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The resuscitation outcomes consortium (ROC) primed impedance threshold device (ITD) cardiac arrest trial: A prospective, randomised, double-blind, controlled clinical trial
S22
Abstracts / Resuscitation 81S (2010) S1–S114
AS081 The resuscitation outcomes consortium (ROC) primed impedance threshold device (ITD) cardiac arrest trial: A prospective, randomised, double-blind, controlled clinical trial Aufderheide T.P. 1 , Nichol G. 2 , Rea T.D. 3 , Brown S. 4 , Leroux B.G. 4 , Pepe P.E. 5 , Kudenchuk P.J. 6 , Christenson J. 7 , Daya M.R. 8 , Dorian P. 9 , Callaway C.W. 10 , Idris A.H. 5 , Andrusiek D. 11 , Stephens S.W. 12 , Hostler D. 10 , Davis D.P. 13 , Dunford J.V. 13 , Pirrallo R.G. 1 , Stiell I.G. 14 , Clement C.M. 14 , Craig A. 15 , Van Ottingham L. 4 , Schmidt T.A. 8 , Wang H.E. 12 , Weisfeldt M.L. 16 , Ornato J.P. 17 , Sopko G. 18 , the Resuscitation Outcomes Consortium (ROC) Investigators 1 Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA 2 University of Washington-Harborview Center for Prehospital Emergency Care, Department of Medicine, University of Washington, Seattle, WA and Clinical Trials Center, Department of Biostatistics, University of Washington, Seattle, WA, USA 3 University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, WA, USA 4 Clinical Trials Center, Department of Biostatistics, University of Washington, Seattle, WA, USA 5 Department of Surgery (Emergency Medicine), University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA 6 Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA, USA 7 Department of Emergency Medicine, University of British Columbia; BC Emergency and Health Services Commission; Vancouver, BC, Canada 8 Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA 9 Department of Cardiology, University of Toronto, Toronto, ON, Canada 10 Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA 11 Emergency and Health Services Commission (EHSC), School of Population and Public Health, University of British Columbia, Canada 12 Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA 13 Department of Emergency Medicine, University of California, San Diego, San Diego, CA, USA 14 Department of Emergency Medicine and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada 15 Toronto Emergency Medical Services, Toronto, ON, Canada 16 Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA 17 Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA 18 National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
Purpose: Previous studies suggest use of the impedance threshold device (ITD) during CPR may improve survival for victims of cardiac arrest. We compared survival to hospital discharge with a modified Rankin score (MRS) < 3 in patients with out-of-hospital cardiac arrest receiving manual chest compressions and cardiopulmonary resuscitation (CPR) with a sham or active ITD. Materials and methods: This prospective, double-blind, randomized, controlled, multicenter clinical trial evaluated adult patients (≥ 18 years old or local age of consent) with non-traumatic out-of-hospital cardiac arrest treated by emergency medical services (EMS) in the Resuscitation Outcomes Consortium. A partial factorial study design was implemented concurrently entering patients with initially 30 s of chest compressions (Analyze Early) versus 3 min of chest compressions (Analyze Later). Results: There were 8718 evaluable patients entered in the study, 4345 (49.8%) of which were treated with a sham ITD and 4373 (50.2%) with an active ITD. Patient demographics, cardiac arrest location, incidence of bystander CPR, and time to EMS arrival were similar between groups. The overall number and proportion of patients who survived to hospital discharge with a modified Rankin score of < 3 was 260/4345 (6.0%) with a sham ITD and 254/4373 (5.8%) with an active ITD, p = 0.61. There were no statistically significant differences in pre-specified subgroup analyses or safety measures. Conclusion: In this large effectiveness trial, manual chest compressions and an active ITD did not significantly improve functional survival from cardiac arrest compared with a sham ITD.
