Resuscitation 2015

Treatment


1. Resuscitation. 2015 Sep;94:91-7. doi: 10.1016/j.resuscitation.2015.07.002. Epub
2015 Jul 17.

Mechanical chest compression for out of hospital cardiac arrest: Systematic
review and meta-analysis.

Gates S(1), Quinn T(2), Deakin CD(3), Blair L(4), Couper K(5), Perkins GD(6).

Author information: 
(1)Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK.
Electronic address: s.gates@warwick.ac.uk. (2)School of Health Sciences, Faculty
of Health and Medical Sciences, Duke of Kent Building, University of Surrey,
Guildford GU2 7XH, UK; Surrey Perioperative, Anaesthetic and Critical Care
Collaborative Research Group, Surrey Health Partners, Egerton Road, Guildford GU2
8DR, UK. (3)South Central Ambulance Service NHS Foundation Trust, Otterbourne,
UK; NIHR Southampton Respiratory Biomedical Research Unit, University Hospital
Southampton NHS Foundation Trust, Southampton, Hampshire, UK. (4)North East
Ambulance Service NHS Foundation Trust, Bernicia House, Goldcrest Way, Newburn
Riverside, Newcastle upon Tyne NE15 8NY, UK. (5)Warwick Clinical Trials Unit,
University of Warwick, Coventry CV4 7AL, UK; Academic Department of Anaesthesia, 
Critical Care, Pain and Resuscitation, Heart of England NHS Foundation Trust,
Birmingham B9 5SS, UK. (6)Warwick Clinical Trials Unit, University of Warwick,
Coventry CV4 7AL, UK.

AIM: To summarise the evidence from randomised controlled trials of mechanical
chest compression devices used during resuscitation after out of hospital cardiac
arrest.
METHODS: Systematic review of studies evaluating the effectiveness of mechanical
chest compression. We included randomised controlled trials or cluster randomised
trials that compared mechanical chest compression (using any device) with manual
chest compression for adult patients following out-of-hospital cardiac arrest.
Outcome measures were return of spontaneous circulation, survival of event,
overall survival, survival with good neurological outcome. Results were combined
using random-effects meta-analysis.
DATA SOURCES: Studies were identified by searches of electronic databases,
reference lists of other studies and review articles.
RESULTS: Five trials were included, of which three evaluated the LUCAS or LUCAS-2
device and two evaluated the AutoPulse device. The results did not show an
advantage to the use of mechanical chest compression devices for survival to
discharge/30 days (average OR 0.89, 95% CI 0.77, 1.02) and survival with good
neurological outcome (average OR 0.76, 95% CI 0.53, 1.11).
CONCLUSIONS: Existing studies do not suggest that mechanical chest compression
devices are superior to manual chest compression, when used during resuscitation
after out of hospital cardiac arrest.

Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights
reserved.

PMID: 26190673  [PubMed - in process]


2. Resuscitation. 2015 Oct 5. pii: S0300-9572(15)00817-5. doi:
10.1016/j.resuscitation.2015.09.396. [Epub ahead of print]

Temperature Management After Cardiac Arrest An Advisory Statement by the Advanced
Life Support Task Force of the International Liaison Committee on Resuscitation
and the American Heart Association Emergency Cardiovascular Care Committee and
the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.

Donnino MW, Andersen LW, Berg KM, Reynolds JC, Nolan JP, Morley PT, Lang E,
Cocchi MN, Xanthos T, Callaway CW, Soar J; FRCA; FFICM; FRCP; ILCOR ALS Task
Force.

For more than a decade, mild induced hypothermia (32°C-34°C) has been standard of
care for patients remaining comatose after resuscitation from out-of-hospital
cardiac arrest with an initial shockable rhythm, and this has been extrapolated
to survivors of cardiac arrest with initially nonshockable rhythms and to
patients with in-hospital cardiac arrest. Two randomized trials published in 2002
reported a survival and neurologic benefit with mild-induced hypothermia. One
recent randomized trial reported similar outcomes in patients treated with
targeted temperature management at either 33°C or 36°C. In response to these new
data, the International Liaison Committee on Resuscitation (ILCOR) Advanced Life
Support (ALS) Task Force performed a systematic review to evaluate 3 key
questions: (1) Should mild induced hypothermia (or some form of targeted
temperature management) be used in comatose post-cardiac arrest patients? (2) If
used, what is the ideal timing of the intervention? (3) If used, what is the
ideal duration of the intervention? The Task Force used GRADE (Grading of
Recommendations Assessment, Development and Evaluation) methodology to assess and
summarize the evidence, and to provide a consensus on science statement and
treatment recommendations. The Task Force recommends targeted temperature
management for adults with out-of-hospital cardiac arrest with an initial
shockable rhythm at a constant temperature between 32°C and 36°C for at least
24hours. Similar suggestions are made for out-of-hospital cardiac arrest with a
nonshockable rhythm and in-hospital cardiac arrest. The Task Force recommends
against prehospital cooling with rapid infusion of large volumes of cold
intravenous fluid. Additional and specific recommendations are provided in the
document.

Copyright © 2015. Published by Elsevier Ireland Ltd.

