Erga Cerchiari

Cardiovascular function and neurologic outcome after cardiac arrest in dogs. The cardiovascular post-resuscitation syndrome

We studied cardiovascular changes and neurologic outcome at 72 h in 42 healthy dogs after normothermic ventricular fibrillation cardiac arrest (no blood flow) of 7.5, 10, or 12.5 min duration, reversed by standard external cardiopulmonary resuscitation (CPR) (< or = 10 min) and followed by controlled ventilation to 20 h and intensive care to 72 h. We found no difference in resuscitability, mortality, neurologic deficit scores, or overall performance categories between the three insult groups. There was no major pulmonary dysfunction. During controlled normotension post-CPR, all dogs presented a transient reduction in cardiac output. In the 12.5-min cardiac arrest group the decrease in cardiac output persisted beyond 12 h post-CPR (P < 0.01) and was associated with more severe arrhythmias (P < 0.05) and worse morphologic myocardial damage (P < 0.01). Both cardiac and neurologic malfunction at 72 h correlated with arrest time. Only cardiac malfunction correlated with CPR time. Neurologic recovery correlated with mild (inadvertent) pre-arrest hypothermia, diastolic arterial pressure during CPR and absence of cardiovascular impairment at 12 h post-CPR. We conclude that prolonged cardiac arrest in previously healthy dogs is followed by persistent cardiovascular derangements that correlate with impaired neurologic recovery.

Visceral, hematologic and bacteriologic changes and neurologic outcome after cardiac arrest in dogs. The visceral post-resuscitation syndrome

We studied the post-resuscitation syndrome in 42 healthy dogs after normothermic ventricular fibrillation cardiac arrest (no blood flow) of 7.5, 10, or 12.5 min duration, reversed by standard external cardiopulmonary resuscitation (CPR) (< or = 10 min) and followed by controlled ventilation to 20 h and intensive care to 72 h. We reported previously, in the same dogs, no difference in resuscitability, mortality, or neurologic outcome between the three insult groups. There was no pulmonary dysfunction, but post-arrest cardiovascular failure, of greater severity in the 12.5 min arrest group. This report concerns renal, hematologic, hepatic and bacteriologic changes. Renal function recovered within 1 h after arrest, without permanent dysfunction. Clotting derangements at 1-24 h postarrest reflect transient disseminated intravascular coagulation with hypocoagulability, more severe after longer arrests, which resolved by 24 h after arrest. Hepatic dysfunction was transient but more severe in the animals that did not recover consciousness and correlated with neurologic dysfunction, but not with brain histologic damage. Bacteremia was present in all animals postarrest. We conclude that in the previously healthy organism after cardiac arrest of 7.5-12.5 min no flow, visceral and hematologic changes, although transient, can retard neurologic recovery.

iCPR: A new application of high-quality cardiopulmonary resuscitation training☆

OBJECTIVES The present study evaluates a new CPR feedback application for the iPhone (iCPR) designed to improve chest compression performance tested in a cardiac arrest simulation to evaluate performance and acceptance by healthcare professionals and lay people. METHODS We built an application specifically dedicated to self-directed CPR training through a tutorial that includes a simple feedback module to guide training in order to improve the quality of chest compressions. We tested it in a sample of 50 users to evaluate the effect of iCPR on performance and it is acceptance. The participants were randomly assigned to one of the study groups and were asked to perform a trial of 2 min of chest compressions (CC), to answer a predefined set of questions and then to perform two more minutes of CC. The first group performing the sequence of CC with iCPR - questions - CC without feedback, and the second the sequence CC without feedback - questions CC with iCPR. RESULTS The mean compression rate was 101±2.8 min(-1) when CC were performed with iCPR and 107.8±20.5 min(-1) when performed without iCPR (p<0.01). Overall, the participants considered iCPR useful to maintain CC at the desired rate of 100 compressions per minute. CONCLUSIONS The iCPR feedback tool was able to significantly improve the performance of chest compressions in terms of the compression rate in a simulated cardiac arrest scenario. The participants also believed that iCPR helped them to achieve the correct chest compression rate and most users found this device easy to use.

