Part 7: Adult Advanced Cardiovascular Life Support

Link, Mark S.; Berkow, Lauren; Kudenchuk, Peter J.; Halperin, Henry R.; Hess, Erik P.; Moitra, Vivek K.; Neumar, Robert W.; O’Neil, Brian J.; Paxton, James H.; Silvers, Scott M.; White, Roger D.; Yannopoulos, Demetris; Donnino, Michael W.

doi:10.1161/cir.0000000000000261

Cited by 1,029 publications

(435 citation statements)

References 158 publications

(111 reference statements)

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“…Although the ILCOR does not recommend the ECPR strategy routinely, it states that in settings where it can be rapidly implemented, ECPR may be considered for select cardiac arrest patients for whom the suspected etiology of the cardiac arrest is potentially reversible during a limited period of mechanical cardiorespiratory support (Class IIb, LOE C-LD). 42 Innovative strategies seeking to minimize the no-to-low flow period include cannulation in the field followed by rapid deployment of mobile ECPR. 19,21 The effectiveness should be compared to early transport under high-quality ongoing resuscitation and ECPR institution after arrival to the hospital.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Nasal Nitric Oxide Measurement as a Diagnostic Test for Primary Ciliary Dyskinesia: A Systematic Review and Meta-Analysis

Shapiro

Josephson

Rosenfeld³

et al. 2017

Annals ATS

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a b s t r a c tAim: Extracorporeal resuscitation during cardiopulmonary resuscitation (ECPR) deploys rapid cardiopulmonary bypass to sustain oxygenated circulation until the return of spontaneous circulation (ROSC). The purpose of this systematic review is to address the defining elements and outcomes (quality survival and organ donation) of currently active protocols for ECPR in refractory out-of-hospital cardiac arrest (OHCA) of cardiac origin in adult patients. The results may inform policy and practices for ECPR and help clarify the corrresponding intersection with deceased organ donation. Methods: We searched Medline, Embase, Cochrane and seven other electronic databases from 2005 to 2015, with no language restrictions. Internal validity and the quality of the studies reporting outcomes and guidelines were assessed. The review was included in the international prospective register of systematic reviews (Prospero, CRD42014015259). Results: One guideline and 20 outcome studies were analyzed. Half of the studies were prospective observational studies assessed to be of fair to good methodological quality. The remainder were retrospective cohorts, case series, and case studies. Ages ranged from 16 to 75 years and initial shockable cardiac rhythms, witnessed events, and a reversible primary cause of cardiac arrest were considered favorable prognostic factors. CPR duration and time to hospital cannulation varied considerably. Coronary revascularization, hemodynamic interventions and targeted temperature management neuroprotection were variable. A total of 833 patients receiving this ECPR approach had an overall reported survival rate of Abbreviations: ECPR, extracorporeal resuscitation; ROSC, return of spontaneous circulation; OHCA, out-of-hospital cardiac arrest; CPC, cerebral performance category; GOS, Glasgow Outcome Scale; LOE, level of evidence; ILCOR, International Liaison Committee on Resuscitation; RCTs, randomized controlled trials; TTM, targeted temperature management; IABP, intra-aortic balloon pump; DBD, donation after brain death; cDCD, controlled donation after circulatory determination of death; ELSO, extracorporeal life support organization. I. Ortega-Deballon et al. / Resuscitation 101 (2016) 12-20 13 22%, including 13% with good neurological recovery. Additionally, 88 potential and 17 actual deceased organ donors were identified among the non-survivor population in 8 out of 20 included studies. Study heterogeneity precluded a meta-analysis preventing any meaningful comparison between protocols, interventions and outcomes. Conclusions: ECPR is feasible for refractory OHCA of cardiac origin in adult patients. It may enable neurologically good survival in selected patients, who practically have no other alternative in order to save their lives with quality of life, and contribute to organ donation in those who die. Large, prospective studies are required to clarify patient selection, modifiable outcome variables, risk-benefit and cost-effectiveness.

