Journal of Clinical Medicine

13 pages, 799 KiB

Open AccessArticle

Multimodal Long-Term Predictors of Outcome in Out of Hospital Cardiac Arrest Patients Treated with Targeted Temperature Management at 36 °C

by Erik Roman-Pognuz, Jonathan Elmer, Frank X. Guyette, Gabriele Poillucci, Umberto Lucangelo, Giorgio Berlot, Paolo Manganotti, Alberto Peratoner, Tommaso Pellis, Fabio Taccone and Clifton Callaway

J. Clin. Med. 2021, 10(6), 1331; https://doi.org/10.3390/jcm10061331 - 23 Mar 2021

Cited by 7 | Viewed by 2461

Abstract

Introduction: Early prediction of long-term outcomes in patients resuscitated after cardiac arrest (CA) is still challenging. Guidelines suggested a multimodal approach combining multiple predictors. We evaluated whether the combination of the electroencephalography (EEG) reactivity, somatosensory evoked potentials (SSEPs) cortical complex and Gray [...] Read more.

Introduction: Early prediction of long-term outcomes in patients resuscitated after cardiac arrest (CA) is still challenging. Guidelines suggested a multimodal approach combining multiple predictors. We evaluated whether the combination of the electroencephalography (EEG) reactivity, somatosensory evoked potentials (SSEPs) cortical complex and Gray to White matter ratio (GWR) on brain computed tomography (CT) at different temperatures could predict survival and good outcome at hospital discharge and six months after the event. Methods: We performed a retrospective cohort study including consecutive adult, non-traumatic patients resuscitated from out-of-hospital CA who remained comatose on admission to our intensive care unit from 2013 to 2017. We acquired SSEPs and EEGs during the treatment at 36 °C and after rewarming at 37 °C, Gray to white matter ratio (GWR) was calculated on the brain computed tomography scan performed within six hours of the hospital admission. We primarily hypothesized that SSEP was associated with favor-able functional outcome at distance and secondarily that SSEP provides independent information from EEG and CT. Outcomes were evaluated using the Cerebral Performance Category (CPC) scale at six months from discharge. Results: Of 171 resuscitated patients, 75 were excluded due to missing data or uninterpretable neurophysiological findings. EEG reactivity at 37 °C has been shown the best single predictor of good out-come (AUC 0.803) while N20P25 was the best single predictor for survival at each time point. (AUC 0.775 at discharge and AUC 0.747 at six months follow up). The predictive value of a model including EEG reactivity, average GWR, and SSEP N20P25 amplitude was superior (AUC 0.841 for survival and 0.920 for good out-come) to any combination of two tests or any single test. Conclusions: Our study, in which life-sustaining treatments were never suspended, suggests SSEP cortical complex N20P25, after normothermia and off sedation, is a reliable predictor for survival at any time. When SSEP cortical complex N20P25 is added into a model with GWR average and EEG reactivity, the predictivity for good outcome and survival at distance is superior than each single test alone. Full article

(This article belongs to the Special Issue “Italian Resuscitation Council” on Resuscitation Science and Emergencies—Part I)

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12 pages, 5367 KiB

Open AccessReview

Sport Related Sudden Death: The Importance of Primary and Secondary Prevention

by Antonio Gianluca Robles, Zefferino Palamà, Martina Nesti, Roberto Michele Tunzi, Pietro Delise, Elena Cavarretta, Maria Penco, Silvio Romano and Luigi Sciarra

J. Clin. Med. 2022, 11(16), 4683; https://doi.org/10.3390/jcm11164683 - 11 Aug 2022

Cited by 11 | Viewed by 1916

Abstract

Sports are a double-edged sword. On the one hand, cardiovascular benefits from sports activity are well-known, and on the other hand, sports may increase the risk of sudden cardiac death (SCD) in subjects with known or unknown cardiovascular diseases. SCD is rare but [...] Read more.

Sports are a double-edged sword. On the one hand, cardiovascular benefits from sports activity are well-known, and on the other hand, sports may increase the risk of sudden cardiac death (SCD) in subjects with known or unknown cardiovascular diseases. SCD is rare but has a very strong emotional issue. There are many examples involving famous professional athletes, but this is only scratching the surface of a widespread phenomenon that also involves amateur athletes. The importance of safely performing physical activity appears clear in both professional and amateur athletes. In particular, the former undergo a pre-participation screening for SCD primary prevention with different recommendations in each country. On the other hand, a medical examination is not mandatory for non-professional athletes and, therefore, for people who practice sports as an amateur. Widespread distribution of automatic external defibrillators and people trained for cardiopulmonary resuscitation are necessary to promote secondary prevention of SCD. We briefly report a case series of athletes with aborted SCD during sports activity in order to underline and discuss in this review the previously highlighted issues. Full article

(This article belongs to the Special Issue “Italian Resuscitation Council” on Resuscitation Science and Emergencies—Part I)

