Basic life support
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These European Resuscitation Council Paediatric Life Support (PLS) guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the management of critically ill infants and children, before, during and after cardiac arrest.
- Klíčová slova
- Advanced life support, Bag-mask ventilation, Basic life support, CPR, Cardiac arrest, Circulatory failure, Defibrillation, Infant, Oxygen, Paediatric, Pediatric, Respiratory failure, Resuscitation child, Shock,
- MeSH
- dítě MeSH
- elektrická defibrilace MeSH
- kardiopulmonální resuscitace * MeSH
- kojenec MeSH
- lidé MeSH
- srdeční zástava * terapie MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
The European Resuscitation Council (ERC) Paediatric Life Support (PLS) guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR). This section provides guidelines on the management of critically ill or injured infants, children and adolescents before, during and after respiratory/cardiac arrest.
Die Leitlinien des European Resuscitation Council (ERC) zu den lebensrettenden Maßnahmen bei Kindern (Paediatric Life Support, PLS) basieren auf dem 2020 verfassten „International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations“ der ILCOR (International Liaison Committee on Resuscitation). Dieses Kapitel beinhaltet Leitlinien zur Behandlung kritisch kranker oder verletzter Säuglinge, von Kindern und Jugendlichen vor, während und nach einem Atem-Kreislauf-Stillstand.
- Klíčová slova
- Advanced life support, Bag-mask ventilation, Basic life support, CPR, Cardiac arrest, Child, Circulatory failure, Defibrillation, Infant, Oxygen, Paediatric, Pediatric, Respiratory failure, Resuscitation, Shock,
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- přehledy MeSH
Success of advanced cardiac life support (ACLS) depends on several factors: character and severity of the primary insult, time interval between cardiac arrest and effective basic life support (BLS) and the ensuing ACLS, patient's general condition before the insult, environmental circumstances and efficacy of BLS and ACLS. From these factors, only the efficacy of ACLS is under control of emergency personnel. The end tidal partial pressure of CO2 (P(ET)CO2) has been shown to be an indicator of the efficiency of ACLS and a general prognostic marker. In this study P(ET)CO2 was monitored during out-of hospital ACLS in three cases of cardiac arrest of different aetiology. The aetiology included lung oedema, tension pneumothorax and high voltage electric injury. P(ET)CO2 served for adjustments of ACLS. In these three cases the predictive value of P(ET)CO2 monitoring corresponded to previously reported recommendations.
- MeSH
- dospělí MeSH
- kapnografie * MeSH
- kardiopulmonální resuscitace MeSH
- lidé MeSH
- mladiství MeSH
- monitorování fyziologických funkcí * MeSH
- oxid uhličitý analýza MeSH
- rozšířená kardiopulmonální recuscitace * MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- práce podpořená grantem MeSH
- Názvy látek
- oxid uhličitý MeSH
The use of extracorporeal life support (ECLS) in cardiopulmonary resuscitation (CPR; ECPR) has been repeatedly published as non-randomized studies, mainly case series and case reports. The aim of this article is to support physicians, perfusionists, nurses and extracorporeal membrane oxygenation (ECMO) specialists who regularly perform ECPR or are willing to start an ECPR program by establishing standards for safe and efficient ECPR procedures. This article represents the experience and recommendations of physicians who provide ECPR routinely. Based on its survival and outcome rates, ECPR can be considered when determining the optimal treatment of patients who require CPR. The successful performance of ECLS cannulation during CPR is a life-saving measure and has been associated with improved outcome (including neurological outcome) after CPR. We summarize the general structure of an ECLS team and describe the cannulation procedure and the approaches for post-resuscitation care. The differences in hospital organizations and their regulations may result in variations of this model.
- Klíčová slova
- CPR, ECLS, in-hospital ECPR, in-hospital cardiac arrest,
- MeSH
- dospělí MeSH
- kardiopulmonální resuscitace metody MeSH
- lidé MeSH
- mimotělní membránová oxygenace metody MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
Veno-arterial extracorporeal membrane oxygenation (ECMO) is increasingly being deployed for selected patients in cardiac arrest who do not attain a native circulation with conventional CPR (ECPR). This ELSO guideline is intended to be a practical guide to implementing ECPR and the early management following establishment of ECMO support. Where a paucity of high-quality evidence exists, a consensus has been reached amongst the authors to provide guidance to the clinician. This guideline will be updated as further evidence in this field becomes available.
