Aurora Ilaria Danza

End-tidal carbon dioxide and defibrillation success in out-of-hospital cardiac arrest

PURPOSEnBasing on the relationship between the quality of cardiopulmonary resuscitation (CPR) and the responsiveness of VF to the defibrillation we aimed to assess whether the values of ETCO2 in the minute before defibrillation could predict the effectiveness of the shock.nnnMATERIALS AND METHODSnWe retrospectively evaluated the reports generated by the manual monitor/defibrillator (Corpuls by GS Elektromedizinische Geräte G. Stemple GmbH, Germany) used for cases of VF cardiac arrest from January 2015 to December 2016. The mean ETCO2 value of the minute preceding the shock (METCO260) was computed. A blind evaluation of the effectiveness of each shock was provided by three cardiologists.nnnRESULTSnA total amount of 207 shocks were delivered for 62 patients. When considering the three tertiles of METCO260 (T1:METCO260 ≤ 20mmHg; T2: 20mmHg < METCO260 ≤ 31mmHg and T3: METCO260 > 31mmHg) a statistically significant difference between the percentages of shock success was found (T1: 50%; T2: 63%; T3: 78%; Chi square p=0.003; p for trend <0.001). When the METCO260 was lower than 7mmHg no shock was effective and when the METCO260 was higher than 45mmHg no shock was ineffective. Shocks followed by ROSC were preceded by higher values of METCO260 as compared either to ineffective shocks or effective ones without ROSC.nnnCONCLUSIONSnThis is the first demonstration of the relation between ETCO2 and defibrillation effectiveness. Our findings stress the pivotal role of High Quality CPR, monitored via ETCO2, and suggest ETCO2 monitoring as an additional weapon to guide defibrillation.

A wearable remote monitoring system for the identification of subjects with a prolonged QT interval or at risk for drug-induced long QT syndrome

BACKGROUNDnA correct measurement of the QT interval in the out-of-hospital setting is important whenever the long QT syndrome (LQTS) is suspected or a therapy might lead to drug-induced LQTS (diLQTS) because QT interval monitoring in the initial days of therapy could alert to dangerous QT prolongation. We explored whether automated QTc measurements (BGM) by BodyGuardian™ (BG), a wearable remote monitoring system, are sufficiently reliable compared to our own manual measurements (MM) performed on the same beats during 12‑lead Holter recordings in LQTS patients (pts) and in healthy controls.nnnMETHODSnWe performed 351 measurements in 20 LQTS pts and 16 controls. MM and BGM were compared by a Bland-Altman plot (BAp). High values of BAp indicate large differences between measurements.nnnRESULTSnIn all 36 subjects QTc was 446u202f±u202f41 and 445u202f±u202f47u202fms in MM and BGM, respectively. The meanu202f±u202fSE BAp was -1.4u202f±u202f1.8u202fms for QTc in all subjects, 8.3u202f±u202f2.3 and -7.2u202f±u202f2.5u202fms respectively in controls and LQTS. The disagreement between BGM and MM <15u202fms in all, in controls, and in LQTS was respectively 57%, 63% and 54%. Among controls, there were only 3/132 false positive measurements (BGM QTc >470u202fms when MM QTc <440u202fms) in 3 different subjects. Among LQTS, there were 10/219 false negative measurements (BGM QTc <440u202fms when MM QTc >470u202fms) in 6 pts, but only two had multiple false negative values.nnnCONCLUSIONSnThis wearable monitoring system reliably identifies a prolonged QT interval and probably also subjects at risk for diLQTS.

Comparative performance assessment of commercially available automatic external defibrillators: A simulation and real-life measurement study of hands-off time

PURPOSEnEarly and good quality cardiopulmonary resuscitation (CPR) and the use of automated external defibrillators (AEDs) improve cardiac arrest patients survival. However, AED peri- and post-shock/analysis pauses may reduce CPR effectiveness.nnnMETHODSnThe time performance of 12 different commercially available AEDs was tested in a manikin based scenario; then the AEDs recordings from the same tested models following the clinical use both in Pavia and Ticino were analyzed to evaluate the post-shock and post-analysis time.nnnRESULTSnNone of the AEDs was able to complete the analysis and to charge the capacitors in less than 10s and the mean post-shock pause was 6.7±2.4s. For non-shockable rhythms, the mean analysis time was 10.3±2s and the mean post-analysis time was 6.2±2.2s. We analyzed 154 AED records [104 by Emergency Medical Service (EMS) rescuers; 50 by lay rescuers]. EMS rescuers were faster in resuming CPR than lay rescuers [5.3s (95%CI 5-5.7) vs 8.6s (95%CI 7.3-10).nnnCONCLUSIONSnAEDs showed different performances that may reduce CPR quality mostly for those rescuers following AED instructions. Both technological improvements and better lay rescuers training might be needed.

Post ROSC pulse-oximetry derived perfusion index and thirty days survival after out-of-hospital cardiac arrest. New insights from the Pavia CARe (Pavia Cardiac Arrest Registry)

The perfusion index (PI) is the ratio of the pulsatile blood flow o the nonpulsatile or static blood in peripheral tissue thus it repesents a noninvasive measure of peripheral perfusion that can be ontinuously and noninvasively obtained from a pulse oximeter. eripheral PI has been proposed for different clinical uses with ome applications in critical patients [1–3]. No data are available bout cardiac arrest survivors, however It is likely that a good eripheral perfusion after the return of spontaneous circulation ROSC) could increase the chance of survival at least in the short erm. Our aim was to assess whether peripheral PI measured after OSC could predict thirty days survival after an out-of-hospital ardiac arrest (OHCA). To address our aim the reports from those atients who achieved ROSC generated by the manual monior/defibrillator (Corpuls by GS Elektromedizinische Geräte G. temple GmbH, Germany) after every case of OHCA were retropectively evaluated. The mean values of PI were automatically rovided in the report every minute from the ROSC onwards and he mean value of 30 min of monitoring (MPI30) was calculated. From January 2015 to December 2016 1501 patients have een enrolled in our OHCA registry (Pavia CARe); in 931 patients ardiopulmonary resuscitation was attempted and 156 patients howed a prehospital ROSC. Among these patients with prehospi-