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Medicina
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Cardiopulmonary Resuscitation: Recent Advances and Future Challenges
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Cardiopulmonary Resuscitation: Recent Advances and Future Challenges

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Intensive Care/ Anesthesiology".

Deadline for manuscript submissions: 31 August 2024 | Viewed by 8239

Special Issue Editor

Dr. Gregor Prosen

E-Mail Website
Guest Editor
Emergency Medicine, University Medical Centre Maribor, Maribor, Slovenia
Interests: cardiopulmonary resuscitation; resuscitation; critical care medicine; emergency management; airway ultrasound

Special Issue Information

Dear Colleagues, 

Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of death and annually affects around 275,000 people in Europe. Despite the advances in the treatment of heart diseases, the outcome of patients experiencing sudden cardiac arrest remains poor. The chances of surviving OHCA rely on resuscitation being started immediately after the patient’s collapse. Vital resuscitation interventions that improve survival from OHCA are collectively known as “The Chain of Survival''. Numerous interventions have been proposed and implemented throughout the years to improve every single link of the chain. Various studies have emphasized the role of bystanders, the prompt usage of AED and usage of additional devices to improve the outcome of OHCA patients. Unfortunately, the aggregate survival rate of OHCA patients recorded across various populations remains between 6.7% and 8.4% and only a minority of these patients have good neurological outcomes after hospital discharge.

Even though bystander cardiopulmonary resuscitation (CPR) and shortened time to defibrillation have improved in the last few years, mainly due to the education of the public, we are dealing with the increasing age of patients with OHCA and decreasing proportion of patients that present a shockable initial rhythm. Hence, the following question remains: what else can be done to improve the neurological outcomes and survival rate of OHCA patients?

The aim of the present Special Issue is to review all the important aspects of managing OHCA patients, its therapy goals and measures that can potentially improve survival and, above all, improve the neurological outcome of the victims of sudden cardiac arrest.

The Special Issue presents research from a wide field of emergency and critical care, addressing the most key issues in CPR in the field, the emergency departments and the intensive care units.

Dr. Gregor Prosen
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • out-of-hospital/in-hospital cardiac arrest
  • cardiopulmonary resuscitation (CPR)
  • chain of survival
  • lay person: CPR knowledge, CPR teaching and retention of CPR knowledge
  • automatic external defibrillator: network, availability and early defibrillation
  • first responders: CPR knowledge, teaching and retention
  • emergency medical service: challenges in the management of out-of-hospital cardiac arrest
  • emergency department: novelties in CPR
  • novelties in intensive care unit management in CPR: hypothermia, vasoactive therapy, neural injury and neuroprognostication
  • extracorporeal membrane oxygenation

Published Papers (7 papers)

