Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Panchal, Ashish R.; Bartos, Jason A.; Cabañas, José G.; Donnino, Michael W.; Drennan, Ian R.; Hirsch, Karen G.; Kudenchuk, Peter J.; Kurz, Michael C.; Lavonas, Eric J.; Morley, Peter; O’Neil, Brian J.; Peberdy, Mary Ann; Rittenberger, Jon C.; Rodriguez, Amber J; Sawyer, Kelly N.; Berg, Katherine M.

doi:10.1161/cir.0000000000000916

Cited by 999 publications

(829 citation statements)

References 880 publications

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“…The recent guideline emphasizes prompt initiation of TTM is necessary for CPCR survivors to ensure optimal functional and neurological outcome [34]. All the patients who do not follow commands after cardiac arrest are indicated for TTM regardless of initial rhythm.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Magnetic Resonance Imaging for Nonischemic Cardiac Disease in Out-of-Hospital Cardiac Arrest Survivors Treated with Targeted Temperature Management: A Multicenter Retrospective Analysis

Kim

Youn

Lee

et al. 2021

JCM

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(1) Background: Cardiac magnetic resonance (CMR) imaging is an emerging tool for investigating nonischemic cardiomyopathies and cardiac systemic disease. However, data on the cardiac arrest population are limited. This study aimed to evaluate the usefulness of CMR imaging in out-of-hospital cardiac arrest (OHCA) survivors treated with targeted temperature management (TTM). (2) Methods: We conducted the retrospective observational study using a multicenter registry of adult non-traumatic comatose OHCA survivors who underwent TTM between January 2010 and December 2019. Of the 949 patients, 389 with OHCA of non-cardiac cause, 145 with significant lesions in the coronary artery, 151 who died during TTM, 81 without further evaluation due to anticipated poor neurological outcome, and 51 whose etiology is underlying disease were excluded. In 36 of the 132 remaining patients, the etiologies included variant angina, long QT syndrome, and complete atrioventricular block in ancillary studies. Fifty-six patients were diagnosed idiopathic ventricular fibrillation without CMR. (3) Results: CMR imaging was performed in the remaining 40 patients with cardiac arrest of unknown cause. The median time from cardiac arrest to CMR imaging was 10.1 days. The CMR finding was normal in 23 patients, non-diagnostic in 12, and abnormal in 5, which suggested non-ischemic cardiomyopathy but did not support the final diagnosis. (4) Conclusions: CMR imaging may not be useful for identifying unknown causes of cardiac arrest in OHCA survivors treated with targeted temperature management without definitive diagnosis even after coronary angiography, echocardiography, and electrophysiology studies. However, further large-scale studies will be needed to confirm these findings.

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Section: Discussionmentioning

confidence: 99%

Cardiac Magnetic Resonance Imaging for Nonischemic Cardiac Disease in Out-of-Hospital Cardiac Arrest Survivors Treated with Targeted Temperature Management: A Multicenter Retrospective Analysis

Kim

Youn

Lee

et al. 2021

JCM

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“…A substudy of the targeted temperature management trial examining patients with out-of-hospital cardiac arrest found no difference in mortality or neurologic outcomes between patients managed at 33 °C versus 36 °C, regardless of initial rhythm [1]. The 2020 American Heart Association (AHA) Guidelines advise targeted temperature management between 32 and 36 °C for all patients not following commands after successful resuscitation from cardiac arrest, regardless of initial rhythm [2]. Nonshockable rhythms now make up the majority of cardiac arrests [3].…”

Section: Contextmentioning

confidence: 99%

Does targeted temperature management improve neurologic outcomes in patients with nonshockable rhythms?

Gossack‐Keenan

Moe

2021

Can J Emerg Med

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“…Outcomes for IO patients included a lower likelihood of prehospital ROSC achieved, lower survival to hospital discharge rates and less favorable neurological outcomes at discharge. As a result, the latest resuscitation guidelines favor IV rather than IO access [14]. However, the subgroup analyses of two randomized clinical trials observed no statistically significant interactions between the route of access and the study drug on outcomes [15,16].…”

Section: Introductionmentioning

confidence: 99%

Effect of prehospital intraosseous combined with in-hospital intravenous access in out-of-hospital cardiac arrest

2021

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Objective: Obtaining vascular access during out-of-hospital cardiac arrest (OHCA) is challenging. The aim of this study was to compare the effectiveness of prehospital intraosseous infusion (IO) combined with in-hospital intravenous (IV) (pre-IO + in-IV) access versus the simple IV (pre-IV + in-IV) access in adult OHCA patients who do not achieve prehospital return of spontaneous circulation (ROSC). Methods: This retrospective observational study included adults with OHCA of presumed cardiac etiology between October 1, 2017-October 1, 2020 at an academic emergency department in China. All of the OHCA patients included within the study had Emergency Medical Services cardiopulmonary resuscitation and received prehospital epinephrine administration, but did not achieve prehospital ROSC. The study population were classified as either pre-IO + in-IV or IV (pre-IV + in-IV) based on their epinephrine administration route. The prehospital epinephrine routes were the first and only attempted route. The primary outcome investigated was sustained ROSC following arrival at the emergency department. The secondary outcome considered was the time from dispatch to the first epinephrine dose. Results: Of 193 included adult OHCA subjects who did not have prehospital ROSC, 128 received IV access only. The 65 pre-IO + in-IV-treated patients received epinephrine faster compared to IV-treated patients in terms of the median time from dispatch to the first injection of epinephrine (14.5 vs. 16.0 min, P = 0.001). In the pre-IO + in-IV group, 34 of 65 patients (52.3%) achieved sustained ROSC compared with 65 of 128 (50.8%) patients in the IV group (χ2 = 0.031, P = 0.841). There was no significant difference in sustained ROSC (adjusted OR1.049, 95% CI: 0.425-2.591, P = 0.918) between the two groups. Conclusion: A similar sustained ROSC rate was achieved for both the pre-IO + in-IV access group and the simple IV access group. Our results suggested that an IV route should be established quickly for prehospital IO-treated OHCA patients who do not achieve prehospital ROSC.

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Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Cited by 999 publications

References 880 publications

Cardiac Magnetic Resonance Imaging for Nonischemic Cardiac Disease in Out-of-Hospital Cardiac Arrest Survivors Treated with Targeted Temperature Management: A Multicenter Retrospective Analysis

Cardiac Magnetic Resonance Imaging for Nonischemic Cardiac Disease in Out-of-Hospital Cardiac Arrest Survivors Treated with Targeted Temperature Management: A Multicenter Retrospective Analysis

Does targeted temperature management improve neurologic outcomes in patients with nonshockable rhythms?

Effect of prehospital intraosseous combined with in-hospital intravenous access in out-of-hospital cardiac arrest

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