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8 pages, 680 KiB

Open AccessReview

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in Non-Traumatic Cardiac Arrest: A Narrative Review of Known and Potential Physiological Effects

by Carlo Alberto Mazzoli, Valentina Chiarini, Carlo Coniglio, Cristian Lupi, Marco Tartaglione, Lorenzo Gamberini, Federico Semeraro and Giovanni Gordini

J. Clin. Med. 2022, 11(3), 742; https://doi.org/10.3390/jcm11030742 - 29 Jan 2022

Cited by 12 | Viewed by 8037

Abstract

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is widely used in acute trauma care worldwide and has recently been proposed as an adjunct to standard treatments during cardiopulmonary resuscitation in patients with non-traumatic cardiac arrest (NTCA). Several case series have been published [...] Read more.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is widely used in acute trauma care worldwide and has recently been proposed as an adjunct to standard treatments during cardiopulmonary resuscitation in patients with non-traumatic cardiac arrest (NTCA). Several case series have been published highlighting promising results, and further trials are starting. REBOA during CPR increases cerebral and coronary perfusion pressure by increasing the afterload of the left ventricle, thus improving the chances of ROSC and decreasing hypoperfusion to the brain. In addition, it may facilitate the termination of malignant arrhythmias by stimulating baroreceptor reflex. Aortic occlusion could mitigate the detrimental neurological effects of adrenaline, not only by increasing cerebral perfusion but also reducing the blood dilution of the drug, allowing the use of lower doses. Finally, the use of a catheter could allow more precise hemodynamic monitoring during CPR and a faster transition to ECPR. In conclusion, REBOA in NTCA is a feasible technique also in the prehospital setting, and its use deserves further studies, especially in terms of survival and good neurological outcome, particularly in resource-limited settings. Full article

(This article belongs to the Special Issue “Italian Resuscitation Council” on Resuscitation Science and Emergencies—Part I)

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17 pages, 666 KiB

Open AccessReview

Community Initiatives to Promote Basic Life Support Implementation—A Scoping Review

by Andrea Scapigliati, Drieda Zace, Tasuku Matsuyama, Luca Pisapia, Michela Saviani, Federico Semeraro, Giuseppe Ristagno, Patrizia Laurenti, Janet E. Bray, Robert Greif and on behalf of the International Liaison Committee on Resuscitation Education, Implementation and Teams Task Force

J. Clin. Med. 2021, 10(24), 5719; https://doi.org/10.3390/jcm10245719 - 07 Dec 2021

Cited by 19 | Viewed by 3173

Abstract

Introduction: Early intervention of bystanders (the first links of the chain of survival) have been shown to improve survival and good neurological outcomes of patients suffering out-of-hospital cardiac arrest (OHCA). Many initiatives have been implemented to increase the engagement of communities in early [...] Read more.

Introduction: Early intervention of bystanders (the first links of the chain of survival) have been shown to improve survival and good neurological outcomes of patients suffering out-of-hospital cardiac arrest (OHCA). Many initiatives have been implemented to increase the engagement of communities in early basic life support (BLS) and cardiopulmonary resuscitation (CPR), especially of lay people with no duty to respond. A better knowledge of the most effective initiatives might help improve survival and health system organization. Aim of the scoping review: To assess the impact of specific interventions involving lay communities on bystander BLS rates and other consistent clinical outcomes, and to identify relevant knowledge gaps. Methods: This scoping review was part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR), and was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. We performed a literature search using the PubMed, EMBASE, and Cochrane databases until 1 February 2021. The screening process was conducted based on predefined inclusion/exclusion criteria, and for each included study, we performed data extraction focusing on the type of intervention implemented, and the impact of these interventions on the specific OHCAs outcomes. Results: Our search strategy identified 19 eligible studies, originating mainly from the USA (47.4%) and Denmark (21%). The type of intervention included in 57.9% of cases was a community CPR training program, in 36.8% bundled interventions, and in 5.3% mass-media campaigns. The most commonly reported outcome for OHCAs was bystander CPR rate (94.7%), followed by survival to hospital discharge (36.8%), proportion of people trained (31.6%), survival to hospital discharge with good neurological outcome (21%), and Return of Spontaneous Circulation (10.5%). Community training programs and bundled interventions improved bystander CPR in most of the included studies. Conclusion: Based on the results of our scoping review, we identified the potential benefit of community initiatives, such as community training in BLS, even as part of bundled intervention, in order to improve bystander CPR rates and patient outcomes. Full article

(This article belongs to the Special Issue “Italian Resuscitation Council” on Resuscitation Science and Emergencies—Part I)

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13 pages, 1531 KiB

Open AccessArticle

Effect of Early Supraglottic Airway Device Insertion on Chest Compression Fraction during Simulated Out-of-Hospital Cardiac Arrest: Randomised Controlled Trial

by Loric Stuby, Laurent Jampen, Julien Sierro, Maxime Bergeron, Erik Paus, Thierry Spichiger, Laurent Suppan and David Thurre

J. Clin. Med. 2022, 11(1), 217; https://doi.org/10.3390/jcm11010217 - 31 Dec 2021

Cited by 5 | Viewed by 3396

Abstract

Early insertion of a supraglottic airway (SGA) device could improve chest compression fraction by allowing providers to perform continuous chest compressions or by shortening the interruptions needed to deliver ventilations. SGA devices do not require the same expertise as endotracheal intubation. This study [...] Read more.

