Cardiac Arrest in the Cardiac Catheterization Laboratory: Combining Mechanical Chest Compressions and Percutaneous LV Assistance.

Objectives: The aim of this study was to evaluate the optimal treatment approach for cardiac arrest (CA) occurring in the cardiac catheterization laboratory.

Background: CA can occur in the cath lab during high-risk percutaneous coronary intervention. While attempting to correct the precipitating cause of CA, several options are available to maintain vital organ perfusion.

Assessment of Simulated Emergency Scenarios: Are Trained Observers Necessary?

Objectives: Simulation-based medical training is associated with superior educational outcomes and improved cost efficiency. Self- and peer-assessment may be a cost-effective and flexible alternative to expert-led assessment. We compared accuracy of self- and peer-assessment of untrained raters using basic evaluation tools to expert assessment using advanced validation tools including validated questionnaires and post hoc video-based analysis.

Prehospital risk factors of mortality and impaired consciousness after severe traumatic brain injury: an epidemiological study.

Background: Severe traumatic brain injury (TBI) is a significant health concern and a major burden for society. The period between trauma event and hospital admission in an emergency department (ED) could be a determinant for secondary brain injury and early survival. The aim was to investigate the relationship between prehospital factors associated with secondary brain injury (arterial hypotension, hypoxemia, hypothermia) and the outcomes of mortality and impaired consciousness of survivors at 14 days.

Prospective observational study on tracheal tube cuff pressures in emergency patients--is neglecting the problem the problem?

Background: Inappropriately cuffed tracheal tubes can lead to inadequate ventilation or silent aspiration, or to serious tracheal damage. Cuff pressures are of particular importance during aeromedical transport as they increase due to decreased atmospheric pressure at flight level. We hypothesised, that cuff pressures are frequently too high in emergency and critically ill patients but are dependent on providers' professional background.

Role of manual and mechanical chest compressions during resuscitation efforts throughout cardiac arrest.

The previously published randomized trials of mechanical versus manual resuscitation of patients with cardiac arrest are inconclusive, but a recent systematic review concluded: "There is no evidence that mechanical cardiopulmonary resuscitation devices improve survival; to the contrary they may worsen neurological outcome." However, in our view, none of the randomized trials to date are definitive as the manual groups with primary cardiac arrest have not been treated optimally; that is, with minimally interrupted manual chest compressions, as advocated with cardiocerebral resuscitation. Since the mechanical chest compression devices work on different principles, it is possible that, while they may not be as effective and may even be worse in some subsets of patients, they may be preferable in others.

Air transfer of patients with intraaortic balloon pump support: Swiss experience and recommendations.

Background And Aim: Inter-hospital transfers are high-risk operations for critically ill patients dependent on intra-aortic balloon pump (IABP) support. Since September 2008, Swiss Air-Rescue (Rega) has offered such transfers by helicopter. The aim of the present study was to review the first 38 IABP transfers and to promulgate the currently used standard operating procedure (SOP).

Prevalence and hemodynamic effects of leaning during CPR.

Background: Cardiopulmonary resuscitation (CPR) guidelines recommend complete release between chest compressions (CC).

Objective: Evaluate the hemodynamic effects of leaning (incomplete chest wall release) during CPR and the prevalence of leaning during CPR.

Results: In piglet ventricular fibrillation cardiac arrests, 10% and 20% (1.

A sternal accelerometer does not impair hemodynamics during piglet CPR.

Aim: To determine whether the residual weight of a 260 g sternal accelerometer/force feedback device (AFFD) adversely affects hemodynamics during cardiopulmonary resuscitation in a piglet model of ventricular fibrillation cardiac arrest.

Methods: After induction of ventricular fibrillation, cardiopulmonary resuscitation was provided to ten piglets (10.8 ± 1.

Epinephrine improves 24-hour survival in a swine model of prolonged ventricular fibrillation demonstrating that early intraosseous is superior to delayed intravenous administration.

Background: Vasopressors administered IV late during resuscitation efforts fail to improve survival. Intraosseous (IO) access can provide a route for earlier administration. We hypothesized that IO epinephrine after 1 minute of cardiopulmonary resuscitation (CPR) (an "optimal" IO scenario) after 10 minutes of untreated ventricular fibrillation (VF) cardiac arrest would improve outcome in comparison with either IV epinephrine after 8 minutes of CPR (a "realistic" IV scenario) or placebo controls with no epinephrine.

Post-resuscitation myocardial microcirculatory dysfunction is ameliorated with eptifibatide.

Background: The post-cardiac arrest syndrome includes a decline in myocardial microcirculation function. Inhibition of the platelet IIb/IIIa glycoprotein receptor has improved myocardial microvascular function post-percutaneous coronary intervention. Therefore, we evaluated such inhibition with eptifibatide for its effect on myocardial microcirculation function post-cardiac arrest and resuscitation.

Gasping in response to basic resuscitation efforts: observation in a Swine model of cardiac arrest.

Objective. To analyze the effect of basic resuscitation efforts on gasping and of gasping on survival. Methods.

Predictors of resuscitation in a swine model of ischemic and nonischemic ventricular fibrillation cardiac arrest: superiority of amplitude spectral area and slope to predict a return of spontaneous circulation when resuscitation efforts are prolonged.

