Homicide Manner-of-Death Classification in Arrest-Related Death.

Multiple studies have documented various factors that influence or determine forensic pathologist classification of manner of death. There do not appear to be any published studies on manner of death classification specifically regarding arrest-related deaths (ARDs). The goal of this study was to consider a large body of cases of nonfirearm ARDs to analyze the homicide classification with regards to numerous decedent and practitioner (medical examiner/coroner [ME/C]) variables.

Inhomogeneity and temporal effects in AutoPulse Assisted Prehospital International Resuscitation--an exception from consent trial terminated early.

Background: The ASPIRE trial (AutoPulse Assisted Prehospital International Resuscitation) was multicenter exception from consent clinical trial that compared mechanical cardiopulmonary resuscitation (CPR) with a device (AutoPulse-CPR) to traditional manual CPR (manual-CPR) in out-of-hospital cardiac arrest. Enrollment was suspended early due to safety concerns. One site (site C) made a potentially important protocol change midtrial, and enrollment at that site was noted to be independently associated with outcome.

Medical device design process.

The current design process is a combination of methods from engineering disciplines, government regulatory agencies (domestic and international) and independent certification and compliance companies. The goal of the processes that have been developed is to be certain that a new product meets the users expectations, is safe and effective in providing its claimed benefits. As products have become more complex and particularly with regard to software control it has become increasingly more difficult to determine the safety and efficacy of a product by inspection or after the fact testing alone.

Medium voltage therapy for preventing and treating asystole and PEA in ICDs.

Introduction: Sudden cardiac death (SCD) takes up to 500,000 lives each year before a victim can even be treated. To address this the implantable cardioverter defibrillator (ICD) was developed to treat those identified at high risk of SCD. Unfortunately, there are a significant number of cases in which the ICD does not successfully return a victim to normal rhythm and effective perfusion of the blood.

Coronary blood flow produced by muscle contractions induced by intracardiac electrical CPR during ventricular fibrillation.

Unlabelled: It has been reported that transthoracic electrical cardiopulmonary resuscitation (ECPR) generates coronary perfusion pressures (CPP) similar to manual chest compressions (MCC). We hypothesized that intracardiac ECPR produces similar CPP.

Methods: ECPR pulse train protocols were applied for 20 seconds in a porcine model following 10 seconds of ventricular fibrillation (VF), using a defibrillator housing electrode and a right ventricular coil (IC-ECPR).

Transthoracic application of electrical cardiopulmonary resuscitation for treatment of cardiac arrest.

Objective: Observational studies have shown that muscular stimulation contracting the thoracic cage may produce coronary perfusion pressures equal to manual chest compressions. This study examined electrical cardiopulmonary resuscitation for coronary perfusion pressures during ventricular fibrillation in a porcine model of cardiac arrest.

Design: Prospective randomized controlled study.

A randomized controlled feasibility trial comparing safety and effectiveness of prehospital pacing versus conventional treatment: 'PrePACE'.

Objective: To evaluate the feasibility of a prehospital randomized controlled trial comparing transcutaneous pacing (TCP) with dopamine for unstable bradycardia.

Methods: Unstable bradycardic patients who failed to respond to a fluid bolus and up to 3mg atropine were enrolled. The intervention was dopamine or TCP with crossover to dopamine if TCP failed.

Sensitivity and specificity of an automated external defibrillator algorithm designed for pediatric patients.

Objective: Electrocardiographic (ECG) rhythm analysis algorithms for cardiac rhythm analysis in automated external defibrillators (AEDs) have been tested against pediatric patient rhythms (patients < or = 8 years old) using adult ECG algorithm criteria. However these adult algorithms may fail to detect non-shockable pediatric tachycardias because they do not account for the difference in the rates of normal sinus rhythm and typical tachyarrhythmias in childhood.

Methods: This study was designed to define shockable and non-shockable rhythm detection criteria specific to pediatric patients to create a pediatric rhythm database of annotated rhythms, to develop a pediatric-based AED rhythm analysis algorithm, and to test the algorithm's accuracy.

Comparison of rectilinear biphasic waveform with biphasic truncated exponential waveform in a pediatric defibrillation model.

Objective: To compare the rectilinear biphasic waveform with a biphasic truncated exponential waveform for pediatric defibrillation.

Design: Prospective, randomized study.

Setting: Experimental laboratory of a university-affiliated research institute.

Effects of biphasic waveforms on outcomes of cardiopulmonary resuscitation in a porcine model of prolonged cardiac arrest.

Objectives: The effects of two clinically available biphasic waveforms on the success of defibrillation and postresuscitation myocardial dysfunction after prolonged ventricular fibrillation were compared with two newly designed dual-path sequential and simultaneous rectilinear biphasic waveforms. Defibrillation via sequential pulses and encircling, overlapping multiple pathway may depolarize a larger myocardial mass and facilitate transthoracic defibrillation.

Design: Animal study.

Reduced cardioversion thresholds for atrial fibrillation and flutter using the rectilinear biphasic waveform.

Background: The RLB waveform has been shown to be superior in overall efficacy to the MDS waveform for cardioversion of AF in one prospective study and one large retrospective analysis. However, little is known about the efficacy of the RLB waveform at lower energies.

Objective: This study was undertaken to define the cardioversion thresholds for atrial fibrillation (AF) and flutter (FL) using the rectilinear biphasic (RLB) waveform and compare these to the cardioversion threshold using the conventional monophasic damped sine (MDS) waveform.

Out-of-hospital cardiac arrest rectilinear biphasic to monophasic damped sine defibrillation waveforms with advanced life support intervention trial (ORBIT).

Background: Although biphasic defibrillation waveforms appear to be superior to monophasic waveforms in terminating VF, their relative benefits in out-of-hospital resuscitation are incompletely understood. Prior comparisons of defibrillation waveform efficacy in out-of-hospital cardiac arrest (OHCA) are confined to patients presenting in a shockable rhythm and resuscitated by first responder (basic life support). This effectiveness study compared monophasic and biphasic defibrillation waveform for conversion of ventricular arrhythmias in all OHCA treated with advance life support (ALS).

Cardiac safety of neuromuscular incapacitating defensive devices.

Neuromuscular incapacitation (NMI) devices discharge a pulsed dose of electrical energy to cause muscle contraction and pain. Field data suggest electrical NMI devices present an extremely low risk of injury. One risk of delivering electricity to a human is the induction of ventricular fibrillation (VF).

Rectilinear biphasic waveform defibrillation of out-of-hospital cardiac arrest.

Objective: The rectilinear biphasic (RLB) waveform has been shown to effectively defibrillate short-duration ventricular fibrillation (VF) at significantly lower energies than a monophasic damped sine (MDS) waveform. This article reports RLB waveform defibrillation effectiveness for patients presenting in VF during out-of-hospital cardiac arrest when compared with historical MDS effectiveness.

Methods: External RLB defibrillators were deployed in the Omaha Fire Department's emergency medical services (EMS) system.

Comparison of the rectilinear biphasic waveform with the monophasic damped sine waveform for external cardioversion of atrial fibrillation and flutter.

External cardioversion using the monophasic damped sine (MDS) waveform is successful 70% to 94% of the time when using up to 360 J. The rectilinear biphasic (RLB) defibrillator has been shown to be superior in efficacy to the MDS waveform in atrial cardioversion in a small randomized study. This larger, retrospective study compares the results of the RLB waveform with those of the MDS waveform for cardioversion of atrial fibrillation (AF) and atrial flutter in a large cohort of patients.