planted organs, rejected organs by bad perfussion and no-donation causes were evaluated. There was no conflict of interests. Results: From 212 potential DCD, 118 belong to the CPRm group and 94 to the LUCAS group, with an age average of 46.5 ± 13.1. 83.5% were males, without differences between age (p = 0.57) and sex (p = 0.09) in both groups. Real donors were 33.9% (n = 40) and 36.2% (n = 34), respectively. 78 kidneys and 28 livers were obtained from CPRm group (2.65 organs/donor) and 68 kidneys and 25 livers (2.73 organs/donor) from LUCAS group (p = 0.19). Kidney transplant rate was 1.27 kidneys/donor (n = 51) in CPRm group and 1.5 kidneys/donor (n = 51) in LUCAS (p = 0.28). Rejected kidneys were discarded due to poor perfusion in 74% in CPRm group and 47% in LUCAS group (p Conclusion: LUCAS® chest compressor has shown to be at least as effective as manual CPR. There is a trend in LUCAS® group to increase in the percentage of potential donors that became real donors, the kidney procurement and transplant rate. A significant decrease of the percentage of rejected kidneys by poor perfusion was observed in LUCAS® group. doi:10.1016/j.resuscitation.2010.09.098 AS083 Correlation between arterial and venous lactate and blood gases in patients treated with extracorporeal life support for refractory cardiac failure or arrest Deye N., Mégarbane B., Le Gall C., Malissin I., Résière D., Haouache H., Haik W., Brun P., Baud F.J. Medical ICU, Lariboisiere Hospital, APHP, Paris, France Purpose of the study: Extracorporeal life support (ECLS) has been proposed as an alternative rescue method to treat patients suffering from refractory cardiogenic shock (RCS) and/or refractory cardiac arrest (CA). Our aims were: (1) to study the correlations between arterial and venous lactate in such patients and (2) to assess their respective predictive values regarding survival in ICU. Methods: Inclusion criteria: all ECLS-treated patients hospitalized in our ICU with simultaneous arterial and venous samplings obtained at the time of femoral vessel cannulation for lactate and blood gases measurements. Inotropic score (IS, g/kg/min) was calculated as: dopamine + dobutamine + (adrénaline x 100) + (noradrénaline x 100). Results were expressed as median (IQ 25-75%). Correlations were performed using Pearson tests, univariate comparisons using Chi-2 and Mann–Whitney tests, and multivariate analysis using logistic regression with odds ratio and 95%-confidence interval determination. Results: Seventy-one patients were included: 49 refractory CA [34 M/15F, 42yo (34–49), SAPSII 88 (81–95), no-flow 1 min (0–10), low-flow 147 min (107–170), 24-h survival rate 35%, ICU survival rate 4%], and 22 in RCS [11 M/11F, 45yo (38–59), SAPSII 72 (64–88), IS 151 g/kg/min (85–282), ICU survival rate 50%]. Whatever was the ECLS indication, correlations between arterial and venous lactate (R2 = 0.78), bicarbonate (R2 = 0.85), base excess (R2 = 0.92), pH (R2 = 0.88), and PCO2 (R2 = 0.49) were correct (p < 0.0001). In contrast to the low-flow duration, none of these parameters were significantly associated with the 24-h survival rate in CA patients. In the multivariate analysis, only the arterial lactate concentration at the time of cannulation [9.4 mmol/l (6.3–12.2)] was a predictive factor of ICU survival in RCS patients [odds ratio 16 (1.1–234.3) for lactate concentrations >8 mmol/l]. Conclusions: Despite good correlations between arterial and venous parameters, only the arterial lactate measurement could predict survival in refractory cardiac failure bur not in refractory CA. doi:10.1016/j.resuscitation.2010.09.099
Post Resuscitation Care AS084
doi:10.1016/j.resuscitation.2010.09.097
Regional TNF␣ mapping in the brain reveals the striatum as a neuroinflammatory target after ventricular fibrillation cardiac arrest in rats
AS082
Janata A. 1 , Drabek T. 1 , Stezoski J.P. 1 , Janesko-Feldman K. 1 , Magnet I.A.M. 2 , Tisherman S.A. 1 , Popp E. 3 , Kochanek P.M. 1
Effect of the implantation of a mechanic chest compressor (LUCAS® ) in organs perfussion and transplant rate from donors after cardiac death (DCD) Maastricht type II Carmona F. 1 , Ruiz A. 2 , Palma P. 1 , Soto A. 1 , Cadenas R. 1 , Alberola M. 2 , Paredes D. 2 1 Sistema 2
d’Emergències Mediques (SEM), Barcelona, Spain Transplant Coordination Unit, Hospital Clínic i Provincial de Barcelona, Spain
