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Routinely pausing chest compressions during cardiac arrest to intubate in the emergency department is not necessary; this is especially true if you have video laryngoscopy and a bougie.
Source
First Attempt Success with Continued versus Paused Chest Compressions During Cardiac Arrest in the Emergency Department. Resuscitation. 2023 Feb 8;109726. doi: 10.1016/j.resuscitation.2023.109726. Online ahead of print.
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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.
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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.
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For in-hospital ventricular fibrillation/ventricular tachycardia (VF/VT) arrest (IHCA), lidocaine may have more favorable outcomes compared to amiodarone.
Source
Comparative Effectiveness of Amiodarone and Lidocaine for Treatment of In-Hospital Cardiac Arrest (IHCA). Chest. 2022 Nov 1;S0012-3692(22)04039-9. doi: 10.1016/j.chest.2022.10.024. Online ahead of print.
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Here are the latest evidence updates on basic, advanced, and pediatric life support – and more – from this expert literature review.
Source
2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation. 2022 Nov 3. doi: 10.1161/CIR.0000000000001095. Online ahead of print.
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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.
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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.
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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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Relative thoracic distention pattern seen on capnography during cardiac arrest may have a negative impact on blood pressure and cerebral perfusion. Here’s how to recognize and fix it.
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With ventilation rate standardized, chest compression depth explains variations in ETCO2 better than chest compression rate.
Source
Contribution of chest compressions to end-tidal carbon dioxide levels generated during out-of-hospital cardiopulmonary resuscitation. Resuscitation. 2022 Oct;179:225-232. doi: 10.1016/j.resuscitation.2022.07.009. Epub 2022 Jul 11.
