Utility of Glucose Testing and Treatment of Hypoglycemia in Patients with Out-of-Hospital Cardiac Arrest
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Objective: Many emergency medical services (EMS) protocols for out-of-hospital cardiac arrests (OHCA) include point-of-care (POC) glucose measurement and administration of dextrose, despite limited knowledge of benefit. The objective of this study was to describe the incidence of hypoglycemia and dextrose administration by EMS in OHCA and subsequent patient outcomes.Methods: This was a retrospective analysis of OHCA in a large, regional EMS system from 2011 to 2017. Patients ≥18 years old with non-traumatic OHCA and attempted field resuscitation by paramedics were included. The primary outcomes were frequency of POC glucose measurement, hypoglycemia (glucose <60 mg/dl), and dextrose/glucagon administration (treatment group). The secondary outcomes included field return of spontaneous circulation (ROSC), survival to hospital discharge (SHD), and survival with good neurologic outcome.Results: There were 46,211 OHCAs during the study period of which 33,851 (73%) had a POC glucose test performed. Glucose levels were documented in 32,780 (97%), of whom 2,335 (7%) were hypoglycemic. Among hypoglycemic patients, 41% (959) received dextrose and/or glucagon. Field ROSC was achieved in 30% (286) of hypoglycemic patients who received treatment. Final outcome was determined for 1,714 (73%) of the hypoglycemic cases, of whom 120 (7%) had SHD and 66 (55%) had a good neurologic outcome. Of the 32,780 patients with a documented POC glucose result who were identified as hypoglycemic, only 27 (0.08%) received field treatment, and survived to discharge with good neurologic outcome. 48 (6%) of patients in the treatment group had SHD vs. 72 (8%) without treatment, risk difference -2.0% (95%CI -4.4%, 0.4%), p = 0.1.Conclusion: In this EMS system, POC glucose testing was common in adult OHCA, yet survival to hospital discharge with good neurologic outcome did not differ between patients treated and untreated for hypoglycemia. These results question the common practice of measuring and treating hypoglycemia in OHCA patients.The aim: Research aim is the evaluation of return of spontaneous circulation (ROSC) ratio among the individuals with out-of-hospital sudden cardiac arrest (SCA), depending on the so-called Telephone Cardiopulmonary Resuscitation (TCPR). T-CPR is based on live instruction given by the dispatcher to incident witness, who is performing CPR efforts until the EMS team arrives on scene. Material and methods: Research was based on the analysis of 782 entries (from EMS documentation) which recorded SCA and CPR. Emergency call voice recording has been rehearsed for each case, in order to confirm the capability of recognizing SCA and providing T-CPR instructions. Data was divided into two groups and the results have been compared. The ROSC ratio for both groups (“T-CPR” and “No T-CPR”) were analyzed along with the type of incident location. Results: The research has shown that 26,4% of all SCA cases researched ended up with the ROSC. In 94% of cases the dispatcher had succeeded in encouraging the witness to perform CPR with telephone instruction (T-CPR) until the EMS team has arrived. In the “T-CPR” group, 28,7% of cases have ended with ROSC. In the “No T-CPR” group, 19,7% of cases have ended with ROSC (28,7% vs. 19,7%). Conclusions: The T-CPR should be utilized by dispatcher in the form of uniform protocol. In the process of training dispatchers there should be special emphasis on the skill of recognizing SCA upon receiving a call. The evaluation of SCA recognition, T-CPR undertaken and ROSC ratio may be an effective indicator of quality monitoring within the State Emergency Medical System.
