Review
Critical Care Medicine
Gavin D. Perkins, Keith Couper
Summary: The Chain of Survival emphasizes the importance of early recognition, calling for help, performing CPR, and early defibrillation in cardiac arrest cases. Despite these interventions, many patients still remain in cardiac arrest. Adrenaline is highly effective in achieving return of spontaneous circulation, but its effectiveness on long-term outcomes and neurological outcome remains uncertain. Vasopressin and high-dose adrenaline have not shown evidence of improved long-term outcomes. Trials to evaluate the interaction between steroids and vasopressin are needed. The use of other vasopressors is not supported by sufficient evidence. Routine use of intravenous calcium chloride is not beneficial and may cause harm. The optimal route for vascular access is still being studied.
Article
Critical Care Medicine
Tatsuma Fukuda, Naoko Ohashi-Fukuda, Ryota Inokuchi, Yutaka Kondo, Takayuki Taira, Ichiro Kukita
Summary: This study analyzed nationwide registry data in Japan and found that delayed epinephrine administration was associated with lower 1-month neurologically favorable survival among out-of-hospital cardiac arrest patients.
Article
Emergency Medicine
Sanae Hosomi, Ling Zha, Kosuke Kiyohara, Tetsuhisa Kitamura, Taro Irisawa, Hiroshi Ogura, Jun Oda
Summary: This study aimed to investigate the association between sex and prehospital advanced cardiac life support (ACLS) interventions provided by emergency medical services in Japan. The study found that females received fewer prehospital ACLS interventions than males, and this disparity was consistent across different subgroups. The study suggests that emergency medical service staff should be aware of this disparity and provide training to improve access to prehospital ACLS interventions for females.
AMERICAN JOURNAL OF EMERGENCY MEDICINE
(2023)
Article
Critical Care Medicine
Kirstie L. Haywood, Chen Ji, Tom Quinn, Jerry P. Nolan, Charles D. Deakin, Charlotte Scomparin, Ranjit Lall, Simon Gates, John Long, Scott Regan, Rachael T. Fothergill, Helen Pocock, Nigel Rees, Lyndsey O'Shea, Gavin D. Perkins
Summary: The PARAMEDIC2 trial compared the effects of adrenaline on early outcomes in out-of-hospital cardiac arrest patients. Adrenaline improved survival up to 12 months follow-up but did not show evidence of improving favorable neurological outcomes. At 6 months, there was a slight increase in favorable neurological outcomes and survival in the adrenaline group compared to the placebo group.
Review
Critical Care Medicine
Michael McLure, Kathryn Eastwood, Michael Parr, Janet Bray
Summary: The rapid review of international and Australian ALS guidelines for anaphylaxis-related cardiac arrest revealed significant variation in recommendations, particularly in adrenaline dosing, antihistamines, and corticosteroid recommendations. While most recommendations were based on low-level evidence, new evidence from studies published in the last decade may provide an opportunity for more consistent international guideline recommendations and educational materials.
Article
Critical Care Medicine
Bard E. Heradstveita, Geir Arne Sunde, Helge Asbjornsen, Rune Aalvika, Tore Wentzel-Larsen, Jon-Kenneth Heltnea
Summary: The study indicates that epinephrine elimination during cardiac arrest is prolonged and repeated doses may lead to increased plasma levels. Further and larger studies are needed to determine the optimal plasma concentration during resuscitation.
Review
Critical Care Medicine
Katherine M. Berg, Jasmeet Soar
Summary: This review discusses potential reasons for the lack of difference in outcomes in recent large trials of advanced cardiac life support, and suggests some points for consideration in planning future trials. The ARREST trial, which was stopped early for benefit, differed in approach from other recent trials, highlighting the importance of refining patient selection and intervention tailoring.
CURRENT OPINION IN CRITICAL CARE
(2021)
Article
Emergency Medicine
Gi Woon Kim, Hyung Jun Moon, Hoon Lim, Yu Jin Kim, Choung Ah. Lee, Yong Jin Park, Kyoung Mi Lee, Jae Hyug Woo, Jin Seong Cho, Won Jung Jeong, Hyuk Joong Choi, Chang Sun Kim, Han Joo Choi, Il Kug Choi, Nam Hun Heo, Jung Soo Park, Young Hwan Lee, Seung Min Park, Dong Kil Jeong
Summary: This study compared the outcomes of out-of-hospital cardiac arrest (OHCA) patients before and after the implementation of Smart Advanced Life Support (SALS) protocol, which involved changes in cardiopulmonary resuscitation (CPR) assistance and coaching by physicians via real-time video calls. The results showed that the use of SALS protocol was associated with better neurological outcomes, higher prehospital return of spontaneous circulation (ROSC), and increased survival to discharge compared to conventional protocol.