PMID: 26449873  [PubMed - as supplied by publisher]


3. Resuscitation. 2015 Nov;96:66-77. doi: 10.1016/j.resuscitation.2015.07.036. Epub
2015 Aug 3.

Cardiopulmonary resuscitation quality and patient survival outcome in cardiac
arrest: A systematic review and meta-analysis.

Talikowska M(1), Tohira H(2), Finn J(3).

Author information: 
(1)Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School
of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA,
Australia. Electronic address: milena.talikowska@postgrad.curtin.edu.au.
(2)Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School
of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA,
Australia. (3)Prehospital, Resuscitation and Emergency Care Research Unit
(PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University,
Bentley, WA, Australia; St. John Ambulance, Western Australia, Belmont, WA,
Australia; School of Public Health and Preventive Medicine, Monash University,
Melbourne, VIC, Australia.

AIM: To conduct a systematic review and meta-analysis to determine whether
cardiopulmonary resuscitation (CPR) quality, as indicated by parameters such as
chest compression depth, compression rate and compression fraction, is associated
with patient survival from cardiac arrest.
METHODS: Five databases were searched (MEDLINE, Embase, CINAHL, Scopus and
Cochrane) as well as the grey literature (MedNar). To satisfy inclusion criteria,
studies had to document human cases of in- or out-of hospital cardiac arrest
where CPR quality had been recorded using an automated device and linked to
patient survival. Where indicated (I(2)<75%), meta-analysis was undertaken to
examine the relationship between individual CPR quality parameters and either
survival to hospital discharge (STHD) or return of spontaneous circulation
(ROSC).
RESULTS: Database searching yielded 8,842 unique citations, resulting in the
inclusion of 22 relevant articles. Thirteen were included in the meta-analysis.
Chest compression depth was significantly associated with STHD (mean difference
(MD) between survivors and non-survivors 2.59mm, 95% CI: 0.71, 4.47); and with
ROSC (MD 0.99mm, 95% CI: 0.04, 1.93). Within the range of approximately
100-120compressions per minute (cpm), compression rate was significantly
associated with STHD; survivors demonstrated a lower mean compression rate than
non-survivors (MD -1.17 cpm, 95% CI: -2.21, -0.14). Compression fraction could
not be examined by meta-analysis due to high heterogeneity, however a higher
fraction appeared to be associated with survival in cases with a shockable
initial rhythm.
CONCLUSIONS: Chest compression depth and rate were associated with survival
outcomes. More studies with consistent reporting of data are required for other
quality parameters.

Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

PMID: 26247143  [PubMed - in process]


4. Resuscitation. 2015 Aug;93:20-6. doi: 10.1016/j.resuscitation.2015.05.007. Epub
2015 May 23.

Endotracheal intubation versus supraglottic airway placement in out-of-hospital
cardiac arrest: A meta-analysis.

Benoit JL(1), Gerecht RB(2), Steuerwald MT(2), McMullan JT(2).

Author information: 
(1)University of Cincinnati, College of Medicine, Department of Emergency
Medicine, 231 Albert Sabin Way PO Box 670769, Cincinnati, OH, 45267-0769, USA.
Electronic address: justin.benoit@uc.edu. (2)University of Cincinnati, College of
Medicine, Department of Emergency Medicine, 231 Albert Sabin Way PO Box 670769,
Cincinnati, OH, 45267-0769, USA.

OBJECTIVE: Overall survival from out-of-hospital cardiac arrest (OHCA) is less
than 10%. After initial bag-valve mask ventilation, 80% of patients receive an
advanced airway, either by endotracheal intubation (ETI) or placement of a
supraglottic airway (SGA). The objective of this meta-analysis was to compare
patient outcomes for these two advanced airway methods in OHCA patients treated
by Emergency Medical Services (EMS).
METHODS: A dual-reviewer search was conducted in PubMed, Scopus, and the Cochrane
Database to identify all relevant peer-reviewed articles for inclusion in the
meta-analysis. Exclusion criteria were traumatic arrests, pediatric patients,
physician/nurse intubators, rapid sequence intubation, video devices, and older
airway devices. Outcomes were (1) return of spontaneous circulation (ROSC), (2)
survival to hospital admission, (3) survival to hospital discharge, and (4)
neurologically intact survival to hospital discharge. Results were adjusted for
covariates when available and combined using the random effects model.
RESULTS: From 3,454 titles, 10 observational studies fulfilled all criteria,
representing 34,533 ETI patients and 41,116 SGA patients. Important covariates
were similar between groups. Patients who received ETI had statistically
significant higher odds of ROSC (odds ratio [OR] 1.28, 95% confidence interval
[CI] 1.05-1.55), survival to hospital admission (OR 1.34, CI 1.03-1.75), and
neurologically intact survival (OR 1.33, CI 1.09-1.61) compared to SGA. Survival
to hospital discharge was not statistically different (OR 1.15, CI 0.97-1.37).
CONCLUSIONS: Patients with OHCA who receive ETI by EMS are more likely to obtain
ROSC, survive to hospital admission, and survive neurologically intact when
compared to SGA.

Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

PMID: 26006743  [PubMed - in process]

Diagnostic

 

Review

None

Clinical Prediction Rules

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