AUTHOR]

This article explores the importance of optimizing brain tissue oxygenation after traumatic brain injury (TBI) to prevent further damage and improve outcomes. It discusses the impact of variables such as blood pressure, oxygen levels, and metabolic demands on cerebral blood flow and tissue oxygenation. The article emphasizes the role of cerebral autoregulation in maintaining blood flow and suggests that monitoring brain tissue oxygenation could be beneficial in TBI management. However, the widespread adoption of this approach by trauma centers is limited. A study by Kunapaisal et al. examines the relationship between blood pressure augmentation, cerebral autoregulation, and brain tissue oxygenation in severe TBI patients. The study identifies individual differences in blood flow response and variability in brain tissue oxygenation after blood pressure augmentation. It suggests that traditional clinical factors may not be as effective in predicting cerebral hypoxia compared to multimodal monitoring techniques. The study raises questions about identifying the patient population that would benefit from autoregulation measurement and the need for further research in this area. The authors of the text discuss the timing and potential benefits of mean arterial pressure (MAP) augmentation in TBI patients. They acknowledge the challenges of comparing results over a large time range due to the evolving nature of brain injury. The authors also highlight missing critical values in the data analysis and express concerns about confounding factors. They propose that incorporating multimodal neuromonitoring and direct measurements can improve blood flow and patient outcomes. The authors caution against indiscriminate MAP augmentation and stress [Extracted from the article]

OBJECTIVES: Signs of life (SOLs) during cardiac arrest (gasping, pupillary light reaction, or any form of body movement) are suggested to be associated with favorable neurologic outcomes in out-of-hospital cardiac arrest (OHCA). While data has demonstrated that extracorporeal cardiopulmonary resuscitation (ECPR) can improve outcomes in cases of refractory cardiac arrest, it is expected that other contributing factors lead to positive outcomes. This study aimed to investigate whether SOL on arrival is associated with neurologic outcomes in patients with OHCA who have undergone ECPR. DESIGN: Retrospective multicenter registry study. SETTING: Thirty-six facilities participating in the Study of Advanced life support for Ventricular fibrillation with Extracorporeal circulation in Japan II (SAVE-J II). PATIENTS: Consecutive patients older than 18 years old who were admitted to the Emergency Department with OHCA between January 1, 2013, and December 31, 2018, and received ECPR. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients were classified into two groups according to the presence or absence of SOL on arrival. The primary outcome was a favorable neurologic outcome (Cerebral Performance Category 1 or 2) at discharge. Of the 2157 patients registered in the SAVE-J II database, 1395 met the inclusion criteria, and 250 (17.9%) had SOL upon arrival. Patients with SOL had more favorable neurologic outcomes than those without SOL (38.0% vs. 8.1%; p < 0.001). Multivariate analysis showed that SOL on arrival was independently associated with favorable neurologic outcomes (odds ratio, 5.65 [95% CI, 3.97-8.03]; p < 0.001). CONCLUSIONS: SOL on arrival was associated with favorable neurologic outcomes in patients with OHCA undergoing ECPR. In patients considered for ECPR, the presence of SOL on arrival can assist the decision to perform ECPR. [ABSTRACT FROM AUTHOR]

Every 10 years, the American Heart Association (AHA) Emergency Cardiovascular Care Committee establishes goals to improve survival from cardiac arrest. These goals align with broader AHA Impact Goals and support the AHA's advocacy efforts and strategic investments in research, education, clinical care, and quality improvement programs. This scientific statement focuses on 2030 AHA emergency cardiovascular care priorities, with a specific focus on bystander cardiopulmonary resuscitation, early defibrillation, and neurologically intact survival. This scientific statement also includes aspirational goals, such as establishing cardiac arrest as a reportable disease and mandating reporting of standardized outcomes from different sources; advancing recognition of and knowledge about cardiac arrest; improving dispatch system response, availability, and access to resuscitation training in multiple settings and at multiple time points; improving availability, access, and affordability of defibrillators; providing a focus on early defibrillation, in-hospital programs, and establishing champions for debriefing and review of cardiac arrest events; and expanding measures to track outcomes beyond survival. The ability to track and report data from these broader aspirational targets will potentially require expansion of existing data sets, development of new data sets, and enhanced integration of technology to collect process and outcome data, as well as partnerships of the AHA with national, state, and local organizations. The COVID-19 (coronavirus disease 2019) pandemic, disparities in COVID-19 outcomes for historically excluded racial and ethnic groups, and the longstanding disparities in cardiac arrest treatment and outcomes for Black and Hispanic or Latino populations also contributed to an explicit focus and target on equity for the AHA Emergency Cardiovascular Care 2030 Impact Goals. [ABSTRACT FROM AUTHOR]

Out-of-hospital cardiac arrest is a leading cause of death, accounting for ≈50% of all cardiovascular deaths. The prognosis of such individuals is poor, with <10% surviving to hospital discharge. Survival with a favorable neurologic outcome is highest among individuals who present with a witnessed shockable rhythm, received bystander cardiopulmonary resuscitation, achieve return of spontaneous circulation within 15 minutes of arrest, and have evidence of ST-segment elevation on initial ECG after return of spontaneous circulation. The cardiac catheterization laboratory plays an important role in the coordinated Chain of Survival for patients with out-of-hospital cardiac arrest. The catheterization laboratory can be used to provide diagnostic, therapeutic, and resuscitative support after sudden cardiac arrest from many different cardiac causes, but it has a unique importance in the treatment of cardiac arrest resulting from underlying coronary artery disease. Over the past few years, numerous trials have clarified the role of the cardiac catheterization laboratory in the management of resuscitated patients or those with ongoing cardiac arrest. This scientific statement provides an update on the contemporary approach to managing resuscitated patients or those with ongoing cardiac arrest. [ABSTRACT FROM AUTHOR]

