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Cardiac Arrest, Special Considerations for Emergency and Intensive Care

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Emergency Medicine".

Deadline for manuscript submissions: closed (20 August 2023) | Viewed by 9201

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Special Issue Editor

Prof. Dr. Endre Zima

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Guest Editor

Heart and Vascular Centre, Semmelweis University, Budapest 1122, Hungary
Interests: acute and intensive cardiac care; cardiogenic shock/acute heart failure; cardiopulmonary resuscitation; post-cardiac arrest intensive care; invasive hemodynamic monitoring; arrhythmias; ICD/IPG/CRT therapy; defibrillator wave-form development

Special Issue Information

Dear Colleagues,

The management of cardiac arrest has developed a lot in recent decades with the improvement of systems including bystanders in cardiopulmonary resuscitation attempts, with the enhancement of post-resuscitation treatment, and with the introduction of novel interventions such as extracorporeal cardiopulmonary resuscitation (eCPR). The aim of the Special Issue is to focus on hot topics affecting the efficacy of cardiopulmonary resuscitation. Articles to be included will discuss the current state of the art in CPR in trauma and in some special circumstances, e.g., in extreme sport activities, and the application of extracorporeal methods in cardiopulmonary resuscitation. The hotly debated question of target temperature management is also of great interest among resuscitation specialists. It is also important to include articles analyzing the most important studies investigating the effects of target temperature management in post-resuscitation treatment.

Prof. Dr. Endre Zima
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Keywords

resuscitation
extracorporeal circulatory support
target temperature management
ECMO
eCPR
survival

Published Papers (7 papers)

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Research

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9 pages, 1216 KiB

Open AccessArticle

Effect of a Real-Time Audio Ventilation Feedback Device on the Survival Rate and Outcomes of Patients with Out-of-Hospital Cardiac Arrest: A Prospective Randomized Controlled Study

by Eun Dong Lee, Yun Deok Jang, Ji Hun Kang, Yong Song Seo, Yoo Sang Yoon, Yang Weon Kim, Woong Bin Jeong and Jae Gu Ji

J. Clin. Med. 2023, 12(18), 6023; https://doi.org/10.3390/jcm12186023 - 18 Sep 2023

Viewed by 986

Abstract

The purpose of this study was to evaluate the effect of real-time audio ventilation feedback on the survival of patients with an out-of-hospital cardiac arrest (OHCA) during advanced cardiac life support (ACLS) performed by paramedics. This research was a prospective randomized controlled study performed in Busan, South Korea, from July 2022 to December 2022. This study included 121 patients, ages 19 and up, who were transferred to the study site, excluding 91 patients who did not receive CPR under a doctor’s direction as well as those who had a ’(DNR)’ order among 212 adult CA patients. OHCA patients’ clinical prognosis was compared by being randomly assigned to either a general manual defibrillator (NVF) group (N = 58) or a manual defibrillator with an audio ventilation feedback (AVF) group (N = 63). To verify the primary outcome, the cerebral performance category (CPC), return of spontaneous consciousness (ROSC), 30h survival, and survival discharge were compared. Multivariate logistic regression was conducted to analyze the association between the audio-feedback manual defibrillator (AVF) and the ROSC of OHCA patients. This study analyzed 121 patients among 212 OHCA patients. The ROSC (AVF group: 32 {26.4%} vs. NVF group: 21 {17.3%}), 24 h survival (AVF group: 24 {19.8%} vs. NVF group: 11 {9.0%}), and survival discharge (AVF group: 12 {9.9%} vs. NVF group: 6 {4.9%}) were higher in the AVF group than the NVF group. However, upon analyzing CPC scores in the surviving patients between the two groups, there was no significant difference (AVF group: 4.1 ± 1.23 vs. NVF group:4.7 ± 1.23, p = 1.232). Multivariate logistic regression analysis showed that the use of AVF was associated with a higher ROSC (odds ratio {OR}, 0.46; 95% confidence interval {CI}, 0.23–0.73; p < 0.01) and higher survival at 30 h (OR, 0.63; 95% CI, 0.41–0.98; p = 0.01). Full article