Early insertion of a supraglottic airway (SGA) device could improve chest compression fraction by allowing providers to perform continuous chest compressions or by shortening the interruptions needed to deliver ventilations. SGA devices do not require the same expertise as endotracheal intubation. This study aimed to determine whether the immediate insertion of an i-gel^® while providing continuous chest compressions with asynchronous ventilations could generate higher CCFs than the standard 30:2 approach using a face-mask in a simulation of out-of-hospital cardiac arrest. A multicentre, parallel, randomised, superiority, simulation study was carried out. The primary outcome was the difference in CCF during the first two minutes of resuscitation. Overall and per-cycle CCF quality of compressions and ventilations parameters were also compared. Among thirteen teams of two participants, the early insertion of an i-gel^® resulted in higher CCFs during the first two minutes (89.0% vs. 83.6%, p = 0.001). Overall and per-cycle CCF were consistently higher in the i-gel^® group, even after the 30:2 alternation had been resumed. In the i-gel^® group, ventilation parameters were enhanced, but compressions were significantly shallower (4.6 cm vs. 5.2 cm, p = 0.007). This latter issue must be addressed before clinical trials can be considered. Full article

(This article belongs to the Special Issue “Italian Resuscitation Council” on Resuscitation Science and Emergencies—Part I)

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12 pages, 1065 KiB

Open AccessArticle

The Automated External Defibrillator: Heterogeneity of Legislation, Mapping and Use across Europe. New Insights from the ENSURE Study

by Enrico Baldi, Niccolò B. Grieco, Giuseppe Ristagno, Hajriz Alihodžić, Valentine Canon, Alexei Birkun, Ruggero Cresta, Diana Cimpoesu, Carlo Clarens, Julian Ganter, Andrej Markota, Pierre Mols, Olympia Nikolaidou, Martin Quinn, Violetta Raffay, Fernando Rosell Ortiz, Ari Salo, Remy Stieglis, Anneli Strömsöe, Ingvild Tjelmeland, Stefan Trenkler, Jan Wnent, Jan-Thorsten Grasner, Bernd W. Böttiger and Simone Savastano Show full author list Hide full author list

J. Clin. Med. 2021, 10(21), 5018; https://doi.org/10.3390/jcm10215018 - 28 Oct 2021

Cited by 5 | Viewed by 3746

Abstract

Introduction: The rapid use of an automated external defibrillator (AED) is crucial for increased survival after an out-of-hospital cardiac arrest (OHCA). Many factors could play a role in limiting the chance of an AED use. We aimed to verify the situation regarding AED [...] Read more.

Introduction: The rapid use of an automated external defibrillator (AED) is crucial for increased survival after an out-of-hospital cardiac arrest (OHCA). Many factors could play a role in limiting the chance of an AED use. We aimed to verify the situation regarding AED legislation, the AED mapping system and first responders (FRs) equipped with an AED across European countries. Methods: We performed a survey across Europe entitled “European Study about AED Use by Lay Rescuers” (ENSURE), asking the national coordinators of the European Registry of Cardiac Arrest (EuReCa) program to complete it. Results: Nineteen European countries replied to the survey request for a population covering 128,297,955 inhabitants. The results revealed that every citizen can use an AED in 15 countries whereas a training certificate was required in three countries. In one country, only EMS personnel were allowed to use an AED. An AED mapping system and FRs equipped with an AED were available in only 11 countries. The AED use rate was 12–59% where AED mapping and FR systems were implemented, which was considerably higher than in other countries (0–7.9%), reflecting the difference in OHCA survival. Conclusions: Our survey highlighted a heterogeneity in AED legislation, AED mapping systems and AED use in Europe, which was reflected in different AED use and survival. Full article

(This article belongs to the Special Issue “Italian Resuscitation Council” on Resuscitation Science and Emergencies—Part I)

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13 pages, 3455 KiB

Open AccessArticle

New Early Warning Score: EMS Off-Label Use in Out-of-Hospital Patients

by Federico Semeraro, Giovanni Corona, Tommaso Scquizzato, Lorenzo Gamberini, Anna Valentini, Marco Tartaglione, Andrea Scapigliati, Giuseppe Ristagno, Carmela Martella, Carlo Descovich, Cosimo Picoco and Giovanni Gordini

J. Clin. Med. 2021, 10(12), 2617; https://doi.org/10.3390/jcm10122617 - 14 Jun 2021

Cited by 3 | Viewed by 2641

Abstract

Background: The National Early Warning Score (NEWS) is an assessment scale of in-hospital patients’ conditions. The purpose of this study was to assess the appropriateness of a potential off-label use of NEWS by the emergency medical system (EMS) to facilitate the identification of [...] Read more.