BACKGROUND: Out of hospital cardiac arrest (OHCA) has a poor outcome. Recent non-randomized studies of ECLS (extracorporeal life support) in OHCA suggested further prospective multicenter studies to define population that would benefit from ECLS. We aim to perform a prospective randomized study comparing prehospital intraarrest hypothermia combined with mechanical chest compression device, intrahospital ECLS and early invasive investigation and treatment in all patients with OHCA of presumed cardiac origin compared to a standard of care. METHODS: This paper describes methodology and design of the proposed trial. Patients with witnessed OHCA without ROSC (return of spontaneous circulation) after a minimum of 5 minutes of ACLS (advanced cardiac life support) by emergency medical service (EMS) team and after performance of all initial procedures (defibrillation, airway management, intravenous access establishment) will be randomized to standard vs. hyperinvasive arm. In hyperinvasive arm, mechanical compression device together with intranasal evaporative cooling will be instituted and patients will be transferred directly to cardiac center under ongoing CPR (cardiopulmonary resuscitation). After admission, ECLS inclusion/exclusion criteria will be evaluated and if achieved, veno-arterial ECLS will be started. Invasive investigation and standard post resuscitation care will follow. Patients in standard arm will be managed on scene. When ROSC achieved, they will be transferred to cardiac center and further treated as per recent guidelines. PRIMARY OUTCOME: 6 months survival with good neurological outcome (Cerebral Performance Category 1-2). Secondary outcomes will include 30 day neurological and cardiac recovery. DISCUSSION: Authors introduce and offer a protocol of a proposed randomized study comparing a combined "hyperinvasive approach" to a standard of care in refractory OHCA. The protocol is opened for sharing by other cardiac centers with available ECLS and cathlab teams trained to admit patients with refractory cardiac arrest under ongoing CPR. A prove of concept study will be started soon. The aim of the authors is to establish a net of centers for a multicenter trial initiation in future. ETHICS AND REGISTRATION: The protocol has been approved by an Institutional Review Board, will be supported by a research grant from Internal Grant Agency of the Ministry of Health, Czech Republic NT 13225-4/2012 and has been registered under ClinicalTrials.gov identifier: NCT01511666.
- MeSH
- indukovaná hypertermie * MeSH
- kardiopulmonální resuscitace přístrojové vybavení MeSH
- lidé MeSH
- srdeční zástava terapie MeSH
- urgentní zdravotnické služby organizace a řízení MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
- Research Support, N.I.H., Extramural MeSH
- srovnávací studie MeSH
BACKGROUND: Survival rates in refractory out-of-hospital cardiac arrest (OHCA) remain low with conventional advanced cardiac life support (ACLS). Extracorporeal life support (ECLS) implantation during ongoing resuscitation, a method called extracorporeal cardiopulmonary resuscitation (ECPR), may increase survival. This study examined whether ECPR is associated with improved outcomes. METHODS: Prague OHCA trial enrolled adults with a witnessed refractory OHCA of presumed cardiac origin. In this secondary analysis, the effect of ECPR on 180-day survival using Kaplan-Meier estimates and Cox proportional hazard model was examined. RESULTS: Among 256 patients (median age 58 years, 83% male) with median duration of resuscitation 52.5 min (36.5-68), 83 (32%) patients achieved prehospital ROSC during ongoing conventional ACLS prehospitally, 81 (32%) patients did not achieve prehospital ROSC with prolonged conventional ACLS, and 92 (36%) patients did not achieve prehospital ROSC and received ECPR. The overall 180-day survival was 51/83 (61.5%) in patients with prehospital ROSC, 1/81 (1.2%) in patients without prehospital ROSC treated with conventional ACLS and 22/92 (23.9%) in patients without prehospital ROSC treated with ECPR (log-rank p < 0.001). After adjustment for covariates (age, sex, initial rhythm, prehospital ROSC status, time of emergency medical service arrival, resuscitation time, place of cardiac arrest, percutaneous coronary intervention status), ECPR was associated with a lower risk of 180-day death (HR 0.21, 95% CI 0.14-0.31; P < 0.001). CONCLUSIONS: In this secondary analysis of the randomized refractory OHCA trial, ECPR was associated with improved 180-day survival in patients without prehospital ROSC. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01511666, Registered 19 January 2012.
- Klíčová slova
- Extracorporeal cardiopulmonary resuscitation, Extracorporeal life support, Extracorporeal membrane oxygenation, Out-of-hospital cardiac arrest, Return of spontaneous circulation,
- MeSH
- dospělí MeSH
- kardiopulmonální resuscitace * metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- mimotělní membránová oxygenace * metody MeSH
- rozšířená kardiopulmonální recuscitace MeSH
- urgentní zdravotnické služby * metody MeSH
- zástava srdce mimo nemocnici * terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
Thanks to developments in pharmacological and non-pharmacological treatment of heart failure over the last half century, there has been improved quality of life and reduced mortality and morbidity. Despite these advances, the prognosis of advanced heart failure remains poor and the number of patients with terminal heart failure is currently increasing. In the general medical community, knowledge of pharmacological and device therapy with implantable cardioverter-defibrillator or resynchronization therapy is prevalent. However, only a limited number of professionals, mostly in tertiary centres, have personal experience with the use of long-term mechanical circulatory support (MCS) in patients with advanced heart failure after the above conventional therapeutic options have been exhausted. The purpose of this communication is, therefore, to provide the general medical community with basic information about benefits, limitations and referral strategies for MCS.
- Klíčová slova
- advanced heart failure, long‑term mechanical circulatory support, therapy, type 2 diabetes,
- MeSH
- chronická nemoc MeSH
- defibrilátory implantabilní * MeSH
- kvalita života MeSH
- lidé MeSH
- podpůrné srdeční systémy * MeSH
- srdeční selhání * terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
