Bibliographie sur l'arrêt cardiaque

Background: The quality cardiopulmonary resuscitation (CPR) coach role was developed for hospital-based resuscitation teams. This supplementary team member (CPR coach) provides real-time, verbal feedback on chest compression quality to compressors during a cardiac arrest.

Objectives: To evaluate the impact of a quality CPR coach training intervention on resuscitation teams, including presence of coaches on teams and physiologic metrics of quality CPR delivery in real compression events.

Methods: The quality CPR coach curriculum and role implementation were designed and evaluated using a logic model framework. Medical records of patients who had in-unit cardiopulmonary arrests were reviewed retrospectively. Data included physiologic metrics of quality CPR delivery. Analysis included descriptive statistics and comparison of arrest data before and after the intervention.

Results: A total of 79 cardiopulmonary arrests were analyzed: 40 before and 39 after the intervention. Presence of a quality CPR coach on resuscitation teams was more frequent after training, increasing from 35% before the intervention to 72% after (P = .002). No significant difference was found in the frequency of application of Zoll defibrillator pads. Metrics of quality CPR delivery and adherence with American Heart Association recommendations were either unchanged or improved after the intervention.

Conclusions: The quality CPR coach training intervention significantly increased coach presence on code teams, which was associated with clinically significant improvements in some metrics of quality CPR delivery in real cardiopulmonary arrests.

Background: Sudden cardiac arrest (SCA) in pediatric populations is a rare yet critical medical emergency characterized by high mortality and significant neurological impairment among survivors. This systematic review and meta-analysis aim to synthesize existing evidence on pediatric resuscitation techniques, focusing on survival rates, neurological outcomes, and the effectiveness of chest compression-only resuscitation (HCPR) versus standard resuscitation (CCPR), thereby addressing current gaps in clinical understanding and informing future guidelines.

Methods: Following PRISMA guidelines, we systematically searched the PubMed, Cochrane Library, and Embase databases for trials comparing HCPR versus CCPR during pediatric resuscitation. We used a comparative meta-analysis to estimate the odds ratio of prehospital return of spontaneous circulation (ROSC), 1-month survival rate, and survival with favorable neurological outcome. Study level odds ratios (ORs) and their 95% confidence intervals (CI) were pooled using random effects.

Results: Prehospital ROSC incidence did not significantly differ between HCPR and CCPR, including subgroup analysis based on cause of cardiac arrest. One-month survival rate was 12.3% in HCPR and 18.0% in CCPR (p = 0.04). Additionally, HCPR was less effective in non-cardiac arrest cases and in children over one year of age. Favorable neurological outcomes at one month were also lower for HCPR (6.3%) compared to CCPR (9.0%; p < 0.001), with similar trends observed across subgroups of non-cardiac arrest origin and varying age groups.

Conclusions: A pediatric resuscitation technique based solely on chest compressions shows lower efficacy in terms of survival at one month and quality of return of neurological function compared to standard resuscitation.

Aims: The Blood Pressure and Oxygenation (BOX) targets after out-of-hospital cardiac arrest trial found no statistically significant differences in mortality or neurological outcomes with mean arterial blood pressure targets of 63 vs. 77 mmHg in patients receiving intensive care post-cardiac arrest. In this study, we aimed to evaluate the effect on 1-year mortality and assess heterogeneity in treatment effects (HTEs) using Bayesian statistics.

Methods and results: We analyzed 1-year all-cause mortality, 1-year neurological outcomes, and plasma neuron-specific enolase (NSE) at 48 h using Bayesian logistic and linear regressions primarily with weakly informative priors. HTE was assessed according to age, plasma lactate, time to return of spontaneous circulation, primary shockable rhythm, history of hypertension, and ST-segment elevation myocardial infarction. Absolute and relative differences are presented with probabilities of any clinical benefit and harm. All 789 patients in the intention-to-treat cohort were included. The risk difference (RD) for 1-year mortality was 1.5%-points [95% credible interval (CrI): -5.1 to 8.1], with <33% probability of benefit with the higher target. There was 33% probability for a better neurological outcome (RD: 1.5%-points; 95% CrI: -5.3 to 8.3) and 35.1% for lower NSE levels (mean difference: 1.5 µg/L, 95% CrI: -6.0 to 9.1). HTE analyses suggested potential harms of the higher blood pressure target in younger patients.

Conclusion: The effects of a higher blood pressure target on overall mortality among comatose patients resuscitated from out-of-hospital cardiac arrest were uncertain. A potential effect modification according to age warrants additional investigation.

Clinical trial registration: ClinicalTrials.gov ID NCT03141099.

Background: Irreversible brain injury may begin 4-6 min after the onset of out-of-hospital cardiac arrest (OHCA) if no cardiopulmonary resuscitation (CPR) is provided. This period is commonly referred to as the "golden window" in China. Based on the walking distance within this window, we proposed an improved public access defibrillation (PAD) deployment strategy to enhance automated external defibrillator (AED) efficiency in typical Chinese cities.

Methods: This observational study used two datasets (an AED inventory and an OHCA registry) to assess the current effectiveness of AED deployment in the urban area of the Xuzhou city, Jiangsu Province. Using Geographic Information System (GIS) to determine the optimal AED placement distance based on the golden window walking-route distance. We also used python to simulate the improved model.