Background: The National Early Warning Score (NEWS) is an assessment scale of in-hospital patients’ conditions. The purpose of this study was to assess the appropriateness of a potential off-label use of NEWS by the emergency medical system (EMS) to facilitate the identification of critical patients and to trigger appropriate care in the pre-hospital setting. Methods: A single centre, longitudinal, prospective study was carried out between July and August 2020 in the EMS service of Bologna. Home patients with age ≥ 18 years old were included in the study. The exclusion criterion was the impossibility to collect all the parameters needed to measure NEWS. Results: A total of 654 patients were enrolled in the study. The recorded NEWS values increased along with the severity of dispatch priority code, the EMS return code, the emergency department triage code, and with patients’ age (r = 0.135; p = 0.001). The aggregated value of NEWS was associated with an increased risk of hospitalization (OR = 1.30 (1.17; 1.34); p < 0.0001). Conclusion: This study showed that the use of NEWS in the urgent and emergency care services can help patient assessment while not affecting EMS crew operation and might assist decision making in terms of severity-code assignment and resources utilization. Full article

(This article belongs to the Special Issue “Italian Resuscitation Council” on Resuscitation Science and Emergencies—Part I)

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11 pages, 620 KiB

Open AccessArticle

The Relationship between Selected Body Composition Components and Cardiopulmonary Resuscitation Parameters in Nurses: An Observational Simulation Study

by Paweł Więch, Marek Muster, Łukasz Godek, Izabela Sałacińska, Edyta Guty, Grzegorz Kucaba and Dariusz Bazaliński

J. Clin. Med. 2022, 11(1), 49; https://doi.org/10.3390/jcm11010049 - 23 Dec 2021

Viewed by 2248

Abstract

The provision of cardiopulmonary resuscitation (CPR) may be related to the physical parameters of the medical personnel, including fat mass (FM) and fat-free mass (FFM) components. In this study, we aimed to assess the relationship between selected body composition components and chest compression [...] Read more.

The provision of cardiopulmonary resuscitation (CPR) may be related to the physical parameters of the medical personnel, including fat mass (FM) and fat-free mass (FFM) components. In this study, we aimed to assess the relationship between selected body composition components and chest compression and ventilation parameters provided by medical staff. An observational simulation study was undertaken between December 2017 and January 2019 at the Center for Innovative Research in Medical and Natural Sciences of Rzeszów. In all participants (505 nurses, 37.71 y ± 12.16), the body weight and height were measured and the body mass index (BMI) was calculated. The body composition indicators were obtained using a bioelectrical impedance device, AKERN BIA 101. Afterwards, all participants performed CPR sequences (30 chest compressions and rescue for 2 breaths) for 2 min on a Laerdal Resusci Anne simulator placed on an examination couch with a self-inflating bag and a face mask. Our observations proved that high values of the anthropometric, nutritional and body composition parameters of the medical staff demonstrated a positive significant correlation with the depth and rate chest parameters and were inversely related to the chest adequate recoil. No statistically significant differences were found between the FM or FFM components and ventilation parameters. This study showed that nutritional status and body composition components may be important factors affecting the quality of CPR. Full article

(This article belongs to the Special Issue “Italian Resuscitation Council” on Resuscitation Science and Emergencies—Part I)

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12 pages, 1593 KiB

Open AccessArticle

A Systematic Review and Meta-Analysis of the Implementation of High-Performance Cardiopulmonary Resuscitation on Out-of-Hospital Cardiac Arrest Outcomes

by Qin Xiang Ng, Ming Xuan Han, Yu Liang Lim and Shalini Arulanandam

J. Clin. Med. 2021, 10(10), 2098; https://doi.org/10.3390/jcm10102098 - 13 May 2021

Cited by 9 | Viewed by 3085

Abstract

Despite numerous technological and medical advances, out-of-hospital cardiac arrests (OHCAs) still suffer from suboptimal survival rates and poor subsequent neurological and functional outcomes amongst survivors. Multiple studies have investigated the implementation of high-quality prehospital resuscitative efforts, and across these studies, different terms describing [...] Read more.

Despite numerous technological and medical advances, out-of-hospital cardiac arrests (OHCAs) still suffer from suboptimal survival rates and poor subsequent neurological and functional outcomes amongst survivors. Multiple studies have investigated the implementation of high-quality prehospital resuscitative efforts, and across these studies, different terms describing high-quality resuscitative efforts have been used, such as high-performance CPR (HP CPR), multi-tiered response (MTR) and minimally interrupted cardiac resuscitation (MICR). There is no universal definition for HP CPR, and dissimilar designs have been employed. This systematic review thus aimed to review current evidence on HP CPR implementation and examine the factors that may influence OHCA outcomes. Eight studies were systematically reviewed, and seven were included in the final meta-analysis. Random-effects meta-analysis found a significantly improved likelihood of prehospital return of spontaneous circulation (pooled odds ratio (OR) = 1.46, 95% CI: 1.16 to 1.82, p < 0.001), survival-to-discharge (pooled OR = 1.32, 95% CI: 1.16 to 1.50, p < 0.001) and favourable neurological outcomes (pooled OR = 1.24, 95% CI: 1.11 to 1.39, p < 0.001) with HP CPR or similar interventions. However, the studies had generally high heterogeneity (I² greater than 50%) and overall moderate-to-severe risk for bias. Moving forward, a randomised, controlled trial is necessary to shed light on the subject. Full article

