There is increasing recognition that systematic post–cardiac arrest care after return of spontaneous circulation (ROSC) can improve the likelihood of patient survival with good quality of life. This is based in part on the publication of results of randomized controlled clinical trials as well as a description of the post–cardiac arrest syndrome. 1–3 Post–cardiac arrest care has significant potential to reduce early mortality caused by hemodynamic instability and later morbidity and mortality from multiorgan failure and brain injury. 3,4 This section summarizes our evolving understanding of the hemodynamic, neurological, and metabolic abnormalities encountered in patients who are initially resuscitated from cardiac arrest. The initial objectives of post–cardiac arrest care are to ● Optimize cardiopulmonary function and vital organ perfusion. ● After out-of-hospital cardiac arrest, transport patient to an appropriate hospital with a comprehensive post–cardiac arrest treatment system of care that includes acute coronary interventions, neurological care, goal-directed critical care, and hypothermia. ● Transport the in-hospital post–cardiac arrest patient to an appropriate critical-care unit capable of providing comprehensive post–cardiac arrest care. ● Try to identify and treat the precipitating causes of the arrest and prevent recurrent arrest.

http://www.kardio.hu/feltoltott/dokumentumok/fajl_201148104747Cardiopulm_resuscit_Pt9_Post_cardiac.pdf

Part 9: Post-Cardiac Arrest Care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

In contrast to adults, cardiac arrest in infants and children does not usually result from a primary cardiac cause. More often it is the terminal result of progressive respiratory failure or shock, also called an asphyxial arrest. Asphyxia begins with a variable period of systemic hypoxemia, hypercapnea, and acidosis, progresses to bradycardia and hypotension, and culminates with cardiac arrest.1

Another mechanism of cardiac arrest, ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), is the initial cardiac rhythm in approximately 5% to 15% of pediatric in-hospital and out-of-hospital cardiac arrests;2,–,9 it is reported in up to 27% of pediatric in-hospital arrests at some point during the resuscitation.6 The incidence of VF/pulseless VT cardiac arrest rises with age.2,4 Increasing evidence suggests that sudden unexpected death in young people can be associated with genetic abnormalities in myocyte ion channels resulting in abnormalities in ion flow (see “Sudden Unexplained Deaths,” below).

Since 2010 marks the 50th anniversary of the introduction of cardiopulmonary resuscitation (CPR),10 it seems appropriate to review the progressive improvement in outcome of pediatric resuscitation from cardiac arrest. Survival from in-hospital cardiac arrest in infants and children in the 1980s was around 9%.11,12 Approximately 20 years later, that figure had increased to 17%,13,14 and by 2006, to 27%.15,–,17 In contrast to those favorable results from in-hospital cardiac arrest, overall survival to discharge from out-of-hospital cardiac arrest in infants and children has not changed substantially in 20 years and remains at about 6% (3% for infants and 9% for children and adolescents).7,9

It is unclear why the improvement in outcome from in-hospital cardiac arrest has occurred, although earlier recognition and management of at-risk patients on general inpatient units …

https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.110.971101

Part 14: Pediatric Advanced Life Support 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

https://www.ilcor.org/data/Post-cardiac_arrest_syndrome.pdf

Post-cardiac arrest syndrome: Epidemiology, pathophysiology, treatment, and prognostication ☆ ☆☆ ★: A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; the Council on Stroke

The contributors to this statement were selected to ensure expertise in all the disciplines relevant to post–cardiac arrest care. In an attempt to make this document universally applicable and generalizable, the authorship comprised clinicians and scientists who represent many specialties in many regions of the world. Several major professional groups whose practice is relevant to post–cardiac arrest care were asked and agreed to provide representative contributors. Planning and invitations took place initially by e-mail, followed a series of telephone conferences and face-to-face meetings of the cochairs and writing group members. International writing teams were formed to generate the content of each section, which corresponded to the major subheadings of the final document. Two team leaders from different countries led each writing team. Individual contributors were assigned by the writing group cochairs to work on 1 or more writing teams, which generally reflected their areas of expertise. Relevant articles were identified with PubMed, EMBASE, and an American Heart Association EndNote master resuscitation reference library, supplemented by hand searches of key papers. Drafts of each section were written and agreed on by the writing team authors and then sent to the cochairs for editing and amalgamation into a single document. The first draft of the complete document was circulated among writing team leaders for initial comment and editing. A revised version of the document was circulated among all contributors, and consensus was achieved before submission of the final version for independent peer review and approval for publication.

