How Much Epinephrine Is Too Much in ECPR?
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High-dose epinephrine (>3mg) was associated with unfavorable neurologic outcome when compared to low-dose epinephrine (≤3mg) after extracorporeal cardiopulmonary resuscitation.
Source
Cumulative epinephrine dose during cardiac arrest and neurologic outcome after extracorporeal cardiopulmonary resuscitation. Am J Emerg Med. 2024 Mar 15;80:61-66. doi: 10.1016/j.ajem.2024.03.013. Epub ahead of print. PMID: 38507848.
Higher ETCO2 and Better Outcomes in Pediatric Arrest
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Targeted ETCO2 ≥20 mm Hg during pediatric resuscitation was associated with higher rate of survival in patients with in-hospital cardiac arrest.
IO for OHCA – Humeral Head or Tibia?
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In subgroup analysis, there may be more successful ROSC in patients with upper extremity IO access compared to lower extremity access in OHCA, but these results should be adopted with caution.
Source
Retrospective Comparison of Upper and Lower Extremity Intraosseous Access During Out-of-Hospital Cardiac Arrest Resuscitation. Prehosp Emerg Care. 2024 Mar 26:1-8. doi: 10.1080/10903127.2024.2321285. Epub ahead of print. PMID: 38416867.
New AHA Statement on Cardiac Cath Lab Activation After OHCA
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The goal of invasive management in the cardiac catheterization laboratory (CCL) is to identify and treat culprit coronary lesion or additional resuscitative measures (such as mechanical circulatory support (MCS) or interventions for massive pulmonary embolism). This is a scientific statement from the American Heart Association (AHA) which provides an update on the role of CCL in the management of resuscitated patients or those with ongoing cardiac arrest.
Source
Cardiac Catheterization Laboratory Management of the Comatose Adult Patient With an Out-of-Hospital Cardiac Arrest: A Scientific Statement From the American Heart Association. Circulation. 2024 Jan 30;149(5):e274-e295. doi: 10.1161/CIR.0000000000001199. Epub 2023 Dec 19. PMID: 38112086.
The Top Cardiac Arrest RCTs of 2023
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This review article discusses four randomized clinical trials (RCT) focusing on interventions for out-of-hospital-cardiac-arrest (OHCA) that were published in 2023, all of which showed negligible impact on survival for the interventions studied.
New Meta-analysis – ECPR vs CPR in Cardiac Arrest
Dr. Amal Mattu and friends have a new video course you don't want to miss. Take a look!
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This updated meta-analysis re-demonstrated a benefit for extracorporeal cardiopulmonary resuscitation (ECPR) in reducing overall in-hospital cardiac arrest (IHCA) mortality and improving neurological outcomes after cardiac arrest but also demonstrated a new significant reduction in out of hospital cardiac arrest (OHCA) mortality with ECPR.
Source
Extracorporeal cardiopulmonary resuscitation versus conventional CPR in cardiac arrest: an updated meta-analysis and trial sequential analysis. Crit Care. 2024 Feb 21;28(1):57. doi: 10.1186/s13054-024-04830-5.
ECMO (aka ECPR) for Refractory OHCA
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This "brass tacks" summary of a recent systematic review found no improvement in favorable neurologic outcomes or reduction of in-hospital mortality for extracorporeal cardiopulmonary resuscitation (ECPR) when compared to standard advanced cardiac life support (ACLS) for refractory out-of-hospital cardiac arrest (OHCA).
Source
Extracorporeal Cardiopulmonary Resuscitation in Refractory Out-of-Hospital Cardiac Arrest. Acad Emerg Med. 2023 Dec 05;31(2):190-192. doi: 10.1111/acem.14844.
Epinephrine or Airway First in OHCA?
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In adults presenting to EMS after OHCA, those receiving epinephrine prior to advanced airway management (AAM = supraglottic airway, SGA, or endotracheal tube) experienced better outcomes and prehospital ROSC than those receiving AAM before epinephrine. This was true for both shockable and non-shockable initial rhythms.
Source
Sequence of Epinephrine and Advanced Airway Placement After Out-of-Hospital Cardiac Arrest. JAMA Netw Open. 2024 Feb 5;7(2):e2356863. doi: 10.1001/jamanetworkopen.2023.56863.
Best Shock Interval for Dual Defibrillation?
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In out-of-hospital cardiac arrest (OHCA) patients with refractory ventricular fibrillation (RVF), there was an association with short-interval (<75ms) dual sequential external defibrillation (DSED) and higher probability of termination of ventricular fibrillation (VF) and return of spontaneous circulation (ROSC) compared with longer DSED intervals.
Source
The impact of double sequential shock timing on outcomes during refractory out-of-hospital cardiac arrest. Resuscitation. 2024 Jan;194:110082. doi: 10.1016/j.resuscitation.2023.110082. Epub 2023 Dec 11.
Don’t Push! Excessive Neonatal Mask Pressure and Apnea-Bradycardia
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When providing respiratory support to preterm infants with a facemask, avoid excessive force on the face that is associated with apnea and bradycardia.
Source
Exerted force on the face mask in preterm infants at birth is associated with apnoea and bradycardia. Resuscitation. 2024;194:110086.