AMERICAN JOURNAL OF EMERGENCY MEDICINE
(2022)
Article
Health Care Sciences & Services
Yu Wang, Qun Zhang, Guang Bo Qu, Fang Fang, Xiao Kang Dai, Liang Xi Yu, Hong Zhang
Summary: This study evaluated the effects of advanced airway management (AAM) and adrenaline treatment on the outcomes of out-of-hospital cardiac arrest (OHCA) patients in China. The results showed that the combined treatment of AAM and adrenaline can increase the rate of return of spontaneous circulation (ROSC) and the rate of survival to admission in OHCA patients.
BMC HEALTH SERVICES RESEARCH
(2022)
Article
Medicine, General & Internal
Deborah Jaeger, Jonathan Koger, Helene Duhem, Caroline Fritz, Victor Jeangeorges, Kevin Duarte, Bruno Levy, Guillaume Debaty, Tahar Chouihed
Summary: The study compared the effects of reduced doses of adrenaline with the recommended 1 mg dose on CPP in a pig model of cardiac arrest. The results showed that the 0.25 mg dose did not achieve the threshold of 35 mmHg, while the 0.5 mg dose and the standard 1 mg dose did not have significant differences in CPP.
JOURNAL OF CLINICAL MEDICINE
(2021)
Article
Nursing
Lydia Team, Melissa J. Bloomer, Bernice Redley
Summary: The study aimed to explore nurses' roles and responsibilities in cardiac advanced life support (CALS) for postoperative cardiac surgical patients through expert consensus. The results showed that there was widespread agreement on nurses' roles and responsibilities before and after cardiac arrest, but uncertainty remained in implementing the CALS protocol.
NURSING IN CRITICAL CARE
(2023)
Article
Emergency Medicine
Deborah Jaeger, Valentine Baert, Francois Javaudin, Guillaume Debaty, Helene Duhem, Jonathan Koger, Pierre-Yves Gueugniaud, Karim Tazarourt, Carlos El Khoury, Herve Hubert, Tahar Chouihed
Summary: This study compared the outcomes of patients treated with different doses of adrenaline during cardiac arrest. The results showed that lower doses of adrenaline had similar survival rates and good neurological outcomes as the recommended dose, while higher doses were associated with lower survival rates and poorer neurological outcomes.
EUROPEAN JOURNAL OF EMERGENCY MEDICINE
(2022)
Article
Cardiac & Cardiovascular Systems
Myra H. Wyckoff, Robert Greif, Peter T. Morley, Kee-Chong Ng, Theresa M. Olasveengen, Eunice M. Singletary, Jasmeet Soar, Adam Cheng, Ian R. Drennan, Helen G. Liley, Barnaby R. Scholefield, Michael A. Smyth, Michelle Welsford, David A. Zideman, Jason Acworth, Richard Aickin, Lars W. Andersen, Diane Atkins, David C. Berry, Farhan Bhanji, Joost Bierens, Vere Borra, Bernd W. Bottiger, Richard N. Bradley, Janet E. Bray, Jan Breckwoldt, Clifton W. Callaway, Jestin N. Carlson, Pascal Cassan, Maaret Castren, Wei-Tien Chang, Nathan P. Charlton, Sung Phil Chung, Julie Considine, Daniela T. Costa-Nobre, Keith Couper, Thomaz Bittencourt Couto, Katie N. Dainty, Peter G. Davis, Maria Fernanda de Almeida, Allan R. de Caen, Charles D. Deakin, Therese Djarv, Michael W. Donnino, Matthew J. Douma, Jonathan P. Duff, Cody L. Dunne, Kathryn Eastwood, Walid El-Naggar, Jorge G. Fabres, Joe Fawke, Judith Finn, Elizabeth E. Foglia, Fredrik Folke, Elaine Gilfoyle, Craig A. Goolsby, Asger Granfeldt, Anne-Marie Guerguerian, Ruth Guinsburg, Karen G. Hirsch, Mathias J. Holmberg, Shigeharu Hosono, Ming-Ju Hsieh, Cindy H. Hsu, Takanari Ikeyama, Tetsuya Isayama, Nicholas J. Johnson, Vishal