We investigated the effect on compression rate and depth of a conventional metronome and a voice metronome in simulated telephone-assisted, protocol-driven bystander Cardiopulmonary resucitation (CPR) compared to standard instruction.Thirty-six lay volunteers performed 10 minutes of compression-only CPR in a prospective, investigator-blinded, 3-arm study on a manikin. Participants were randomized either to standard instruction ("push down firmly, 5 cm"), a regular metronome pacing 110 beats per minute (bpm), or a voice metronome continuously prompting "deep-deepdeep- deeper" at 110 bpm. The primary outcome was deviation from the ideal chest compression target range (50 mm compression depth x 100 compressions per minute x 10 minutes = 50 m). Secondary outcomes were CPR quality measures (compression and leaning depth, rate, no-flow times) and participants' related physiological response (heart rate, blood pressure and nine hole peg test and borg scales score). We used a linear regression model to calculate effects.The mean (SD) deviation from the ideal target range (50 m) was -11 (9) m in the standard group, -20 (11) m in the conventional metronome group (adjusted difference [95%, CI], 9.0 [1.2-17.5 m], P=.03), and -18 (9) m in the voice metronome group (adjusted difference, 7.2 [-0.9-15.3] m, P=.08). Secondary outcomes (CPR quality measures and physiological response of participants to CPR performance) showed no significant differences.Compared to standard instruction, the conventional metronome showed a significant negative effect on the chest compression target range. The voice metronome showed a non-significant negative effect and therefore cannot be recommended for regular use in telephone-assisted CPR.Se investigó el efecto sobre la tasa y profundidad de compresión utilizando un metrónomo regular, un metrónomo de voz, en comparación con instrucciones estándar, siguiendo el protocolo de reanimación cardiopulmonar (RCP) por interviniente con asistencia telefónica.Treinta y seis individuos legos realizaron 10 minutos de compresiones de RCP sobre un maniquí en un estudio prospectivo, ciego. Los participantes fueron asignados al azar, ya sea en base a la instrucción estándar (empuje hacia abajo con firmeza 5 cm); a un metrónomo normal a un ritmo de 110 pulsaciones por minuto (ppm) o un metrónomo de voz incitando continuamente "profundo-profundo-profundo-más profunda" a 110 ppm. El objetivo primario fue evaluar la desviación del rango objetivo ideal de compresión torácica (50 mm de profundidad de compresión x 100 compresiones por minuto x 10 minutos = 50 m). Los objetivos secundarios fueron las mediciones de RCP de calidad (profundidad y tasa de compresiones, comprensiones que no generan flujo) y la respuesta fisiológica de los participantes (frecuencia cardiaca, presión arterial, Nine Hole Peg Test y Escala de Borg). Se utilizó un modelo de regresión lineal para calcular los resultados.En relación al objetivo primario, la desviación del rango objetivo ideal (50 metros) fue –11 (9) m en el grupo estándar versus –20 (11) m en el grupo de metrónomo regular (diferencia ajustada 9,0 (1,2-17,5) m, p = 0,03), y –18 (9) m en el grupo de metrónomo de voz [diferencia ajustada de 7,2 (–0,9 a 15,3) m, p = 0,08]. Los objetivos secundarios con respecto a las medidas de calidad de RCP y la respuesta fisiológica de los participantes durante la realización de RCP no mostraron diferencias significativas.El metrónomo normal y el metrónomo de voz mostraron un efecto negativo (significativo y no significativo respectivamente) en el rango objetivo de compresión torácica en comparación con la instrucción estándar y por lo tanto no puede ser recomendado su uso regular en la RCP asistida telefónicamente.
Background: The outcome of patients after OHCA has been poor. The probability of return of spontaneous circulation decreases over time. New therapeutic attempts like E-ECLS at the ED are tried to improve outcome of selected cases. The "Vienna Cardiac Arrest Registry" (VICAR) was introduced August 1, 2013 to collect Utstein-style data. Our aim was to identify those patients which might fulfill ‘load&go’ criteria for E-ECLS at the ED after OHCA. Methods: Therefore VICAR was retrospectively analysed for following criteria: age<75a;witnessed OHCA; basic life support (BLS); ventricular fibrillation/ventricular tachycardia (VF/VT); no return of spontaneous circulation (ROSC) within 15min CPR by EMS. Patients had to fulfill all these criteria. Results: Overall 701 patients were registered from August 1, 2013 to April 30, 2014. Excluded were because of poor documentation 26(4%) patients, because of missing criteria data 49(7%) and because they were younger than 18 years 7 (1%). The final analysis included 619(88%) patients; of those 68(11%) were transported under ongoing CPR to the ED. Moreover E-ECLS was applied in 15 patients at the ED. Conclusion: We found 30 (5%) patients to fulfill ’load & go’ criteria. Of 68 patients, who were transported with ongoing CPR to the ED only 8 (8%) met the criteria. Further promotion of these criteria within the ambulance crews is needed. Maybe these criteria could then serve as a decision support for emergency physicians/paramedics, which patients to transport under ongoing CPR to the ED for E-ECLS.