Purpose: To analyze the impact of a mechanic chest compressor (LUCAS® ) during the transport of the potential DCD to hospital in organs perfussion and the procurement and transplant of organs. Methods: Prospective and comparative study of potential DCD from January 2006 until January 2010. From all the cardiac arrest where resuscitation was attempted with standard advanced life support with manual chest compressions, potential DCD where reanimation during hospital transport continued with manual chest-compressions (CPRm) or using LUCAS® device were compared. DCD selection criteria were: age ? 65, time of asystolia without reanimation under 30 min, total warm ischemia time under 150 min, no absolute contraindications for donation. Age, sex, procured organs, trans-
1 Safar 2 3
Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, USA Medical University of Vienna, Vienna, Austria Deparment of Anesthesiology, University of Heidelberg, Heidelberg, Germany
Purpose of the study: Neuroinflammation contributes to delayed neuronal death after cardiac arrest (CA). In a rat model of ventricular fibrillation (VF) CA, we tested the hypothesis that brain regions are differentially affected by inflammation, as reflected by brain tissue levels of tumor necrosis factor (TNF)␣. Materials and methods: Using isoflurane anesthesia, adult male rats were intubated, cannulated and randomized to 6 (CA6) or 8 (CA8) of VF or sham (anesthesia and surgery only) group. Body temperature was maintained at 37.0 ◦ C. Resuscitation was performed with drugs (epinephrine, sodium bicarbonate), mechanical ventilation and manual chest compressions (200/min). 3 h after restoration of spontaneous circulation, tissue samples of cortex, striatum, hippocampus and cerebellum were obtained for ELISA. Results: TNF␣-levels [pg/mg protein, mean ± SD; sham/CA6/CA8] were in the cerebellum 0.13 ± 0.1/0.48 ± 0.22/0.47 ± 0.14, in the hippocampus 0.16 ± 0.12/0.33 ± 0.19/0.27 ± 0.11, in the striatum 0.22 ± 0.14/1.34 ± 0.37/1.31 ± 0.38 and in the cortex 0.11 ± 0.07/0.37 ± 0.23/0.31 ± 0.08. CA6 and CA8 caused a significant increase in TNF␣ vs. sham in the cortex (p = 0.028), cerebellum (p = 0.009) and striatum
Abstracts / Resuscitation 81S (2010) S1–S114
AS081 The resuscitation outcomes consortium (ROC) primed impedance threshold device (ITD) cardiac arrest trial: A prospective, randomised, double-blind, controlled clinical trial Aufderheide T.P. 1 , Nichol G. 2 , Rea T.D. 3 , Brown S. 4 , Leroux B.G. 4 , Pepe P.E. 5 , Kudenchuk P.J. 6 , Christenson J. 7 , Daya M.R. 8 , Dorian P. 9 , Callaway C.W. 10 , Idris A.H. 5 , Andrusiek D. 11 , Stephens S.W. 12 , Hostler D. 10 , Davis D.P. 13 , Dunford J.V. 13 , Pirrallo R.G. 1 , Stiell I.G. 14 , Clement C.M. 14 , Craig A. 15 , Van Ottingham L. 4 , Schmidt T.A. 8 , Wang H.E. 12 , Weisfeldt M.L. 16 , Ornato J.P. 17 , Sopko G. 18 , the Resuscitation Outcomes Consortium (ROC) Investigators 1 Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA 2 University of Washington-Harborview Center for Prehospital Emergency Care, Department of Medicine, University of Washington, Seattle, WA and Clinical Trials Center, Department of Biostatistics, University of Washington, Seattle, WA, USA 3 University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, WA, USA 4 Clinical Trials Center, Department of Biostatistics, University of Washington, Seattle, WA, USA 5 Department of Surgery (Emergency Medicine), University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA 6 Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA, USA 7 Department of Emergency Medicine, University of British Columbia; BC Emergency and Health Services Commission; Vancouver, BC, Canada 8 Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA 9 Department of Cardiology, University of Toronto, Toronto, ON, Canada 10 Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA 11 Emergency and Health Services Commission (EHSC), School of Population and Public Health, University of British Columbia, Canada 12 Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA 13 Department of Emergency Medicine, University of California, San Diego, San Diego, CA, USA 14 Department of Emergency Medicine and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada 15 Toronto Emergency Medical Services, Toronto, ON, Canada 16 Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA 17 Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA 18 National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