(This article belongs to the Special Issue “Italian Resuscitation Council” on Resuscitation Science and Emergencies—Part I)

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13 pages, 3305 KiB

Open AccessReview

The Influence of COVID-19 on Out-Hospital Cardiac Arrest Survival Outcomes: An Updated Systematic Review and Meta-Analysis

by Karol Bielski, Agnieszka Szarpak, Miłosz Jaroslaw Jaguszewski, Tomasz Kopiec, Jacek Smereka, Aleksandra Gasecka, Przemysław Wolak, Grazyna Nowak-Starz, Jaroslaw Chmielewski, Zubaid Rafique, Frank William Peacock and Lukasz Szarpak

J. Clin. Med. 2021, 10(23), 5573; https://doi.org/10.3390/jcm10235573 - 27 Nov 2021

Cited by 33 | Viewed by 3377

Abstract

Cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest (OHCA) is associated with poor prognosis. Because the COVID-19 pandemic may have impacted mortality and morbidity, both on an individual level and the health care system as a whole, our purpose was to determine rates [...] Read more.

Cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest (OHCA) is associated with poor prognosis. Because the COVID-19 pandemic may have impacted mortality and morbidity, both on an individual level and the health care system as a whole, our purpose was to determine rates of OHCA survival since the onset of the SARS-CoV2 pandemic. We conducted a systematic review and meta-analysis to evaluate the influence of COVID-19 on OHCA survival outcomes according to the PRISMA guidelines. We searched the literature using PubMed, Scopus, Web of Science and Cochrane Central Register for Controlled Trials databases from inception to September 2021 and identified 1775 potentially relevant studies, of which thirty-one articles totaling 88,188 patients were included in this meta-analysis. Prehospital return of spontaneous circulation (ROSC) in pre-COVID-19 and COVID-19 periods was 12.3% vs. 8.9%, respectively (OR = 1.40; 95%CI: 1.06–1.87; p < 0.001). Survival to hospital discharge in pre- vs. intra-COVID-19 periods was 11.5% vs. 8.2% (OR = 1.57; 95%CI: 1.37–1.79; p < 0.001). A similar dependency was observed in the case of survival to hospital discharge with the Cerebral Performance Category (CPC) 1–2 (6.7% vs. 4.0%; OR = 1.71; 95%CI: 1.35–2.15; p < 0.001), as well as in the 30-day survival rate (9.2% vs. 6.4%; OR = 1.63; 95%CI: 1.13–2.36; p = 0.009). In conclusion, prognosis of OHCA is usually poor and even worse during COVID-19. Full article

(This article belongs to the Special Issue “Italian Resuscitation Council” on Resuscitation Science and Emergencies—Part I)

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19 pages, 9038 KiB

Open AccessReview

Cardiac Arrest Occurring in High-Rise Buildings: A Scoping Review

by Ming Xuan Han, Amelia Natasha Wen Ting Yeo, Marcus Eng Hock Ong, Karen Smith, Yu Liang Lim, Norman Huangyu Lin, Bobo Tan, Shalini Arulanandam, Andrew Fu Wah Ho and Qin Xiang Ng

J. Clin. Med. 2021, 10(20), 4684; https://doi.org/10.3390/jcm10204684 - 13 Oct 2021

Cited by 2 | Viewed by 2724

Abstract

Out-of-hospital cardiac arrests (OHCAs) occurring in high-rise buildings are a challenge to Emergency Medical Services (EMS). Contemporary EMS guidelines lack specific recommendations for systems and practitioners regarding the approach to these patients. This scoping review aimed to map the body of literature pertaining [...] Read more.

Out-of-hospital cardiac arrests (OHCAs) occurring in high-rise buildings are a challenge to Emergency Medical Services (EMS). Contemporary EMS guidelines lack specific recommendations for systems and practitioners regarding the approach to these patients. This scoping review aimed to map the body of literature pertaining to OHCAs in high-rise settings in order to clarify concepts and understanding and to identify knowledge gaps. Databases were searched from inception through to 6 May 2021 including OVID Medline, PubMed, Embase, CINAHL, and Scopus. Twenty-three articles were reviewed, comprising 8 manikin trials, 14 observational studies, and 1 mathematical modelling study. High-rise settings commonly have lower availability of bystanders and automatic external defibrillators (AEDs), while height constraints often lead to delays in EMS interventions and suboptimal cardiopulmonary resuscitation (CPR), scene access, and extrication. Four studies found return of spontaneous circulation (ROSC) rates to be significantly poorer, while seven studies found rates of survival-to-hospital discharge (n = 3) and neurologically favourable survival (n = 4) to be significantly lower in multistorey settings. Mechanical chest compression devices, transfer sheets, and strategic defibrillator placement were suggested as approaches to high-rise OHCA management. A shift to maximising on-scene treatment time, along with bundling novel prehospital interventions, could ameliorate some of these difficulties and improve clinical outcomes for patients. Full article

