This is the first (of a series) of literature reviews dedicated to a particular topic of Emergency Medicine clinical life.

We tried to give a deep look to all the articles that had a relevance for a particular argument in this year, and made some considerations regarding the emerged evidences . All the articles are full text end ready to be downloaded.

The first edition is focused on the “king argument” for an emergency medicine and critical care professional:

Cardiac Arrest

Chest compressions

This year the importance of chest compressions in CA was confirmed and even emphasized as one of the few (along with defibrillation) really wothy intervention to perform during CPR.

• Chest Compression Alone Cardiopulmonary Resuscitation Is Associated With Better Long-Term Survival Compared with Standard Cardiopulmonary Resuscitation
• Chest compression depth and survival in out-of-hospital cardiac arrest

Mechanical Devices

The “black year” for mechanical devices saw 3 major trials finding no difference in outcome between mechanical and (good quality) manual chest compressions. Still remains the subjective (personal) impression that mechanical devices are of some utility for the human resources management and  transport during CPR.

• Manual vs. integrated automatic load-distributing band CPR with equal survival after out of hospital cardiac arrest. The randomized CIRC trial
• Mechanical chest compressions and simultaneous defibrillation-vs-conventional cardiopulmonary resuscitation in-out-of-hospital cardiac arrest The LINC RCT
• Do Mechanical Devices Improve Return of Spontaneous Circulation Over Manual Chest Compressions in Out-of-Hospital Cardiac Arrest
• Prehospital Randomized Assessment of a Mechanical Compression Device in Cardiac Arrest (PARAMEDIC)

Vasoactive (and other) drugs

Like (and perhaps more) than for mechanical devices, 2014 signed a really bad year for epinephrine.

Lack of evidence on his utility and emerging ones on detrimental effects, accompanied this “historical” drug through the year that preludes to new 2015 CA Guidelines. Will epinephrine still be there at the end of this 2015? Or new emerging trends on use of steroids and vasopressin will prevale at the end?

• Vasopressin, Steroids, and Epinephrine and Neurologically Favorable Survival After In-Hospital Cardiac Arrest
• Epinephrine, vasopressin and steroids for in-hospital cardiac arrest: the right cocktail therapy?
• Glucocorticoids as an Emerging Pharmacologic Agent for Cardiopulmonary Resuscitation
• Epinephrine in Cardiac Arrest and Patients Outcomes
• Adrenaline for out-of-hospital cardiac arrest resuscitation- A systematic review and meta-analysis of randomized controlled trials
• Adrenaline (epinephrine) dosing period and survival after in-hospital cardiac arrest- A retrospective review of prospectively collected data
• Time to administration of epinephrine and outcome after in-hospital cardiac arrest with non-shockable rhythms: retrospective analysis of large in-hospital data registry
• Does Calcium Administration During Cardiopulmonary Resuscitation Improve Survival for Patients in Cardiac Arrest?

ECLS

And after interventions that are loosing evidence in the years, new future prospectives for the management of CA patients, comes from Extra-Corporeal Membrane Oxygenation that gives renewed hopes of better survival and good neurological outcome, despite initial difficulties and skepticism.

• Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest- A prospective observational study
• An optimal transition time to extracorporeal cardiopulmonary resuscitation for predicting good neurological outcome in patients with out-of-hospital cardiac arrest- a propensity-matched study

Outcome and prognostication

• Exploring which patients without return of spontaneous circulation following ventricular fibrillation out-of-hospital cardiac arrest should be transported to hospital
• Predicting the lack of ROSC during pre-hospital CPR- Should an end-tidal CO 2 of 1.3 kPa be used as a cut-off value
• Shorter time until return of spontaneous circulation is the only independent factor for a good neurological outcome in patients with postcardiac arrest syndrome
• Survival rates in out-of-hospital cardiac arrest patients transported without prehospital return of spontaneous circulation: An observational cohort study
• Trends in Short- and Long-Term Survival Among Out-of-Hospital Cardiac Arrest Patients Alive at Hospital Arrival
• Early coronary angiography and induced hypothermia are associated with survival and functional recovery after out-of-hospital cardiac arrest
• Angiography Urged in All Resuscitated Out-of-Hospital Cardiac Arrest

Therapeutic Hypothermia

New era for the post-resuscitative care! Less oxygen, lower tidal volume and last, but not least, less cooling. And, while this year will give us some answers about intra-arrest cooling, now we know that 33°C is equally effective as 36°C and is no longer recommended in post ROSC patients! Maybe….

• Effect of Prehospital Induction of Mild Hypothermia on Survival andNeurological Status Among Adults With Cardiac Arrest A Randomized Clinical Tria.pdf
• Targeted Temperature Management Processes and Outcomes After Out-of-Hospital Cardiac Arrest- An Observational Cohort Study
• From therapeutic hypothermia towards targeted temperature management: a decade of evolution

Other

Hypotermia (accidental not therapeutic), highlights from ERC 2014 Congress and decision on non starting CPR: what changes and what remains in our daily practice.

• Cardiac arrest from accidental hypothermia, a rare condition with potentially excellent neurological outcome, if you treat it right
• Resuscitation highlights- Part 1
• Resuscitation highlights- Part 2
• Current Opinion in Critical Care-Cardica Arrest
• Decisions Relating To CPR
• Hemodynamic–directed cardiopulmonary resuscitation during in–hospital cardiac arrest

DISCLOSURE: MEDEST strongly encourage AWARNESS reading the propoused articles.

Abstracts are often misleading and articles potentially biased. Even this selection is not immune from potential bias (just human factors not commercial interests).

So download the full text and read it carefully to have a clear and complete opinion of the related topics.

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Tag:ACR, advanced airway management, Antiaggregazione, antiplatelets, arresto cardiaco, clinical decision rules, emergency medicine, emergenza sanitaria territoriale, gestione avanzata delle vie aeree, litterature review, medicina d'urgenza, prehospital emergency medicine, sindromi coronariche acute, Stroke