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Research

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14 pages, 301 KiB  
Article
Perception of Personal Participation of the Nurses in Resuscitation Procedures: A Qualitative Study
by Anton Koželj, Maja Strauss, Vita Poštuvan, Anže Strauss Koželj and Matej Strnad
Medicina 2024, 60(2), 196; https://doi.org/10.3390/medicina60020196 - 24 Jan 2024
Viewed by 751
Abstract
Background and Objectives: Resuscitation is one of the most stressful tasks in emergency medicine. The participation of nurses in this procedure can have specific effects on them. In this research, we wanted to find out what these effects are. Materials and Methods: A [...] Read more.
Background and Objectives: Resuscitation is one of the most stressful tasks in emergency medicine. The participation of nurses in this procedure can have specific effects on them. In this research, we wanted to find out what these effects are. Materials and Methods: A qualitative approach by conducting semi-structured interviews was used, and a thematic data analysis of the recorded interviews was carried out. The collected data were transcribed verbatim, with no corrections to the audio recordings. The computer program ATLAS.ti 22 was used for the qualitative data analysis. Results: Eleven male registered nurses were interviewed, with an average of 18.5 years of experience working in a prehospital environment (max. 32/min. 9). A total of 404 min of recordings were analyzed, and 789 codes were found, which were combined into 36 patterns and 11 themes. As the most stressful situations, the interviewees pointed out the resuscitation of a child, familiar persons, conflicts with the environment, conflicts within the resuscitation team, nonfunctioning or insufficient equipment, complications during resuscitation, and resuscitating a person only for training. As positive effects, the interviewees cited successful resuscitations or their awareness that, despite an unsuccessful resuscitation, they did everything they could. Conclusions: Participation in these interventions has a specific positive or negative impact on the performers. The interviewees shared the opinion that they can cope effectively with the adverse or stressful effects of resuscitation. Yet, despite everything, they allow the possibility of subconscious influences of this intervention on themselves. Full article
(This article belongs to the Special Issue Cardiopulmonary Resuscitation: Recent Advances and Future Challenges)
14 pages, 1413 KiB  
Article
Addition of Vitamin C Does Not Decrease Neuron-Specific Enolase Levels in Adult Survivors of Cardiac Arrest—Results of a Randomized Trial
by Matevž Privšek, Matej Strnad and Andrej Markota
Medicina 2024, 60(1), 103; https://doi.org/10.3390/medicina60010103 - 05 Jan 2024
Viewed by 892
Abstract
Background and Objectives: Survival with favorable neurologic outcomes after out-of-hospital cardiac arrest (OHCA) remains elusive. Post-cardiac arrest syndrome (PCAS) involves myocardial and neurological injury, ischemia-reperfusion response, and underlying pathology. Neurologic injury is a crucial determinant of survival and functional outcomes, with damage [...] Read more.
Background and Objectives: Survival with favorable neurologic outcomes after out-of-hospital cardiac arrest (OHCA) remains elusive. Post-cardiac arrest syndrome (PCAS) involves myocardial and neurological injury, ischemia-reperfusion response, and underlying pathology. Neurologic injury is a crucial determinant of survival and functional outcomes, with damage caused by free radicals among the responsible mechanisms. This study explores the feasibility of adding intravenous vitamin C to the treatment of OHCA survivors, aiming to mitigate PCAS. Vitamin C, a nutrient with antioxidative and free radical-scavenging properties, is often depleted in critically ill patients. Materials and Methods: This randomized, double-blinded trial was conducted at a tertiary-level university hospital with adult OHCA survivors. Participants received either standard care or the addition of 1.5 g of intravenous vitamin C every 12 h for eight consecutive doses. Neurologic injury was assessed using neuron-specific enolase (NSE) levels, with additional clinical and laboratory outcomes, such as enhanced neuroprognostication factors, inflammatory markers, and cardiac parameters. Results: NSE levels were non-significantly higher in patients who received vitamin C compared to the placebo group (55.05 µg/L [95% confidence interval (CI) 26.7–124.0] vs. 39.4 µg/L [95% CI 22.6–61.9], p > 0.05). Similarly, a non-significantly greater proportion of patients in the vitamin C group developed myoclonus in the first 72 h. We also observed a non-significantly shorter duration of mechanical ventilation, fewer arrhythmias, and reduced length of stay in the intensive care unit in the group of patients who received vitamin C (p = 0.031). However, caution is warranted in interpretation of our results due to the small number of participants. Conclusions: Our findings suggest that intravenous vitamin C should not be used outside of clinical trials for OHCA survivors. Due to the small sample size and conflicting results, further research is needed to determine the potential role of vitamin C in post-cardiac arrest care. Full article
(This article belongs to the Special Issue Cardiopulmonary Resuscitation: Recent Advances and Future Challenges)
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11 pages, 1194 KiB  
Article
Dynamics of Capillary Lactate Levels in Patients with Out-of-Hospital Cardiac Arrest
by Vitka Vujanović, Vesna Borovnik Lesjak, Dušan Mekiš and Matej Strnad
Medicina 2023, 59(11), 1989; https://doi.org/10.3390/medicina59111989 - 11 Nov 2023
Viewed by 718
Abstract
Background and Objectives: An effective strategy for cardiopulmonary resuscitation should be based on tissue perfusion. Our primary aim was to determine the association between capillary lactate values and initial rhythm as well as the probability of the return of spontaneous circulation in [...] Read more.