(This article belongs to the Special Issue Cardiac Arrest, Special Considerations for Emergency and Intensive Care)

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12 pages, 1048 KiB

Open AccessArticle

Sex Difference on Neurological Outcomes and Post-Cardiac Arrest Care in Out-of-Hospital Cardiac Arrest Patients Treated with Targeted Temperature Management: Post-Hoc Study of a Prospective, Multicenter, Observational Cohort Study

by Seon Yeong Park, Sang Hoon Oh, Sang Hyun Park, Jae Hun Oh and Soo Hyun Kim

J. Clin. Med. 2023, 12(16), 5297; https://doi.org/10.3390/jcm12165297 - 14 Aug 2023

Viewed by 882

Abstract

Conflicting results regarding sex-based differences in the outcomes of out-of-hospital cardiac arrest (OHCA) patients have been reported. We aimed to evaluate the association between sex and neurological outcome as well as various in-hospital process in OHCA patients treated with targeted temperature management. We retrospectively analyzed a prospective registry data collected between October 2015 and December 2018. To evaluate the effect of sex on patient outcomes, we created various multivariable logistic regression models. When the results were adjusted using resuscitation variables and in-hospital variables, there was no significant difference (OR = 1.22, 95% CI: 0.85–1.74; OR = 1.13, 95 CI: 0.76–1.68, respectively). Regarding the in-hospital course, the daily total SOFA score was similar in both sexes, whereas cardiovascular scores were higher in women on days 2 and 3. The adjusted effect of sex was not associated with the clinician’s decision to perform early cardiac interventions, except for those men that had more extracorporeal membrane oxygenation (OR = 2.51, 95% CI: 1.11–5.66). The findings seems that men had more favorable 6-month neurological outcomes. However, after adjusting for confounders, there was no difference between the sexes. The results regarding in-hospital course were similar in men and women. Full article

(This article belongs to the Special Issue Cardiac Arrest, Special Considerations for Emergency and Intensive Care)

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13 pages, 2778 KiB

Open AccessArticle

Saline versus Plasma Solution-A in Initial Resuscitation of Patients with Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial

by Jae-Hyug Woo, Yong Su Lim, Jin Seong Cho, Hyuk Jun Yang, Jae Ho Jang, Jea Yeon Choi and Woo Sung Choi

J. Clin. Med. 2023, 12(15), 5040; https://doi.org/10.3390/jcm12155040 - 31 Jul 2023

Viewed by 1192

Abstract

Background: Although saline is commonly used during cardiopulmonary resuscitation (CPR) or post-cardiac arrest care, it has detrimental effects. This trial aimed to evaluate the efficacy of a balanced crystalloid solution (Plasma Solution-A [PS]) in out-of-hospital cardiac arrest (OHCA) patients and compare it with the efficacy of saline. Methods: A randomized, unblinded clinical trial was conducted using PS and saline for intravenous fluid administration during CPR and post-cardiac arrest care of non-traumatic OHCA patients admitted to the emergency department of a tertiary university hospital. Patients received saline (saline group) or PS (PS group) within 24 h of hospital arrival. The primary outcomes were changes in arterial pH, bicarbonate, base excess (BE), and chloride levels within 24 h. The secondary outcomes were clinical outcomes including mortality. Results: Of the 364 patients, data from 27 and 26 patients in the saline and PS groups, respectively, were analyzed. Analysis using a linear mixed model revealed a significant difference in BE change over time between the groups (treatment-by-time p = 0.044). Increase in BE and bicarbonate levels from 30 min to 2 h was significantly greater (p = 0.044 and p = 0.024, respectively) and the incidence of hyperchloremia was lower (p < 0.001) in the PS group than in the saline group. However, there was no difference in clinical outcomes. Conclusion: Use of PS for resuscitation resulted in a faster improvement in BE and bicarbonate, especially in the early phase of post-cardiac arrest care, and lower hyperchloremia incidence than the use of saline, without differences in clinical outcomes, in OHCA patients. Full article

(This article belongs to the Special Issue Cardiac Arrest, Special Considerations for Emergency and Intensive Care)

