Tag Archives: Heart Arrest

Safety of mechanical chest compression devices AutoPulse and LUCAS in cardiac arrest

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“Mechanical chest compression devices are designed to perform chest compressions at specified rate and depth and therefore were expected to improve outcome. There are at
present two widely used and Food and Drug Administration-approved devices: the AutoPulse, a load-distributed band device that rhythmically compresses and restricts the chest wall and the LUCAS, a piston device with a cup that is placed in the centre of the chest and pushes the sternum down over a distance of 5.2 cm and pulls back to the neutral position. Significant improvement of aortic blood pressure and coronary perfusion pressure is documented in humans from the AutoPulse compared with manual chest compressions. Chest compression with LUCAS resulted in significantly higher end-tidal carbon dioxide in humans compared with manual chest compressions. For several years, only one randomized clinical trial with the AutoPulse was available (ASPIRE), which was terminated after interim analysis because of a trend to reduced survival to discharge compared with manual control CPR. None of the more recent randomized clinical trials demonstrated survival benefit of AutoPulse or LUCAS over manual controls. Anecdotal and possibly biased observations in our hospital and a published letter suggested increased
damage caused by mechanical chest compression devices.”

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Cardiopulmonary resuscitation and outcomes with in-hospital cardiac arrest

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“In-hospital cardiac arrest is an important public health problem, affecting approximately 300 000 adults annually in the United States, with a high mortality rate.1 2 The survival rate after in-hospital cardiac arrest in the US improved from 2000 to 2010 and has remained plateaued after 2010, with approximately 25% of patients surviving to hospital discharge.
Achieving return of spontaneous circulation is the first step toward long term survival and favorable functional recovery. However, for nearly half of patients with in-hospital cardiac arrest, resuscitative efforts are terminated without achievement of return
of spontaneous circulation.”

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Lance-Adams syndrome

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Marcellino C, Wijdicks EF. Posthypoxic action myoclonus (the Lance Adams syndrome). BMJ Case Rep. 2020 Apr 16;13(4):e234332.

Free full-text. (Includes video.)

  • Action myoclonus is exceptionally rare (less than 0.5% in a series of patients who have a cardiac arrest).
  • Myoclonus occurring after hypoxic brain injury from cardiac arrest, characterised by abrupt irregular muscle contractions. (1)
    • Acute: starting within 48 hours after the arrest (when isolated, sometimes terms acute Lance-Adams syndrome). (2)
    • Chronic: Lance-Adams syndrome, which may start from days to weeks after arrest and progressively worsen, with or without other neurological symptoms.
  • Potentially confused with myoclonus status in a comatose patient, yet the examination, imaging, degree of disability and prognosis are very divergent.
  • Typically, no EEG seizure correlates.

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Intraoperative cardiac arrest: Resuscitation and Management

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One discussion this week included intraoperative cardiac arrest.

Reference: Moitra VK, et al. Cardiac arrest in the operating room: resuscitation and management for the anesthesiologist: part 1. Anesthesia & Analgesia. 2018 Mar;126(3):876-888. doi: 10.1213/ANE.0000000000002596.

Summary: Cardiac arrest in the operating room and procedural areas has a different spectrum of causes (ie, hypovolemia, gas embolism, and hyperkalemia), and rapid and appropriate evaluation and management of these causes require modification of traditional cardiac arrest algorithms. There is a small but growing body of literature describing the incidence, causes, treatments, and outcomes of circulatory crisis and perioperative cardiac arrest. These events are almost always witnessed, frequently known, and involve rescuer providers with knowledge of the patient and their procedure.

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