Background and Objectives: An effective strategy for cardiopulmonary resuscitation should be based on tissue perfusion. Our primary aim was to determine the association between capillary lactate values and initial rhythm as well as the probability of the return of spontaneous circulation in out-of-hospital cardiac arrest patients. Materials and Methods: This prospective observational cohort study included all patients with non-traumatic out-of-hospital cardiac arrest, older than 18 years, resuscitated by a prehospital emergency medical team between April 2020 and June 2021. Capillary lactate samples were collected at the time of arrival and every 10 min after the first measurement until the time of the return of spontaneous circulation (ROSC) or, if ROSC was not achieved, at the time of declaring death on the scene. Results: In total, 83 patients were enrolled in the study. ROSC was achieved in 28 patients (33.7%), 21 were admitted to hospital (26.3%), and 6 (7.23%) of them were discharged from hospital. At discharge, all patients had Cerebral Performance Category Scale 1 or 2. Initial capillary lactate values were significantly higher in patients with a non-shockable rhythm compared to the group with a shockable rhythm (9.19 ± 4.6 versus 6.43 ± 3.81; p = 0.037). A significant difference also persisted in a second value taken 10 min after the initial value (10.03 ± 5,19 versus 5.18 ± 3.47; p = 0.019). Capillary lactate values were higher in the ROSC group and non-ROSC group at the time of restored circulation (11.10 ± 6.59 and 6.77 ± 4.23, respectively; p = 0.047). Conclusions: Capillary lactate values are significantly higher in patients with a non-shockable first rhythm in out-of-hospital cardiac arrest (OHCA). There is also a significantly different rise in capillary lactate levels in patients with ROSC. Full article
(This article belongs to the Special Issue Cardiopulmonary Resuscitation: Recent Advances and Future Challenges)
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9 pages, 297 KiB  
Article
Prehospital Predictors of Survival in Patients with Out-of-Hospital Cardiac Arrest
by Matej Strnad, Vesna Borovnik Lesjak, Pia Jerot and Maruša Esih
Medicina 2023, 59(10), 1717; https://doi.org/10.3390/medicina59101717 - 26 Sep 2023
Cited by 1 | Viewed by 1342
Abstract
Background and Objectives: Despite advances in the treatment of heart diseases, the outcome of patients experiencing sudden cardiac arrest remains poor. The aim of our study was to determine the prehospital variables as predictors of survival outcomes in out-of-hospital cardiac arrest (OHCA) [...] Read more.
Background and Objectives: Despite advances in the treatment of heart diseases, the outcome of patients experiencing sudden cardiac arrest remains poor. The aim of our study was to determine the prehospital variables as predictors of survival outcomes in out-of-hospital cardiac arrest (OHCA) victims. Materials and Methods: This was a retrospective observational cohort study of OHCA cases. EMS protocols created in accordance with the Utstein style reporting for OHCA, first responder intervention reports, medical dispatch center dispatch protocols and hospital medical reports were all reviewed. Multivariate logistic regression was performed with the following variables: age, gender, witnessed status, location, bystander CPR, first rhythm, and etiology. Results: A total of 381 interventions with resuscitation attempts were analyzed. In more than half (55%) of them, bystander CPR was performed. Thirty percent of all patients achieved return of spontaneous circulation (ROSC), 22% of those achieved 30-day survival (7% of all OHCA victims), and 73% of those survived with Cerebral Performance Score 1 or 2. The logistic regression model of adjustment confirms that shockable initial rhythm was a predictor of ROSC [OR: 4.5 (95% CI: 2.5–8.1)] and 30-day survival [OR: 9.3 (95% CI: 2.9–29.2)]. Age was also associated (≤67 years) [OR: 3.9 (95% CI: 1.3–11.9)] with better survival. Conclusions: Elderly patients have a lower survival rate. The occurrence of bystander CPR in cardiac arrest remains alarmingly low. Shockable initial rhythm is associated with a better survival rate and neurological outcome compared with non-shockable rhythm. Full article
(This article belongs to the Special Issue Cardiopulmonary Resuscitation: Recent Advances and Future Challenges)
12 pages, 1386 KiB  
Article
Learning of Basic Life Support through the Flipped Classroom in Secondary Schoolchildren: A Quasi-Experimental Study with 12-Month Follow-Up
by Miguel Cons-Ferreiro, Marcos Mecias-Calvo, Vicente Romo-Perez and Rubén Navarro-Patón
Medicina 2023, 59(9), 1526; https://doi.org/10.3390/medicina59091526 - 23 Aug 2023
Viewed by 1028
Abstract
Background and Objectives: International institutions together with the World Health Organisation recommend the teaching of BLS in schools. Therefore, the objective of this research was to study the feasibility of teaching CPR and AED through the flipped classroom, exploring the medium- and [...] Read more.
Background and Objectives: International institutions together with the World Health Organisation recommend the teaching of BLS in schools. Therefore, the objective of this research was to study the feasibility of teaching CPR and AED through the flipped classroom, exploring the medium- and long-term retention of knowledge and practical skills among high school students. Materials and Methods: The sample consisted of 260 secondary schoolchildren (137 in the experimental group (EG) and 123 in the control group (CG)) between 12 and 14 years old (M = 12.75 ± 1.02). Results: The data revealed that the EG obtained better post-course results in the correct position of the hands (p = 0.011), the depth of external cardiac compression (p > 0.001), and the mean time to apply an effective shock with the AED (p = 0.013). The CG obtained better results in compressions with complete chest re-expansion (p = 0.025). These differences disappeared at 6 months (p > 0.05) and 12 months (p > 0.05). Conclusions: A training program based on the flipped classroom is as effective and viable as traditional training, although more efficient since it is applied in less time, in the sequence of action in BLS, CPR skills, and the application of an effective shock with an AED. Full article
(This article belongs to the Special Issue Cardiopulmonary Resuscitation: Recent Advances and Future Challenges)
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Review

