Catheterization laboratory activation during mechanical cardiopulmonary resuscitation: when should we say "No?".

Sudden cardiac arrest is a devastating manifestation of coronary artery disease and a leading cause of death in the western world. Early and effective cardiopulmonary resuscitation is essential for return of spontaneous circulation. If manual compression is ongoing and return of spontaneous circulation has not been achieved, the prognosis is poor, and the logistics of performing cardiac catheterization are forbidding. With the advent of mechanical chest compression, however, this clinical scenario has become much more complex. Coronary angiography and percutaneous coronary intervention, although still cumbersome, has been established as feasible with ongoing mechanical chest compression. This article discusses the strengths and pitfalls of mechanical cardiopulmonary resuscitation, our experience, and current evidence behind activation of the catheterization laboratory with ongoing mechanical chest compression.

The Impact of a Handheld Ultrasound Device in a Rheumatic Heart Disease Screening Program in Ethiopia.

Background: Rheumatic heart disease (RHD) affects 33 million people in low and middle income countries and is the leading cause of cardiovascular death among children and young adults. Penicillin prophylaxis prevents progression in asymptomatic disease. Efforts to expand echocardiographic screening are focusing on simplified protocols, non-physician ultrasonographers, and portable ultrasound devices, including handheld ultrasound. Recent advances support the use of single-view screening protocols. With the increasing availability and low cost of handheld devices, studies are needed to evaluate their performance in these settings. Methods: We conducted a retrospective study comparing the rate of screen positive ultrasounds before and after the use of a handheld ultrasound in an RHD screening program in Ethiopia. We also performed a cross-sectional device comparison in 19 at-risk school-children participating in the rheumatic heart disease screening program. Results: Between March of 2019 and January of 2022, 6631 children were screened for rheumatic heart disease of whom 4029 were screened after the introduction of a handheld device. Before the use of the handheld ultrasound device 291 (11.2%) children had a screen positive ultrasounds compared with 167 (4.1%) afterwards (p<0.001). We also compared non-expert to expert interpretation by device and found a significant difference in interpretation for the Lumify (p=0.025). There was a trend towards shorter jet length by color Doppler in the handheld ultrasound device for both expert and non-expert review. Conclusions: Our study highlights that the screen-positive rate in a RHD screening program is influenced by the device being used in the screening process.

Saving time saves lives! A time focused evaluation of a single-view echocardiographic screening protocol for subclinical rheumatic heart disease.

BACKGROUND: Rheumatic heart disease affects 33 million people in low and middle income countries and is the leading cause of cardiovascular death among children and young adults. Evidence increasingly supports that simplified screening protocols can identify at risk children with good accuracy. One of the more proximal and pragmatic hurdles that has not been completely explored is the time required for executing the screening exam. METHODS: We conducted an observational study comparing three different echocardiographic strategies in four separate school-based screening programs in Kenya and Cameroon. RESULTS: In a sample of 911 children, we found that a single-view screening strategy can be obtained in an average time of 1.2 min/child, the two-view in an average of 2.1 min/child, and multi-view in an average of 5 min/child. CONCLUSIONS: Our study demonstrates that there are significant differences in the time required to execute different screening protocols and is an essential consideration in the feasibility of large scale populations based rheumatic heart disease screening programs.