Background: Basic life support education for schoolchildren has become a key initiative to increase bystander cardiopulmonary resuscitation rates. Our objective was to review the existing literature on teaching schoolchildren basic life support to identify the best practices to provide basic life support training in schoolchildren. Methods: After topics and subgroups were defined, a comprehensive literature search was conducted. Systematic reviews and controlled and uncontrolled prospective and retrospective studies containing data on students <20 years of age were included. Results: Schoolchildren are highly motivated to learn basic life support. The CHECK-CALL-COMPRESS algorithm is recommended for all schoolchildren. Regular training in basic life support regardless of age consolidates long-term skills. Young children from 4 years of age are able to assess the first links in the chain of survival. By 10 to 12 years of age, effective chest compression depths and ventilation volumes can be achieved on training manikins. A combination of theoretical and practical training is recommended. Schoolteachers serve as effective basic life support instructors. Schoolchildren also serve as multipliers by passing on basic life support skills to others. The use of age-appropriate social media tools for teaching is a promising approach for schoolchildren of all ages. Conclusions: Schoolchildren basic life support training has the potential to educate whole generations to respond to cardiac arrest and to increase survival after out-of-hospital cardiac arrest. Comprehensive legislation, curricula, and scientific assessment are crucial to further develop the education of schoolchildren in basic life support. [ABSTRACT FROM AUTHOR]

School nurses from the Klein Independent School District in Harris County, Texas, have educated students, some as young as kindergarteners, on cardiopulmonary resuscitation (CPR) and how to recognize and use automatic external defibrillators and provide basic first aid. Through a collaboration with community partners and CPR-certified high school students, these school nurses are empowering the next generation with lifesaving skills. How school nurses from one Texas school district taught students cardiopulmonary resuscitation and how to recognize and use automatic external defibrillators and provide basic first aid. [ABSTRACT FROM AUTHOR]

Cardiopulmonary resuscitation, diastolic pressure, outcomes, pediatrics Keywords: cardiopulmonary resuscitation; diastolic pressure; outcomes; pediatrics EN cardiopulmonary resuscitation diastolic pressure outcomes pediatrics 151 153 3 12/19/22 20230101 NES 230101 In this issue of I Critical Care Medicine i , in a study authored by Berg et al ([1]), the investigators tried to answer an important question for clinicians delivering cardiopulmonary resuscitation (CPR) in children: is attaining a diastolic arterial pressure during CPR helpful?. [Extracted from the article]

Background: Studies examining gender-based differences in outcomes of patients experiencing out-of-hospital cardiac arrest have demonstrated that, despite a higher likelihood of return of spontaneous circulation, women do not have higher survival.Methods: Patients successfully resuscitated from out-of-hospital cardiac arrest enrolled in the CCC trial (Trial of Continuous or Interrupted Chest Compressions during CPR) were included. Hierarchical multivariable logistic regression models were constructed to evaluate the association between gender and survival after adjustment for age, gender, cardiac arrest rhythm, witnessed status, bystander cardiopulmonary resuscitation, episode location, epinephrine dose, emergency medical services response time, and duration of resuscitation. Do not resuscitate (DNR) and withdrawal of life-sustaining therapy (WLST) order status were used to assess whether differences in postresuscitation outcomes were modified by baseline prognosis. The analysis was replicated among ALPS trial (Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest) participants.Results: Among 4875 successfully resuscitated patients, 1825 (37.4%) were women and 3050 (62.6%) were men. Women were older (67.5 versus 65.3 years), received less bystander cardiopulmonary resuscitation (49.1% versus 54.9%), and had a lower proportion of cardiac arrests that were witnessed (55.1% versus 64.5%) or had shockable rhythm (24.3% versus 44.6%, P<0.001 for all). A significantly higher proportion of women received DNR orders (35.7% versus 32.1%, P=0.009) and had WLST (32.8% versus 29.8%, P=0.03). Discharge survival was significantly lower in women (22.5% versus 36.3%, P<0.001; adjusted odds ratio, 0.78 [95% CI, 0.66-0.93]; P=0.005). The association between gender and survival to discharge was modified by DNR and WLST order status such that women had significantly reduced survival to discharge among patients who were not designated DNR (31.3% versus 49.9%, P=0.005; adjusted odds ratio, 0.74 [95% CI, 0.60-0.91]) or did not have WLST (32.3% versus 50.7%, P=0.002; adjusted odds ratio, 0.73 [95% CI, 0.60-0.89]). In contrast, no gender difference in survival was noted among patients receiving a DNR order (6.7% versus 7.4%, P=0.90) or had WLST (2.8% versus 2.4%, P=0.93). Consistent patterns of association between gender and postresuscitation outcomes were observed in the secondary cohort.Conclusions: Among patients resuscitated after experiencing out-of-hospital cardiac arrest, discharge survival was significantly lower in women than in men, especially among patients considered to have a favorable prognosis. [ABSTRACT FROM AUTHOR]

