Impact of bystander cardiopulmonary resuscitation on neurological outcomes in patients undergoing veno-arterial extracorporeal membrane oxygenation.

BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) requires a large amount of economic and human resources. The presence of bystander cardiopulmonary resuscitation (CPR) was focused on selecting appropriate V-A ECMO candidates. RESULT: This study retrospectively enrolled 39 patients with V-A ECMO due to out-of-hospital cardiac arrest (CA) between January 2010 and March 2019. The introduction criteria of V-A ECMO included the following: (1) < 75 years old, (2) CA on arrival, (3) < 40 min from CA to hospital arrival, (4) shockable rhythm, and (5) good activity of daily living (ADL). The prescribed introduction criteria were not met by 14 patients, but they were introduced to V-A ECMO at the discretion of their attending physicians and were also included in the analysis. Neurological prognosis at discharge was defined using The Glasgow-Pittsburgh Cerebral Performance and Overall Performance Categories of Brain Function (CPC). Patients were divided into good or poor neurological prognosis (CPC ≤ 2 or ≥ 3) groups (8 vs. 31 patients). The good prognosis group had a significantly larger number of patients who received bystander CPR (p = 0.04). The mean CPC at discharge was compared based on the combination with the presence of bystander CPR and all five original criteria. Patients who received bystander CPR and met all original five criteria showed significantly better CPC than patients who did not receive bystander CPR and did not meet some of the original five criteria (p = 0.046). CONCLUSION: Considering the presence of bystander CPR help in selecting the appropriate candidate of V-A ECMO among out-of-hospital CA cases.

The Association between Cardiopulmonary Resuscitation in Out-of-Hospital Settings and Chest Injuries: A Retrospective Observational Study.

OBJECTIVES: The aim of this study was to assess the risk of cardiopulmonary resuscitation (CPR) performed in out-of-hospital settings for chest injuries in patients with out-of-hospital cardiac arrest (OHCA). METHODS: This retrospective, observational study was conducted in an emergency critical care medical center in Japan. Non-traumatic OHCA patients transferred to the hospital from April 2013 through August 2016 were analyzed. The outcome was defined by chest injuries related to CPR, which is composite of rib fractures, sternal fractures, and pneumothoraces. A multivariate logistic regression analysis was performed to assess the independent risk factors for chest injuries related to CPR. The threshold of out-of-hospital CPR duration that increased risk of chest injuries was also assessed. RESULTS: A total of 472 patients were identified, of whom 233 patients sustained chest injuries. The multivariate logistic regression model showed that the independent risk factors for chest injuries were age and out-of-hospital CPR duration (age: AOR=1.06 [95% CI, 1.04 to 1.07]; out-of-hospital CPR duration: AOR=1.03 [95% CI, 1.01 to 1.05]). In-hospital CPR duration was not an independent risk factor for chest injuries. When the duration of out-of-hospital CPR extended over 15 minutes, the likelihood of chest injuries increased; however, this association was not statistically significant. CONCLUSIONS: Long duration of out-of-hospital CPR was an independent risk factor for chest injuries, possibly due to the difficulty of maintaining adequate quality of CPR. Further investigations to assess the efficacy of alternative CPR devices are expected in cases requiring long transportation times. Takayama W , Koguchi H , Endo A , Otomo Y . The association between cardiopulmonary resuscitation in out-of-hospital settings and chest injuries: a retrospective observational study. Prehosp Disaster Med. 2018;33(2):171-175.

The Event Chain of Survival in the Context of Music Festivals: A Framework for Improving Outcomes at Major Planned Events.

Despite the best efforts of event producers and on-site medical teams, there are sometimes serious illnesses, life-threatening injuries, and fatalities related to music festival attendance. Producers, clinicians, and researchers are actively seeking ways to reduce the mortality and morbidity associated with these events. After analyzing the available literature on music festival health and safety, several major themes emerged. Principally, stakeholder groups planning in isolation from one another (ie, in silos) create fragmentation, gaps, and overlap in plans for major planned events (MPEs). The authors hypothesized that one approach to minimizing this fragmentation may be to create a framework to "connect the dots," or join together the many silos of professionals responsible for safety, security, health, and emergency planning at MPEs. Adapted from the well-established literature regarding the management of cardiac arrests, both in and out of hospital, the "chain of survival" concept is applied to the disparate groups providing services that support event safety in the context of music festivals. The authors propose this framework for describing, understanding, coordinating and planning around the integration of safety, security, health, and emergency service for events. The adapted Event Chain of Survival contains six interdependent links, including: (1) event producers; (2) police and security; (3) festival health; (4) on-site medical services; (5) ambulance services; and (6) off-site medical services. The authors argue that adapting and applying this framework in the context of MPEs in general, and music festivals specifically, has the potential to break down the current disconnected approach to event safety, security, health, and emergency planning. It offers a means of shifting the focus from a purely reactive stance to a more proactive, collaborative, and integrated approach. Improving health outcomes for music festival attendees, reducing gaps in planning, promoting consistency, and improving efficiency by reducing duplication of services will ultimately require coordination and collaboration from the beginning of event production to post-event reporting. Lund A , Turris SA . The Event Chain of Survival in the context of music festivals: a framework for improving outcomes at major planned events. Prehosp Disaster Med. 2017;32(4):437-443.

