Minimally Interrupted Cardiac Resuscitation by Emergency Medical Services for Out-of-Hospital Cardiac Arrest

Bobrow, Bentley J.

doi:10.1001/jama.299.10.1158

Cited by 445 publications

(274 citation statements)

References 34 publications

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“…Recent studies have indicated that frequent and prolonged interruptions of CPR for defibrillations, for example, may have deleterious effects. 5,6 For this reason, no further attempts at defibrillation were made once the decision was made to proceed with VA-ECMO.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal membrane oxygenation as a rescue device for postreperfusion cardiac arrest during liver transplantation

Tejani

Eudailey

et al. 2015

Liver Transpl

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TO THE EDITORS:Intraoperative cardiac arrest is a dreaded complication of liver transplantation with a poor outcome. 1,2 The majority of cardiac arrests occur during the neohepatic phase, especially during reperfusion, and most are caused by either postreperfusion syndrome or pulmonary thromboembolic events. 2 Almost 20% of patients with intraoperative cardiac arrest cannot be successfully resuscitated and do not regain a spontaneous rhythm and circulation. Of those who regain a spontaneous rhythm and circulation with cardiopulmonary resuscitation (CPR), more than 12% will not survive the surgery. The mortality of intraoperative cardiac arrest increases exponentially with the duration of CPR. If spontaneous rhythm and circulation are not restored rapidly, the prognosis is usually poor. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been used as an extension of CPR in many clinical scenarios with varying success. We describe a successful case of the use of VA-ECMO to treat postreperfusion cardiac arrest and discuss practical aspects of using VA-ECMO as rescue CPR during liver transplantation. CASE REPORTA 61-year-old man with hepatitis B cirrhosis and hepatocellular carcinoma underwent deceased donor liver transplantation. He had previously undergone transarterial chemoembolization of the hepatocellular carcinoma and esophageal banding for esophageal varices. His physiologic Model for End-Stage Liver Disease score was 8 (serum creatinine 5 0.66 mg/dL, total bilirubin 5 0.9 mg/dL, and international normalized ratio 5 1.2). He was well compensated and reported good exercise tolerance with no symptoms of cardiac disease. A transthoracic echocardiogram 3 months before surgery demonstrated a left ventricular ejection fraction of 60% to 65%, normal biventricular systolic function, and no valvular pathologies. There was no evidence of wall motion abnormalities on a technetium-99m sestamibi pharmacologic stress test, which was also performed 3 months before surgery.A suitable standard criteria donor organ was identified (a 25-year-old woman who had a subarachnoid hemorrhage). The liver graft was procured and coldpreserved in a standard fashion without a perfusion circuit. The cold ischemia time of the graft was 5 hours 15 minutes, and the warm ischemia time was 47 minutes.The recipient was brought into the operating room, and after induction of general anesthesia, left radial and right femoral arterial catheters were placed along with a right internal jugular introducer with a pulmonary artery catheter without any complications. Initial intraoperative laboratory values were unremarkable. The dissection phase proceeded without complications and without the need for blood products. The patient tolerated clamping of the inferior vena cava and removal of the native liver with only low-dose vasopressor support (norepinephrine at 1 mg/minute and vasopressin at 1 U/hour). During the anhepatic phase, the patient remained hemodynamically stable and required slowly increasing doses of vasopressors with peak doses o...

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Section: Discussionmentioning

confidence: 99%

Extracorporeal membrane oxygenation as a rescue device for postreperfusion cardiac arrest during liver transplantation

Tejani

Eudailey

et al. 2015

Liver Transpl

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“…1 Moreover, a prospective study of survival-to-hospital discharge with minimally interrupted cardiac resuscitation (MICR) was performed in Arizona and found a significant increase in the survival-tohospital discharge after implementation of MICR as an alternate EMS protocol (odds ratio =3.4 in patients with witnessed VF). 44 The MICR protocol includes (1) initial series of 200 pre-shock uninterrupted chest compressions and rhythm analysis with a single shock, (2) 200 immediate post-shock chest compressions, (3) early administration of epinephrine, and (4) delayed ETT intubation for 3 cycles of 200 compressions and rhythm reanalysis. The MICR discourages early and excessive ventilation by advocating passive high-flow oxygen insufflation via an oropharyngeal airway and a non-rebreather face mask rather than positive pressure ventilation.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Arterial Blood Gases of Laryngeal Mask Airway and Bag-Valve-Mask Ventilation in Out-of-Hospital Cardiac Arrests