Randomized Trials - Brain, Kidney, and Heart 18631 Finerenone and Cardiovascular Outcomes in Patients With Chronic Kidney Disease and Type 2 Dia... Gerasimos Filippatos SP 1 sp , Stefan D Anker SP 2 sp , Rajiv Agarwal SP 3 sp , Bertram Pitt SP 4 sp , Peter Rossing SP 5 sp , Luis M Ruilope SP 6 sp , Peter Kolkhof SP 7 sp , Patrick Schloemer SP 8 sp , Ingo Tornus SP 9 sp , Amer Joseph SP 9 sp , George L Bakris SP 10 sp ; SP 1 sp Sch of Medicine, Dept of Cardiology, Attikon Univ Hosp, National and Kapodistrian Univ of Athens, Athens, Greece, SP 2 sp Dept of Cardiology (CVK), and Berlin Institute of Health Cntr for Regenerative Therapies, German Cntr for Cardiovascular Rsch Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany, SP 3 sp Richard L. Roudebush VA Med Cntr, Indiana Univ, Indianapolis, IN, SP 4 sp Dept of Medicine, Univ of Michigan Sch of Medicine, Ann Arbor, MI, SP 5 sp Dept of Clinical Medicine, Steno Diabetes Cntr Copenhagen & Univ of Copenhagen, Copenhagen, Denmark, SP 6 sp Cardiorenal Translational Laboratory and Hypertension Unit, CIBER-CV & Faculty of Sport Sciences, Institute of Rsch imas12, Hosp 12 de Octubre & European Univ of Madrid, Madrid, Spain, SP 7 sp Rsch and Development, Preclinical Rsch Cardiovascular, Bayer AG, Berlin, Germany, SP 8 sp Rsch and Development, Statistics and Data Insights, Bayer AG, Berlin, Germany, SP 9 sp Cardiology and Nephrology Clinical Development, Bayer AG, Berlin, Germany, SP 10 sp Dept of Medicine, Univ of Chicago Medicine, Chicago, IL B Introduction: b Patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) face substantial cardiovascular (CV) morbidity and mortality. B Methods: b We randomly assigned asymptomatic patients with severe MS (defined as mitral valve area between 1.0 and 1.5 cm SP 2 sp ) to early PMC (84 patients) or to conventional treatment (83 patients). [Extracted from the article]

Objectives: Extracorporeal cardiopulmonary resuscitation has shown survival benefit in select patients with refractory cardiac arrest but there is insufficient data on the frequency of different types of brain injury. We aimed to systematically review the prevalence, predictors of and survival from neurologic complications in patients who have undergone extracorporeal cardiopulmonary resuscitation.Data Sources: MEDLINE (PubMed) and six other databases (EMBASE, Cochrane Library, CINAHL Plus, Web of Science, and Scopus) from inception to August 2019.Study Selection: Randomized controlled trials and observational studies in patients greater than 18 years old.Data Extraction: Two independent reviewers extracted the data. Study quality was assessed by the Cochrane Risk of Bias tool for randomized controlled trials, the Newcastle-Ottawa Scale for cohort and case-control studies, and the Murad tool for case series. Random-effects meta-analyses were used to pool data.Data Synthesis: The 78 studies included in our analysis encompassed 50,049 patients, of which 6,261 (12.5%) received extracorporeal cardiopulmonary resuscitation. Among extracorporeal cardiopulmonary resuscitation patients, the median age was 56 years (interquartile range, 52-59 yr), 3,933 were male (63%), 3,019 had out-of-hospital cardiac arrest (48%), and 2,289 had initial shockable heart rhythm (37%). The most common etiology of cardiac arrest was acute coronary syndrome (n = 1,657, 50% of reported). The median extracorporeal cardiopulmonary resuscitation duration was 3.2 days (interquartile range, 2.1-4.9 d). Overall, 27% (95% CI, 0.17-0.39%) had at least one neurologic complication, 23% (95% CI, 0.14-0.32%) hypoxic-ischemic brain injury, 6% (95% CI, 0.02-0.11%) ischemic stroke, 6% (95% CI, 0.01-0.16%) seizures, and 4% (95% CI, 0.01-0.1%) intracerebral hemorrhage. Seventeen percent (95% CI, 0.12-0.23%) developed brain death. The overall survival rate after extracorporeal cardiopulmonary resuscitation was 29% (95% CI, 0.26-0.33%) and good neurologic outcome was achieved in 24% (95% CI, 0.21-0.28%).Conclusions: One in four patients developed acute brain injury after extracorporeal cardiopulmonary resuscitation and the most common type was hypoxic-ischemic brain injury. One in four extracorporeal cardiopulmonary resuscitation patients achieved good neurologic outcome. Further research on assessing predictors of extracorporeal cardiopulmonary resuscitation-associated brain injury is necessary. [ABSTRACT FROM AUTHOR]

