Objective Healthcare providers frequently spend excessive time identifying a pulse and have difficulties in precisely verifying its existence. Point-of-care carotid artery ultrasound has been suggested as a potential substitute technique for pulse checks. This study aimed to evaluate the effectiveness of manual pulse checks, 2D carotid ultrasonography (USG), and rapid increases in endtidal carbon dioxide (EtCO2) levels in determining the return of spontaneous circulation (ROSC) in patients who experienced a cardiac arrest in an emergency department (ED).
Methods The study was designed as a single-center, prospective, observational study. Non-traumatic adult patients in cardiopulmonary arrest who were brought to the ED were included. Upon identifying cardiac arrest, the following data were recorded: the initial arrest rhythm, ultrasonographic and manual pulse evaluations, EtCO2 levels, resuscitation period, and vital signs post-ROSC. Team leaders’ judgement used for adjudication of ROSC used as the reference standart.
Results The investigation included 88 patients with a total of 642 CPR cycles administered to who suffered cardiopulmonary arrest. AUC values of the USG, EtCO2 and manual pulse checks were 0.974, 0.802 and 0.862 (p<0.001, p<0.001, p<0.001, respectively). AUC comparisons of USG vs manual pulse check and EtCO2 were significantly different, while manual pulse checks vs EtCO2 had no significant difference (p=0.001, p<0.001, p=0.167, respectively). The sensitivity of bedside USG for detecting carotid pulse was found to be 93.8%, with a specificity of 100%.
Conclusion This study suggests that 2D carotid ultrasonography can be effectively utilized for detecting pulses in patients suffering cardiopulmonary arrest.
Background Rescuer posture, position, and patient height during chest compressions (CC) influence its efficacy and efficiency. No clear recommendations exist on these aspects. It is essential to systematize the existing knowledge, especially for nurses and healthcare providers involved in resuscitation.
Purpose: To conduct a systematic review about the impact of rescuer posture, position, and manikin/patient height on CC efficacy and efficiency.
Methods The study followed PRISMA guidelines and was registered on PROSPERO. Eligibility criteria included peer-reviewed articles or conference papers comparing different rescuer postures, positions, or manikin/patient heights during CC performed with both hands, regarding efficacy or efficiency. Databases consulted: MEDLINE Complete, SPORTDiscus, Cochrane Reviews, and CINAHL Complete. Methodological quality was assessed using the Quality Assessment Tool for Quantitative Studies.
Results Of 6539 articles, only 34 met inclusion criteria. All were observational, used manikins, and were classified as weak in global methodological quality. Compared with standing, several studies suggested the kneeling posture may be associated with more effective and efficient CC. Evidence regarding the optimal patient height, including potential anthropometric-based adjustments, remains limited. Findings across the included studies indicated that variations in hand position appeared to have minimal influence on CC quality. Some studies reported decreased CC quality when rescuers performed CC while walking.
Conclusions The available evidence suggested that performing CC while kneeling on a firm surface may be beneficial when feasible. Future research is needed to further evaluate the impact of bed height, self-selected rescuer position, and their relevance to emergency practice.
Objective We investigated the possible association between lower serum lactate to albumin ratio upon hospital arrival and out-of-hospital cardiac arrest (OHCA) outcome.
Methods Records from the Japanese Association for Acute Medicine–Out-of-Hospital Cardiac Arrest (JAAM-OHCA) Registry were used for this multicenter observational study. Enrolled patients were ≥18 years old with OHCA of medical etiology who were hospitalized after spontaneous circulation returned between June 1, 2014, and December 31, 2021. We excluded those with missing data or those who failed to meet predefined inclusion criteria. The primary outcome was a cerebral performance category scale of 1 or 2 which indicated 30-day survival with favorable neurological outcome. Patients were divided into quartiles based on serum lactate to albumin ratios. The multivariable logistic regression analysis included adjustment for multiple factors.
