Standard cardiopulmonary resuscitation versus active compression-decompression cardiopulmonary resuscitation with augmentation of negative intrathoracic pressure for out-of-hospital cardiac arrest: a randomised trial

Aufderheide, Tom P.; Frascone, Ralph J.; Wayne, Michael; Mahoney, Brian D.; Swor, Robert A.; Domeier, Robert M.; Olinger, Michael; Holcomb, Richard; Tupper, David E.; Yannopoulos, Demetris; Lurie, Keith G.

doi:10.1016/s0140-6736(10)62103-4

Cited by 229 publications

(167 citation statements)

References 31 publications

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“…In addition, Dijon is medium-sized town, with relatively light traffic, meaning that the EMS arrive on scene rapidly, starting specialized management to optimize brain oxygenation, notably by setting up the MCC as soon as possible. Indeed, using MCC enables continuous and effective cardiac massage thus optimizing organ perfusion (25,26). Finally, we think that it is important to have an early biological marker for the decision to implement or not implement an ECLS.…”

Section: Discussionmentioning

confidence: 99%

Comparable Outcome of Out‐of‐Hospital Cardiac Arrest and In‐Hospital Cardiac Arrest Treated With Extracorporeal Life Support

et al. 2017

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Extracorporeal life support (ECLS) has shown benefits in the management of refractory inhospital cardiac arrest (IHCA) by improving survival. Nonetheless, the results concerning out-of-hospital refractory cardiac arrests (OHCA) remain uncertain. The aim of our investigation was to compare survival between the two groups. We realized a single-center retrospective, observational study of all patients who presented IHCA or OHCA treated with ECLS between 2011 and 2015. Multivariate analysis was realized to determine independent factors associated with mortality. Over the 4-year period, 65 patients were included, 43 in the IHCA group (66.2%), and 22 (33.8%) in the OHCA group. The duration of low flow was significantly longer in the OHCA group (60 vs. 90 min, P 5 0.004). Survival to discharge from the hospital was identical in the two groups (27% in the OHCA group vs. 23% in the IHCA group, P 5 0.77). All surviving patients in the OHCA group had a cerebral performance categories score of 1-2. In multivariate analysis, we found that the initial lactate level and baseline blood creatinine were independently associated with mortality. We found comparable survival and neurological score in patients who presented IHCA and OHCA treated with ECLS. We believe that appropriate selection of patients and optimization of organ perfusion during resuscitation can lead to good results in patients with OHCA treated with ECLS. Key Words: Extracorporeal life support-Cardiac arrestCardiopulmonary resuscitation.Conventional management of cardiac arrest (CA) has evolved considerably in recent years, nevertheless mortality is still high (1,2). This is essentially related to the neurological prognosis and thus to cerebral damage due to ischemia and reperfusion injury. Given this, the management of CA should focus on maintaining effective circulation during the external cardiac massage and to manage adequately the return to spontaneous circulation.The use of extracorporeal life support (ECLS) for the management of in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) has been widely described (3). Nonetheless, doubts have been expressed about the usefulness of ECLS in OHCA (4). Indeed, rapid ECLS implementation is a major concern. However, in large towns with heavy traffic, timely implementation of ECLS and restoration of effective circulation is sometimes very long.To update our management practices and to determine the usefulness of ECLS in OHCA, we conducted a retrospective study of all IHCA and OHCA treated with ECLS to compare survival and the neurological prognosis of our patients.

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Section: Discussionmentioning

confidence: 99%

Comparable Outcome of Out‐of‐Hospital Cardiac Arrest and In‐Hospital Cardiac Arrest Treated With Extracorporeal Life Support

et al. 2017

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“…15 The combination of ITD with active compression-decompression CPR may be a reasonable alternative to conventional CPR in settings with available equipment and properly trained personnel. 16,17 Conventional manual chest compressions remain the standard of care for the treatment of cardiac arrest, but mechanical chest compression devices may be a reasonable alternative for use by properly trained personnel. [18][19][20] When rapidly implemented, extracorporeal cardiopulmonary resuscitation (ECPR) can prolong viability for patients who are not resuscitated with conventional CPR.…”

