Load distributing band device for mechanical chest compressions: An Utstein-categories based analysis of survival to hospital discharge.

PURPOSE: The role of load distributing band device (LDB, AutoPulse®, Zoll Medical Corporation, Chelmsford, MA, USA) in out-of-hospital cardiac arrest is still a matter of debate, with few studies reaching conflicting results available in literature. We sought to assess whether the use of the LBD device could affect survival to hospital discharge in the different Utstein categories. MATERIALS AND METHODS: All consecutive patients enrolled in our provincial cardiac arrest registry (Pavia CARe) from January 2015 to December 2017 were included and pre-hospital data were computed as well as survival to hospital discharge. RESULTS: Among 1401 resuscitation attempts, the LDB device was used in 235 (17%) patients. The LDB device was significantly more used for shockable cardiac arrest (42.6% vs 13.7%, p < 0.001). The rate of ROSC and of survival to hospital discharge in the LDB group compared to the manual group was 40% vs 17% (p < 0.001) and 10% vs 7% (p = 0.2), respectively. However, after correction for independent predictors of LDB use, LDB device was a strong independent predictor of survival to hospital discharge only for non-shockable witnessed OHCA [n = 624/1401, OR 11.9 (95% CI 1.5-95.2), p = 0.02]. In this categories of patients LDB group showed longer resuscitation time [49.3 min (IQR 37-71) vs 23.6 (IQR 15-35), p < 0.001] and a higher rate of conversion to a shockable rhythm (33/83 = 40% vs 29/541 = 5%, p < 0.001). CONCLUSION: Utstein categories-based analysis showed that the LDB device positively affect survival to hospital discharge for non-shockable witnessed cardiac arrests with a neutral effect for shockable rhythms.

End-tidal carbon dioxide and defibrillation success in out-of-hospital cardiac arrest.

PURPOSE: Basing on the relationship between the quality of cardiopulmonary resuscitation (CPR) and the responsiveness of VF to the defibrillation we aimed to assess whether the values of ETCO2 in the minute before defibrillation could predict the effectiveness of the shock. MATERIALS AND METHODS: We retrospectively evaluated the reports generated by the manual monitor/defibrillator (Corpuls by GS Elektromedizinische Geräte G. Stemple GmbH, Germany) used for cases of VF cardiac arrest from January 2015 to December 2016. The mean ETCO2 value of the minute preceding the shock (METCO260) was computed. A blind evaluation of the effectiveness of each shock was provided by three cardiologists. RESULTS: A total amount of 207 shocks were delivered for 62 patients. When considering the three tertiles of METCO260 (T1:METCO260 ≤ 20mmHg; T2: 20mmHg < METCO260 ≤ 31mmHg and T3: METCO260 > 31mmHg) a statistically significant difference between the percentages of shock success was found (T1: 50%; T2: 63%; T3: 78%; Chi square p=0.003; p for trend <0.001). When the METCO260 was lower than 7mmHg no shock was effective and when the METCO260 was higher than 45mmHg no shock was ineffective. Shocks followed by ROSC were preceded by higher values of METCO260 as compared either to ineffective shocks or effective ones without ROSC. CONCLUSIONS: This is the first demonstration of the relation between ETCO2 and defibrillation effectiveness. Our findings stress the pivotal role of High Quality CPR, monitored via ETCO2, and suggest ETCO2 monitoring as an additional weapon to guide defibrillation.

Comparative performance assessment of commercially available automatic external defibrillators: A simulation and real-life measurement study of hands-off time.

PURPOSE: Early and good quality cardiopulmonary resuscitation (CPR) and the use of automated external defibrillators (AEDs) improve cardiac arrest patients' survival. However, AED peri- and post-shock/analysis pauses may reduce CPR effectiveness. METHODS: The time performance of 12 different commercially available AEDs was tested in a manikin based scenario; then the AEDs recordings from the same tested models following the clinical use both in Pavia and Ticino were analyzed to evaluate the post-shock and post-analysis time. RESULTS: None of the AEDs was able to complete the analysis and to charge the capacitors in less than 10s and the mean post-shock pause was 6.7±2.4s. For non-shockable rhythms, the mean analysis time was 10.3±2s and the mean post-analysis time was 6.2±2.2s. We analyzed 154 AED records [104 by Emergency Medical Service (EMS) rescuers; 50 by lay rescuers]. EMS rescuers were faster in resuming CPR than lay rescuers [5.3s (95%CI 5-5.7) vs 8.6s (95%CI 7.3-10). CONCLUSIONS: AEDs showed different performances that may reduce CPR quality mostly for those rescuers following AED instructions. Both technological improvements and better lay rescuers training might be needed.

[Strategies for reducing door to balloon time in patients with acute myocardial infarction undergoing primary angioplasty: the Pavia experience]. / Strategie per ridurre il tempo door to balloon in pazienti con infarto miocardico acuto trattati con angioplastica primaria: l'esperienza pavese.