Results: In the model, a total of 1,350 OHCAs and 1,238 AEDs were included and 78.4% of OHCAs occurred in the community. The AED coverage rate within 100 m was 7.93 and 7.33% based on the straight-line model and walking-route model. The proportion of OHCAs where an AED was accessible within the walking distance of the golden window accounted for 53.04% on average, with an average of 1.19 AEDs per case. The optimal deployment distance for AEDs to achieve maximum efficiency and approximate the standards of developed cities (Average = 1, Proportion = 40%) is computed to be 270-280 m in straight line. The simulation demonstration of the improved model shows that the benefit is significantly improved.

Conclusion: Our model verified the current mismatch between AED deployment and OHCA cases in Xuzhou city. Based on this, we proposed an improved allocation model, which demonstrated the potential to optimize AED deployment more effectively. Furthermore, by integrating updated PAD strategies, our model can be further adapted to support drone-based AED delivery systems, offering a flexible and data-driven approach for future implementation.

Editorial: Double sequential external defibrillation (DSED), the technique of providing two rapid shocks from two defibrillators with pads placed in the anterior-lateral and anterior-posterior position has been studied in animal labs and clinical practice for over two decades. In 2022, the Double Sequential External Defibrillation for Refractory Ventricular Fibrillation (DOSE-VF, clinicaltrials.gov: NCT04080986) trial was published in the New England Journal of Medicine. This cluster randomized crossover trial involved six paramedic services in Ontario, Canada, and compared standard (anterior-lateral) defibrillation to vector change defibrillation (VC, anterior-posterior pad repositioning) or DSED for patients with ventricular fibrillation (VF) and unresponsive to three standard shocks. The trial showed superior outcomes for all primary and secondary endpoints (VF termination, return of spontaneous circulation [ROSC], survival to hospital discharge, and neurologically intact survival) with DSED versus standard defibrillation, and improved VF termination and survival to discharge, but not ROSC or neurologically intact survival, with VC versus standard defibrillation. These findings, along with the 2023 updated ILCOR guidelines endorsing DSED for refractory VF, have generated significant global interest in it's implementation. This manuscript explores the scientific rationale and underlying mechanisms of DSED, examines controversies surrounding its implementation, and outlines directions for future research.

Background: Early cardiopulmonary resuscitation (CPR) and defibrillation with Automated External Defibrillators (AEDs) by the public at an out-of-hospital cardiac arrest (OHCA) increases patient survival, but AEDs are infrequently used. Using drones to deliver AEDs may be one way to increase uptake, but there is limited understanding about what members of the public think about this. The aim of the study was to explore public attitudes towards drone AED delivery for OHCA.

Methods: We conducted 14 remote, semi-structured interviews with real-life OHCA bystanders. Participants were recruited via social media, a UK cardiac arrest survivor charity and the Welsh Ambulance Services University NHS Trust. We analysed data using the Theoretical Domains Framework and mapped findings to the Capability, Opportunity and Motivation model of Behaviour (COM-B) to identify perceived barriers and facilitators to the retrieval and use of drone-delivered AEDs. We used The Behaviour Change Wheel to identify potential interventions to optimise use of drone-delivered AEDs.

Results: Participants experienced varying levels of physical and social opportunities in relation to (un)available AEDs and (in)appropriate support from the call-handler, affecting the likelihood of them performing CPR and/or using an AED effectively. Most participants were unsure about how to use an AED, and none knew how a drone-delivered AED system would work in practice. Many participants questioned whether they would possess sufficient capability and motivation to retrieve and/or operate a drone-delivered AED during a time-critical emergency. There were five key themes for potential interventions: incorporating information about drone-delivered AED use into pre-existing training programmes and materials; ensuring drone use complies with specific regulatory and/or legislative requirements; making the drone-delivered AED easy to identify and access; optimising call-handler scripts to incorporate drone-delivered AED use; providing social support via a robust co-responder model to complement drone-delivered AED use.

Conclusions: Participants accepted drone-delivered AEDs for OHCA, but were unsure if it would be effective. They identified several issues that we addressed through the development of a comprehensive intervention framework. A comprehensive call-handler script that incorporates drone-delivered AED use and support for bystanders was the most salient potential intervention for future testing by relevant stakeholders.

Editorial: Out-of-hospital cardiac arrest (OHCA) is a leading cause of death worldwide, with a low survival rate of around 7% globally. Key factors for improving survival include witnessed arrest, bystander cardiopulmonary resuscitation (CPR), and early defibrillation. Despite guidelines advocating for the "chain of survival", bystander CPR and defibrillation rates remain suboptimal. Innovative approaches, such as dispatcher-assisted CPR (DA-CPR) and smartphone-based alerts, have emerged to address these challenges. DA-CPR effectively transforms emergency callers into lay rescuers, and smartphone apps are increasingly being used to alert volunteer first responders to OHCA incidents, enhancing response times and increasing survival rates. Smartphone-based systems offer advantages over traditional text messaging by providing real-time guidance and automated external defibrillator (AED) locations. Studies show improved outcomes with app-based alerts, including higher rates of early CPR, increased survival rates and improved neurological outcomes. Additionally, the potential of unmanned aerial vehicles (drones) to deliver AEDs rapidly to OHCA sites has been demonstrated, particularly in rural areas with extended emergency medical services response times. Despite technological advancements, challenges such as ensuring responder training, effective dispatching, and maintaining responder well-being, particularly during the coronavirus disease 19 (COVID-19) pandemic, remain. During the pandemic, some community first responder programs were suspended or modified due to shortages of personal protective equipment (PPE) and increased risks of infection. However, systems that adapted by using PPE and revising protocols generally maintained responder participation and effectiveness. Moving forward, integrating new technology within robust responder systems and support mechanisms will be essential to improving OHCA outcomes and sustaining effective response networks.