Good Bagging in CPR Saves Lives?
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For the majority of out-of-hospital cardiac arrest (OHCA) patients undergoing standard (30:2 compressions:breaths) cardiopulmonary resuscitation (CPR) prior to definitive airway placement, bag-valve mask (BVM) ventilations did not achieve adequate lung volumes most of the time. Receiving adequate BVM ventilations >50% of the time was associated with significantly higher rates of return of spontaneous circulation (ROSC) and survival.
Source
Bag-Valve-Mask Ventilation and Survival from Out-of-Hospital Cardiac Arrest: A Multicenter Study. Circulation. 2023 Nov 12. doi: 10.1161/CIRCULATIONAHA.123.065561. Epub ahead of print.
New App for Pediatric Cardiac Arrest
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This RCT found residents using a pediatric cardiac arrest app better adhered to the pediatric cardiac arrest algorithm when compared to those using a PALS visual aid or no aid at all.
Source
Effectiveness of a Novel Tablet Application in Reducing Guideline Deviations During Pediatric Cardiac Arrest: A Randomized Clinical Trial. JAMA Netw Open. 2023 Aug 1;6(8):e2327272. doi: 10.1001/jamanetworkopen.2023.27272.
Handy EMS OHCA Handoff Checklist
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In this video review, information contained in out-of-hospital cardiac arrest (OHCA) patient handoffs was highly variable, which is an area for quality improvement and standardization. Try this checklist!
Source
Emergency Medical Services handoff of patients in cardiac arrest in the Emergency Department: A retrospective video review study of duration and details of handoff. Resuscitation. 2023 Aug;189:109834. doi: 10.1016/j.resuscitation.2023.109834. Epub 2023 May 16.
CT FIRST – Full Body CT Post-OHCA – Does CT Help?
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A full-body CT protocol in resuscitated adults with out of hospital cardiac arrest (OHCA) more often - and more quickly - found the cause of arrest than standard of care CT but did not improve neurologically intact survival.
How Helpful Is CT Post-Arrest?
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Computed tomography (CT) after out-of-hospital cardiac arrest (OHCA) often identifies clinically important pathology such as the etiology of the arrest, traumatic injuries from resuscitation, and consequences from inadequate perfusion.
Source
Diagnostic yield of computed tomography after non-traumatic out-of-hospital cardiac arrest. Resuscitation. 2023 Aug;189:109898. doi: 10.1016/j.resuscitation.2023.109898. Epub 2023 Jul 6.
TAME RCT – Does Hypercapnia Post-Arrest Lead to Better Outcomes?
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In patients resuscitated after out-of-hospital cardiac arrest (OHCA), targeted mild hypercapnia was not associated with better neurologic outcomes at 6 months compared to normocapnia.
Source
Mild Hypercapnia or Normocapnia after Out-of-Hospital Cardiac Arrest. N Engl J Med. 2023 Jun 15. doi: 10.1056/NEJMoa2214552. Epub ahead of print.
Pediatric Resuscitation vs Adult – Cognitive Load and Quality
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In this cross-sectional simulation study of seven EMS agencies in Oregon, researchers found that resuscitation quality was significantly lower in pediatric out of hospital cardiac arrests (OHCA) compared to adult OHCA as measured by defect free resuscitations.
Source
Comparison of Resuscitation Quality in Simulated Pediatric and Adult Out-of-Hospital Cardiac Arrest. JAMA Netw Open. 2023 May 1;6(5):e2313969. doi: 10.1001/jamanetworkopen.2023.13969.
Best CPR Quality in Children – 1 or 2 Hands, 2 Thumbs, 2 Fingers?
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Using a 1-handed technique in infants <1yr and 2-handed technique in children >1yr resulted in deeper compressions, closer to AHA guideline recommendations, but compliance with rate and depth were mediocre regardless of technique.
Source
The effect of hand position on chest compression quality during CPR in young children: Findings from the Videography in Pediatric Resuscitation (VIPER) collaborative. Resuscitation. 2023 Apr;185:109741. doi: 10.1016/j.resuscitation.2023.109741. Epub 2023 Feb 16.
Do STEMI Equivalents Post-ROSC Need Immediate Cath?
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In patients with ROSC after OHCA, these 'STEMI equivalents' do not appear to accurately diagnose ACS based on this study.
CPR is Tired Work, But Best Not Done in Bed
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CPR performed by laymen benefits from being done on a hard surface rather than on a mattress, though neither group met the AHA recommended depth of 5cm.
Source
Effectiveness of Lay Bystander Hands-Only Cardiopulmonary Resuscitation on a Mattress versus the Floor: A Randomized Cross-Over Trial. Ann Emerg Med. 2023 Feb 23;S0196-0644(23)00026-4. doi: 10.1016/j.annemergmed.2023.01.012. Online ahead of print.