S. Kapadia, Mandira Daripa Kawakami, Han-Suk Kim, Monica Kleinman, David A. Kloeck, Peter J. Kudenchuk, Anthony T. Lagina, Kasper G. Lauridsen, Eric J. Lavonas, Henry C. Lee, Yiqun (Jeffrey) Lin, Andrew S. Lockey, Ian K. Maconochie, R. John Madar, Carolina Malta Hansen, Siobhan Masterson, Tasuku Matsuyama, Christopher J. D. McKinlay, Daniel Meyran, Patrick Morgan, Laurie J. Morrison, Vinay Nadkarni, Firdose L. Nakwa, Kevin J. Nation, Ziad Nehme, Michael Nemeth, Robert W. Neumar, Tonia Nicholson, Nikolaos Nikolaou, Chika Nishiyama, Tatsuya Norii, Gabrielle A. Nuthall, Brian J. O'Neill, Yong-Kwang Gene Ong, Aaron M. Orkin, Edison F. Paiva, Michael J. Parr, Catherine Patocka, Jeffrey L. Pellegrino, Gavin D. Perkins, Jeffrey M. Perlman, Yacov Rabi, Amelia G. Reis, Joshua C. Reynolds, Giuseppe Ristagno, Antonio Rodriguez-Nunez, Charles C. Roehr, Mario Rudiger, Tetsuya Sakamoto, Claudio Sandroni, Taylor L. Sawyer, Steve M. Schexnayder, Georg M. Schmolzer, Sebastian Schnaubelt, Federico Semeraro, Markus B. Skrifvars, Christopher M. Smith, Takahiro Sugiura, Janice A. Tijssen, Daniele Trevisanuto, Patrick Van de Voorde, Tzong-Luen Wang, Gary M. Weiner, Jonathan P. Wyllie, Chih-Wei Yang, Joyce Yeung, Jerry P. Nolan, Katherine M. Berg
Summary: This article summarizes the International Liaison Committee on Resuscitation's International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It covers a wide range of topics related to resuscitation and provides consensus treatment recommendations based on evidence quality assessment. The article also highlights knowledge gaps for future research.
Article
Medicine, General & Internal
I-Ting Wang, Chieh-Jen Wang, Chao-Hsien Chen, Sheng-Hsiung Yang, Chun-Yen Chen, Yen-Chun Huang, Chang-Yi Lin, Chien-Liang Wu
Summary: TTM for post-cardiac arrest patients can improve outcomes, but the optimal timing for initiating cooling is uncertain. This retrospective analysis found that a shorter delay before TTM was associated with lower survival rates, while a longer time to reach the target temperature was associated with better neurological outcomes and survival rates. The influence of the delay before TTM on survival became insignificant after regression analysis, but patients who cooled slowest still had a better chance of survival. Further prospective studies are needed to determine the appropriate time window for TTM.
JOURNAL OF CLINICAL MEDICINE
(2023)
Review
Medicine, General & Internal
Manuel Obermaier, Stephan Katzenschlager, Othmar Kofler, Frank Weilbacher, Erik Popp
Summary: Technological advances and user-friendly portable devices have been developed to improve the chance of survival from sudden cardiac arrest. Feedback systems, automated mechanical CPR devices, and advanced invasive procedures can enhance the quality of CPR and provide better treatment options for patients.
JOURNAL OF CLINICAL MEDICINE
(2022)
Article
Emergency Medicine
Judith C. Finn, Deon Brink, Nicole Mckenzie, Antony Garcia, Hideo Tohira, Gavin D. Perkins, Glenn Arendts, Daniel M. Fatovich, Delia Hendrie, Brendan McQuillan, Quentin Summers, Antonio Celenza, Ashes Mukherjee, Ben Smedley, Gavin Pereira, Stephen Ball, Teresa Williams, Paul Bailey
Summary: The study demonstrates that prehospital CPAP by EMS paramedics can effectively reduce dyspnoea and tachypnoea in patients with severe respiratory distress, but does not impact hospital length of stay.