Keywords: cardiopulmonary resuscitation EN cardiopulmonary resuscitation e933 e943 11 06/25/20 20200623 NES 200623 Existing American Heart Association cardiopulmonary resuscitation (CPR) guidelines do not address the challenges of providing resuscitation in the setting of the coronavirus disease 2019 (COVID-19) global pandemic, wherein rescuers must continuously balance the immediate needs of the patients with their own safety. Healthcare systems and EMS agencies should institute policies to guide frontline providers in determining the appropriateness of starting and terminating CPR for patients with COVID-19, taking into account patient risk factors to estimate the likelihood of survival. Summary of adjustments to cardiopulmonary resuscitation (CPR) algorithms in patients with suspected or confirmed coronavirus disease 2019 (COVID-19). If unable to safely transition the patient to a supine position, place the defibrillator pads in the anterior-posterior position and provide CPR with the patient remaining prone with hands in the standard position over the T7/10 vertebral bodies.[18] Postarrest Patients Consult local infection control practices concerning transport after resuscitation. [Extracted from the article]

This 2019 focused update to the American Heart Association pediatric basic life support guidelines follows the 2019 systematic review of the effects of dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) on survival of infants and children with out-of-hospital cardiac arrest. This systematic review and the primary studies identified were analyzed by the Pediatric Task Force of the International Liaison Committee on Resuscitation. It aligns with the International Liaison Committee on Resuscitation's continuous evidence review process, with updates published when the International Liaison Committee on Resuscitation completes a literature review based on new published evidence. This update summarizes the available pediatric evidence supporting DA-CPR and provides treatment recommendations for DA-CPR for pediatric out-of-hospital cardiac arrest. Four new pediatric studies were reviewed. A systematic review of this data identified the association of a significant improvement in the rates of bystander CPR and in survival 1 month after cardiac arrest with DA-CPR. The writing group recommends that emergency medical dispatch centers offer DA-CPR for presumed pediatric cardiac arrest, especially when no bystander CPR is in progress. No recommendation could be made for or against DA-CPR instructions when bystander CPR is already in progress. [ABSTRACT FROM AUTHOR]

Survival after out-of-hospital cardiac arrest requires an integrated system of care (chain of survival) between the community elements responding to an event and the healthcare professionals who continue to care for and transport the patient for appropriate interventions. As a result of the dynamic nature of the prehospital setting, coordination and communication can be challenging, and identification of methods to optimize care is essential. This 2019 focused update to the American Heart Association systems of care guidelines summarizes the most recent published evidence for and recommendations on the use of dispatcher-assisted cardiopulmonary resuscitation and cardiac arrest centers. This article includes the revised recommendations that emergency dispatch centers should offer and instruct bystanders in cardiopulmonary resuscitation during out-of-hospital cardiac arrest and that a regionalized approach to post–cardiac arrest care may be reasonable when comprehensive postarrest care is not available at local facilities. [ABSTRACT FROM AUTHOR]

The article offers news briefs related to nursing industry in the U.S. Topics include people and advocacy organizations sent a letter to Facebook chief executive officer Mark Zuckerberg demanding that Facebook and its subsidiary, Instagram, cease accepting advertisements with false or misleading warnings about Truvada; and . Home deaths have surpassed hospital deaths in the U.S. for the first time since the early 20th century, as reported in the New England Journal of Medicine.

Objectives: To perform an updated systematic review and meta-analysis of clinical trials evaluating epinephrine for adult out-of-hospital cardiac arrest resuscitation.Data Sources: The search included MEDLINE, EMBASE, and Ovid Evidence-Based Medicine, clinical trial registries, and bibliographies.Study Selection: Randomized and quasi-randomized controlled trials that compared the current standard dose of epinephrine to placebo, high or low dose epinephrine, any other vasopressor alone or in combination were screened by three independent reviewers.Data Extraction: Randomized and quasi-randomized controlled trials that compared the current standard dose of epinephrine to placebo, high or low dose epinephrine, any other vasopressor alone or in combination were screened by three independent reviewers.Data Synthesis: A total of 17 trials (21,510 patients) were included; seven were judged to be at high risk of bias. Compared to placebo, pooled results from two trials showed that standard dose of epinephrine increased return of spontaneous circulation (risk ratio, 3.09; 95% CI, 2.82-3.89), survival to hospital admission (risk ratio, 2.50; 95% CI, 1.68-3.72), and survival to discharge (risk ratio, 1.44; 95% CI, 1.11-1.86). The largest placebo-controlled trial showed that standard dose of epinephrine also improved survival at 30 days and 3 months but not neurologic outcomes, standard dose of epinephrine decreased return of spontaneous circulation (risk ratio, 0.87; 95% CI, 0.77-0.98) and survival to admission (risk ratio, 0.88; 95% CI, 0.78-0.99) when compared with high dose epinephrine. There were no differences in outcomes between standard dose of epinephrine and vasopressin alone or in combination with epinephrine.Conclusions: Largely based on one randomized controlled trial, standard dose of epinephrine improved overall survival but not neurologic outcomes in out-of-hospital cardiac arrest patients compared with placebo. There is a paucity of trials with meaningful patient outcomes; future epinephrine trials should evaluate dose and method of delivery on long-term survival, neurologic function, and quality of life after cardiac arrest. [ABSTRACT FROM AUTHOR]

