We Nar-CAN But Should We? Naloxone Impact on OHCA – Part 2
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In contrast to yesterday's paper, this retrospective study of more than 8,000 out-of-hospital cardiac arrest (OHCA) patients detected higher rates of ROSC and survival discharge among patients who received naloxone.
Source
Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California. JAMA Netw Open. 2024 Aug 1;7(8):e2429154. doi: 10.1001/jamanetworkopen.2024.29154. PMID: 39163042; PMCID: PMC11337064.
Does Naloxone Impact OHCA Outcomes? – Part 1
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This analysis of more than 700 out-of-hospital cardiac arrest (OHCA) patients in an area with a high prevalence of opioid overdose did not find an association between naloxone administration and improved patient outcomes.
Source
Outcomes of Out-of-Hospital Cardiac Arrest Patients Who Received Naloxone in an Emergency Medical Services System With a High Prevalence Of Opioid Overdose. J Emerg Med. 2024 Sep;67(3):e249-e258. doi: 10.1016/j.jemermed.2024.03.038. Epub 2024 Apr 9. PMID: 39034160.
Does Defibrillator Pad Placement Matter for OHCA?
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Anterior-posterior (AP) - compared to standard anterolateral (AL) defibrillator pad placement - was associated with higher rates of ROSC among patients with out-of-hospital-cardiac-arrest (OHCA), but no difference in survival to discharge or functional survival at discharge was observed.
Source
Initial Defibrillator Pad Position and Outcomes for Shockable Out-of-Hospital Cardiac Arrest. JAMA Netw Open. 2024 Sep 3;7(9):e2431673. doi: 10.1001/jamanetworkopen.2024.31673. PMID: 39250154; PMCID: PMC11385052.
The IV vs IO Debate in OHCA Continues…
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This retrospective observational analysis showed an association with more favorable neurologic outcomes, survival to hospital discharge, and ROSC upon ED arrival, in an IV-first approach compared to humeral IO in out-of-hospital cardiac arrests.
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The association of intravenous vs. humeral-intraosseous vascular access with patient outcomes in adult out-of-hospital cardiac arrests. Resuscitation. 2024 Sep;202:110360. doi: 10.1016/j.resuscitation.2024.110360. Epub 2024 Aug 16. PMID: 39154890.
IM Epinephrine for OHCA – Quicker and Better?
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In non-traumatic out of hospital cardiac arrest (OHCA), administration of an initial dose of IM epinephrine by EMS prior to an established IV or IO was associated with improved survival outcomes.
Source
Early intramuscular adrenaline administration is associated with improved survival from out-of-hospital cardiac arrest. Resuscitation. 2024 Aug;201:110266. doi: 10.1016/j.resuscitation.2024.110266. Epub 2024 Jun 9. PMID: 38857847.
Breath of Fresh Air – Capnography Trends in OHCA
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Dynamic increases in continuous end-tidal CO2 (EtCO2) were associated with increased odds of return of spontaneous circulation (ROSC) for patients with out-of-hospital cardiac arrest (OHCA), but EtCO2 trended down in patients who did not achieve ROSC.
Source
Temporal Trends in End-Tidal Capnography and Outcomes in Out-of-Hospital Cardiac Arrest: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2024;7(7):e2419274. doi:10.1001/jamanetworkopen.2024.19274. PMID: 38967927.
VICTOR RCT – IO or IV for OHCA?
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Attempting initial vascular access in the field by intraosseous (IO) vs. intravenous (IV) route made no difference in survival to hospital discharge for out-of-hospital cardiac arrest (OHCA), despite greater IO success rates.
Source
Intraosseous versus intravenous vascular access in upper extremity among adults with out-of-hospital cardiac arrest: cluster randomised clinical trial (VICTOR trial). BMJ. 2024 Jul 23:386:e079878. doi: 10.1136/bmj-2024-079878. PMID: 39043416.
VF or VT – Earlier Defibrillation Is Better?
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In a retrospective study of 142 patients with an initial shockable rhythm and 4 to 5 episodes of recurrent/refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT), shorter duration of VF and pVT was associated with higher rates of ROSC.
Source
The impact of time to defibrillation on return of spontaneous circulation in out-of-hospital cardiac arrest patients with recurrent shockable rhythms. Resuscitation. 2024;201:110286. doi:10.1016/j.resuscitation.2024.110286. PMID: 38901663.
Mechanism of Calcium for Hyperkalemia – Not What You Think
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Giving calcium for hyperkalemia restores normal cardiac conduction velocity but does not restore resting membrane potential, as is commonly stated.
Source
Beneficial Effect of Calcium Treatment for Hyperkalemia Is Not Due to "Membrane Stabilization". Crit Care Med. Published online July 24, 2024. PMID: 39046789.
Should We Terminate Termination of Resuscitation Rules?
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This systematic review and meta-analysis of 43 nonrandomized studies over 30 years looking at termination of resuscitation (TOR) rules in out of hospital cardiac arrest (OHCA) found that there was insufficient evidence to support widespread implementation of TOR rules in clinical practice, as this may lead to missed survivors.
Source
Termination of Resuscitation Rules and Survival Among Patients With Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2024 Jul 1;7(7):e2420040. doi: 10.1001/jamanetworkopen.2024.20040. PMID: 38958975; PMCID: PMC11222995.