Rumo ao Consenso Internacional de Ressuscitação Cardiopulmonar e Cuidados Cardiovasculares de Emergência 2010 da Aliança Internacional dos Comitês de Ressuscitação / The 2010 Consensus on Cardiopulmary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations ? International Liaison Committee on Resuscitation

JUSTIFICATIVA E OBJETIVOS: O International Liaison Committee on Resuscitation (ILCOR) foi formada em 1992 para fornecer um fórum de articulação entre as organizações de ressuscitação principal no mundo inteiro. As organizações criam de diretrizes de ressuscitação. Atualmente, é composto por representantes do ILCOR: American Heart Association (AHA); Conselho Europeu de Ressuscitação (ERC); Heart Stroke Foundation of Canada (HSFC); Conselho de Ressuscitação da Austrália e Nova Zelândia (ANZCOR); Conselhos e Ressuscitação da África do Sul (RCSA); Inter American Heart Foundation (IAHF); Resuscitation Council of Asia (RCA). Os objetivos do ILCOR são proporcionar um fórum de discussão e de coordenação de todos os aspectos da ressuscitação cardiopulmonar no mundo inteiro; promover a investigação científica em áreas de reanimação, onde há falta de dados ou, quando há controvérsia; divulgar informações sobre a formação e a educação em ressuscitação; criar um mecanismo para recolher, analisar e compartilhamento de dados científicos internacionais de ressuscitação; produzir declarações sobre temas específicos relacionados à ressuscitação que reflitam um consenso internacional. CONTEÚDO: O ILCOR se reúne duas vezes por ano geralmente alternando entre um local nos Estados Unidos e um espaço no resto do mundo. Em colaboração com a AHA, o ILCOR produziu as primeiras Diretrizes Internacionais de RCP em 2000, um consenso internacional sobre RCP e ECC Ciência com Recomendações de Tratamento em 2005. Mais uma vez, em colaboração com a AHA, o ILCOR está coordenando uma revisão baseada em evidências da ciência de reanimação, que culminará com um consenso 2010. CONCLUSÃO: Os trabalhos da reunião, a ser publicado em outubro de 2010, irá fornecer o material para as organizações regionais de reanimação, como a ERC, a escrever suas diretrizes de ressuscitação.

BACKGROUND AND OBJECTIVES: The International Liaison Committee on Resuscitation (ILCOR) was formed in 1992 to provide a forum for Liaison between principal resuscitation organizations worldwide. Although the criteria for participation were not closely defined, member organizations were expected to have an accepted remit for creating resuscitation guidelines, preferably for more than one country, and to be multidisciplinary in membership. At present, ILCOR comprises representatives of American Heart Association (AHA); European Resuscitation Council (ERC); Heart and Stroke Foundation of Canada (HSFC); Australian and New Zealand Committee on Resuscitation (ANZCOR); Resuscitation Councils of Southern Africa (RCSA); Inter American Heart Foundation (IAHF); Resuscitation Council of Asia (RCA: current members Japan, Korea, Singapore, Taiwan). The objectives of the ILCOR are to: Provide a forum for discussion and for coordination of all aspects of cardiopulmonary and cerebral resuscitation worldwide. Foster scientific research in areas of resuscitation where there is a lack of data or where there is controversy. Disseminate information on training and education in resuscitation. Provide a mechanism for collecting, reviewing and sharing international scientific data on resuscitation. Produce statements on specific issues related to resuscitation that reflect international consensus. CONTENTS: ILCOR meets twice each year usually alternating between a venue in the United States and a venue elsewhere in the world. In collaboration with the AHA, ILCOR produced the first International CPR Guidelines in 2000 and an International Consensus on CPR and ECC Science with Treatment Recommendations in 2005. In collaboration with the AHA, ILCOR is now coordinating an evidence-based review of resuscitation science, which will culminate in a Consensus 2010, to be published in October 2010(...)