Effects of combined superoxide dismutase and deferoxamine on recovery of brainstem auditory evoked potentials and EEG after asphyxial cardiac arrest in dogs

In a randomized study in 23 dogs, we tested the following anti-free radical combination therapy, administered at the beginning of CPR, following apnea-induced cardiac arrest of 7 min: a) ventilation with 100% nitrogen for 30 s to allow the delivery of therapy before oxygen; b) superoxide dismutase (10 mg/kg i.a. followed by 10 mg/kg i.v. over 1 h) to scavenge the superoxide anion radical; and c) deferoxamine (20 mg/kg i.v. over 1 h) to prevent membrane lipid peroxidation. We evaluated the effects of this treatment on the recovery of cardiovascular and cerebral variables short term (6 h) after resuscitation. We reported previously that this treatment mitigated the post-arrest cerebral blood flow changes and enhanced the recovery of somatosensory evoked potentials. This is a secondary report from the same study concerning the effects of this treatment on the recovery of brainstem auditory evoked potentials (BAEPs) and EEG. Compared to control (n = 10), the experimental treatment (n = 10) did not exert a clearcut, significant effect on the recovery of BAEP which normalized in both groups at 1 h post-arrest and enhanced the post-arrest recovery of EEG spectra total power by reducing the post-arrest increase in slow frequency bands. However, the relative distribution of EEG frequencies never recovered the pre-arrest pattern in either group, during the 6 h post-arrest observation period. We conclude that the combination treatment tested enhances the recovery but does not normalize cerebral function post-arrest, suggesting that other treatments should also be entertained or that, indeed, such an insult may not be completely ameliorated by any such treatments.

Motion detection technology as a tool for cardiopulmonary resuscitation (CPR) quality training: A randomised crossover mannequin pilot study

INTRODUCTION Outcome after cardiac arrest is dependent on the quality of chest compressions (CC). A great number of devices have been developed to provide guidance during CPR. The present study evaluates a new CPR feedback system (Mini-VREM: Mini-Virtual Reality Enhanced Mannequin) designed to improve CC during training. METHODS Mini-VREM system consists of a Kinect(®) (Microsoft, Redmond, WA, USA) motion sensing device and specifically developed software to provide audio-visual feedback. Mini-VREM was connected to a commercially available mannequin (Laerdal Medical, Stavanger, Norway). Eighty trainees (healthcare professionals and lay people) volunteered in this randomised crossover pilot study. All subjects performed a 2 min CC trial, 1h pause and a second 2 min CC trial. The first group (FB/NFB, n=40) performed CC with Mini-VREM feedback (FB) followed by CC without feedback (NFB). The second group (NFB/FB, n=40) performed vice versa. Primary endpoints: adequate compression (compression rate between 100 and 120 min(-1) and compression depth between 50 and 60mm); compressions rate within 100-120 min(-1); compressions depth within 50-60mm. RESULTS When compared to the performance without feedback, with Mini-VREM feedback compressions were more adequate (FB 35.78% vs. NFB 7.27%, p<0.001) and more compressions achieved target rate (FB 72.04% vs. 31.42%, p<0.001) and target depth (FB 47.34% vs. 24.87%, p=0.002). The participants perceived the system to be easy to use with effective feedback. CONCLUSIONS The Mini-VREM system was able to improve significantly the CC performance by healthcare professionals and by lay people in a simulated CA scenario, in terms of compression rate and depth.

