Management of cardiac arrest

Phillips, John H.; Burch, George E.

doi:10.1016/0002-8703(64)90378-3

Cited by 27 publications

(2 citation statements)

References 39 publications

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“…After the initial publication of seminal studies of the potential life-saving benefit of chest compressions, non-invasive ventilation and defibrillation in the early 1960s, 21–23 reports began to surface about different hospitals’ approaches to providing resuscitation. 24–26 Given widespread concerns about the best processes for applying these treatments, numerous professional organizations then developed protocols to standardize CPR, BLS and ACLS. In the 1970s, these protocols were standardized by groups like the American Heart Association into ACLS – a focus of resuscitation care that has continued largely uninterrupted over almost five decades.…”

Section: Discussionmentioning

confidence: 99%

How Do Resuscitation Teams at Top-Performing Hospitals for In-Hospital Cardiac Arrest Succeed?

Nallamothu

Guetterman

Harrod³

et al. 2018

Circulation

130

121

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Key Words: cardiac arrest, sudden ◼ cardiopulmonary resuscitation ◼ health services research ◼ quality improvement ◼ qualitative research Sources of Funding, see page 162Editorial, see p 164 BACKGROUND: In-hospital cardiac arrest (IHCA) is common, and outcomes vary substantially across US hospitals, but reasons for these differences are largely unknown. We set out to better understand how top-performing hospitals organize their resuscitation teams to achieve high survival rates for IHCA. METHODS:We calculated risk-standardized IHCA survival to discharge rates across American Heart Association Get With The Guidelines-Resuscitation registry hospitals between 2012 and 2014. We identified geographically and academically diverse hospitals in the top, middle, and bottom quartiles of survival for IHCA and performed a qualitative study that included site visits with in-depth interviews of clinical and administrative staff at 9 hospitals. With the use of thematic analysis, data were analyzed to identify salient themes of perceived performance by informants. RESULTS:Across 9 hospitals, we interviewed 158 individuals from multiple disciplines including physicians (17.1%), nurses (45.6%), other clinical staff (17.1%), and administration (20.3%). We identified 4 broad themes related to resuscitation teams: (1) team design, (2) team composition and roles, (3) communication and leadership during IHCA, and (4) training and education. Resuscitation teams at top-performing hospitals demonstrated the following features: dedicated or designated resuscitation teams; participation of diverse disciplines as team members during IHCA; clear roles and responsibilities of team members; better communication and leadership during IHCA; and in-depth mock codes. CONCLUSIONS:Resuscitation teams at hospitals with high IHCA survival differ from non-top-performing hospitals. Our findings suggest core elements of successful resuscitation teams that are associated with better outcomes and form the basis for future work to improve IHCA. 2 It is not surprising that hospitals have chosen to dedicate substantial resources to train healthcare providers in resuscitation and establish facility-wide emergency response systems to optimize their performance and improve outcomes of patients experiencing cardiac arrest. Despite these sizeable investments, however, overall rates of in-hospital survival after these events remain poor, with substantial variation noted across facilities. 3,4 On the surface, this variation in survival following IHCA may seem surprising. Established guidelines provide logical, sequential algorithms for advanced cardiac life support (ACLS) that are widely accepted and used across much of the world; thus, providers at most hospitals attempt to deliver the same treatments for the same reasons after the same ACLS training. 5,6 Yet, these algorithms largely focus on guiding individuals on technical tasks at a patient's bedside. They have less frequently addressed complex issues surrounding the implementation of these algorithms in real-w...

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Section: Discussionmentioning

confidence: 99%

How Do Resuscitation Teams at Top-Performing Hospitals for In-Hospital Cardiac Arrest Succeed?

Nallamothu

Guetterman

Harrod³

et al. 2018

Circulation

130

121

View full text Add to dashboard Cite

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“…If applied rhythmically to the precordium (‘precordial percussion’), 5 repetitive thumps have been shown to be an effective means for extracorporeal pacing of the asystolic 6 , 7 or bradycardic 8 heart, while benefits of MS for cardioversion of tachycardias is limited 9 . As mechanically-induced heartbeats have a greater hemodynamic effect than external chest compressions, 10 they can maintain consciousness in patients during extended periods of ventricular standstill (cases as long as 2 h 45 min have been reported) 6 , 11 …”

Section: Introductionmentioning

confidence: 99%

Comparing maximum rate and sustainability of pacing by mechanical vs. electrical stimulation in the Langendorff-perfused rabbit heart

Quinn

Kohl

2016

EP Europace

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AimsMechanical stimulation (MS) represents a readily available, non-invasive means of pacing the asystolic or bradycardic heart in patients, but benefits of MS at higher heart rates are unclear. Our aim was to assess the maximum rate and sustainability of excitation by MS vs. electrical stimulation (ES) in the isolated heart under normal physiological conditions.Methods and resultsTrains of local MS or ES at rates exceeding intrinsic sinus rhythm (overdrive pacing; lowest pacing rates 2.5±0.5 Hz) were applied to the same mid-left ventricular free-wall site on the epicardium of Langendorff-perfused rabbit hearts. Stimulation rates were progressively increased, with a recovery period of normal sinus rhythm between each stimulation period. Trains of MS caused repeated focal ventricular excitation from the site of stimulation. The maximum rate at which MS achieved 1:1 capture was lower than during ES (4.2±0.2 vs. 5.9±0.2 Hz, respectively). At all overdrive pacing rates for which repetitive MS was possible, 1:1 capture was reversibly lost after a finite number of cycles, even though same-site capture by ES remained possible. The number of MS cycles until loss of capture decreased with rising stimulation rate. If interspersed with ES, the number of MS to failure of capture was lower than for MS only.ConclusionIn this study, we demonstrate that the maximum pacing rate at which MS can be sustained is lower than that for same-site ES in isolated heart, and that, in contrast to ES, the sustainability of successful 1:1 capture by MS is limited. The mechanism(s) of differences in MS vs. ES pacing ability, potentially important for emergency heart rhythm management, are currently unknown, thus warranting further investigation.

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