EMERGENCY MEDICINE JOURNAL
(2022)
Article
Medicine, General & Internal
Gavin D. Perkins, Chen Ji, Bronwen A. Connolly, Keith Couper, Ranjit Lall, J. Kenneth Baillie, Judy M. Bradley, Paul Dark, Chirag Dave, Anthony De Soyza, Anna Dennis, Anne Devrell, Sara Fairbairn, Hakim Ghani, Ellen A. Gorman, Christopher A. Green, Nicholas Hart, Siew Wan Hee, Zoe Kimbley, Shyam Madathil, Nicola McGowan, Benjamin Messer, Jay Naisbitt, Chloe Norman, Dhruv Parekh, Emma M. Parkin, Jaimin Patel, Scott E. Regan, Clare Ross, Anthony J. Rostron, Mohammad Saim, Anita K. Simonds, Emma Skilton, Nigel Stallard, Michael Steiner, Rama Vancheeswaran, Joyce Yeung, Daniel F. McAuley
Summary: Among patients with acute hypoxemic respiratory failure due to COVID-19, an initial strategy of CPAP significantly reduced the risk of tracheal intubation or mortality compared with conventional oxygen therapy, but there was no significant difference between an initial strategy of HFNO compared with conventional oxygen therapy. The study may have been underpowered for the comparison of HFNO vs conventional oxygen therapy, and early study termination and crossover among the groups should be considered when interpreting the findings.
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
(2022)
Article
Respiratory System
Rebecca L. Winslow, Jie Zhou, Ella F. Windle, Intesar Nur, Ranjit Lall, Chen Ji, Jonathan Edward Millar, Paul M. Dark, Jay Naisbitt, Anita Simonds, Jake Dunning, Wendy Barclay, John Kenneth Baillie, Gavin D. Perkins, Malcolm Gracie Semple, Daniel Francis McAuley, Christopher A. Green
Summary: The study found that the use of CPAP and HFNO in treating COVID-19 patients did not result in higher levels of air or surface viral contamination compared to the use of supplemental oxygen. This suggests that the risk of viral transmission to healthcare workers and patients is not significantly increased when using CPAP and HFNO.
Article
Critical Care Medicine
Matthew J. Rowland, Tonny Veenith, Charlotte Scomparin, Mark H. Wilson, Peter J. Hutchinson, Angelos Kolias, Ranjit Lall, Scott Regan, James Mason, Peter J. D. Andrews, Daniel Horner, Jay Naisbitt, Anne Devrell, Andrew Malins, Paul Dark, Danny McAuley, Gavin D. Perkins
JOURNAL OF THE INTENSIVE CARE SOCIETY
(2022)
Review
Critical Care Medicine
Adam J. Boulton, Marina Del Rios, Gavin D. Perkins
Summary: This review discusses the health inequities faced by out-of-hospital cardiac arrest patients and proposes solutions. Research shows significant disparities in different regions and ethnic groups, including low rates of CPR and AED usage, as well as unequal distribution of medical resources. These inequities result in lower survival rates among disadvantaged communities and ethnic minorities. Addressing these issues will require coordinated action with these communities.
CURRENT OPINION IN CRITICAL CARE
(2022)
Review
Critical Care Medicine
J. P. Nolan, J. P. Ornato, M. J. A. Parr, G. D. Perkins, J. Soar
Summary: This review highlights some key papers published in Resuscitation during 2021, demonstrating the continuous evolution of resuscitation science and its focus on all links in the chain of survival.
Article
Geriatrics & Gerontology
Julie Bruce, Anower Hossain, Chen Ji, Ranjit Lall, Susanne Arnold, Emma Padfield, Martin Underwood, Sarah E. Lamb
Summary: This study validated the use of a postal risk screener in identifying fall and fracture risk in community-dwelling populations, and found that the addition of variables improved the performance of the screener.
Article
Cardiac & Cardiovascular Systems
Nilesh Pareek, Christopher Frohmaier, Mathew Smith, Peter Kordis, Antonio Cannata, Jo Nevett, Rachael Fothergill, Robert C. Nichol, Mark Sullivan, Nicholas Sunderland, Thomas W. Johnson, Marko Noc, Jonathan Byrne, Philip MacCarthy, Ajay M. Shah
Summary: A machine learning algorithm was developed to predict the presence of a culprit lesion in patients with out-of-hospital cardiac arrest. The algorithm incorporates nine variables and was validated using data from the King's Out-of-Hospital Cardiac Arrest Registry. The results showed that the algorithm has high accuracy in predicting culprit coronary artery disease lesions and outperforms the current standard electrocardiogram.
CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS
(2023)
Article
Endocrinology & Metabolism
Chukwuma Uduku, Valentina Pendolino, Narvada Jugnee, Nick Oliver, Rachael Fothergill, Monika Reddy
Summary: Real-time continuous glucose monitoring can reduce the risk of severe hypoglycaemia for adults with type 1 diabetes, but its impact immediately after an episode of severe hypoglycaemia has not been assessed.
Article
Health Care Sciences & Services
Bridie A. Evans, Ashra Khanom, Adrian Edwards, Bethan Edwards, Angela Farr, Theresa Foster, Rachael Fothergill, Penny Gripper, Imogen Gunson, Alison Porter, Nigel Rees, Jason Scott, Helen Snooks, Alan Watkins
Summary: People who frequently call emergency ambulances perceive their care needs as urgent and ongoing. They are unable to see alternative ways to receive help and resolve problems. Communication between health professionals and service users appears inadequate. Further research is needed to understand service users' motivations and requirements to inform the design and delivery of accessible and effective services.
HEALTH EXPECTATIONS
(2023)
Article
Cardiac & Cardiovascular Systems
Robert Aldous, Roman Roy, Antonio Cannata, Muhamad Abdrazak, Shamika Mohanan, Nicholas Beckley-Hoelscher, Daniel Stahl, Ritesh Kanyal, Peter Kordis, Nicholas Sunderland, Aleksandra Parczewska, Ali Kirresh, Joanne Nevett, Rachael Fothergill, Ian Webb, Rafal Dworakowski, Narbeh Melikian, Sundeep Kalra, Thomas W. Johnson, Gianfranco Sinagra, Serena Rakar, Marko Noc, Sameer Patel, Georg Auzinger, Marcin Gruchala, Ajay M. Shah, Jonathan Byrne, Philip MacCarthy, Nilesh Pareek
Summary: This study compared the discrimination performance of the MIRACLE2 score, downtime, and current randomized controlled trial (RCT) recruitment criteria in predicting poor neurologic outcome after out-of-hospital cardiac arrest (OHCA). The results showed that the MIRACLE2 score had a stronger association with outcome and higher discrimination for poor outcome compared to downtime and RCT recruitment criteria. The potential for the MIRACLE2 score to improve the selection of OHCA patients should be evaluated in future RCTs.
JACC-CARDIOVASCULAR INTERVENTIONS
(2023)
Article
Medicine, General & Internal
Tiffany Patterson, Gavin Perkins, Alexander Perkins, Tim Clayton, Richard Evans, Matthew Dodd, Steven Robertson, Karen Wilson, Adam Mellett-Smith, Rachael Fothergill, Paul Mccrone, Miles Dalby, Philip Maccarthy, Sam Firoozi, Iqbal Malik, Roby Rakhit, Ajay Jain, Jerry P. Nolan, ARREST Trial Collaborators
Summary: This study assessed whether expedited delivery to a cardiac arrest center compared with current standard of care reduces deaths in patients with resuscitated cardiac arrest. The results showed that expedited delivery to a cardiac arrest center did not reduce mortality in adult patients without ST elevation.
Article
Critical Care Medicine
Sharvari Vadeyar, Alexandra Buckle, Amy Hooper, Scott Booth, Charles D. Deakin, Rachael Fothergill, Chen Ji, Jerry P. Nolan, Martina Brown, Alan Cowley, Emma Harris, Maureen Ince, Robert Marriott, John Pike, Robert Spaight, Gavin Perkins, Keith Couper
Summary: This study aimed to explore changes over time in the use of intraosseous and intravenous drug routes in out-of-hospital cardiac arrest in England. The results showed that the use of intraosseous access has progressively increased, while the use of intravenous access has decreased.
Review
Critical Care Medicine
Helen Pocock, Charles D. Deakin, Ranjit Lall, Christopher M. Smith, Gavin D. Perkins
Summary: This systematic review did not determine the optimal first-shock energy for biphasic defibrillation. No survival advantage was found at 30 days when comparing fixed and escalating energy strategies.
RESUSCITATION PLUS
(2022)
Review
Critical Care Medicine
Gavin D. Perkins, Jerry P. Nolan
Summary: This article is one of the ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2022, and more information can be found online.