(This article belongs to the Special Issue “Italian Resuscitation Council” on Resuscitation Science and Emergencies—Part I)

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14 pages, 443 KiB

Open AccessReview

Point of Care Ultrasonography for the Septic Patient in the Emergency Department: A Literature Review

by Christos Verras, Ioannis Ventoulis, Sofia Bezati, Dionysis Matsiras, John Parissis and Effie Polyzogopoulou

J. Clin. Med. 2023, 12(3), 1105; https://doi.org/10.3390/jcm12031105 - 31 Jan 2023

Cited by 4 | Viewed by 2276

Abstract

The point-of-care ultrasound (POCUS) has been effectively used in intensive care units for the management of septic patients. Since it is a time- and cost-effective non-invasive imaging modality, its use in the emergency department (ED) has been advocated for by medical experts. This [...] Read more.

The point-of-care ultrasound (POCUS) has been effectively used in intensive care units for the management of septic patients. Since it is a time- and cost-effective non-invasive imaging modality, its use in the emergency department (ED) has been advocated for by medical experts. This review summarizes the existing literature regarding the breadth of POCUS as a supplementary tool to the holistic approach of septic patients in the ED setting. A literature search was conducted via PubMed (MEDLINE), Cochrane Library, and Scopus databases, analyzing studies which examined the use of POCUS in the ED for non-traumatic, septic, and/or undifferentiated hypotensive patients, resulting in 26 studies. The first cluster of studies investigates the efficiency of POCUS protocols in the differential diagnosis and its reliability for distributive/septic shock and sepsis management. In the second cluster, POCUS use results in faster sepsis cause identification and improves therapeutic management. The third cluster confirms that POCUS aids in the accurate diagnosis and management, even in rare and complicated cases. The results of the present review support the well-documented utility of POCUS and highlight the importance of POCUS incorporation in the comprehensive management of the septic patient in the ED setting. Full article

(This article belongs to the Special Issue “Italian Resuscitation Council” on Resuscitation Science and Emergencies—Part I)

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11 pages, 1126 KiB

Open AccessReview

Targeted Temperature Management after Cardiac Arrest: A Systematic Review and Meta-Analysis with Trial Sequential Analysis

by Filippo Sanfilippo, Luigi La Via, Bruno Lanzafame, Veronica Dezio, Diana Busalacchi, Antonio Messina, Giuseppe Ristagno, Paolo Pelosi and Marinella Astuto

J. Clin. Med. 2021, 10(17), 3943; https://doi.org/10.3390/jcm10173943 - 31 Aug 2021

Cited by 21 | Viewed by 2886

Abstract

Target temperature management (TTM) in cardiac arrest (CA) survivors is recommended after hospital admission for its possible beneficial effects on survival and neurological outcome. Whether a lower target temperature (i.e., 32–34 °C) improves outcomes is unclear. We conducted a systematic review and meta-analysis [...] Read more.

Target temperature management (TTM) in cardiac arrest (CA) survivors is recommended after hospital admission for its possible beneficial effects on survival and neurological outcome. Whether a lower target temperature (i.e., 32–34 °C) improves outcomes is unclear. We conducted a systematic review and meta-analysis on Pubmed and EMBASE to evaluate the effects on mortality and neurologic outcome of TTM at 32–34 °C as compared to controls (patients cared with “actively controlled” or “uncontrolled” normothermia). Results were analyzed via risk ratios (RR) and 95% confidence intervals (CI). Eight randomized controlled trials (RCTs) were included. TTM at 32–34 °C was compared to “actively controlled” normothermia in three RCTs and to “uncontrolled” normothermia in five RCTs. TTM at 32–34 °C does not improve survival as compared to normothermia (RR:1.06 (95%CI 0.94, 1.20), p = 0.36; I² = 39%). In the subgroup analyses, TTM at 32–34 °C is associated with better survival when compared to “uncontrolled” normothermia (RR: 1.31 (95%CI 1.07, 1.59), p = 0.008) but shows no beneficial effects when compared to “actively controlled” normothermia (RR: 0.97 (95%CI 0.90, 1.04), p = 0.41). TTM at 32–34 °C does not improve neurological outcome as compared to normothermia (RR: 1.17 (95%CI 0.97, 1.41), p = 0.10; I² = 60%). TTM at 32–34 °C increases the risk of arrhythmias (RR: 1.35 (95%CI 1.16, 1.57), p = 0.0001, I² = 0%). TTM at 32–34 °C does not improve survival nor neurological outcome after CA and increases the risk of arrhythmias. Full article

(This article belongs to the Special Issue “Italian Resuscitation Council” on Resuscitation Science and Emergencies—Part I)

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20 pages, 1816 KiB

Open AccessReview

One-Year Review in Cardiac Arrest: The 2022 Randomized Controlled Trials

by Alessio Penna, Aurora Magliocca, Giulia Merigo, Giuseppe Stirparo, Ivan Silvestri, Francesca Fumagalli and Giuseppe Ristagno

J. Clin. Med. 2023, 12(6), 2235; https://doi.org/10.3390/jcm12062235 - 14 Mar 2023

Cited by 3 | Viewed by 2976

Abstract

Cardiac arrest, one of the leading causes of death, accounts for numerous clinical studies published each year. This review summarizes the findings of all the randomized controlled clinical trials (RCT) on cardiac arrest published in the year 2022. The RCTs are presented according [...] Read more.