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Purpose: Effectiveness of cardiopulmonary resuscitation (CPR) is associated to return of spontaneous circulation (ROSC), but the alignment of the characteristics of compressions (rate and depth) to AHA recommendations has not been proven to improve outcome. In this study the power of the near infrared spectroscopy to discriminate productive CPR, i.e. chest compression sequences leading to ROSC, was evaluated. Material and methods: The cerebral oxygen saturation (rSO 2 ) measured in both cerebral lobules was recorded with the Nonin SenSmart 100X oximeter by Emergentziak-Osakidetza, the emergency service of the Basque Country, in the out-of-hospital cardiac arrest (OHCA). Concurrently, the ECG and bioimpedance were recorded by the Lifepak 15 desfibrillator. Chest compressions were delivered by Lucas 2 & Lucas 3 devices. Sequences of compressions longer than 30 s were extracted, and changes in the left (rSO 2,L ) and right (rSO 2,R ) lobes were automatically computed by signal processing. The increase of rSO2, measured every 4 s during the CPR-sequence, was adjusted with linear regression and compared for ROSC/no-ROSC patients as registered in the emergency department (ED). Results: Chest compression intervals were identified in the bioimpedance, and 403 CPR-segments were extracted from 115 patients (80 from 43 patients with ED-ROSC) with a mean(std) duration of 2.46(1.07) min. The median(IQR) increase of brain saturation per patient, rSO 2,L and rSO 2,R , were 2.1(1.1-5.5) and 1.9(0.9-3.8) points. The figure shows the linear adjustment of the evolutions for both ROSC/no-ROSC groups, with slopes of: 1.81 vs 1.23 min -1 for ΔrSO 2,L (p>0.05), 1.78 vs 0.95 min -1 (p<0.05) for ΔrSO 2,R, and 2.03 vs 1-08 min -1 (p<0.05) for the combination of both. Conclusions: Cerebral oximetry showed different evolution during mechanical chest compressions for patients with ED-ROSC. Significantly higher slopes in the rSO 2 evolution were observed for patients who achieved ROSC in OHCA.
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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.DATA SOURCES: Searches were conducted in MEDLINE, the ClinicalTrials.gov registry, and bibliographies on manufacturer websites for studies written in English.STUDY SELECTION: Selection criteria for the meta-analysis required that studies must be human controlled (randomized, historical, or case-control) investigations with confirmed out-of-hospital cases.DATA EXTRACTION: A total of 12 studies (load-distributing band cardiopulmonary resuscitation versus manual cardiopulmonary resuscitation = 8, piston-driven cardiopulmonary resuscitation versus manual cardiopulmonary resuscitation = 4), comprising a total of 6,538 subjects with 1,824 return of spontaneous circulation events, met the selection criteria.DATA SYNTHESIS: Random effects models were used to assess the relative effect of treatments on return of spontaneous circulation. Compared with manual cardiopulmonary resuscitation, load-distributing band cardiopulmonary resuscitation had significantly greater odds of return of spontaneous circulation (odds ratio, 1.62 [95% CI, 1.36, 1.92], p < 0.001). The treatment effect for piston-driven cardiopulmonary resuscitation was similar to manual cardiopulmonary resuscitation (odds ratio, 1.25 [95% CI, 0.92, 1.68];p = 0.151). The corresponding difference in percentages of return of spontaneous circulation rates from cardiopulmonary resuscitation was 8.3% for load-distributing band cardiopulmonary resuscitation and 5.2% for piston-driven cardiopulmonary resuscitation. Compared with manual cardiopulmonary resuscitation, combining both mechanical cardiopulmonary resuscitation devices produced a significant treatment effect in favor of higher odds of return of spontaneous circulation with mechanical cardiopulmonary resuscitation devices (odds ratio, 1.53 [95% CI, 1.32, 1.78], p < 0.001).CONCLUSION: The ability to achieve return of spontaneous circulation with mechanical chest compression devices is significantly improved when compared with manual chest compressions. In the case of load-distributing band cardiopulmonary resuscitation, it was superior to manual cardiopulmonary resuscitation as the odds of return of spontaneous circulation were over 1.6 times greater. The robustness of these findings should be tested in large randomized clinical trials. PMID: 23660728