Objective: We have demonstrated that a return of spontaneous circulation in the first 3 mins of resuscitation in swine is predicted by ventricular fibrillation waveform (amplitude spectral area or slope) when untreated ventricular fibrillation duration or presence of acute myocardial infarction is unknown. We hypothesized that in prolonged resuscitation efforts that return of spontaneous circulation immediately after a second or later shock with postshock chest compression is independently predicted by end-tidal CO2, coronary perfusion pressure, and ventricular fibrillation waveform measured before that shock in a swine model of ischemic and nonischemic ventricular fibrillation arrest.

Design: Animal intervention study with comparison to a control group.

Continued breathing followed by gasping or apnea in a swine model of ventricular fibrillation cardiac arrest.

Background: Continued breathing following ventricular fibrillation has here-to-fore not been described.

Methods: We analyzed the spontaneous ventilatory activity during the first several minutes of ventricular fibrillation (VF) in our isoflurane anesthesized swine model of out-of-hospital cardiac arrest. The frequency and type of ventilatory activity was monitored by pneumotachometer and main stream infrared capnometer and analyzed in 61 swine during the first 3 to 6 minutes of untreated VF.

Endotracheal tube intracuff pressure during helicopter transport.

Study Objective: We evaluate changes in endotracheal tube intracuff pressures among intubated patients during aeromedical transport. We determine whether intracuff pressures exceed 30 cm H(2)O during aeromedical transport.

Methods: During a 12-month period, a helicopter-based rescue team prospectively recorded intracuff pressures of mechanically ventilated patients before takeoff and as soon as the maximum flight level was reached.

Mass casualty incidents with multiple burn victims: rationale for a Swiss burn plan.

Introduction: Mass casualty incidents involving victims with severe burns pose difficult and unique problems for both rescue teams and hospitals. This paper presents an analysis of the published reports with the aim of proposing a rational model for burn rescue and hospital referral for Switzerland.

Methods: Literature review including systematic searches of PubMed/Medline, reference textbooks and journals as well as landmark articles.

Continuous chest compression resuscitation in arrested swine with upper airway inspiratory obstruction.

Background: This study was designed to compare 24-h survival rates and neurological function of swine in cardiac arrest treated with one of three forms of simulated basic life support CPR.

Methods: Thirty swine were randomized equally among three experimental groups to receive either 30:2 CPR with an unobstructed endotracheal tube (ET) or continuous chest compression (CCC) CPR with an unobstructed ET or CCC CPR with a collapsable rubber sleeve on the ET allowing air outflow but completely restricting air inflow. The swine were anesthetized but not paralyzed.

Leaning during chest compressions impairs cardiac output and left ventricular myocardial blood flow in piglet cardiac arrest.

Objective: Complete recoil of the chest wall between chest compressions during cardiopulmonary resuscitation is recommended, because incomplete chest wall recoil from leaning may decrease venous return and thereby decrease blood flow. We evaluated the hemodynamic effect of 10% or 20% lean during piglet cardiopulmonary resuscitation.

Design: Prospective, sequential, controlled experimental animal investigation.

Preshock cardiopulmonary resuscitation worsens outcome from circulatory phase ventricular fibrillation with acute coronary artery obstruction in swine.

Background: Some clinical studies have suggested that chest compressions before defibrillation improve survival in cardiac arrest because of prolonged ventricular fibrillation (VF; ie, within the circulatory phase). Animal data have also supported this conclusion, and we have previously demonstrated that preshock chest compressions increase the VF median frequency and improve the likelihood of a return of spontaneous circulation in normal swine. We hypothesized that chest compressions before defibrillation in a swine model of acute myocardial ischemia would also increase VF median frequency and improve resuscitation outcome.

Predictors of resuscitation outcome in a swine model of VF cardiac arrest: A comparison of VF duration, presence of acute myocardial infarction and VF waveform.

Introduction: Factors that affect resuscitation to a perfusing rhythm (ROSC) following ventricular fibrillation (VF) include untreated VF duration, acute myocardial infarction (AMI), and possibly factors reflected in the VF waveform. We hypothesized that resuscitation of VF to ROSC within 3min is predicted by the VF waveform, independent of untreated VF duration or presence of acute MI.

Methods: AMI was induced by the occlusion of the left anterior descending coronary artery.

The use of Glasgow Coma Scale in injury assessment: a critical review.

Primary Objective: Patients with brain injuries are assessed using the Glasgow Coma Scale (GCS). This review evaluates the use of GCS scoring in medical literature and identifies the reasons for inaccuracy. LITERATURE SELECTION AND CRITICAL APPRAISAL: Pubmed and ISI Web of Knowledge SM were searched using specific keywords.

Gasping during cardiac arrest.

Purpose Of Review: The purpose of this study is to review the prevalence and significance of gasping in patients experiencing cardiac arrest.

Recent Findings: In a recent study by Bobrow et al., gasping was identified in 33% of patients who arrested after the arrival of emergency medical services (EMS).

Gasping during cardiac arrest in humans is frequent and associated with improved survival.

Background: The incidence and significance of gasping after cardiac arrest in humans are controversial.

Methods And Results: Two approaches were used. The first was a retrospective analysis of consecutive confirmed out-of-hospital cardiac arrests from the Phoenix Fire Department Regional Dispatch Center text files to determine the presence of gasping soon after collapse.

Myocardial microcirculatory dysfunction after prolonged ventricular fibrillation and resuscitation.

Objective: The etiology of postresuscitation myocardial stunning is unknown but is thought to be related to either ischemia occurring during cardiac arrest and resuscitation efforts and/or reperfusion injury after restoration of circulation. A potential common pathway for postischemia/reperfusion end-organ dysfunction is microvascular injury. We hypothesized that myocardial microcirculatory function is markedly abnormal in the postresuscitation period.