Virtual reality enhanced mannequin (VREM) that is well received by resuscitation experts

UNLABELLED The objective of this study was to test acceptance of, and interest in, a newly developed prototype of virtual reality enhanced mannequin (VREM) on a sample of congress attendees who volunteered to participate in the evaluation session and to respond to a specifically designed questionnaire. METHODS A commercial Laerdal HeartSim 4000 mannequin was developed to integrate virtual reality (VR) technologies with specially developed virtual reality software to increase the immersive perception of emergency scenarios. To evaluate the acceptance of a virtual reality enhanced mannequin (VREM), we presented it to a sample of 39 possible users. Each evaluation session involved one trainee and two instructors with a standardized procedure and scenario: the operator was invited by the instructor to wear the data-gloves and the head mounted display and was briefly introduced to the scope of the simulation. The instructor helped the operator familiarize himself with the environment. After the patients collapse, the operator was asked to check the patients clinical conditions and start CPR. Finally, the patient started to recover signs of circulation and the evaluation session was concluded. Each participant was then asked to respond to a questionnaire designed to explore the trainees perception in the areas of user-friendliness, realism, and interaction/immersion. RESULTS Overall, the evaluation of the system was very positive, as was the feeling of immersion and realism of the environment and simulation. Overall, 84.6% of the participants judged the virtual reality experience as interesting and believed that its development could be very useful for healthcare training. CONCLUSIONS The prototype of the virtual reality enhanced mannequin was well-liked, without interfence by interaction devices, and deserves full technological development and validation in emergency medical training.

Predictors of electromechanical dissociation during cardiac arrest

ECG patterns observed during cardiac arrest were analyzed in 261 comatose cardiac arrest survivors. Forty-seven patients (18%) exhibited electromechanical dissociation (EMD) at some point before restoration of stable spontaneous circulation. These patients had a higher mortality (P = .05) and a lower rate of cerebral recovery (P = .01) during the one-year follow-up than study patients who did not exhibit EMD. Patients who developed EMD subsequent to defibrillation had better outcome than patients presenting with EMD. Multivariate analysis revealed that age more than 70 years old (P = .007), pulmonary disease (P less than .001), diabetes (P = .013, in-hospital arrests only), and prearrest hypoxemia (P = .013, outside-hospital arrests only) were independently predictive of the occurrence of EMD. Although the generalizability of these findings is limited, they may offer new clues to the pathophysiology of EMD.

Relive: a serious game to learn how to save lives.

A recent review has provided evidence in support of new nd alternative methods for CPR training.1 Among these, are he “serious games”, which are applications developed using omputer game technologies more often associated with enterainment, but characterized by a serious purpose. Indeed, during he last decade, many serious games have been developed and sed successfully in the field of health, including training of oth technical and non-technical skills relevant to the surgical rea.2 The Italian Resuscitation Council (IRC) has implemented a erious game for the Viva! Campaign 20133 called Viva! Game http://www.viva2013.it/viva-game). Viva! Game is a serious game irected to kids and young adults. It served as a tool to create wareness on cardiac arrest and cardiopulmonary resuscitation CPR) in a soft and enjoyable way. The game has different scenaros, i.e. school, home, stadium, through which the player needs to nteract. More specifically, during the development of the story, he player finds himself in the need to perform a high quality hest compression to save another character from cardiac arrest. iva! CPR (http://www.viva2013.it/vivacpr) is an application for eal time feedback on chest compression quality created for smarthones directed to general population to increase awareness and nowledge about chest compression only manoeuvres. The numer of downloads of Viva! Game and Viva! CPR during the Viva! ampaign 2013 was around 10,000 (Table 1). For the Viva! Camaign 2014, the Italian Resuscitation Council developed a new and ore ambitious project called “Relive” game. Relive is a serious ame focusing on CPR with the main purpose of increasing kids nd young adults’ awareness on CPR and prompting them to attend PR classes and be prepared to intervene in case of cardiac arrest. elive is a first person 3D adventure taking place on planet Mars, n a near future. The game is divided into two different playing odes: a tournament mode and a story mode. The tournament ode is a ready-to-play simulated emergency scene, taken from elected game scenes, where the player faces different rescue sit-

Motion detection technology as a tool for cardiopulmonary resuscitation (CPR) quality improvement.

The most popular method of training in basic life support and AED remains instructor-led training courses. Recent reviews provide good evidence to support alternative methods of training including lay instructors, self-directed learning (web, video, poster) and CPR feedback/prompt devices.