EMS

Amiodarone or Lidocaine for Early Shockable OHCA?

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In this secondary analysis of the ALPS trial (Amiodarone, Lidocaine, or Placebo Study), researchers found that early administration of amiodarone (within 8 minutes) is associated with greater functional survival in OHCA with initial shockable rhythm when compared to placebo.

Source
Survival by Time-to-Administration of Amiodarone, Lidocaine, or Placebo in Shock-Refractory Out-of-Hospital Cardiac Arrest. Acad Emerg Med. 2023 Mar 4. doi: 10.1111/acem.14716. Epub ahead of print.

Epi for OHCA – ROSC, Survival…But Are We Saving the Brain?

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In this systematic review and meta-analysis, researchers found the epinephrine in standard doses, high doses, and with vasopressin lead to an improvement in ROSC and survival to hospital admission in out of hospital cardiac arrest (OHCA) but did not improve survival to discharge or functional neurologic outcome.

Source
Epinephrine in Out-of-Hospital Cardiac Arrest: A Network Meta-analysis and Subgroup Analyses of Shockable and Nonshockable Rhythms. Chest. 2023 Jan 31:S0012-3692(23)00165-4. doi: 10.1016/j.chest.2023.01.033. Epub ahead of print.

CPR Fatigue Is REAL – How Do Fit Rescuers Perform?

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In this study of firefighters performing CPR with feedback devices, researchers found that compression depth decreased over the course of a two-minute chest compression cycle while compression rate stayed within goal.

Source
Temporal analysis of continuous chest compression rate and depth performed by firefighters during out of hospital cardiac arrest. Resuscitation. 2023 Feb 16;185:109738. doi: 10.1016/j.resuscitation.2023.109738. Epub ahead of print.

EXACT Trial – Oxygen Saturation Targets after Cardiac Arrest

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Targeting a lower oxygen saturation (90-94%), compared to standard care (98-100%), in patients who were resuscitated after out-of-hospital cardiac arrest (OHCA) until admission to the intensive care unit did not significantly improve survival to hospital discharge.

Source
Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge Among Patients Resuscitated After Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial. JAMA. 2022 Nov 8;328(18):1818-1826. doi: 10.1001/jama.2022.17701.

Does Calcium Work for PEA in Suspected Hyperkalemia?

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Empiric calcium administration in PEA arrest not only failed to improve ROSC, but also had no impact when ECG features of hyperkalemia and acute myocardial ischemia were present.

Source
Effect of Calcium in Patients with Pulseless Electrical Activity and Electrocardiographic Characteristics Potentially Associated with Hyperkalemia and Ischemia-Sub-study of the Calcium for Out-of-hospital Cardiac Arrest (COCA) trial. Resuscitation. 2022 Nov 17;S0300-9572(22)00712-2. doi: 10.1016/j.resuscitation.2022.11.006. Online ahead of print.

Refractory Ventricular Fibrillation – What’s the Best Defibrillation Strategy?

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For the treatment of refractory ventricular fibrillation (VF) in out-of-hospital cardiac arrest, survival to hospital discharge was more common among patients who received double sequential external defibrillation (DSED) and vector-change (VC) defibrillation than those who received standard defibrillation. 

Source
Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med. 2022 Nov 6. doi: 10.1056/NEJMoa2207304. Online ahead of print.

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