Results Data from 4,413 patients were analyzed. The primary outcome was achieved by 558 of 1,104 patients (50.5%) in the first quartile (lactate to albumin ratio, ≤2.23), 240 of 1,111 patients (21.6%) in the second quartile (lactate to albumin ratio >2.23–3.39), 96 of 1,096 patients (8.8%) in the third quartile (lactate to albumin ratio >3.39–4.70), and 24 of 1,102 patients (2.2%) in the fourth quartile (lactate to albumin ratio, >4.70). Adjusted odds ratios (95% confidence intervals) for the primary outcome in the second, third, and fourth quartile compared with the first quartile were 0.33 (0.26–0.42), 0.19 (0.14–0.26), and 0.07 (0.04–0.11), respectively.
Conclusion A statistically significant association between categorization in the lower lactate to albumin ratio quartile group and favorable neurological outcome after OHCA was identified.
Objective To determine whether a transesophageal echocardiography (TEE) probe can accurately measure temperature and be used to monitor temperature changes over time without overheating in an experimental model of hypothermia and rewarming.
Methods A 6-L water bath was heated with a sous vide immersion circulator to 24, 28, 32, and 36 °C to simulate severe hypothermia, moderate hypothermia, mild hypothermia, and normothermia, respectively. A TEE probe, esophageal temperature probe, and bladder temperature probe were used to measure temperature every 60 seconds for 15 minutes.
Results The TEE probe reported temperatures with a mean difference of 0.60 °C (95% confidence interval [CI], 0.51 to 0.69 °C) compared to the sous vide immersion circulator. The esophageal probe and bladder probe reported temperatures with a mean difference of –0.19 °C (95% CI, –0.23 to –0.14 °C) and –0.20 °C (95% CI, –0.26 to –0.14 °C), respectively.
Conclusion During this simulation, the TEE tip temperature did not increase beyond the expected changes produced by water temperature. The probe temperature was less accurate than the esophageal and bladder temperature probes but demonstrated precision in monitoring temperature changes and stable hypothermia. Based on this study, TEE probes should not be relied upon for an accurate initial temperature but can likely be used to monitor changes in temperature over time.
This bibliometric analysis of the 100 most cited articles on experimental cardiac arrest models in rats identifies key contributors, publication trends, research themes, and collaboration networks. A comprehensive literature search of the Web of Science database was performed on June 11, 2024, using keywords related to cardiac arrest and rat models. The top 100 most cited articles were analyzed using the biblioshiny web application from the bibliometrix R ver. 4.2.3 and categorized by primary research focus. The articles were published from 1980 to 2022 and involved 416 authors and 44 journals, averaging 106.7 citations each. The primary research themes were neurology (72%), organ transplantation (7%), cardiovascular system (6%), Cardiopulmonary resuscitation outcomes after local anesthetic toxicity (4%), and other topics (5%). The United States, Japan, and Germany were leading contributors. Major clusters identified include “cerebral ischemia and outcomes,” “brain imaging metrics,” and “blood brain barrier.” The most commonly used methodologies for cardiac arrest induction were asphyxia, induction by magnesium or potassium chloride, and electrical stimulation. This first bibliometric analysis on this topic reveals the dominance of neuroscience in experimental cardiac arrest models in rats. High-impact journals such as the Journal of Cerebral Blood Flow and Metabolism play critical roles in disseminating significant research. The study highlights substantial gaps in global research engagement, with minimal contributions from lower income countries and few international collaborations. This analysis provides a roadmap for future research and opportunities for more extensive international and interdisciplinary collaboration, always with a focus on scientific rigor.
Objective This study assessed the efficacy of electrocardiogram (ECG) compared to pulse oximetry (PO) in detecting heart rate (HR) during high-risk newborn resuscitation. Methods A prospective observational study was performed with high-risk delivery cases to measure the time required for HR detection. A conventional PO and a standard ECG monitor were used for HR assessment. Results Forty-one infants were analyzed in the study, and 11 needed resuscitation. The study population was divided according to gestational age (GA): 9 were GA <32 weeks, 28 were GA 32–35 weeks, and 4 were GA ≥36 weeks. Time from ECG placement to HR detection (median, 30 seconds; interquartile range [IQR], 20–43.5 seconds) was significantly faster than that from PO placement (median, 125 seconds; IQR, 100–175 seconds; P<0.001). Time from ECG placement to HR detection was shortest in infants with GA <32 weeks at birth (19 seconds [IQR, 11.5–30.0] for GA <32 weeks vs. 34.5 seconds [IQR, 25.0–44.3] for GA 32–35 weeks vs. 39.5 seconds [IQR, 30.0–64.8] for GA ≥36 weeks; P=0.039). Conclusion ECG effectively evaluated HR during neonatal resuscitation compared to PO. Low- GA infants who require resuscitation may benefit from HR evaluation with nearby standard ECG.
