Showing papers by "Jo Kramer-Johansen published in 2008"
TL;DR: Reporting cardiopulmonary resuscitation quality data should be standard in all studies of cardiac arrest as effects of studied interventions can depend on or influence cardiopUL pulmonary resuscitationQuality data are also valuable in quality improvement processes both in-hospital and out of hospital.
Abstract: Purpose of review There is correlation between quality of bystander cardiopulmonary resuscitation and patient survival. Recent developments in defibrillator technology enable recording of cardiopulmonary resuscitation quality, and have shown quality of professional cardiopulmonary resuscitation far from guidelines' levels for factors such as chest compression depth and rate, ventilation rate, and pauses in chest compressions. The effects of cardiopulmonary resuscitation quality factors on patient survival are presently under scrutiny. Recent findings Factors such as depth of and pauses in chest compressions immediately before defibrillation attempts affect outcome. Both immediate automated feedback on cardiopulmonary resuscitation quality and use of the same quality data during postevent debriefing improve cardiopulmonary resuscitation quality, and the combination appears to improve outcome. The increased awareness of quality problems, particularly unwanted pauses in chest compressions, has caused more emphasis on chest compressions in cardiopulmonary resuscitation protocols including the 2005 Guidelines. There is a growing number of reports of increased survival with these new protocols. Summary Cardiopulmonary resuscitation quality affects survival after cardiac arrest. Reporting cardiopulmonary resuscitation quality data should be standard in all studies of cardiac arrest as effects of studied interventions can depend on or influence cardiopulmonary resuscitation quality. These data are also valuable in quality improvement processes both in-hospital and out-of-hospital.
73 citations
TL;DR: CPR artefacts can be suppressed using methods based on the analysis of the ECG alone, and the hardware of current AEDs does not need to be replaced, although better artefact suppression methods exist for modified Aeds with additional reference channels.
55 citations
TL;DR: An experimental study retrospectively analyzed 127 PEA segments and 91 PR segments out of 219 and 113 segments to identify pulse and found that automatic identification of pulse could avoid unnecessary pulse checks and thereby reduce no-flow time and potentially increase the chance of survival.
Abstract: The main problem during pulse check in out-of-hospital cardiac arrest is the discrimination between normal pulse-generating rhythm (PR) and pulseless electrical activity (PEA). It has been suggested that circulatory information can be acquired by measuring the thoracic impedance via the defibrillator pads. To investigate this, we performed an experimental study where we retrospectively analyzed 127 PEA segments and 91 PR segments out of 219 and 113 segments. A PEA versus PR classification framework was developed, that uses short segments (< 10 s) of ECG and impedance measurements to discriminate between the two rhythms. Using realistic data analyzed over a duration of 3 s, our system correctly identifies 90.0% of the segments with rhythm being pulseless electrical activity, and 91.5% of the normal pulse rhythm segments. Automatic identification of pulse could avoid unnecessary pulse checks and thereby reduce no-flow time and potentially increase the chance of survival.
48 citations
TL;DR: The dynamics of resuscitation can be described in terms of state transitions and a Markov probability model, which enables prediction of short-term clinical development, supports informed decisions during CPR, and suggests a novel area for research.
44 citations
TL;DR: Transthoracic impedance changes may be used to detect malpositioned and dislodged tubes also during situations without spontaneous circulation, and predictive values must be retested in another population.
36 citations
TL;DR: The presence of random effects shows that the shock outcome prediction accuracy can be improved by explaining more of the variation between patients, for example using the approaches outlined above, and that there is within-patient correlation between samples that should be accounted for when evaluating prediction accuracy.
26 citations
TL;DR: Excessive time for ventilation cannot explain the high no-flow time during CPR by professional rescuers before intubation.
23 citations
TL;DR: The accuracy of shock outcome prediction during CPR could be increased by using filtered ECG features from higher ECG subbands instead of features derived from the main ECG spectrum.
19 citations
TL;DR: It is possible to improve current shock prediction methods by using an updating algorithm capable of learning from previous shocks within a resuscitation effort.
14 citations
TL;DR: The hemodynamic effects of prearrest anticoagulation with a low-molecular-weight heparin suitable for clinical use during cardiopulmonary resuscitation in pigs were studied to demonstrate activation of coagulation during cardiac arrest.
Abstract: Objective: Both animal and human studies demonstrate activation of coagulation during cardiac arrest. Prearrest anticoagulation is used routinely in many experimental studies. We studied the hemodynamic effects of prearrest anticoagulation with a low-molecular-weight heparin suitable for clinical use during cardiopulmonary resuscitation in pigs. Design: Randomized and blinded experimental animal study. Setting: University hospital-affiliated research laboratory. Subjects: Sixteen female domestic pigs. Interventions: Three minutes before electrically induced ventricular fibrillation, enoxaparin 1 mg/kg or physiologic saline was blinded and administered intravenously. After 10 mins of untreated ventricular fibrillation, advanced cardiac life support was initiated with continuous mechanical chest compressions and interposed manual ventilation with 100% oxygen. Epinephrine was administered after 2 mins of advanced cardiac life support followed by attempted defibrillation 1 min thereafter. Advanced cardiac life support was continued for 10 mins following international guidelines. Electrocardiogram was recorded continuously and ventricular fibrillation waveform was analyzed (median slope). Animals with return of spontaneous circulation were observed for ten more minutes. Blood specimens were drawn for analysis of coagulation activation (thrombin-antithrombin complex) and drug effect (anti-factor Xa activity). Measurements and Main Results: Six of eight (75%) pigs in each group achieved return of spontaneous circulation. Thrombin-antithrombin complex levels were significantly lower in pigs that received enoxaparin. There was no significant difference either in measured hemodynamics between the groups during advanced cardiac life support and after return of spontaneous circulation or in median slope values during ventricular fibrillation. Epinephrine caused a significant decrease in femoral and increase in cerebral cortical blood flow with no difference between the groups. Conclusions: Prearrest anticoagulation with enoxaparin did not influence either hemodynamics during advanced cardiac life support and after return of spontaneous circulation or the frequency of return of spontaneous circulation in porcine cardiac arrest.
12 citations
TL;DR: Ventilation during basic life support performed according to international guidelines (2000) resulted in arterial hypercapnia and hypoxia.