Cardiopulmonary resuscitation (CPR) in patients with severe acute respiratory syndrome coronavirus-2-associated disease (coronavirus disease 2019) poses a unique challenge to health- care providers due to the risk of viral aerosolization and disease transmission. This has caused some centers to modify existing CPR procedures, limit the duration of CPR, or consider avoiding CPR altogether. In this review, the authors propose a procedure for CPR in the intensive care unit that minimizes the number of personnel in the immediate vicinity of the patient and conserves the use of scarce personal protective equipment. Highlighting the low likelihood of successful resuscitation in high-risk patients may prompt patients to decline CPR. The authors recommend the preemptive placement of central venous lines in high-risk patients with intravenous tubing extensions that allow for medication delivery from outside the patients' rooms. During CPR, this practice can be used to deliver critical medications without delay. The use of a mechanical compression system for CPR further reduces the risk of infectious exposure to health- care providers. Extracorporeal membrane oxygenation should be reserved for patients with few comorbidities and a single failing organ system. Reliable teleconferencing tools are essential to facilitate communication between providers inside and outside the patients' rooms. General principles regarding the ethics and peri-resuscitative management of coronavirus 2019 patients also are discussed.
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http://dx.doi.org/10.1053/j.jvca.2020.06.008 | DOI Listing |
Artif Organs
December 2024
Department of Cardiology and Angiology, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
Background: The clinical outcome and fluid balance of patients with veno-arterial extracorporeal membrane oxygenation (VA ECMO) or after extracorporeal cardiopulmonary resuscitation (eCPR) may be improved by addressing the high fluid demand with an early albumin administration.
Methods: In this prospective observational study, patients supported with VA ECMO or eCPR received early albumin administration (25 g/L) to prime the VA ECMO system. These patients were compared to patients who received a regimen based solely on balanced crystalloids (crystalloid group) or a regimen based on a 1:4 volume mixture of albumin (10 g/L) and balanced crystalloids (albumin group).
Aim: The optimal arterial partial pressure of carbon dioxide (PaCO) for patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) remains unknown. We aimed to investigate the association between post-resuscitation PaCO and neurological outcomes.
Methods: This retrospective cohort study analyzed data from the Study of Advanced Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan, a multicenter registry study across 36 hospitals in Japan, including patients with out-of-hospital cardiac arrest (OHCA) admitted to intensive care units (ICU) after ECPR between 2013 and 2018.
Int J Cardiol Congenit Heart Dis
December 2024
Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.
Objectives: To describe the workflow and value of three-dimensional rotational angiography (3DRA) in percutaneous pulmonary valve implantation (PPVI).
Background: 3DRA offers visualization of the entire topography in the chest and may enhance safety and reduce the risk for complications in PPVI through improved pre-procedural planning and per-procedural guidance.
Methods: All PPVI procedures with the use of 3DRA performed between August 2011 and December 2022 were reviewed.
Mater Sociomed
January 2024
Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina.
Background: The Out-of-hospital cardiac arrest (OHCA) remains a major public health challenge worldwide, with survival outcomes heavily influenced by early intervention. The presence of an initial shockable rhythm significantly increases the likelihood of survival when combined with timely cardiopulmonary resuscitation (CPR) and defibrillation.
Objective: To analyze patient outcomes and the incidence of bystander and dispatch-guided CPR in cases of OHCA with an initial shockable rhythm treated by physician-led emergency medical teams in Bosnia and Herzegovina.
J Crit Care
December 2024
Université Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; École Nationale Vétérinaire d'Alfort, IMRB, AfterROSC Network, F-94700 Maisons-Alfort, France; Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France.; Faculté de Santé, Université Paris Est Créteil, 94010 Créteil, France. Electronic address:
Background: The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a cardiocirculatory support has tremendously increased in critically ill patients. Although fluid therapy is an essential component of the hemodynamic management of VA-ECMO patients, the optimal fluid resuscitation strategy remains controversial. We performed a scoping review to map out the existing knowledge on fluid management in terms of fluid type, dosing and the impact of fluid balance on VA-ECMO patient outcomes.
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