Background: Bystander cardiopulmonary resuscitation (B-CPR) delivery and survival after out-of-hospital cardiac arrest vary at the neighborhood level, with lower survival seen in predominantly black neighborhoods. Although the Hispanic population is the fastest-growing minority population in the United States, few studies have assessed whether the proportion of Hispanic residents in a neighborhood is associated with B-CPR delivery and survival from out-of-hospital cardiac arrest. We assessed whether B-CPR rates and survival vary by neighborhood-level ethnicity. We hypothesized that neighborhoods with a higher proportion of Hispanic residents have lower B-CPR rates and lower survival.Methods: We conducted a retrospective cohort study using data from the Resuscitation Outcomes Consortium Epistry at US sites. Neighborhoods were classified by census tract based on percentage of Hispanic residents: <25%, 25% to 50%, 51% to 75%, or >75%. We independently modeled the likelihood of receipt of B-CPR and survival by neighborhood-level ethnicity controlling for site and patient-level confounding characteristics.Results: From 2011 to 2015, the Resuscitation Outcomes Consortium collected 27 481 US arrest events; after excluding pediatric arrests, emergency medical services-witnessed arrests, or arrests occurring in a healthcare or institutional facility, 18 927 were included. B-CPR was administered in 37% of events. In neighborhoods with <25% Hispanic residents, B-CPR was administered in 39% of events, whereas it was administered in 27% of events in neighborhoods with >75% Hispanic residents. Compared with <25% Hispanic neighborhoods in a multivariable analysis, out-of-hospital cardiac arrest in predominantly Hispanic neighborhoods had lower B-CPR rates (51% to 75% Hispanic: odds ratio, 0.79 [CI, 0.65-0.95], P=0.014; >75% Hispanic: odds ratio, 0.72 [CI, 0.55-0.96], P=0.025) and lower survival rates (global P value 0.029; >75% Hispanic: odds ratio, 0.56 [CI, 0.34-0.93], P=0.023).Conclusions: Individuals with out-of-hospital cardiac arrest in predominantly Hispanic neighborhoods were less likely to receive B-CPR and had lower likelihood of survival. These findings suggest a need to understand the underlying disparities in cardiopulmonary resuscitationdelivery and an unmet cardiopulmonary resuscitationtraining need in Hispanic communities. [ABSTRACT FROM AUTHOR]

This 2019 focused update to the American Heart Association pediatric basic life support guidelines follows the 2019 systematic review of the effects of dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) on survival of infants and children with out-of-hospital cardiac arrest. This systematic review and the primary studies identified were analyzed by the Pediatric Task Force of the International Liaison Committee on Resuscitation. It aligns with the International Liaison Committee on Resuscitation's continuous evidence review process, with updates published when the International Liaison Committee on Resuscitation completes a literature review based on new published evidence. This update summarizes the available pediatric evidence supporting DA-CPR and provides treatment recommendations for DA-CPR for pediatric out-of-hospital cardiac arrest. Four new pediatric studies were reviewed. A systematic review of this data identified the association of a significant improvement in the rates of bystander CPR and in survival 1 month after cardiac arrest with DA-CPR. The writing group recommends that emergency medical dispatch centers offer DA-CPR for presumed pediatric cardiac arrest, especially when no bystander CPR is in progress. No recommendation could be made for or against DA-CPR instructions when bystander CPR is already in progress. [ABSTRACT FROM AUTHOR]

Survival after out-of-hospital cardiac arrest requires an integrated system of care (chain of survival) between the community elements responding to an event and the healthcare professionals who continue to care for and transport the patient for appropriate interventions. As a result of the dynamic nature of the prehospital setting, coordination and communication can be challenging, and identification of methods to optimize care is essential. This 2019 focused update to the American Heart Association systems of care guidelines summarizes the most recent published evidence for and recommendations on the use of dispatcher-assisted cardiopulmonary resuscitation and cardiac arrest centers. This article includes the revised recommendations that emergency dispatch centers should offer and instruct bystanders in cardiopulmonary resuscitation during out-of-hospital cardiac arrest and that a regionalized approach to post-cardiac arrest care may be reasonable when comprehensive postarrest care is not available at local facilities. [ABSTRACT FROM AUTHOR]

Dissemination of pediatric basic life support skills, while recommended, is not done routinely for pregnant women and their partners within the maternity services. This study evaluates an e-learning program coupled with the use of a novel infant pillow mannequin to determine whether a low-cost intervention with potential for widespread application could enable training in the event of an infant choking and the provision of basic life support. A prospective cohort study with an uncontrolled pre- and posttest design was used following institutional ethical approval. A 4-week cycle of antenatal education classes in a regional Maternity Hospital in Ireland and a purposive sample of pregnant women and their partners attending the antenatal education classes were used. The following measures were assessed: (1) confidence in knowing what to do in the event of an infant choking; (2) confidence in performing infant cardiopulmonary resuscitation (CPR); (3) ability to perform the requisite skills; and (4) the perceived acceptability of the infant pillow mannequin as a means of practice. Twenty-four individuals completed a pre- and postprogram questionnaire. The e-learning program along with practice on the pillow mannequin significantly affected confidence ( P< .001) in the actions to take in the event of an infant choking and in performing infant CPR. Forty-four participants used the pillow mannequin for practice and volunteered to have their skills assessed. More than 90% demonstrated correct positioning of the infant in the event of choking, correctly identified the correct ratio of chest compressions to breaths, and conducted chest compressions to the required depth. Three distinct categories of comment were identified: usefulness of the program; simplicity of the program/ pillow mannequin; and accessibility for practice at home. A self-instructional e-learning program coupled with an infant pillow mannequin enables parents to learn the procedure in the event of an infant choking and to demonstrate basic life support. This low-cost intervention has the potential for widespread application within developed and developing countries. [ABSTRACT FROM AUTHOR]

