The goal of therapy for bradycardia or tachycardia is to rapidly identify and treat patients who are hemodynamically unstable or symptomatic due to the arrhythmia. Drugs or, when appropriate, pacing may be used to control unstable or symptomatic bradycardia. Cardioversion or drugs or both may be used to control unstable or symptomatic tachycardia. ACLS providers should closely monitor stable patients pending expert consultation and should be prepared to aggressively treat those with evidence of decompensation.

/pdf/part-8-adult-advanced-cardiovascular-life-support-2010-344vtppnij.pdf

Part 8: Adult Advanced Cardiovascular Life Support 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

ContextCardiopulmonary resuscitation (CPR) guidelines recommend target values
for compressions, ventilations, and CPR-free intervals allowed for rhythm
analysis and defibrillation. There is little information on adherence to these
guidelines during advanced cardiac life support in the field.ObjectiveTo measure the quality of out-of-hospital CPR performed by ambulance
personnel, as measured by adherence to CPR guidelines.Design and SettingCase series of 176 adult patients with out-of-hospital cardiac arrest
treated by paramedics and nurse anesthetists in Stockholm, Sweden, London,
England, and Akershus, Norway, between March 2002 and October 2003. The defibrillators
recorded chest compressions via a sternal pad fitted with an accelerometer
and ventilations by changes in thoracic impedance between the defibrillator
pads, in addition to standard event and electrocardiographic recordings.Main Outcome MeasureAdherence to international guidelines for CPR.ResultsChest compressions were not given 48% (95% CI, 45%-51%) of the time
without spontaneous circulation; this percentage was 38% (95% CI, 36%-41%)
when subtracting the time necessary for electrocardiographic analysis and
defibrillation. Combining these data with a mean compression rate of 121/min
(95% CI, 118-124/min) when compressions were given resulted in a mean compression
rate of 64/min (95% CI, 61-67/min). Mean compression depth was 34 mm (95%
CI, 33-35 mm), 28% (95% CI, 24%-32%) of the compressions had a depth of 38
mm to 51 mm (guidelines recommendation), and the compression part of the duty
cycle was 42% (95% CI, 41%-42%). A mean of 11 (95% CI, 11-12) ventilations
were given per minute. Sixty-one patients (35%) had return of spontaneous
circulation, and 5 of 6 patients discharged alive from the hospital had normal
neurological outcomes.ConclusionsIn this study of CPR during out-of-hospital cardiac arrest, chest compressions
were not delivered half of the time, and most compressions were too shallow.
Electrocardiographic analysis and defibrillation accounted for only small
parts of intervals without chest compressions.

https://jamanetwork.com/journals/jama/articlepdf/200195/joc42116.pdf

Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest

The International Liaison Committee on Resuscitation (ILCOR) Advanced Life Support (ALS) Task Force performed detailed systematic reviews based on the recommendations of the Institute of Medicine of the National Academies1 and using the methodological approach proposed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group.2 Questions to be addressed (using the PICO [population, intervention, comparator, outcome] format)3 were prioritized by ALS Task Force members (by voting). Prioritization criteria included awareness of significant new data and new controversies or questions about practice. Questions about topics no longer relevant to contemporary practice or where little new research has occurred were given lower priority. The ALS Task Force prioritized 42 PICO questions for review. With the assistance of information specialists, a detailed search for relevant articles was performed in each of 3 online databases (PubMed, Embase, and the Cochrane Library).

By using detailed inclusion and exclusion criteria, articles were screened for further evaluation. The reviewers for each question created a reconciled risk of bias assessment for each of the included studies, using state-of-the-art tools: Cochrane for randomized controlled trials (RCTs),4 Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 for studies of diagnostic accuracy,5 and GRADE for observational studies that inform both therapy and prognosis questions.6

GRADE evidence profile tables7 were then created to facilitate an evaluation of the evidence in support of each of the critical and important outcomes. The quality of the evidence (or confidence in the estimate of the effect) was categorized as high, moderate, low, or very low,8 based on the study methodologies and the 5 core GRADE domains of risk of bias, inconsistency, indirectness, imprecision, and other considerations (including publication bias).9

These evidence profile tables were then used to create a …

/pdf/part-4-advanced-life-support-2015-international-consensus-on-3s0zzf6w8u.pdf

Part 4: Advanced life support: 2015 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations

The apparatus of one embodiment of the present invention is comprised of a flexible sheath instrument, a flexible guide instrument, and a tool. The flexible sheath instrument comprises a first instrument base removably coupleable to an instrument driver and defines a sheath instrument working lumen. The flexible guide instrument comprises a second instrument base removably coupleable to the instrument driver and is threaded through the sheath instrument working lumen. The guide instrument also defines a guide instrument working lumen. The tool is threaded through the guide instrument working lumen. For this embodiment of the apparatus, the sheath instrument and guide instrument are independently controllable relative to each other.

