How to optimize care for the cardiac arrest patient in the prehospital setting?

International Chair on Interventional Cardiology and Transradial Approach

Speaker: Jacob Hollenberg Event: #SSAI2017. All conference content here: https://scanfoam.org/ssai2017/

Health & Medicine

OUT-OF-HOSPITAL CARDIAC ARREST
OPTIMIZEDTREATMENTPRIORTOHOSPITALARRIVAL
Jacob Hollenberg
Associate Professor, Senior Consultant
MICU, Dept of Cardiology, Södersjukhuset
Director, Centre for Resuscitation Science, Karolinska Institutet
Swedish Resuscitation Council, Chair D-CPR

CPR QUALITY
• Chest compressions where not performed during 48% of the time
without circulation!
• Only 28% of given chest compressions were adequate
(frequency + depth).
• Manual ventilations often to high frequency
JAMA 2003

(Edelson Resuscitation. 2006)
EFFECT ON SHOCK-SUCCESS

0
10
20
30
40
50
60
70
80
0-2 5-6 9-10 13-14 17-18 21-
Survival %
min.
EARLY DEFIBRILLATION
2+1+ 11=14 minutes
For each minute without treatment (CPR + defibrillation)
the chance of survival decreases by 10%

50-70 % CAN SURVIVE PUBLIC DEFIBRILLATION
Defibrillation by: Ambulance Polis/Fire dept Public
AEDs
Number: 326 53 74
Survival: n (%) 101 (31%) 22 (42%) 51 (71%)
Witnessed cardiac arrest, outside home, cardiac cause (VT/VF).
Resuscitation

17 % available for Public Access Defibrillation
Only 2,5 % on High Incidences Sites
1 arrest / 5 years (ERC)
1 arrest / 2 years (AHA)

• Prospective RCT.
• 2003-2008 Norway
• ACLS vs. ACLS without IV-access
IV No-IV P
Patients 418 433
Admitted 32% 21% 0,0001
Survival 10,5% 9,2% 0,6
JAMA 2009

• Multicenter RCT.
• 2006-2009 Australia + New Zeeland
• Adrenaline vs. Placebo
• Primary endpoint: survival (power on 2% increase, 2425 pat in each group)
• All OHCA > 18

Placebo Adrenaline P
(n = 262) (n = 272)
ROSC (pre-hosp) 8 % 24 % <0.001
Admitted alive 13 % 25 % <0.001
Survival (discharged) 2 % 4 % 0.15
n = 5 n = 5
* Note number of survivors

VASOPRESSIN? STEROIDS?
Greece, 268 in-hospital cardiac arrest
Adrenaline + Vasopressin + Steroids
vs.
Adrenaline + Placebo
Survival: 13,9% vs. 5,1% (p 0,02)
JAMA 2013

DRUGS
• Adrenaline
• Adrenaline + Vasopressin + Steroids – new study?
• B-blockers - intra-arrest?
• Levosimendan - intra-arrest?

AIRWAY MANAGEMENT (DURING CPR)
• Registry data point towards better survival with simple
airway management
(Fouche Prehosp Emerg Care 2014)
(Hasegawa JAMA 2013)
• If use of airway device, perhaps better with intubation
(low evidence reg.data)
(Wang Resuscitation 2012)
(Benoit Resuscitation 2015)

AIRWAY MANAGEMENT (DURING CPR)
• Ventilations during CPR?
- TANGO2 (Sweden: Simplified CRR vs. CPR)
• If yes, how manage airway management?
- PART (USA: Laryngeal tube vs. Intubation)
- IRWAYS2 (England, I-gel vs. Intubation)
- CAAM (France, mask-ventilation to ROSC vs. Intubation)

Witnessed OHCA
Randomization
No pre-hosp hypothermiaPre-hosp hypothermia
Hypothermia at ICU Hypothermia at ICU
PRINCESS

Rubertsson et al
JAMA 2013
MECHANICAL CPR

WHY NOT TREAT CARDIAC ARREST
PATIENTS LIKE TRAUMA CASES

Inclusion criteria
• 18-65 years
• Bystander CPR
• ACLS > 6 min
• VF
• Cardiac etiology
STEP
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Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk

CHEMOTHERAPY_RDP_CHAPTER 3_ANTIFUNGAL AGENT.pdf

Travel Clinic Cardiff: Health Advice for International Travelers

NX Healthcare

Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk

REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx

LaniyaNasrink

Artificial Intelligence Symposium (THAIS)

Josep Vidal-Alaball

Osteoporosis - Definition , Evaluation and Management .pdf

Jim Jacob Roy

Pharmacology of 5-hydroxytryptamine and Antagonist

Dr. Nikhilkumar Sakle

5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness. It is mostly found in the brain, intestines, and blood platelets. 5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin. It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.

CBL Seminar 2024_Preliminary Program.pdf

suvadeepdas911

Histololgy of Female Reproductive System.pptx

AyeshaZaid1

Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.

Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx

Dr. Rabia Inam Gandapore

MERCURY GROUP.BHMS.MATERIA MEDICA.HOMOEOPATHY

DRPREETHIJAMESP

Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions. The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.

CHEMOTHERAPY_RDP_CHAPTER 2 _LEPROSY.pdf1