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9 pages, 894 KiB

Open AccessArticle

Diagnostic Value of Serum Lactate Dehydrogenase Level Measured in the Emergency Department in Predicting Clinical Outcome in Out-of-Hospital Cardiac Arrest: A Multicenter, Observational Study

by Jihyun Kim, Yong Won Kim and Tae-Youn Kim

J. Clin. Med. 2023, 12(8), 3006; https://doi.org/10.3390/jcm12083006 - 20 Apr 2023

Viewed by 1239

Abstract

Introduction: Out-of-hospital cardiac arrest (OHCA) is complex, and risk stratification tools have the potential to include components other than clinical risk indicators, thus requiring extensive studies. Simple and accurate biomarkers for OHCA patients with poor prognoses are still needed. Serum lactate dehydrogenase (LDH) has been identified as a risk factor in patients with various diseases, such as cancer, liver disease, severe infections, and sepsis. The primary aim of this study was to assess the accuracy of LDH values at initial presentation in the emergency department (ED) in predicting the clinical outcome in OHCA. Methods: This retrospective multicenter observational study was performed in the ED of two tertiary university hospitals and one general hospital between January 2015 and December 2021. All patients with OHCA who visited the ED were included. The primary outcome was the sustained return of spontaneous circulation (ROSC; >20 min) after advanced cardiac life support (ACLS). The secondary outcome was survival to discharge (including home care and nursing care discharge) among patients with ROSC. The neurological prognosis was considered a tertiary outcome in patients who survived to discharge. Results: In total, 759 patients were enrolled in the final analysis. The median LDH level in the ROSC group was 448 U/L (range: 112–4500), which was significantly lower than that in the no-ROSC group (p < 0.001). The median LDH level in the survival-to-discharge group was 376 U/L (range: 171–1620), which was significantly lower than that in the death group (p < 0.001). Using the adjusted model, the odds ratio of the LDH value (≤634 U/L) for primary outcomes was 2.418 (1.665–3.513) and the odds ratio of LDH value (≤553 U/L) for secondary outcomes was 4.961 (2.184–11.269). Conclusions: In conclusion, the serum LDH levels of patients with OHCA measured in the ED can potentially serve as a predictive marker for clinical outcomes such as ROSC and survival to discharge, although it may be difficult to predict neurological outcomes. Full article

(This article belongs to the Special Issue Cardiac Arrest, Special Considerations for Emergency and Intensive Care)

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10 pages, 1426 KiB

Open AccessArticle

Lapses of the Heart: Frequency and Subjective Salience of Impressions Reported by Patients after Cardiac Arrest

by Fritz Sterz, Michael L. Berger, Gerhard Ruzicka and Roland Beisteiner

J. Clin. Med. 2023, 12(5), 1968; https://doi.org/10.3390/jcm12051968 - 2 Mar 2023

Viewed by 2012

Abstract

After cardiac arrest (CA), some patients report impressions with highly realistic features, often referred to as near-death experience (NDE). The frequency of such episodes seems to be variable, with various types of content. In a prospective study, we subjected 126 CA cases treated at the Department of Emergency Medicine of the Medical University of Vienna under carefully controlled conditions to a structured interview. We included all patients admitted due to CA, whose communicative abilities were restored and who agreed to participate in the study. The questionnaire inquired as to living conditions, attitudes towards issues of life and death, and last recollections before and first impressions after the CA. The majority of the subjects (91 = 76%) replied to inquiries concerning impressions during CA with “nothing” or “blackout”, but 20 (16%) gave a detailed account. A German version of the Greyson questionnaire specifically addressing NDE phenomena (included towards the end of the interview) resulted in ≥7 points in five patients (4%). Three patients reported a meeting with deceased relatives (one with 6 Greyson points), one an out-of-body episode, and one having been sucked into a colorful tunnel. Eleven of these twenty cases had their cardiopulmonary resuscitation (CPR) started within the first min of CA, a higher fraction than cases without experience. Reported experience after CA was of high significance for the patients; many of them changed their point of view on issues of life and death. Full article