While guidelines mentioned supraglottic airway management in the case of out-of- hospital cardiac arrest, robust data of their impact on the patient outcome remain scare and results are inconclusive.To assess the impact of the airway strategy on the patient outcome we prospectively enrolled 2224 individuals suffering cardiac arrest who were treated by the Viennese municipal emergency medical service. To control for potential confounders, propensity score matching was performed. Patients were matched in four groups with a 1:1:1:1 ratio ( n=210/group) according to bag-mask-valve, laryngeal tube, endotracheal intubation and secondary endotracheal intubation after primary laryngeal tube ventilation.The laryngeal tube subgroup showed the lowest 30-day survival rate among all tested devices ( p<0.001). However, in the case of endotracheal intubation after primary laryngeal tube ventilation, survival rates were comparable to the primary endotracheal tube subgroup. The use of a laryngeal tube was independently and directly associated with mortality with an adjusted odds ratio of 1.97 (confidence interval: 1.14-3.39; p=0.015). Additionally, patients receiving laryngeal tube ventilation showed the lowest rate of good neurological performance (6.7%; p<0.001) among subgroups. However, if patients received endotracheal intubation after initial laryngeal tube ventilation, the outcome proved to be significantly better (9.5%; p<0.001).We found that the use of a laryngeal tube for airway management in cardiac arrest was significantly associated with poor 30-day survival rates and unfavourable neurological outcome. A primary endotracheal airway management needs to be considered at the scene, or an earliest possible secondary endotracheal intubation during both pre-hospital and in-hospital post-return of spontaneous circulation critical care seems crucial and most beneficial for the patient outcome.
The purpose of this study was to demonstrate the feasibility of a combined cooling strategy started out of hospital as an adjunctive to percutaneous coronary intervention (PCI) in the treatment of ST-elevation acute coronary syndrome (STE-ACS).Non-randomised, single-centre feasibility trial.Department of emergency medicine of a tertiary-care facility, Medical University of Vienna, Vienna, Austria. In cooperation with the Municipal ambulance service of the city of Vienna.Consecutive patients with STE-ACS presenting to the emergency medical service within 6 h after symptom onset.Cooling was initiated with surface cooling pads in the out-of-hospital setting, followed by the administration of 1000-2000 mL of cold saline at hospital arrival and completed by endovascular cooling in the catheterisation laboratory.Feasibility of lowering core temperature below 35.0°C prior to immediately performed revascularisation. Safety and tolerability of the cooling procedure.In enrolled 19 patients (one woman, median age 51 years (IQR 45-59)), symptom onset to first medical contact (FMC) was 45 min (IQR 31-85). A core temperature below 35.0°C at reperfusion of the culprit lesion was achieved in 11 patients (78%) within 100 min (IQR 90-111) after FMC without any cooling-related serious adverse event. Temperature could be lowered from baseline 36.4°C (IQR 36.2-36.5°C) to 34.4°C (IQR 34.1-35.0°C) at the time of reperfusion.With limitations an immediate out-of-hospital therapeutic hypothermia strategy was feasible and safe in patients with STE-ACS undergoing primary PCI.http://www.clinicaltrials.gov/ct2/show/NCT01864343; clinical trials unique identifier: NCT01864343.
Cardiac arrest (CA) is still associated with high mortality and morbidity. Data on the changes in management and outcomes over a long period of time are limited. Using data from a single emergency department (ED), we assessed changes over two decades.In this single-center observational study, we prospectively included 4133 patients receiving cardiopulmonary resuscitation and being admitted to the ED of a tertiary care hospital between January 1992 and December 2012.There was a significant improvement in both 6-month survival rates (+10.8%; p < 0.001) and favorable neurological outcome (+4.7%; p < 0.001). While the number of witnessed CA cases decreased (-4.7%; p < 0.001) the proportion of patients receiving bystander basic life support increased (+8.3%; p < 0.001). The proportion of patients with initially shockable ECG rhythms remained unchanged, but cardiovascular causes of CA decreased (-9.6%; p < 0.001). Interestingly, the time from CA until ED admission increased (+0.1 hours; p = 0.024). The use of percutaneous coronary intervention and therapeutic hypothermia were significantly associated with survival.Outcomes of patients with CA treated at a specialized ED have improved significantly within the last 20 years. Improvements in every link in the chain of survival were noted.