BACKGROUND: Primary percutaneous coronary intervention (pPCI) is the treatment of choice in patients with ST-elevation myocardial infarction (STEMI) if performed by an experienced team within 120 min of first medical contact. The door to balloon time (DTB) has become a performance measure and is the focus of local, regional and national quality improvement initiatives. The primary objective of the present study was to evaluate whether the implementation of reperfusion strategies could result in shorter DTB times. METHODS: In 2007, at the cath lab of the IRCCS Policlinico San Matteo (a hub of a network including 7 spoke centers), 245 pPCI were performed with a median DTB time of 116 (25th-75th percentile, 96-155) min, and <90 min only in 20% of cases. To improve time to reperfusion, the following strategies were adopted in 2010 and 2011: direct access to the cath lab without initial coronary care unit admission; activation of the cath lab based on pre-hospital ECG; a faster triage with ECG performed within 10 min and use of a dedicated ambulance for patients presenting directly to the emergency room (ER) of the hub. RESULTS: Overall, 226 and 258 pPCI were performed in 2010 and 2011, respectively, with no differences in type of hospital admission (emergency medical service, ER, or spoke) compared with 2007. A significant DTB reduction was observed (2007 vs 2010 vs 2011: 116 [96-155] vs 99 [77-129] vs 97 [80-125] min, p<0.0001), with a significant improvement in the number of patients treated within 90 min (20 vs 41 vs 40%, p<0.0001) as a result of a significant reduction in the time from first medical contact to cath lab (86 [64-124] vs 66 [50-93] vs 62 [46-93] min, p<0.0001). By analyzing only data from 2010 and 2011, median DTB was 88 (73-104) min for patients arriving through the emergency medical service, 139 (116-179) min for patients presenting to spoke centers, and 96 (75-126) min for patients presenting to the ER, with pPCI performed within 90 min in 55%, 8% e 42% of cases, respectively. The longer DTB time of the spoke centers was solely due to transportation to the hub (emergency medical service vs spoke: 56 [42-68] vs 106 [86-147] min, p<0.0001), with no differences in time to reperfusion once the cath lab was reached. CONCLUSIONS: Based on our strategies and experience including 729 STEMI patients treated with pPCI in 2007, 2010 and 2011, a significant improvement in DTB time was achieved. The main factor affecting our results is transportation to the cath lab for patients with direct access to spoke centers. Further exploration and advocacy for DTB implementation in these patients are warranted.

Positive trend in survival to hospital discharge after out-of-hospital cardiac arrest: a quantitative review of the literature.

BACKGROUND: Seven editions of cardiopulmonary resuscitation (CPR) and emergency cardiovascular care guidelines have been published with many changes, in particular, about CPR. OBJECTIVES: The aim of our study was to evaluate the temporal trend of survival to hospital discharge after out-of-hospital cardiac arrest (OHCA) as a possible effect of guidelines changes. METHODS: We searched PubMed for observational studies on 'survival to hospital discharge after OHCA'. Survival to discharge was the primary outcome; prehospital return of spontaneous circulation and survival to hospital admission were our secondary endpoints. All data were analyzed according to the year of inclusion: group 1 before 2000; group 2 between 2000 and 2005; and group 3 after 2005. Mortality rates were compared between groups by means of a group frequency-weighted log-linear model. RESULTS: We considered 38 of 201 studies for a total of 156 301 patients. Survival to hospital discharge rate was 5.0% [95% confidence interval (CI) 4.9-5.2) in group 1; 6.1% (95% CI 5.9-6.4) in group 2; and 9.1% (95% CI 8.9-9.4) in group 3 (P < 0.001). A statistically significant decrease in risk of mortality in group 2 vs. group 1 (risk ratio 0.988, 95% CI 0. 985-0.0.992, P < 0.001) and in group 3 vs. group 2 (risk ratio 0.967, 95% CI 0.964-0.971, P < 0.001) was observed. Similar trends were observed for return of spontaneous circulation and survival to hospital admission. CONCLUSION: Survival to hospital discharge after OHCA has significantly improved. Many aspects may influence survival, but surely, the reduction of time and an early and good quality CPR have positively influenced the outcome.

Prospective performance evaluation of emergency medical services for cardiac arrest in Lombardia: is something moving forward?

BACKGROUND: Limited data are available in our region on out-of-hospital treatment of cardiac arrest. The aim of this study is to evaluate whether the changes implemented in the emergency system (i.e. an increased number of basic life support and advance life support crews that were dispatched) produced the expected outcome improvements. METHODS: (a) EXPERIMENTAL DESIGN: data were prospectively collected on patients with sudden out-of-hospital cardiac arrest in three emergency dispatch centers for 3 months during two study periods, year 2000 and year 2003, differentiated only by the increase of qualified crews. Outcomes and survival were evaluated at 24 h and 1 month after the event. (b) SETTING: out-of-hospital treatment. (c) PATIENTS: 352 (174 in the second study period) patients suffering cardiac arrest. (d) INTERVENTIONS: the study was observational. RESULTS: We could document, between the two study periods, stable 24 h (12.6 vs 9.1%) and 1 month survival (3.4 vs 5.8%, NS). Nevertheless, arrival time on site was significantly higher in the second period (from 8.3+/-3.3 to 10.1+/-5.4 min, P<0.05). CONCLUSIONS: The strengthening of only one link of the chain-of-survival did not improve 1 month survival.