(This article belongs to the Special Issue Cardiac Arrest, Special Considerations for Emergency and Intensive Care)

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Review

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13 pages, 644 KiB

Open AccessReview

The Beginning of an ECLS Center: First Successful ECPR in an Emergency Department in Romania—Case-Based Review

by Paul Lucian Nedelea, Emilian Manolescu, Adi-Ionut Ciumanghel, Mihai Constantin, Alexandra Hauta, Oana Sirbu, Lidia Ionescu, Mihaela Blaj, Mihaela Corlade-Andrei, Victorita Sorodoc and Diana Cimpoesu

J. Clin. Med. 2023, 12(15), 4922; https://doi.org/10.3390/jcm12154922 - 26 Jul 2023

Cited by 2 | Viewed by 1195

Abstract

According to the latest international resuscitation guidelines, extracorporeal cardiopulmonary resuscitation (ECPR) involves the utilization of extracorporeal membrane oxygenation (ECMO) in specific patients experiencing cardiac arrest, and it can be considered in situations where standard cardiopulmonary resuscitation efforts fail if they have a potentially reversible underlying cause, among which we can also find hypothermia. In cases of cardiac arrest, both witnessed and unwitnessed, hypothermic patients have higher chances of survival and favorable neurological outcomes compared to normothermic patients. ECPR is a multifaceted procedure that requires a proficient team, specialized equipment, and comprehensive multidisciplinary support within a healthcare system. However, it also carries the risk of severe, life-threatening complications. With the increasing use of ECPR in recent years and the growing number of centers implementing this technique outside the intensive care units, significant uncertainties persist in both prehospital and emergency department (ED) settings. Proper organization is crucial for an ECPR program in emergency settings, especially given the challenges and complexities of these treatments, which were previously not commonly used in ED. Therefore, within a narrative review, we have incorporated the initial case of ECPR in an ED in Romania, featuring a successful resuscitation in the context of severe hypothermia (20 °C) and a favorable neurological outcome (CPC score of 1). Full article

(This article belongs to the Special Issue Cardiac Arrest, Special Considerations for Emergency and Intensive Care)

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Other

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9 pages, 4737 KiB

Open AccessCase Report

Early Application of ECMO after Sudden Cardiac Arrest to Prevent Further Deterioration: A Review and Case Report

by Boldizsár Kiss, Bettina Nagy, Ádám Pál-Jakab, Bálint Lakatos, Ádám Soltész, István Osztheimer, Krisztina Heltai, István Ferenc Édes, Endre Németh, Béla Merkely and Endre Zima

J. Clin. Med. 2023, 12(13), 4249; https://doi.org/10.3390/jcm12134249 - 25 Jun 2023

Cited by 1 | Viewed by 1211

Abstract

ECMO has become a therapeutic modality for in- and out-of-hospital scenarios and is also suitable as a bridging therapy until further decisions and interventions can be made. Case report: A 27-year-old male patient with mechanical aortic valve prothesis had a sudden cardiac arrest (SCA). ROSC had been achieved after more than 60 min of CPR and eight DC shocks due to ventricular fibrillation (VF). The National Ambulance Service unit transported the patient to our clinic for further treatment. Due to the trauma and therapeutic INR, a CT scan was performed and ruled out bleeding. Echocardiography described severely decreased left ventricular function. Coronary angiography was negative. Due to the therapeutic refractory circulatory and respiratory failure against intensive care, VA-ECMO implantation was indicated. After four days of ECMO treatment, the patient’s circulation was stabilized without neurological deficit, and the functions of the end organs were normalized. Cardiac MRI showed no exact etiology behind SCA. ICD was implanted due to VF and SCA. The patient was discharged after 19 days of hospitalization. Conclusion: This case report points out that the early application of mechanical circulatory support could be an outcome-determinant therapeutic modality. Post-resuscitation care includes cardiorespiratory stabilization, treatment of reversible causes of malignant arrhythmia, and secondary prevention. Full article

(This article belongs to the Special Issue Cardiac Arrest, Special Considerations for Emergency and Intensive Care)

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