EditorialResuscitation highlights in 2012
Section snippets
Epidemiology
An analysis of a nationwide registry in South Korea showed that poisonings were responsible for 4.4% of 20, 536 out-of-hospital cardiac arrest (OHCA) cases of non-cardiac aetiology.1 Poisons included insecticides (15.5%); herbicides (13.2%); unknown pesticides (19.9%); non-pesticide drugs (16.8%); and unknown poisons (6%). The survival to admission rate was 22.5% for insecticides, 3.2% for herbicides, 16.2% for unknown pesticides, 16.7% for non-pesticides and 11.3% for the unknown poisoning
Prevention
Resuscitation continues to be a leading journal for publications related to rapid response teams (RRTs) and systems and identification of the deteriorating patient. After expansion of the medical emergency system to include a mental health facility, it was shown that the rate of Medical Emergency Team (MET) calls to this facility was similar to that of a tertiary hospital; the staff needed to manage neurological and cardiovascular problems in particular.5
The ANZICS-CORE MET dose Investigators
Defibrillation
The value of a brief period of CPR before defibrillation continues to be studied. Whether a brief period of CPR during prolonged ventricular fibrillation (VF) restores high energy phosphates in the myocardium was studied using a rat model.15 After 4 min of untreated VF, just 2 min of CPR restored ATP levels to that of control rats not in cardiac arrest.
Using a porcine prolonged (8 min) VF model, the effect on oxygen metabolism and resuscitation outcomes of a shock-first versus strategy was
Resuscitation teams
There has been a steady growth in the number of studies examining the evaluation/auditing of resuscitation team performance. Investigators have used a variety of methods to document performance ranging from direct observation10, 18 and chart review19 downloads from CPR feedback/prompt devices,20, 21 audio recording,22 video recording,23, 24 analysis of transthoracic impedance,25, 26 ECG signals27 and capnography.28 Whilst most studies that have used these data for post event debriefing have
Quality of CPR
Important data on the quality of CPR and its relationship with outcome emerged during 2012. In a series of large, observational studies, new insights into optimal chest compression characteristics were identified. A relationship between chest compression rate and depth was identified first in a simulation study – faster chest compression rates compromised the ability to maintain adequate compression depth.36 These findings have been verified in subsequent human studies. Among 133 patients
Airway
The role of advanced airway techniques during CPR is controversial. Observational data from the North American ROC epistry compared tracheal intubation with one of the three supraglottic airway (SGA) devices: laryngeal tube (LT), Combitube, or laryngeal mask airway (LMA) for 10,455 OHCAs recruited to the ROC PRIMED trial.41 Survival to hospital discharge with modified Rankin score ≤3 was: intubation 4.7%, SGA 3.9%. Successful tracheal intubation was associated with increased survival to
Post cardiac arrest syndrome
The pathophysiology of the post cardiac arrest syndrome (PCAS) continues to be investigated. The endothelial glycocalyx is known to modulate vascular permeability and inflammation. In 25 post cardiac arrest patients, plasma levels of the glycocalyx components syndecan-1, heparan sulfate and hyaluronic acid increased compared with controls. This implies that shedding of the endothelial glycocalyx is a pathophysiological component of the PCAS.87 Coenzyme Q10 (ubiquinone) is a component of the
Prognostication
Prognostication in the comatose cardiac arrest survivor continues to be challenging and has been made potentially more difficult following widespread implementation of TH. A review of the history of prognostication in anoxic–ischaemic coma117 provides valuable background and sets the scene for eagerly anticipated revised guidelines.
In a retrospective analysis of 38 comatose PCAS patients treated with TH and continuous EEG monitoring (cEEG), 9 (23%) had electrographic seizures and 17 (48%) had
Cardiac arrest centres
There is a trend towards treating post cardiac arrest patients in cardiac arrest centres that can provide 24/7 cardiac catheterisation and that treat large numbers of such patients. Whether this results in better outcomes is unproven. In a Korean study of 27,662 OHCA patients without prehospital ROSC, a higher rate of survival to discharge was documented among patients who were transported to high-volume (4.78%) rather than low-volume centres (1.43%).124 The rate was still significantly higher
Conflict of interest statement
JPN is Editor-in-Chief of Resuscitation. GDP, JPO, MJAP and JS are Editors of Resuscitation. JO is on the Science Advisory Board for ZOLL Circulation and serves as Cardiac Co-Chair for the National Institutes of Health-sponsored Resuscitation Outcomes Consortium (ROC). He serves as the Virginia Commonwealth University Principal Investigator for the National Institutes of Health-sponsored Neurological Emergency Treatment Trials Network (NETT). JS is Co-Chair of the Advanced Life Support Task
References (126)
- et al.
Epidemiology and outcomes of poisoning-induced out-of-hospital cardiac arrest
Resuscitation
(2012) - et al.
Long-term prognosis following resuscitation from out-of-hospital cardiac arrest: role of aetiology and presenting arrest rhythm
Resuscitation
(2012) - et al.
Resuscitation of out-of-hospital cardiac arrests in residential aged care facilities in Melbourne, Australia
Resuscitation
(2012) - et al.
Expansion of a medical emergency team system to a mental health facility
Resuscitation
(2012) - et al.
Validation of an abbreviated Vitalpac Early Warning Score (ViEWS) in 75,419 consecutive admissions to a Canadian Regional Hospital
Resuscitation
(2012) - et al.