Study Design: A retrospective analysis of prospectively collected data.Objective: The aim of this study was to determine the ability of Revised Cardiac Risk Index (RCRI) to predict adverse cardiac events following posterior lumbar decompression (PLD).Summary Of Background Data: PLD is an increasingly common procedure used to treat a variety of degenerative spinal conditions. The RCRI is used to predict risk for cardiac events following noncardiac surgery. There is a paucity of literature that directly addresses the relationship between RCRI and outcomes following PLD, specifically, the discriminative ability of the RCRI to predict adverse postoperative cardiac events.Methods: ACS-NSQIP was utilized to identify patients undergoing PLD from 2006 to 2014. Fifty-two thousand sixty-six patients met inclusion criteria. Multivariate and ROC analysis was utilized to identify associations between RCRI and postoperative complications.Results: Membership in the RCRI=1 cohort was a predictor for myocardial infarction (MI) [odds ratio (OR) = 3.3, P = 0.002] and cardiac arrest requiring cardiopulmonary resuscitation (CPR) (OR = 3.4, P = 0.013). Membership in the RCRI = 2 cohort was a predictor for MI (OR = 5.9, P = 0.001) and cardiac arrest requiring CPR (OR = 12.5), Membership in the RCRI = 3 cohort was a predictor for MI (OR = 24.9) and cardiac arrest requiring CPR (OR = 26.9, P = 0.006). RCRI had a good discriminative ability to predict both MI [area under the curve (AUC) = 0.876] and cardiac arrest requiring CPR (AUC = 0.855). The RCRI had a better discriminative ability to predict these outcomes that did ASA status, which had discriminative abilities of "fair" (AUC = 0.799) and "poor" (AUC = 0.674), respectively. P < 0.001 unless otherwise specified.Conclusion: RCRI was predictive of cardiac events following PLD, and RCRI had a better discriminative ability to predict MI and cardiac arrest requiring CPR than did ASA status. Consideration of the RCRI as a component of preoperative surgical risk stratification can minimize patient morbidity and mortality. Studies such as this can allow for implementation of guidelines that better estimate the preoperative risk profile of surgical patients.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Background: Survival following out-of-hospital cardiac arrest (OHCA) with shockable rhythms can be improved with early defibrillation. Although shockable OHCA accounts for only ≈25% of overall arrests, ≈60% of public OHCAs are shockable, offering the possibility of restoring thousands of individuals to full recovery with early defibrillation by bystanders. We sought to determine the association of bystander automated external defibrillator use with survival and functional outcomes in shockable observed public OHCA.Methods: From 2011 to 2015, the Resuscitation Outcomes Consortium prospectively collected detailed information on all cardiac arrests at 9 regional centers. The exposures were shock administration by a bystander-applied automated external defibrillator in comparison with initial defibrillation by emergency medical services. The primary outcome measure was discharge with normal or near-normal (favorable) functional status defined as a modified Rankin Score ≤2. Survival to hospital discharge was the secondary outcome measure.Results: Among 49 555 OHCAs, 4115 (8.3%) observed public OHCAs were analyzed, of which 2500 (60.8%) were shockable. A bystander shock was applied in 18.8% of the shockable arrests. Patients shocked by a bystander were significantly more likely to survive to discharge (66.5% versus 43.0%) and be discharged with favorable functional outcome (57.1% versus 32.7%) than patients initially shocked by emergency medical services. After adjusting for known predictors of outcome, the odds ratio associated with a bystander shock was 2.62 (95% confidence interval, 2.07-3.31) for survival to hospital discharge and 2.73 (95% confidence interval, 2.17-3.44) for discharge with favorable functional outcome. The benefit of bystander shock increased progressively as emergency medical services response time became longer.Conclusions: Bystander automated external defibrillator use before emergency medical services arrival in shockable observed public OHCA was associated with better survival and functional outcomes. Continued emphasis on public automated external defibrillator utilization programs may further improve outcomes of OHCA. [ABSTRACT FROM AUTHOR]