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To determine the differences between the factors such as return of spontaneous circulation positivity, duration of cardiopulmonary resuscitation, and cardiac rhythm at first arrival affecting neurological outcomes in cardiac-arrest cases.This study was conducted at the Malatya State Hospital, Malatya, Turkey, from January to December 2014, and comprised patients who had received cardiopulmonary resuscitation. Patients were divided into two groups; in-hospital cardiac arrest and out-of-hospital cardiac arrest. The groups were compared in terms of gender, age, initial rhythm, cardiopulmonary resuscitation durations, cardiopulmonary resuscitation results (exitus, return), return of spontaneous circulation rates observed after cardiopulmonary resuscitation, and neurological outcome responses of the cases in which return of spontaneous circulation was observed. SPSS 22 was used for data analysis.Of the 321 cases, 88(27.41%) were in-hospital and 233(72.59%) were out-of-hospital cardiac arrest cases. Besides, 189(58.9%) of the patients were men and 132(41.1%) were women with an overall mean age of 67.21±15.25 years (range: 18-98 years). Moreover, 16(18.2%) in-hospital cases and 47(20.2%) out-of-hospital cases had shockable rhythms at the time of arrival. Cardiopulmonary resuscitation was applied to 74(23%) patients for less than 20 minutes and to 247(76.9%) for more than 20 minutes. Return of spontaneous circulation positivity was recorded in 134(41.7%) patients, of whom 62(70.5%) were in-hospital and 72(30.9%) were out-of-hospital cases. Moreover, 19(5.9%) patients were discharged with good neurological outcome. In cases where cardiopulmonary resuscitation was applied for less than 20 minutes, return of spontaneous circulation positivity was present in 43(100%) in-hospital and 31(100%) out-of-hospital cases. Return of spontaneous circulation positivity and good neurological outcome rate of the patients having shockable rhythms was 48(76.2%) and 8(12.7%), respectively.Return of spontaneous circulation positivity, favourable neurological outcome response and survival rates were significantly higher among in-hospital cardiac arrest cases.
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Abstract BackgroundNear-infrared spectroscopy (NIRS) provides regional tissue oxygenation (rSO 2 ) even in pulseless states such as out-of-hospital cardiac arrest (OHCA). Brain rSO 2 seems to be important predictor of return of spontaneous circulation (ROSC) during cardiopulmonary resuscitation (CPR). Aim of our study was to explore feasibility for monitoring and detecting changes of skeletal muscle rSO 2 during resuscitation.MethodsSkeletal muscle and brain rSO 2 were measured by NIRS (SenSmart Model X-100, Nonin, USA) during CPR in adult patient with OHCA. Start (basal) rSO 2 , maximal during CPR (maximal), difference between maximal-minimal rSO 2 (delta-rSO 2 ), and at the end of CPR (end-CPR rSO 2 ) were recorded. Patients were divided into ROSC and NO-ROSC group.Results20 patients (age: 66.0ys (60.5–79.5), 65% male) with OHCA (50% witnessed, 70% BLS, time to ALS 13.5min (11.0–19.0)) were finally analyzed. 10 patients were excluded due to violation of protocol or technical difficulties. ROSC was confirmed in 5 (25%) patients. Basal, maximal and end-CPR skeletal muscle rSO 2 were higher in ROSC compared to NO-ROSC group (49.0% (39.7–53.7) vs. 15.0% (12.0-25.2), p = 0.006; 76.0% (52.7–80.5) vs. 34.0% (18.0-49.5), p = 0.005; 72.0% (48.7–74.7) vs. 16.0% (12.0–35.0), p = 0.002, respectively). There was weak relationship between time of collapse and basal skeletal muscle rSO 2 in witnessed OHCA (n = 7, rho: -0.750, p = 0.0522). There was correlation between maximal skeletal muscle and brain rSO 2 (n = 18, rho: 0.578, P = 0.0121).ConclusionsRecording of skeletal muscle rSO 2 during CPR in patients with OHCA is feasible. Basal, maximal and end-CPR skeletal muscle rSO2 were higher in ROSC compared to NO-ROSC group.Clinical trial registration number:ClinicalTrials.gov, NCT04058925, registered on: 16th August 2019. URL of trial registry record: https://www.clinicaltrials.gov/ct2/show/NCT04058925?titles=Tissue+Oxygenation+During+Cardiopulmonary+Resuscitation+as+a+Predictor+of+Return+of+Spontaneous+Circulation&draw=2&rank=1