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While nonocclusive mesenteric ischemia (NOMI) has been reported in a significant percentage of adults who were resuscitated after cardiac arrest, it is rare in children. This report presents the first known Japanese case of pediatric NOMI after return of spontaneous circulation following cardiac arrest. A 16-month-old boy experienced cardiac arrest due to asphyxiation from foreign bodies in the airway. After receiving 10 doses of adrenaline, with a maximum arrest time of 95 minutes, the patient achieved return of spontaneous circulation. However, 40 hours after onset, the patient developed NOMI, resulting in refractory hypotensive shock with decreased blood pressure, distended abdomen, and increased intravesical pressure. The patient was successfully rescued with two laparotomies and was discharged. Although NOMI is uncommon in children, appropriate treatment can be lifesaving.
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Objective Given the lack of a unified tool for appraising the quality of educational resources for lay-rescuer delivery of adult basic life support (BLS), this study aimed to develop an appropriate evaluation checklist based on a consensus of international experts.
Methods In a two-round Delphi study, participating experts completed questionnaires to rate each item of a predeveloped 72-item checklist indicating agreement that an item should be utilized to evaluate the conformance of an adult BLS educational resource with resuscitation guidelines. Consensus on item inclusion was defined as a rating of ≥7 points from ≥75% of experts. Experts were encouraged to add anonymous suggestions for modifying or adding new items.
Results Of the 46 participants, 42 (91.3%) completed the first round (representatives of 25 countries with a median of 16 years of professional experience in resuscitation) and 40 (87.0%) completed the second round. Thirteen of 72 baseline items were excluded, 55 were included unchanged, four were included after modification, and four new items were added. The final checklist comprises 63 items under the subsections “safety” (one item), “recognition” (nine items), “call for help” (four items), “chest compressions” (12 items), “rescue breathing” (12 items), “defibrillation” (nine items), “continuation of CPR” (two items), “choking” (10 items) and “miscellaneous” (four items).
Conclusion The produced checklist is a ready-to-use expert consensus–based tool for appraising the quality of educational content on lay-rescuer provision of adult BLS. The checklist gives content developers a tool to ensure educational resources comply with current resuscitation knowledge, and may serve as a component of a prospective standardized international framework for quality assurance in resuscitation education.
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Sung Phil Chung, Youdong Sohn, Jisook Lee, Youngsuk Cho, Kyoung-Chul Cha, Ju Sun Heo, Ai-Rhan Ellen Kim, Jae Guk Kim, Han-Suk Kim, Hyungoo Shin, Chiwon Ahn, Ho Geol Woo, Byung Kook Lee, Yong Soo Jang, Yu Hyeon Choi, Sung Oh Hwang, on behalf of the Guideline Committee of the Korean Association of Cardiopulmonary Resuscitation (KACPR)
Clin Exp Emerg Med 2023;10(4):382-392. Published online August 25, 2023
Considerable evidence has been published since the 2020 Korean Cardiopulmonary Resuscitation Guidelines were reported. The International Liaison Committee on Resuscitation (ILCOR) also publishes the Consensus on CPR and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR) summary annually. This review provides expert opinions by reviewing the recent evidence on CPR and ILCOR treatment recommendations. The authors reviewed the CoSTR summary published by ILCOR in 2021 and 2022. PICO (patient, intervention, comparison, outcome) questions for each topic were reviewed using a systemic or scoping review methodology. Two experts were appointed for each question and reviewed the topic independently. Topics suggested by the reviewers for revision or additional description of the guidelines were discussed at a consensus conference. Forty-three questions were reviewed, including 15 on basic life support, seven on advanced life support, two on pediatric life support, 11 on neonatal life support, six on education and teams, one on first aid, and one related to COVID-19. Finally, the current Korean CPR Guideline was maintained for 28 questions, and expert opinions were suggested for 15 questions.
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