Elsevier

Resuscitation

Volume 84, Issue 2, February 2013, Pages 129-136
Resuscitation

Editorial
Resuscitation highlights in 2012

https://doi.org/10.1016/j.resuscitation.2013.01.002Get rights and content

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

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      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.

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