Section: Advanced Life Support-adultmentioning

confidence: 99%

What is new in the 2015 American Heart Association guidelines, what is recycled from 2010, and what is relevant for emergency medicine in Canada

Morrison

Caen

Bhanji

et al. 2016

CJEM

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“…2,3 Briefly, the study compared the safety and effectiveness of two methods of cardiopulmonary resuscitation (CPR; active compression decompression CPR plus an impedance threshold device, and standard CPR) administered by emergency medical services (EMS) providers at seven sites across the United States. The primary study endpoint was survival to hospital discharge with favorable neurologic function (Modified Rankin Scale score ≤ 3) in subjects with arrests of presumed cardiac etiologies.…”

Section: Study Setting and Populationmentioning

confidence: 99%

“…2,3 Demographic and cardiac arrest characteristics were obtained from EMS run reports and hospital admission data. Outcome data were collected in a variety of ways, depending on the informed consent status of the patient.…”

Section: Study Protocolmentioning

confidence: 99%

The Association of Health Status and Providing Consent to Continued Participation in an Out‐of‐hospital Cardiac Arrest Trial Performed Under Exception From Informed Consent

Salzman

Frascone

Burkhart

et al. 2015

Academic Emergency Medicine

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Objectives: Emergency medical research performed under federal regulation 21 § CFR 50.24 provides a means to protect human subjects and investigate novel time-sensitive treatments. Although prospective individual consent is not required for studies conducted under this regulation, consent from a legally authorized representative (LAR) or the patient at the earliest feasible opportunity is required to obtain short-and long-term outcome data. The objective of this study was to determine which demographic, cardiac arrest, and patient outcome characteristics predicted the likelihood of obtaining informed consent following enrollment under exception from informed consent in a multicenter cardiac arrest study. Methods:This investigation was an analysis of data collected during a multisite, randomized, controlled, out-of-hospital cardiac arrest clinical trial performed under 21 § CFR 50.24. Research personnel attempted to obtain informed consent from LARs and subjects for medical records review of primary outcome data, as well as consent for neurologic outcome assessments up to 1 year post-cardiac arrest. Hospital discharge and neurologic status were obtained from public records and/or medical records up until the time consent was formally denied, in accordance with federal regulations and guidance. Local institutional review boards also allowed medical records review for cases where consent was neither obtained nor declined despite multiple consent attempts. Patient demographic, cardiac arrest, and clinical outcome characteristics were analyzed in univariate multinomial regression models, with consent status (obtained, denied, neither obtained nor denied) as the dependent variable. A multivariate multinomial logistic regression was then performed. An exploratory secondary analysis following the same process was performed after assigning patients who neither consented nor declined to the declined consent group.Results: Among a total study population of 1,655 cardiac arrest subjects, 457 were transported and had consent attempted (27.6%). The survival status and neurologic function at the time of hospital discharge were known in 440 of 457 (96%) subjects. In the multivariate analysis, initial rhythm of ventricular fibrillation/ventricular tachycardia (VF/VT) and survival with good neurologic outcome were strong predictors of obtaining consent (odds ratio [OR] = 3.15, 95% confidence interval [CI] = 1.73 to 5.75;

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Standard cardiopulmonary resuscitation versus active compression-decompression cardiopulmonary resuscitation with augmentation of negative intrathoracic pressure for out-of-hospital cardiac arrest: a randomised trial

Cited by 229 publications

References 31 publications

Comparable Outcome of Out‐of‐Hospital Cardiac Arrest and In‐Hospital Cardiac Arrest Treated With Extracorporeal Life Support

Comparable Outcome of Out‐of‐Hospital Cardiac Arrest and In‐Hospital Cardiac Arrest Treated With Extracorporeal Life Support

What is new in the 2015 American Heart Association guidelines, what is recycled from 2010, and what is relevant for emergency medicine in Canada

The Association of Health Status and Providing Consent to Continued Participation in an Out‐of‐hospital Cardiac Arrest Trial Performed Under Exception From Informed Consent

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