Differences in outcomes between ICU attending and senior resident physician led medical emergency team responses
Resuscitation
(2012) - et al.
Sifting through the heterogeneity of the rapid response system literature
Resuscitation
(2012) - et al.
Medication errors during medical emergencies in a large, tertiary care, academic medical center
Resuscitation
(2012) - et al.
Supporting the detection of patient deterioration: observation chart design affects the recognition of abnormal vital signs
Resuscitation
(2012) - et al.
Point-of-care testing during medical emergency team activations: a pilot study
Resuscitation
(2012)
S(p)O(2) values in acute medical admissions breathing air – implications for the British Thoracic Society guideline for emergency oxygen use in adult patients
Resuscitation
Is the Modified Early Warning Score (MEWS) superior to clinician judgement in detecting critical illness in the pre-hospital environment
Resuscitation
Timing and teamwork – an observational pilot study of patients referred to a rapid response team with the aim of identifying factors amenable to re-design of a rapid response system
Resuscitation
Impact of resuscitation system errors on survival from in-hospital cardiac arrest
Resuscitation
Evaluation of quantitative debriefing after pediatric cardiac arrest
Resuscitation
Resuscitation feedback and targeted education improves quality of pre-hospital resuscitation in Scotland
Resuscitation
The sounds of cardiac arrest: innovating to obtain an accurate record during in-hospital cardiac arrest
Resuscitation
Auditing resuscitation of preterm infants at birth by recording video and physiological parameters
Resuscitation
Video analysis of dispatcher–rescuer teamwork – effects on CPR technique and performance
Resuscitation
Assessment of CPR interruptions from transthoracic impedance during use of the LUCAS mechanical chest compression system
Resuscitation
Transthoracic impedance for the monitoring of quality of manual chest compression during cardiopulmonary resuscitation
Resuscitation
A new way to analyze resuscitation quality by reviewing automatic external defibrillator data
Resuscitation
Factors complicating interpretation of capnography during advanced life support in cardiac arrest – a clinical retrospective study in 575 patients
Resuscitation
Auditing resuscitation performance: innovating to improve practice
Resuscitation
Human factors in resuscitation teaching
Resuscitation
Team performance in resuscitation teams: comparison and critique of two recently developed scoring tools
Resuscitation
Rating medical emergency teamwork performance: development of the Team Emergency Assessment Measure (TEAM)
Resuscitation
Observational Skill-based Clinical Assessment tool for Resuscitation (OSCAR): development and validation
Resuscitation
The Simulation Team Assessment Tool (STAT): development, reliability and validation
Resuscitation
The impact of chest compression rates on quality of chest compressions – a manikin study
Resuscitation
Excessive chest compression rate is associated with insufficient compression depth in prehospital cardiac arrest
Resuscitation
Push hard and fast (but not too fast)
Resuscitation
Part 5: Adult basic life support: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations
Resuscitation
Endotracheal intubation versus supraglottic airway insertion in out-of-hospital cardiac arrest
Resuscitation
Out-of-hospital airway management and cardiac arrest outcomes: a propensity score matched analysis
Resuscitation
Impairment of carotid artery blood flow by supraglottic airway use in a swine model of cardiac arrest
Resuscitation
Anatomical relationships of the Air-Q supraglottic airway during elective MRI scan of brain and neck
Resuscitation
King LTS-D use by EMT-intermediates in a rural prehospital setting without intubation availability
Resuscitation
iGel supraglottic airway use during hospital cardiopulmonary resuscitation
Resuscitation
Supraglottic airway device preference and insertion speed in F1 doctors
Resuscitation
Emergency airway management in Japan: interim analysis of a multi-center prospective observational study
Resuscitation
The factors associated with successful paediatric endotracheal intubation on the first attempt in emergency departments: a 13-emergency-department registry study
Resuscitation
Expertise in prehospital endotracheal intubation by emergency medicine physicians – comparing ‘proficient performers’ and ‘experts’
Resuscitation
Comparison of different video laryngoscopes for emergency intubation in a standardized airway manikin with immobilized cervical spine by experienced anaesthetists. A randomized, controlled crossover trial
Resuscitation
Comparison of GlideScope((R)) versus Macintosh laryngoscope for the removal of a hypopharyngeal foreign body: a randomized cross-over cadaver study
Resuscitation
European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary
Resuscitation
Favourable survival of in-hospital compared to out-of-hospital refractory cardiac arrest patients treated with extracorporeal membrane oxygenation: an Italian tertiary care centre experience
Resuscitation
A 5-year experience with cardiopulmonary resuscitation using extracorporeal life support in non-postcardiotomy patients with cardiac arrest
Resuscitation
Emergency physician-initiated extracorporeal cardiopulmonary resuscitation
Resuscitation
Resuscitation of non-postcardiotomy cardiogenic shock or cardiac arrest with extracorporeal life support: the role of bridging to intervention
Resuscitation
Cited by (1)
Intensive care unit without walls: Seeking patient safety by improving the efficiency of the system
2014, Medicina IntensivaCitation Excerpt :This is a necessary measure, for despite structured organization and quality in management of cardiac arrest, the results obtained are disappointing, with a survival rate to Hospital discharge of about 17% according to the American Heart Association (AHA). In the case of an initial shockable rhythm, this figure increases to 37%, but drops to only 11% in the case of asystolia or pulseless electrical activity.23,24 It has been demonstrated that during the hours before a serious patient event occurs (aggravation or even cardiac arrest), detectable physiological changes have already developed.