Did the Heimlich Maneuver Just Choke?
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Back blows outperformed abdominal thrusts and chest compressions in successful clearance of out-of-hospital foreign body airway obstructions (FBAO).
Source
Evaluation of basic life support interventions for foreign body airway obstructions: A population-based cohort study. Resuscitation. 2024 Aug;201:110258. doi: 10.1016/j.resuscitation.2024.110258. Epub 2024 May 31. PMID: 38825222.
Re-DOSE VF… DSED for Shock-Refractory VF?
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This secondary analysis of the DOSE VF trial found that DSED (dual sequence external defibrillation) was the superior strategy for obtaining ROSC and functional neurologic outcome regardless of whether the patient was in recurrent VF or shock-refractory VF after three standard defibrillation shocks.
Source
The impact of alternate defibrillation strategies on shock-refractory and recurrent ventricular fibrillation: A secondary analysis of the DOSE VF cluster randomized controlled trial. Resuscitation. 2024 May;198:110186. doi: 10.1016/j.resuscitation.2024.110186. Epub 2024 Mar 24. PMID: 38522736.
How Dangerous Are Pauses In Pediatric Chest Compressions?
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Data supporting pediatric cardiac arrest guidelines are limited. This study found increases in the longest pause in chest compressions (CC) during pediatric in-hospital cardiac arrest (pIHCA) were inversely associated with survival and ROSC.
Source
Association Between Chest Compression Pause Duration and Survival After Pediatric In-Hospital Cardiac Arrest. Circulation. 2024 May 7;149(19):1493-1500. doi: 10.1161/CIRCULATIONAHA.123.066882. Epub 2024 Apr 2. PMID: 38563137; PMCID: PMC11073898.
Timing of Airway Management in OHCA – Does It Matter?
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In a large retrospective review of patients with out-of-hospital-cardiac-arrest (OHCA) there was a very small, and probably clinically insignificant, association with favorable neurological outcome and survival in those who underwent early as opposed to late advanced airway management.
Source
Early versus late advanced airway management for adult patients with out-of-hospital cardiac arrest: A time-dependent propensity score matched analysis. Acad Emerg Med. 2024 Apr 8. Epub ahead of print. DOI: 10.111/acem.14907
Do We Need to Rethink NRP ETT Sizes?
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In a very specific subgroup of weights, using an ETT that is 0.5 mm smaller than the NRP recommended size was associated with reduced adverse events during tracheal intubation of neonates.
Source
Endotracheal tube size adjustments within 7 day of neonatal intubation. Pediatrics. 2024 Mar 12:e2023062925. Online Ahead of Print.
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.