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.
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.
INCEPTION RCT – Early ECMO for Refractory Arrest
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This multicenter randomized controlled trial (the INCEPTION trial), comparing ECPR vs conventional CPR for refractory cardiac arrest, showed no improvement in neurologically intact survival at 30 days.
Source
Early Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest. N Engl J Med. 2023 Jan 26;388(4):299-309. doi: 10.1056/NEJMoa2204511.
Should We Pause Compressions to Intubate During CPR?
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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.
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.