Cardiac arrest, one of the leading causes of death, accounts for numerous clinical studies published each year. This review summarizes the findings of all the randomized controlled clinical trials (RCT) on cardiac arrest published in the year 2022. The RCTs are presented according to the following categories: out-of- and in-hospital cardiac arrest (OHCA, IHCA) and post-cardiac arrest care. Interestingly, more than 80% of the RCTs encompassed advanced life support and post-cardiac arrest care, while no studies focused on the treatment of IHCA, except for one that, however, explored the temperature control after resuscitation in this population. Surprisingly, 9 out of 11 RCTs led to neutral results demonstrating equivalency between the newly tested interventions compared to current practice. One trial was negative, showing that oxygen titration in the immediate pre-hospital post-resuscitation period decreased survival compared to a more liberal approach. One RCT was positive and introduced new defibrillation strategies for refractory cardiac arrest. Overall, data from the 2022 RCTs discussed here provide a solid basis to generate new hypotheses to be tested in future clinical studies. Full article

(This article belongs to the Special Issue “Italian Resuscitation Council” on Resuscitation Science and Emergencies—Part I)

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13 pages, 1542 KiB

Open AccessArticle

High Oxygen Does Not Increase Reperfusion Injury Assessed with Lipid Peroxidation Biomarkers after Cardiac Arrest: A Post Hoc Analysis of the COMACARE Trial

by Jaana Humaloja, Maximo Vento, Julia Kuligowski, Sture Andersson, José David Piñeiro-Ramos, Ángel Sánchez-Illana, Erik Litonius, Pekka Jakkula, Johanna Hästbacka, Stepani Bendel, Marjaana Tiainen, Matti Reinikainen and Markus B. Skrifvars

J. Clin. Med. 2021, 10(18), 4226; https://doi.org/10.3390/jcm10184226 - 17 Sep 2021

Cited by 3 | Viewed by 1883

Abstract

The products of polyunsaturated fatty acid peroxidation are considered reliable biomarkers of oxidative injury in vivo. We investigated ischemia-reperfusion-related oxidative injury by determining the levels of lipid peroxidation biomarkers (isoprostane, isofuran, neuroprostane, and neurofuran) after cardiac arrest and tested the associations between the [...] Read more.

The products of polyunsaturated fatty acid peroxidation are considered reliable biomarkers of oxidative injury in vivo. We investigated ischemia-reperfusion-related oxidative injury by determining the levels of lipid peroxidation biomarkers (isoprostane, isofuran, neuroprostane, and neurofuran) after cardiac arrest and tested the associations between the biomarkers and different arterial oxygen tensions (PaO₂). We utilized blood samples collected during the COMACARE trial (NCT02698917). In the trial, 123 patients resuscitated from out-of-hospital cardiac arrest were treated with a 10–15 kPa or 20–25 kPa PaO₂ target during the initial 36 h in the intensive care unit. We measured the biomarker levels at admission, and 24, 48, and 72 h thereafter. We compared biomarker levels in the intervention groups and in groups that differed in oxygen exposure prior to randomization. Blood samples for biomarker determination were available for 112 patients. All four biomarker levels peaked at 24 h; the increase appeared greater in younger patients and in patients without bystander-initiated life support. No association between the lipid peroxidation biomarkers and oxygen exposure either before or after randomization was found. Increases in the biomarker levels during the first 24 h in intensive care suggest continuing oxidative stress, but the clinical relevance of this remains unresolved. Full article

(This article belongs to the Special Issue “Italian Resuscitation Council” on Resuscitation Science and Emergencies—Part I)

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19 pages, 1082 KiB

Open AccessReview

Recent Non-Invasive Parameters to Identify Subjects at High Risk of Sudden Cardiac Death

by Maria Delia Corbo, Enrica Vitale, Maurizio Pesolo, Grazia Casavecchia, Matteo Gravina, Pierluigi Pellegrino, Natale Daniele Brunetti and Massimo Iacoviello

J. Clin. Med. 2022, 11(6), 1519; https://doi.org/10.3390/jcm11061519 - 10 Mar 2022

Cited by 1 | Viewed by 2591

Abstract

Cardiovascular diseases remain among the leading causes of death worldwide and sudden cardiac death (SCD) accounts for ~25% of these deaths. Despite its epidemiologic relevance, there are very few diagnostic strategies available useful to prevent SCD mainly focused on patients already affected by [...] Read more.