Objective: To explore factors associated with neurological recovery at 1 year relative to hospital discharge after cardiac arrest.Design: Observational, retrospective review of a prospectively collected cohort.Setting: Medical or surgical ICUs in a single tertiary care center.Patients: Older than 18 years, resuscitated following either in-hospital or out-of-hospital cardiac arrest and considered for targeted temperature management between 2007 and 2013.Interventions: None.Measurements and Main Results: Logistic regressions to determine factors associated with a poor recovery pattern after 1 year, defined as persistent Cerebral Performance Category Score 3-4 or any worsening of Cerebral Performance Category Score relative to discharge status. In total, 30% (117/385) of patients survived to hospital discharge; among those discharged with Cerebral Performance Category Score 1, 2, 3, and 4, good recovery pattern was seen in 54.5%, 48.4%, 39.5%, and 0%, respectively. Significant variables showing trends in associations with a poor recovery pattern (62.5%) in a multivariate model were age more than 70 years (odds ratio, 4; 95% CIs, 1.1-15; p = 0.04), Hispanic ethnicity (odds ratio, 4; CI, 1.2-13; p = 0.02), and discharge disposition (home needing out-patient services (odds ratio, 1), home requiring no additional services (odds ratio, 0.15; CI, 0.03-0.8; p = 0.02), acute rehabilitation (odds ratio, 0.23; CI, 0.06-0.9; p = 0.04).Conclusions: Patients discharged with mild or moderate cerebral dysfunction sustained their risk of neurological worsening within 1 year of cardiac arrest. Old age, Hispanic ethnicity, and discharge disposition of home with out-patient services may be associated with a poor 1 year neurological recovery pattern after hospital discharge from cardiac arrest. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Home births have increased 77% from 2004 to 2017 and further increased with the COVID-19 pandemic. While the majority of home births are uneventful, some are complicated and require attendance of emergency medical services (EMS). Understanding characteristics of out-of-hospital births and EMS care is increasingly important to improve care. METHODS: We conducted a chart review of pediatric out-of-hospital cardiac arrests (POHCAs) from EMS agencies across the United States to evaluate the care provided by first responders. The study was approved by Oregon Health & Science University and respective IRBs. RESULTS: Of 1,020 POHCAs, 54 were responses to births and 43 were for other neonates. While most neonatal POHCAs occurred in a home or residence (84%), some births occurred at other locations such as a health care facility, public or commercial building, and street or highway. Bystander cardiopulmonary resuscitation was performed in less than half of births but more than half of other neonates. Return of spontaneous circulation was twice as likely for births as for other neonates (27% versus 13%). Overall, serious adverse safety events were observed in three-fourths of neonatal resuscitations. Births were more likely to be associated with failure to follow the correct resuscitation algorithm and lack of positive pressure ventilation. CONCLUSION: There are unique challenges in the care of out-of-hospital births for the EMS system. There is an opportunity to improve use of neonatal resuscitation protocols and early ventilation. [ABSTRACT FROM AUTHOR]

This section offers news briefs on the field of nursing in the U.S. as of July 2019. A study has revealed the association of cardiopulmonary resuscitation (CPR) with doubled survival rates in cardiac arrest patients. A guideline has been issued by the American Academy of Neurology (AAN) for clinicians treating patients with Tourette syndrome. The American Academy of Nursing (AAN) has called for the end to prosecution of pregnant and parenting women based solely on their substance use.

An editorial is presented in which author discusses the cardiopulmonary resuscitation (CPR) in 1966. It mentions the role of rescue breathing during CPR on the basis of emerging laboratory and clinical research; and describe the changes in the frequency and type of bystander CPR performed for all bystander-witnessed out-of-hospital cardiac arrests.

Witnessed cardiac arrest and bystander cardiopulmonary resuscitation (CPR) are associated with improved rates of ROSC and survival to hospital discharge. These findings suggest that bystander CPR may be factored into the total resuscitation time by emergency clinicians when considering the multifactorial decision to terminate CPR. B Introduction: b Long term outcomes for patients with out-of-hospital cardiac arrest (OHCA) are generally poor, with global 1-month survival rates of just over 10%. [Extracted from the article]

Objectives: The aim of this study was to describe the characteristics of out-of-hospital cardiac arrest (OHCA) in different workplaces, their management, and the survival rate. Methods: A post hoc analysis included all the OHCA cases that occurred at the workplace and were listed in the Fire Brigade of Paris database registry (2010 to 2014). Utstein-style variables, survival, and types of workplace were analyzed. Results: The study included 298 OHCA cases, mostly young (44% between 18 and 50 years), male (86%), and nontraumatic (86%). Differences in the survival chain were found to be related to the types of work location: bystander cardiopulmonary resuscitation was performed in 0% to 55% of cases, and workplace-automated external defibrillators were used in 0% to 20% of cases. Long-term survival without major incapacity was 0% to 23%. Conclusions: The characteristics of OHCA differ as a function of the type of workplace. [ABSTRACT FROM AUTHOR]

The author reflects on the death caused by chest compression, which is the only cardiopulmonary resuscitation for primary cardiac arrest. Topics discussed include cardiovascular disease, survival rate of patients with out-of-hospital cardiac arrest (OHCA) in the U.S., and lack of bystander cardiopulmonary resuscitation (CPR).

B Introduction: b Immediate bystander CPR can significantly improve chances of survival in out-of-hospital cardiac arrest, but socioeconomic status, race, and urban environments lead to disparities in bystander CPR rates. B Methods: b We performed a retrospective analysis of the Cardiac Arrests Registry to Enhance Survival (CARES) database to assess the rates of lay-person bystander CPR compared to rates of medically trained but off-duty bystander CPR. While it is known that disparity populations have lower rates of bystander CPR, we do not currently know if there are differences in who is performing bystander CPR, lay people vs. medically trained bystanders. [Extracted from the article]

B Introduction: b Bystander CPR is a significant predictor of outcomes in cardiac arrest. According to the 2018 report by the Cardiac Arrest Registry to Enhance Survival (CARES) database, the average rate of bystander CPR in cases of witnessed cardiac arrest in the United States (US) is 47%. [Extracted from the article]