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Section: Discussionmentioning

confidence: 99%

Accuracy of Nasal Nitric Oxide Measurement as a Diagnostic Test for Primary Ciliary Dyskinesia: A Systematic Review and Meta-Analysis

Shapiro

Josephson

Rosenfeld³

et al. 2017

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“…Em relação às medidas terapêuticas adotadas nos casos de PCR na gestação, as mais citadas foram a realização de RCP, com compressões torácicas externas, ventilação com oxigê-nio a 100%, a realização de desfibrilação e administração de epinefrina 14-31 -medidas essas preconizadas para o atendimento da população em geral 32 .…”

Section: Resultsunclassified

“…Os estudos selecionados para esta revisão evidenciaram o desfecho alta materna e fetal com bom prognóstico neurológico na maioria dos casos 14,[16][17][18][19]21,22,25,26,[28][29][30][31][32] , o que pode estar relacionado a ocorrência de PCR em pessoas previamente hígidas, em ambiente intrahospitalar, com início da RCP precoce e realização precoce da cesárea de emergência.…”

Section: Referênciasunclassified

Ressuscitação cardiopulmonar na gestação: uma revisão integrativa

et al. 2016

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Artigo de revisão resUMoO objetivo deste estudo foi identificar dados sobre atendimento à parada cardiorrespiratória na gestação. Foi realizada uma revisão integrativa de artigos publicados entre 2010 e 2015, em português, inglês e espanhol com a utilização dos seguintes descritores: "Parada Cardíaca"; "Ressuscitação Cardiopulmonar"; "Gestante" e "Gestação", nas seguintes bases de dados: MEDLINE, LILACS, IBECS e CUMED. A idade gestacional variou de 10 a 41 semanas, as etiologias mais comuns da parada cardiorrespiratória foram embolia pulmonar e trauma, os ritmos foram fibrilação ventricular e atividade elétrica sem pulso e o tempo em parada cardiorrespiratória variou de 15 a 60 minutos. O tratamento foi ressuscitação cardiopulmonar, intubação, administração de epinefrina e cesárea de emergência. Os desfechos mais observados nas mães e recém-nascidos foram alta e bom estado neurológico. Conclui-se que protocolos de atendimento específicos podem respaldar e auxiliar a tomada de decisão da equipe durante a ressuscitação cardiopulmonar, aumentando a sobrevida e diminuindo o dano neurológico nestas pacientes.Palavras-chave: parada cardíaca; ressuscitação cardiopulmonar; gravidez. ABstrACtThe objective of this study was to identify data of compliance in cardiac arrest during pregnancy. An integrative review of articles published between 2010 and 2015 in Portuguese, English and Spanish using the following descriptors: "Cardiac Arrest"; "Cardiopulmonary Resuscitation"; "Pregnant" and "Pregnancy" was perfeormed in the following databases: MEDLINE, LILACS, IBECS and CUMED. The gestational age ranged from 10 to 41 weeks, the most common etiologies of cardiopulmonary arrest were pulmonary embolism and trauma, the rhythms were ventricular fibrillation and pulseless electrical activity and the time in cardiac arrest ranged from 15 to 60 minutes. Treatment was cardiopulmonary resuscitation, intubation, administration of epinephrine and emergency cesarean section. The outcomes observed in more mothers and newborns were hospital discharge and good neurological status. In conclusion, specific care protocols can endorse and assist the team's decision-making during cardiopulmonary resuscitation, increasing survival and decreasing neurological damage in these patients.

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“…AHA guidelines state that ECPR may be considered for selected patients when the suspected aetiology of cardiac arrest is potentially reversible during a limited period of mechanical cardiorespiratory support (5). This definition is conceptually correct, but in the real world applies on a very limited group of patients: those who received a diagnosis of myocardial infarction before or after the admission to hospital.…”

Section: Federico Pappalardo 1 Andrea Montiscimentioning

confidence: 99%