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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. Data Sources: Searches were conducted in MEDLINE, the ClinicalTrials.gov registry, and bibliographies on manufacturer websites for studies written in English. Study Selection: Selection criteria for the meta-analysis required that studies must be human controlled (randomized, historical, or case-control) investigations with confirmed out-of-hospital cases. Data Extraction: A total of 12 studies (load-distributing band cardiopulmonary resuscitation versus manual cardiopulmonary resuscitation = 8, piston-driven cardiopulmonary resuscitation versus manual cardiopulmonary resuscitation = 4), comprising a total of 6,538 subjects with 1,824 return of spontaneous circulation events, met the selection criteria. Data Synthesis: Random effects models were used to assess the relative effect of treatments on return of spontaneous circulation. Compared with manual cardiopulmonary resuscitation, load-distributing band cardiopulmonary resuscitation had significantly greater odds of return of spontaneous circulation (odds ratio, 1.62 [95% CI, 1.36, 1.92], p < 0.001). The treatment effect for piston-driven cardiopulmonary resuscitation was similar to manual cardiopulmonary resuscitation (odds ratio, 1.25 [95% CI, 0.92, 1.68];p = 0.151). The corresponding difference in percentages of return of spontaneous circulation rates from cardiopulmonary resuscitation was 8.3% for load-distributing band cardiopulmonary resuscitation and 5.2% for piston-driven cardiopulmonary resuscitation. Compared with manual cardiopulmonary resuscitation, combining both mechanical cardiopulmonary resuscitation devices produced a significant treatment effect in favor of higher odds of return of spontaneous circulation with mechanical cardiopulmonary resuscitation devices (odds ratio, 1.53 [95% CI, 1.32, 1.78], p < 0.001). Conclusion: The ability to achieve return of spontaneous circulation with mechanical chest compression devices is significantly improved when compared with manual chest compressions. In the case of load-distributing band cardiopulmonary resuscitation, it was superior to manual cardiopulmonary resuscitation as the odds of return of spontaneous circulation were over 1.6 times greater. The robustness of these findings should be tested in large randomized clinical trials.
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We have previously reported high ROSC rates and excellent survival in OHCA in our region [1,2]. Prehospital emergency physicians (anesthesiologists) take active part in most resuscitation. If ROSC is not achieved, resuscitation is terminated on the scene in most cases. We want to investigate factors linked to survival in the few patients transported with ongoing resuscitation to the hospital.
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Introduction: Cardiopulmonary arrest is a serious medical emergency that can be reversed with prompt and sufficient cardiopulmonary resuscitation (CPR). Out-of-hospital cardiac arrests (OHCA) occur on average at a rate of 60 per 100.000 people. Cardiopulmonary resuscitation must start immediately in order to achieve the desired outcome. Aim: To investigate the association between proximity to the emergency department and the return of spontaneous circulation (ROSC). Subjects and methods: This study is a single-center registry-based retrospective cohort study. All the patients from the cardiopulmonary resuscitation registry of the Emergency department of the Health Center Livno were included and divided into 2 groups: the patients who experienced cardiac arrest within a radius of less than five kilometers and the patients who experienced cardiac arrest within a radius of more than five kilometers. Results: Patients who experienced OHCA within a radius of less than five kilometers had an overall better prognosis for achieving ROSC (p=0.002). Even though men experienced cardiac arrest at a higher percentage (74.1 %) than women, there was no significant difference regarding the final outcome. The total incidence did not differ regarding the initial cardiac rhythm. Conclusion: Poviding prompt, sufficient CPR is essential for attaining the most favorable outcomes regarding OHCA. Keywords: Cardiopulmonary Resuscitation, Out-of-Hospital Cardiac Arrest, Return of Spontaneous Circulation
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We report return of spontaneous circulation (ROSC) and neurological outcome after inhospital Lund University Cardiac Arrest System cardiopulmonary resuscitation (LUCAS-CPR).
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