B Introduction: b The modified physiological approach to CPR using head-up/torso-up (HTup) positions and adjuncts to lower ICP (and enhance venous return) clearly facilitates neuro-intact survival pre-clinically and markedly improves resuscitation rates in pilot clinical studies of out-of-hospital cardiac arrest (OHCA). B Conclusions: b The HTup CPR resuscitation bundle was associated with markedly improved odds of neurologically-favorable OHCA survival versus C-CPR even when comparing well-matched controls with closely-monitored CPR performance. [Extracted from the article]

It could be hypothesized that increasing the ambulance density may also shorten the time of response, facilitating early cardiopulmonary resuscitation and defibrillation, and consequently improving outcome after OHCA. 1 Chocron R Loeb T Lamhaut L Jost D Adnet F Lecarpentier E Bougouin W Beganton F Juvin P Marijon E Ambulance density and outcomes after out-of-hospital cardiac arrest: Insights From the Paris Sudden Death Expertise Center Registry. [Extracted from the article]

We read with interest the article by Chocron and the Paris Sudden Death Expertise Center Investigators in a recent issue of I Circulation i ,[1] reporting that, in a large sample of cases of out-of-hospital cardiac arrests, a higher density of ambulances providing basic and advanced life support was associated with successful return of spontaneous circulation. 1 Chocron R Loeb T Lamhaut L Jost D Adnet F Lecarpentier E Bougouin W Beganton F Juvin P Marijon E Paris SDEC Investigators Ambulance density and outcomes after out-of-hospital cardiac arrest: insights from the Paris Sudden Death Expertise Center Registry. [Extracted from the article]

Future studies should empirically test whether D-CPR and other interventions improve rates of bystander CPR and, importantly, improve bystander CPR equitably among all patient groups. 3 Blewer AL McGovern SK Schmicker RH May S Morrison LJ Aufderheide TP Daya M Idris AH Callaway CW Kudenchuk PJ Resuscitation Outcomes Consortium (ROC) Investigators Gender disparities among adult recipients of bystander cardiopulmonary resuscitation in the public. [Extracted from the article]

The article discusses the findings of the study "Bystander efforts and 1-year outcomes in out-of-hospital cardiac arrest" published in "The New England Journal of Medicine" on May 4, 2017 to show the advantages of administering bystander cardiopulmonary resuscitation (CPR).

We read with interest the article by Perman et al (2019).[1] This article considers the claim that women receive less bystander cardiopulmonary resuscitation (CPR) than men. We found no gender variation in the chances of a cardiac arrest victim to receive bystander CPR. [Extracted from the article]

These include rearrangement of the A-B-C paradigm to C-A-B, the removal of ventilation from bystander CPR protocols, and emphasis on BLS airways to minimize interruptions during endotracheal intubation. Hypothesis: Performing endotracheal intubation while chest compressions are ongoing is not different than with active CPR in obtaining definitive airway without delay or complications. A paired t-test was conducted comparing TTI with concurrent CPR and No CPR and found that successful intubation during concurrent CPR was 2.15 +/-.81 seconds slower than without concurrent CPR (p=0.0103). [Extracted from the article]

B Learning Objectives: b Hands-on cardiopulmonary resuscitation (CPR) skills are essential for high-quality CPR, but current life support courses do not provide learners sufficient training towards mastery with hands-on CPR skills. RCDP was not superior or inferior to VD for improving CC rate, fraction, time to shock and confidence level for hands-on CPR skills. [Extracted from the article]

B Learning Objectives: b Bystander cardiopulmonary resuscitation (CPR) after out-of-hospital cardiac arrest (OHCA) improves survival and neurological outcomes. In participants with prior CPR training, 61.1% reported concerns about performing CPR on women, with 18.9% having concerns about performing chest compressions in relation to breast location. Causing injury and exposing the patient were top concerns to perform CPR in women amongst participants who were uncomfortable (30.5% and 17.5% respectively) and comfortable (14.5% and 9.8% respectively) performing CPR in public. [Extracted from the article]

B Learning Objectives: b Arrhythmia and sudden cardiac decompensation (AMI or acute heart failure) are the most often causes of out-of-hospital cardiac arrest (OHCA). Two patients with triple vessel disease received coronary artery bypassing surgery (CABG) and one patient with subaortic stenosis underwent aortic valve replacement surgery. B Conclusions: b The resuscitated OHCA (ROSC) patients with any cardiac disease in the past, should undergo emergency cardiac catheterization and possible intervention procedures with an acceptable result [survival to hospital discharge rate of 26.6% (14 + 2+1=17/64)]. [Extracted from the article]

B Learning Objectives: b Several studies have examined the impact of underlying causes of cardiac arrest on extracorporeal cardiopulmonary resuscitation (ECPR) survival. B Results: b We enrolled 110 patients, including 71 ACS patients and 39 non-ACS patients. Kaplan-Meier analysis showed that the patients with ACS had a significantly higher 30-day survival rate compared to those with non-ACS patients (P <0.05). [Extracted from the article]

B Learning Objectives: b Arrhythmia and sudden cardiac decompensation (AMI or acute heart failure) are the most often causes of out-of-hospital cardiac arrest (OHCA). B Conclusions: b The resuscitated OHCA pts (ROSC) with any cardiac disease in the past, should consider undergoing emergency cardiac catheterization and possible intervention procedure with an acceptable result (survival to hospital discharge rate of 21.2%). [Extracted from the article]