group

2009

Circ J

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“…17,29,30 CPR quality is a focus for many EMS services, which have championed real-time biometric feedback and post-event quality improvement strategies. 31 These efforts have led to a more than doubled increase in survival from out-ofhospital cardiac arrest, but have not yet been implemented in many hospital settings. 32 …”

Section: Ems-centred Researchmentioning

confidence: 99%

Applying Hospital Evidence to Paramedicine: Issues of Indirectness, Validity and Knowledge Translation

Bigham

Welsford

2015

CJEM

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The practice of emergency medicine (EM) has been intertwined with emergency medical services (EMS) for more than 40 years. In this commentary, we explore the practice of translating hospital based evidence into the prehospital setting. We will challenge both EMS and EM dogmabringing hospital care to patients in the field is not always better. In providing examples of therapies championed in hospitals that have failed to translate into the field, we will discuss the unique prehospital environment, and why evidence from the hospital setting cannot necessarily be translated to the prehospital field. Paramedicine is maturing so that the capability now exists to conduct practice-specific research that can inform best practices. Before translation from the hospital environment is implemented, evidence must be evaluated by people with expertise in three domains: critical appraisal, EM, and EMS. Scientific evidence should be assessed for: quality and bias; directness, generalizability, and validity to the EMS population; effect size and anticipated benefit from prehospital application; feasibility (including economic evaluation, human resource availability in the mobile environment); and patient and provider safety. RÉSUMÉLa pratique de la médecine d'urgence (MU) est étroitement liée aux services médicaux d'urgence (SMU) depuis plus d'une quarantaine d'années. Aussi les auteurs traitent-ils, dans le présent article, du transfert des données probantes, du milieu hospitalier au milieu préhospitalier. Sera remis en question un dogme admis tant par la MU que par les SMU; en effet, le transfert, sur le terrain, des pratiques en milieu hospitalier n'est pas toujours la meilleure solution. Il sera question, à l'aide d'exemples de traitements préconisés dans les hôpitaux qui se sont soldés par des échecs sur le terrain, du caractère propre du milieu préhospitalier et des raisons pour lesquelles l'application directe des données probantes, recueillies en milieu hospitalier ne convient pas nécessairement au milieu préhospitalier. Les secours paramédicaux sont une discipline en évolution, si bien que la capacité de recherche sur la pratique est suffisamment importante pour jeter une lumière nouvelle sur les pratiques exemplaires. Avant d'envisager l'application des connaissances recueillies en milieu hospitalier, il faut que les données probantes à l'appui soient évaluées par des experts dans trois domaines: l'évaluation critique, la MU et les SMU. Les données probantes de scientifiques devrait faire l'objet d'examen à l'égard: de la qualité et des biais; de l'application directe des données dans la population visée par les SMU ainsi que de leur généralisabilité et de leur validité; de l'ampleur de l'effet et des avantages prévisibles de l'application préhospitalière de ces pratiques; de la faisabilité (y compris l'évaluation économique et la suffisance des ressources humaines dans un environnement mobile); et finalement de la sécurité tant des patients que des fournisseurs de soins.

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Minimally Interrupted Cardiac Resuscitation by Emergency Medical Services for Out-of-Hospital Cardiac Arrest

Cited by 445 publications

References 34 publications

Extracorporeal membrane oxygenation as a rescue device for postreperfusion cardiac arrest during liver transplantation

Extracorporeal membrane oxygenation as a rescue device for postreperfusion cardiac arrest during liver transplantation

Comparison of Arterial Blood Gases of Laryngeal Mask Airway and Bag-Valve-Mask Ventilation in Out-of-Hospital Cardiac Arrests

Applying Hospital Evidence to Paramedicine: Issues of Indirectness, Validity and Knowledge Translation

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