Robotic catheter system and methods

CONTEXT\nCardiopulmonary resuscitation (CPR) guidelines recommend target values for compressions, ventilations, and CPR-free intervals allowed for rhythm analysis and defibrillation. There is little information on adherence to these guidelines during advanced cardiac life support in the field.\n\n\nOBJECTIVE\nTo measure the quality of out-of-hospital CPR performed by ambulance personnel, as measured by adherence to CPR guidelines.\n\n\nDESIGN AND SETTING\nCase series of 176 adult patients with out-of-hospital cardiac arrest treated by paramedics and nurse anesthetists in Stockholm, Sweden, London, England, and Akershus, Norway, between March 2002 and October 2003. The defibrillators recorded chest compressions via a sternal pad fitted with an accelerometer and ventilations by changes in thoracic impedance between the defibrillator pads, in addition to standard event and electrocardiographic recordings.\n\n\nMAIN OUTCOME MEASURE\nAdherence to international guidelines for CPR.\n\n\nRESULTS\nChest compressions were not given 48% (95% CI, 45%-51%) of the time without spontaneous circulation; this percentage was 38% (95% CI, 36%-41%) when subtracting the time necessary for electrocardiographic analysis and defibrillation. Combining these data with a mean compression rate of 121/min (95% CI, 118-124/min) when compressions were given resulted in a mean compression rate of 64/min (95% CI, 61-67/min). Mean compression depth was 34 mm (95% CI, 33-35 mm), 28% (95% CI, 24%-32%) of the compressions had a depth of 38 mm to 51 mm (guidelines recommendation), and the compression part of the duty cycle was 42% (95% CI, 41%-42%). A mean of 11 (95% CI, 11-12) ventilations were given per minute. Sixty-one patients (35%) had return of spontaneous circulation, and 5 of 6 patients discharged alive from the hospital had normal neurological outcomes.\n\n\nCONCLUSIONS\nIn this study of CPR during out-of-hospital cardiac arrest, chest compressions were not delivered half of the time, and most compressions were too shallow. Electrocardiographic analysis and defibrillation accounted for only small parts of intervals without chest compressions.

Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest

Methods and apparatus are provided for renal neuromodulation using a pulsed electric field to effectuate electroporation or electrofusion. It is expected that renal neuromodulation (e.g., denervation) may, among other things, reduce expansion of an acute myocardial infarction, reduce or prevent the onset of morphological changes that are affiliated with congestive heart failure, and/or be efficacious in the treatment of end stage renal disease. Embodiments of the present invention are configured for percutaneous intravascular delivery of pulsed electric fields to achieve such neuromodulation.

Methods and apparatus for renal neuromodulation

A method and apparatus for treatment of heart failure, hypertension and renal failure by stimulating the renal nerve. The goal of therapy is to reduce sympathetic activity of the renal nerve. Therapy is accomplished by at least partially blocking the nerve with drug infusion or electrostimulation. Apparatus can be permanently implanted or catheter based.

Renal nerve stimulation method and apparatus for treatment of patients

Methods and system are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulation may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers. In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues. In some embodiments, thermally-induced renal neuromodulation is achieved via delivery of a pulsed thermal therapy.

Methods and systems for thermally-induced renal neuromodulation

Methods and apparatus are provided for thermally-induced renal neuromodulation. Thermally-induced renal neuromodulation may be achieved via direct and/or via indirect application of thermal energy to heat or cool neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers. In some embodiments, parameters of the neural fibers, of non-target tissue, or of the thermal energy delivery element, may be monitored via one or more sensors for controlling the thermally-induced neuromodulation. In some embodiments, protective elements may be provided to reduce a degree of thermal damage induced in the non-target tissues. In some embodiments, thermally-induced renal neuromodulation is achieved via delivery of a pulsed thermal therapy.

Methods and apparatus for thermally-induced renal neuromodulation

A method and apparatus for treatment of cardiac and renal diseases associated with the elevated sympathetic renal nerve activity by implanting a device to block the renal nerve signals to and from the kidney. The device can be a drug pump (105) or a drug eluding implant for targeted delivery of a nerve-blocking agent to the periarterial space of the renal artery.

Mark Gelfand

Papers

Methods and apparatus for renal neuromodulation

Renal nerve stimulation method and apparatus for treatment of patients

Methods and systems for thermally-induced renal neuromodulation

Methods and apparatus for thermally-induced renal neuromodulation

Methods and devices for renal nerve blocking