This scientific statement outlines current understanding and identifies knowledge gaps in the pathophysiology, treatment, and prognosis of patients who regain spontaneous circulation after cardiac arrest. The purpose is to provide a resource for optimization of post–cardiac arrest care and to pinpoint the need for research focused on gaps in knowledge that would potentially improve outcomes …

Post–Cardiac Arrest Syndrome

https://anestesiar.org/WP/uploads/2011/01/7-neonatos-ERC-2010.pdf

European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary.

A therapy-delivering, portable medical device (200) capable of triggering and/or communicating with an alarm system (100), as well as a related system and method therefor. The portable medical device (200) is configured to establish a communication link (107) with an alarm system (100) such as a residential or business alarm, upon the occurrence of a triggering event. Triggering events may be related to the use, operation or deployment of the portable medical device (200) in an emergency situation, or they may be for service, status or maintenance purposes, e.g., to report device failures, system checks, etc. The portable medical device (200) is configured to deliver therapy to a patient, wherein the therapy delivered to the patient may be any or combination of medial therapies, e.g., defibrillation, drugs, etc., for any one or combination of medical applications, such as stroke, cardiac arrest, diabetic shock, etc.

Therapy-delivering portable medical device capable of triggering and communicating with an alarm system

An external defibrillator/pacer includes an output circuit with four legs arrayed to form an H-bridge. Each leg of the output circuit contains a switch. In a defibrillation mode, pairs of switches in the H-bridge are selectively switched to generate a biphasic defibrillation pulse. Three switches are silicon controlled rectifiers (SCRs). Gate drive circuits are coupled to the SCRs to bias the SCRs with a voltage that allows the SCRs in response to control signals. One switch includes an insulated gate bipolar transistor (IGBT). A gate drive circuit is coupled to the gate of the IGETs to provide a slow turn-on and a fast turn-off of the IGBT. In a pacing mode, a bypass circuit or current source circuit is used to provide a current path bypassing an SCR switch, which cannot be triggered by the relatively low current of pacing pulses.

Circuit for performing external pacing and biphasic defibrillation

Devices, methods, and software implementing those methods for providing communicating external chest compression (ECC) devices and defibrillation (DF) devices, where the ECC and DF devices can be physically separate from each other. Both ECC and DF devices are able to operate autonomously, yet able to communicate with and cooperate with another device when present. Some ECC and DF devices are adapted to be physically and/or electrically coupled to each other. One ECC device includes a backboard, a chest compression member, a communication module, controller, and at least one sensor, electrode lead or electrode. One DF device includes a defibrillator module, a controller, and a communication module that can communicate with the ECC communication module. The communicating ECC and DF devices may deliver ECC, pacing, defibrillation, ventilation, and cooling therapies, and may deliver instructions to human assistants, in a coordinated and cooperative fashion.

Cooperating defibrillators and external chest compression devices

The present invention provides a system, method and apparatus for obtaining status information from a portable medical device and communicating said status information to a remote system or user. In one embodiment, the system comprises a sensing device that comprises an optical receiver for receiving status information from at least one status indicator of the portable medical device. The optical receiver is positioned in sufficient proximity to the status indicator to allow optical communication between the optical receiver and the status indicator. A circuit couplable to the optical receiver communicates the status information represented by the status indicator to the remote system or user. In another embodiment, the sensing device comprises a microphone to receive audible status signals from the portable medical device. In yet another embodiment, the sensing device is mounted to a housing, which allows sensing device to sense the status information of an enclosed portable medical device.

Richard C. Nova

Papers

Therapy-delivering portable medical device capable of triggering and communicating with an alarm system

Circuit for performing external pacing and biphasic defibrillation

Cooperating defibrillators and external chest compression devices

System, method and apparatus for sensing and communicating statu s information from a portable medical device

Better outcome after pediatric defibrillation dosage than adult dosage in a swine model of pediatric ventricular fibrillation.