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High-quality cardiopulmonary resuscitation: current and future directions

5/3/2016

 
Foto
Current Opinion in Critical Care: June 2016;22(3):218-224.
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Purpose of review: Cardiopulmonary resuscitation (CPR) represents the cornerstone of cardiac arrest resuscitation care. Prompt delivery of high-quality CPR can dramatically improve survival outcomes; however, the definitions of optimal CPR have evolved over several decades. The present review will discuss the metrics of CPR delivery, and the evidence supporting the importance of CPR quality to improve clinical outcomes.
Recent findings: The introduction of new technologies to quantify metrics of CPR delivery has yielded important insights into CPR quality. Investigations using CPR recording devices have allowed the assessment of specific CPR performance parameters and their relative importance regarding return of spontaneous circulation and survival to hospital discharge. Additional work has suggested new opportunities to measure physiologic markers during CPR and potentially tailor CPR delivery to patient requirements.
Summary: Through recent laboratory and clinical investigations, a more evidence-based definition of high-quality CPR continues to emerge. Exciting opportunities now exist to study quantitative metrics of CPR and potentially guide resuscitation care in a goal-directed fashion. Concepts of high-quality CPR have also informed new approaches to training and quality improvement efforts for cardiac arrest care.
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Extracorporeal Cardiopulmonary Resuscitation (E-CPR) During Pediatric In-Hospital Cardiopulmonary Arrest Is Associated With Improved Survival to Discharge 

3/25/2016

 
Circulation. 2016;133:165-176. DOI: 10.1161/CIRCULATIONAHA.115.016082. 

Background: Although extracorporeal cardiopulmonary resuscitation (E-CPR) can result in survival after failed conventional CPR (C-CPR), no large, systematic comparison of pediatric E-CPR and continued C-CPR has been reported. 

Methods and Results: Consecutive patients <18 years old with CPR events ≥10 minutes in duration reported to the Get With the Guidelines–Resuscitation registry between January 2000 and December 2011 were identified. Hospitals were grouped by teaching status and location. Primary outcome was survival to discharge. Regression modeling was performed, conditioning on hospital groups. A secondary analysis was performed with the use of propensity score matching. Of 3756 evaluable patients, 591 (16%) received E-CPR and 3165 (84%) received C-CPR only. Survival to hospital discharge and survival with favorable neurological outcome (Pediatric Cerebral Performance Category score of 1–3 or unchanged from admission) were greater for E-CPR (40% [237 of 591] and 27% [133 of 496]) versus C-CPR patients (27% [862 of 3165] and 18% [512 of 2840]). Odds ratios (ORs) for survival to hospital discharge and survival with favorable neurological outcome were greater for E-CPR versus C-CPR. After adjustment for covariates, patients receiving E-CPR had higher odds of survival to discharge (OR, 2.80; 95% confidence interval, 2.13–3.69; P<0.001) and survival with favorable neurological outcome (OR, 2.64; 95% confidence interval, 1.91–3.64; P<0.001) than patients who received C-CPR. This association persisted when analyzed by propensity score–matched cohorts (OR, 1.70; 95% confidence interval, 1.33–2.18; P<0.001; and OR, 1.78; 95% confidence interval, 1.31–2.41; P<0.001, respectively]. 

​Conclusion: For children with in-hospital CPR of ≥10 minutes duration, E-CPR was associated with improved survival to hospital discharge and survival with favorable neurological outcome compared with C-CPR.
Klik hier voor link in PubMed

Trauma Care at a Multinational United Kingdom-Led Role 3 Combat Hospital: Resuscitation Outcomes From a Multidisciplinary Approach

11/10/2014

 
Mil Med. 2014 Nov;179(11):1258-62.  


Abstract:
Recent conflicts have led significant advancements in casualty care. Facilities serving combat wounded operate in challenging environments. Our purpose is to describe the multidisciplinary resuscitation algorithm utilized at a United Kingdom-led, Role 3 multinational treatment facility in Afghanistan focusing on injury severity and in-hospital mortality. Methods: Data were extracted from our prospectively collected trauma registry on military members wounded in action. Results: From November 1, 2009 to September 30, 2011, there were 3483 military trauma admissions. Common mechanisms of injury were improvised explosive devices (48%), followed by gunshot wounds (29%). Most patients (83.1%) had an Injury Severity Score (ISS) <15. For patients with complete ISS data, 8.4% had massive transfusion and 6.1% had an initial base deficit >5. Patients admitted with signs of life had a died of wounds rate of 1.8% with an average 1.2 day hospital stay. The mortality rate for patients undergoing massive transfusion was 4.8%, and for patients with a base deficit >5, mortality was 12.3%. Severely injured patients (ISS > 24) had a mortality rate of 16.5%. Conclusion: A systematic, multidisciplinary approach to trauma is associated with low in-hospital mortality. The outcomes in this study serve as a measure for future care in Role 3 facilities.
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Mechanical versus manual chest compressions in out-of-hospital cardiac arrest:  a meta analysis

6/16/2014

 

Critical Care Medicine: July 2013 - Volume 41 - Issue 7 - p 1782-1789

Westfall, Mark DO; Krantz, Steve EMT-P; Mullin, Christopher MS; Kaufman, Christopher PhD

Objective:  The objective of this study was to conduct a meta-analysis of literature examining rates of return of spontaneous circulation from load-distributing band and piston-driven chest compression devices as compared with manual cardiopulmonary resuscitation.

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