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11 pages, 729 KiB  
Review
Common Complications and Cardiopulmonary Resuscitation in Patients with Left Ventricular Assist Devices: A Narrative Review
by Jerica Zaloznik Djordjevic, Timur Özkan, Eva Göncz, Jus Ksela, Martin Möckel and Matej Strnad
Medicina 2023, 59(11), 1981; https://doi.org/10.3390/medicina59111981 - 10 Nov 2023
Viewed by 1287
Abstract
Heart failure remains a major global burden regarding patients’ morbidity and mortality and health system organization, logistics, and costs. Despite continual advances in pharmacological and resynchronization device therapy, it is currently well accepted that heart transplantation and mechanical circulatory support represent a cornerstone [...] Read more.
Heart failure remains a major global burden regarding patients’ morbidity and mortality and health system organization, logistics, and costs. Despite continual advances in pharmacological and resynchronization device therapy, it is currently well accepted that heart transplantation and mechanical circulatory support represent a cornerstone in the management of advanced forms of this disease, with the latter becoming an increasingly accepted treatment modality due to the ongoing shortage of available donor hearts in an ever-increasing pool of patients. Mechanical circulatory support strategies have seen tremendous advances in recent years, especially in terms of pump technology improvements, indication for use, surgical techniques for device implantation, exchange and explantation, and postoperative patient management, but not in the field of treatment of critically ill patients and those undergoing cardiac arrest. This contemporary review aims to summarize the collected knowledge of this topic with an emphasis on complications in patients with left ventricular assist devices, their treatment, and establishing a clear-cut algorithm and the latest recommendations regarding out-of-hospital or emergency department management of cardiac arrest in this patient population. Full article
(This article belongs to the Special Issue Cardiopulmonary Resuscitation: Recent Advances and Future Challenges)
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11 pages, 293 KiB  
Review
How Can Out-of-Hospital Cardiac Arrest (OHCA) Data Collection in Slovenia Be Improved?
by Luka Petravić, Evgenija Burger, Urša Keše, Domen Kulovec, Rok Miklič, Eva Poljanšek, Gašper Tomšič, Tilen Pintarič, Miguel Faria Lopes, Ema Turnšek and Matej Strnad
Medicina 2023, 59(6), 1050; https://doi.org/10.3390/medicina59061050 - 30 May 2023
Cited by 1 | Viewed by 1554
Abstract
Background and Objectives: The prevalence of out-of-hospital cardiac arrest (OHCA) has been established as a significant contributor to mortality rates in developed nations. Due to the challenges associated with conducting controlled randomized trials, there exists a necessity for the collection of high-quality [...] Read more.
Background and Objectives: The prevalence of out-of-hospital cardiac arrest (OHCA) has been established as a significant contributor to mortality rates in developed nations. Due to the challenges associated with conducting controlled randomized trials, there exists a necessity for the collection of high-quality data to enhance the comprehension of the impact of interventions. Several nations have initiated efforts to gather information pertaining to out-of-hospital cardiac arrest (OHCA). The Republic of Slovenia has been collecting data from interventions; however, the variables and data attributes have not yet been standardized to comply with international standards. This lack of conformity poses a challenge in making comparisons or drawing inferences. The aim of this study is to identify how to better gather OHCA data in Slovenia. Materials and methods: The Utstein resuscitation registry protocol (UP) was compared to the Slovenian data points that must be gathered in accordance with the Rules on Emergency Medical Service (REMS) during interventions. In addition, we have proposed alternative measures of digitization to enhance pre-hospital data. Results: Missing data points and attribute mismatches were detected in Slovenia. Eight data points necessitated by the UP are gathered in several databases (hospitals, the National Institute of Public Health, dispatch services, intervention reports from first responders, and defibrillator files), but not in the mandated protocols based on REMS. Two data points have variables that do not match those of the UP. A total of 16 data points according to UP are currently not being collected in Slovenia. The advantages and potential drawbacks of digitizing emergency medical services have been discussed. Conclusions: The study has identified gaps in the methods employed for collecting data on OHCA in Slovenia. The assessment conducted serves as a basis for enhancing the process of data collection, integrating quality control measures across the nation, and establishing a nationwide registry for out-of-hospital cardiac arrest (OHCA) in Slovenia. Full article
(This article belongs to the Special Issue Cardiopulmonary Resuscitation: Recent Advances and Future Challenges)
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