Cardiovascular diseases remain among the leading causes of death worldwide and sudden cardiac death (SCD) accounts for ~25% of these deaths. Despite its epidemiologic relevance, there are very few diagnostic strategies available useful to prevent SCD mainly focused on patients already affected by specific cardiovascular diseases. Unfortunately, most of these parameters exhibit poor positive predictive accuracy. Moreover, there is also a need to identify parameters to stratify the risk of SCD among otherwise healthy subjects. This review aims to provide an update on the most relevant non-invasive diagnostic features to identify patients at higher risk of developing malignant ventricular arrhythmias and SCD. Full article

(This article belongs to the Special Issue “Italian Resuscitation Council” on Resuscitation Science and Emergencies—Part I)

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9 pages, 5036 KiB

Open AccessArticle

Effect of Wearing Personal Protective Equipment (PPE) on CPR Quality in Times of the COVID-19 Pandemic—A Simulation, Randomised Crossover Trial

by Simon Rauch, Michiel Jan van Veelen, Rosmarie Oberhammer, Tomas Dal Cappello, Giulia Roveri, Elisabeth Gruber and Giacomo Strapazzon

J. Clin. Med. 2021, 10(8), 1728; https://doi.org/10.3390/jcm10081728 - 16 Apr 2021

Cited by 18 | Viewed by 3654

Abstract

Cardiopulmonary resuscitation (CPR) is considered an aerosol-generating procedure. Consequently, COVID-19 resuscitation guidelines recommend the use of personal protective equipment (PPE) during resuscitation. In this simulation of randomised crossover trials, we investigated the influence of PPE on the quality of chest compressions (CCs). Thirty-four [...] Read more.

Cardiopulmonary resuscitation (CPR) is considered an aerosol-generating procedure. Consequently, COVID-19 resuscitation guidelines recommend the use of personal protective equipment (PPE) during resuscitation. In this simulation of randomised crossover trials, we investigated the influence of PPE on the quality of chest compressions (CCs). Thirty-four emergency medical service BLS-providers performed two 20 min CPR sequences (five 2 min cycles alternated by 2 min of rest) on manikins, once with and once without PPE, in a randomised order. The PPE was composed of a filtering facepiece 3 FFP3 mask, safety glasses, gloves and a long-sleeved gown. The primary outcome was defined as the difference between compression depth with and without PPE; secondary outcomes were defined as differences in CC rate, release and the number of effective CCs. The participants graded fatigue and performance, while generalised estimating equations (GEE) were used to analyse data. There was no significant difference in CC quality between sequences without and with PPE regarding depth (mean depth 54 ± 5 vs. 54 ± 6 mm respectively), rate (mean rate 119 ± 9 and 118 ± 6 compressions per minute), release (mean release 2 ± 2 vs. 2 ± 2 mm) and the number of effective CCs (43 ± 18 vs. 45 ± 17). The participants appraised higher fatigue when equipped with PPE in comparison to when equipped without PPE (p < 0.001), and lower performance was appraised when equipped with PPE in comparison to when equipped without PPE (p = 0.031). There is no negative effect of wearing PPE on the quality of CCs during CPR in comparison to not wearing PPE. Full article

(This article belongs to the Special Issue “Italian Resuscitation Council” on Resuscitation Science and Emergencies—Part I)

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8 pages, 1294 KiB

Open AccessArticle

Carotid Artery Ultrasound in the (peri-) Arrest Setting—A Prospective Pilot Study

by Moritz Koch, Matthias Mueller, Alexandra-Maria Warenits, Michael Holzer, Alexander Spiel and Sebastian Schnaubelt

J. Clin. Med. 2022, 11(2), 469; https://doi.org/10.3390/jcm11020469 - 17 Jan 2022

Cited by 3 | Viewed by 1885

Abstract

Point-of-care ultrasounds (US) are used during cardiopulmonary resuscitation (CPR) and after return of spontaneous circulation (ROSC). Carotid ultrasounds are a potential non-invasive monitoring tool for chest compressions, but their general value and feasibility during CPR are not fully determined. In this prospective observational [...] Read more.

Point-of-care ultrasounds (US) are used during cardiopulmonary resuscitation (CPR) and after return of spontaneous circulation (ROSC). Carotid ultrasounds are a potential non-invasive monitoring tool for chest compressions, but their general value and feasibility during CPR are not fully determined. In this prospective observational study, we performed carotid US during conventional- and extracorporeal CPR and after ROSC with at least one transverse and coronal image, corresponding loops with and without color doppler, and pulsed-wave doppler loops. The feasibility of carotid US during (peri-)arrest and type and frequency of diagnostic findings were examined. We recruited 16 patients and recorded utilizable US images in 14 cases (88%; complete imaging protocols in 11 patients [69%]). In three of all patients (19%) and in 60% (3/5) of cases during CPR plus a full imaging protocol, we observed: (i) in one patient a collapse of the common carotid artery linked to hypovolemia, and (ii) in two patients a biphasic flow during CPR linked to prolonged low-flow time prior to admission and adverse outcome. Carotid artery morphology and carotid blood flow characteristics may serve as therapeutic target and prognostic parameters. However, future studies with larger sample sizes are needed. Full article

(This article belongs to the Special Issue “Italian Resuscitation Council” on Resuscitation Science and Emergencies—Part I)

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