Part 6: Electrical Therapies

Link, Mark S.; Atkins, Dianne L.; Passman, Rod; Halperin, Henry R.; Samson, Ricardo A.; White, Roger D.; Cudnik, Michael T.; Berg, Marc; Kudenchuk, Peter J.; Kerber, Richard E.

doi:10.1161/circulationaha.110.970954

Cited by 268 publications

(104 citation statements)

References 222 publications

(154 reference statements)

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“…1,2 Timing of defibrillation in relationship to CC, however, is a subject of major interest because it is difficult to determine the priority of cardiopulmonary resuscitation (CPR) interventions (ie, defibrillation first or CC first). 3,4 Indeed, the 2010 guidelines highlighted insufficient evidence to support or refute an interval of CC before defibrillation and called for early defibrillation, [3][4][5][6] whereas it has been recommended that subsequent defibrillations be attempted on a time-based protocol (ie, after every 2-minute cycle of CC) without any evaluation of the pathophysiological pattern of the arrested myocardium over time. 4,7 Thus, the current defibrillation algorithm may lead to futile defibrillation attempts and unnecessary CC interruptions, potentially worsening outcome.…”

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confidence: 99%

“…3,4 Indeed, the 2010 guidelines highlighted insufficient evidence to support or refute an interval of CC before defibrillation and called for early defibrillation, [3][4][5][6] whereas it has been recommended that subsequent defibrillations be attempted on a time-based protocol (ie, after every 2-minute cycle of CC) without any evaluation of the pathophysiological pattern of the arrested myocardium over time. 4,7 Thus, the current defibrillation algorithm may lead to futile defibrillation attempts and unnecessary CC interruptions, potentially worsening outcome. [8][9][10][11] Clinical Perspective on p 487 ECG analysis might represent an optimal noninvasive guide toward identification of priority of CPR intervention.…”

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confidence: 99%

“…12 Indeed, evidence exists for ventricular fibrillation (VF) waveform changes over time, which might enable prediction of the success of a defibrillation attempt. 4,[12][13][14][15][16][17] Small clinical studies have demonstrated that amplitude spectrum area (AMSA) is one of the most accurate predictors of defibrillation success. 16,17 However, none of these studies reported any patients'…”

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confidence: 99%

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Amplitude Spectrum Area to Guide Defibrillation

et al. 2015

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Background-This study sought to validate the ability of amplitude spectrum area (AMSA) to predict defibrillation success and long-term survival in a large population of out-of-hospital cardiac arrests. Methods and Results-ECGs recorded by automated external defibrillators from different manufacturers were obtained from patients with cardiac arrests occurring in 8 city areas. A database, including 2447 defibrillations from 1050 patients, was used as the derivation group, and an additional database, including 1381 defibrillations from 567 patients, served as validation. A 2-second ECG window before defibrillation was analyzed, and AMSA was calculated. Univariable and multivariable regression analyses and area under the receiver operating characteristic curve were used for associations between AMSA and study end points: defibrillation success, sustained return of spontaneous circulation, and long-term survival. Among the 2447 defibrillations of the derivation database, 26.2% were successful. AMSA was significantly higher before a successful defibrillation than a failing one (13±5 versus 6.8±3.5 mV-Hz) and was an independent predictor of defibrillation success (odds ratio, 1.33; 95% confidence interval, 1.20-1.37) and sustained return of spontaneous circulation (odds ratio, 1.22; 95% confidence interval, 1.17-1.26). Area under the receiver operating characteristic curve for defibrillation success prediction was 0.86 (95% confidence interval, 0.85-0.88). AMSA was also significantly associated with long-term survival. The following AMSA thresholds were identified: 15.5 mV-Hz for defibrillation success and 6.5 mV-Hz for defibrillation failure. In the validation database, AMSA ≥15.5 mV-Hz had a positive predictive value of 84%, whereas AMSA ≤6.5 mV-Hz had a negative predictive value of 98%. Conclusions-In this large derivation-validation study, AMSA was validated as an accurate predictor of defibrillation success. AMSA also appeared as a predictor of long-term survival. (Circulation. 2015;131:478-487.

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Amplitude Spectrum Area to Guide Defibrillation

et al. 2015

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“…The development of the AED has been important to improving survival in cases of witnessed VT/VF arrest. 31 An easily accessible AED obviates the need to wait for activation of the emergency medical response system and the arrival of advanced life support personnel (paramedics) with a manual defibrillator. The availability of an AED allows earlier defibrillation by first responder personnel or by laypeople if an AED is strategically located near the scene of the arrest (what has become known as public-access defibrillation).…”

Section: Defibrillator Technologies and Limitationsmentioning

confidence: 99%

Wearable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death

Piccini¹,

Allen²,

Kudenchuk³

et al. 2016

Circulation

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117

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“…If attempted, it could be planned supplementary to an already existing PAD network that is based on population density and probability of use. (12,13) Most of the responding dentists had undergone undergraduate and postgraduate training in providing BLS. Our study shows that dentists in Slovenia quite regularly refresh their BLS knowledge and skills since the majority of responding dentists participated in a postgraduate BLS training course within the preceding 5 years, although such postgraduate training is not yet obligatory.…”

Section: Discussionmentioning

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Medical emergencies in dental offices in Slovenia and readiness of dentists to handle them

Umek¹,

Šoštarič²

2018

Signa Vitae

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Introduction. Dentists, and all other dental healthcare workers, can expect to face a medical emergency directly or indirectly related to dental treatment. This study evaluates the incidence of medical emergencies in dental offices in Slovenia, the readiness of dentists and possession of specific medical equipment.Methods. An anonymous online based questionnaire was sent through the Medical Chamber of Slovenia via email to all 1503 active dentists in Slovenia. The questionnaire was pilot-tested on 25 dentists and improved accordingly. Thirty closedended questions were answered by 289 (19.2 %) dentists. Results. 93.4 % (n=267) of dentists reported a medical emergency in their dental office. The most prevalent diagnosis was syncope (1.88-2.44/dentist/year) followed by hypoglycaemia (0.20-0.25/dentist/year), hypertensive crisis (0.4/dentists/year) and anaphylaxis (0.3/dentists/year). There were no cardiac arrests reported in the dentists' entire careers. 85.1 % (n=239) of dentists underwent postgraduate BLS training, 87.4 % (n=209) of them in the last 5 years. Responding dentists estimated that they are most capable of dealing with syncope and least proficient in dealing with stroke, cardiac arrest and a hypertensive crisis. They felt generally more prepared to manage than diagnose a medical emergency. Only 58.1 % (n=161) of dentists have access to a self-inflating bag with a reservoir, and 54.9 % (n=152) to an oxygen mask. Only 4.0 % (n=11) of them have a full set of equipment recommended by Medical Chamber of Slovenia. Conclusions. Results support modification of the undergraduate and postgraduate curriculum for dental students to address specific medical emergencies and the usage

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Part 6: Electrical Therapies

Cited by 268 publications

References 222 publications

Amplitude Spectrum Area to Guide Defibrillation

Amplitude Spectrum Area to Guide Defibrillation

Wearable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death

Medical emergencies in dental offices in Slovenia and readiness of dentists to handle them

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