Purpose: Previous studies suggest use of the impedance threshold device (ITD) during CPR may improve survival for victims of cardiac arrest. We compared survival to hospital discharge with a modified Rankin score (MRS) < 3 in patients with out-of-hospital cardiac arrest receiving manual chest compressions and cardiopulmonary resuscitation (CPR) with a sham or active ITD. Materials and methods: This prospective, double-blind, randomized, controlled, multicenter clinical trial evaluated adult patients (≥ 18 years old or local age of consent) with non-traumatic out-of-hospital cardiac arrest treated by emergency medical services (EMS) in the Resuscitation Outcomes Consortium. A partial factorial study design was implemented concurrently entering patients with initially 30 s of chest compressions (Analyze Early) versus 3 min of chest compressions (Analyze Later). Results: There were 8718 evaluable patients entered in the study, 4345 (49.8%) of which were treated with a sham ITD and 4373 (50.2%) with an active ITD. Patient demographics, cardiac arrest location, incidence of bystander CPR, and time to EMS arrival were similar between groups. The overall number and proportion of patients who survived to hospital discharge with a modified Rankin score of < 3 was 260/4345 (6.0%) with a sham ITD and 254/4373 (5.8%) with an active ITD, p = 0.61. There were no statistically significant differences in pre-specified subgroup analyses or safety measures. Conclusion: In this large effectiveness trial, manual chest compressions and an active ITD did not significantly improve functional survival from cardiac arrest compared with a sham ITD.
planted organs, rejected organs by bad perfussion and no-donation causes were evaluated. There was no conflict of interests. Results: From 212 potential DCD, 118 belong to the CPRm group and 94 to the LUCAS group, with an age average of 46.5 ± 13.1. 83.5% were males, without differences between age (p = 0.57) and sex (p = 0.09) in both groups. Real donors were 33.9% (n = 40) and 36.2% (n = 34), respectively. 78 kidneys and 28 livers were obtained from CPRm group (2.65 organs/donor) and 68 kidneys and 25 livers (2.73 organs/donor) from LUCAS group (p = 0.19). Kidney transplant rate was 1.27 kidneys/donor (n = 51) in CPRm group and 1.5 kidneys/donor (n = 51) in LUCAS (p = 0.28). Rejected kidneys were discarded due to poor perfusion in 74% in CPRm group and 47% in LUCAS group (p Conclusion: LUCAS® chest compressor has shown to be at least as effective as manual CPR. There is a trend in LUCAS® group to increase in the percentage of potential donors that became real donors, the kidney procurement and transplant rate. A significant decrease of the percentage of rejected kidneys by poor perfusion was observed in LUCAS® group. doi:10.1016/j.resuscitation.2010.09.098 AS083 Correlation between arterial and venous lactate and blood gases in patients treated with extracorporeal life support for refractory cardiac failure or arrest Deye N., Mégarbane B., Le Gall C., Malissin I., Résière D., Haouache H., Haik W., Brun P., Baud F.J. Medical ICU, Lariboisiere Hospital, APHP, Paris, France Purpose of the study: Extracorporeal life support (ECLS) has been proposed as an alternative rescue method to treat patients suffering from refractory cardiogenic shock (RCS) and/or refractory cardiac arrest (CA). Our aims were: (1) to study the correlations between arterial and venous lactate in such patients and (2) to assess their respective predictive values regarding survival in ICU. Methods: Inclusion criteria: all ECLS-treated patients hospitalized in our ICU with simultaneous arterial and venous samplings obtained at the time of femoral vessel cannulation for lactate and blood gases measurements. Inotropic score (IS, g/kg/min) was calculated as: dopamine + dobutamine + (adrénaline x 100) + (noradrénaline x 100). Results were expressed as median (IQ 25-75%). Correlations were performed using Pearson tests, univariate comparisons using Chi-2 and Mann–Whitney tests, and multivariate analysis using logistic regression with odds ratio and 95%-confidence interval determination. Results: Seventy-one patients were included: 49 refractory CA [34 M/15F, 42yo (34–49), SAPSII 88 (81–95), no-flow 1 min (0–10), low-flow 147 min (107–170), 24-h survival rate 35%, ICU survival rate 4%], and 22 in RCS [11 M/11F, 45yo (38–59), SAPSII 72 (64–88), IS 151 g/kg/min (85–282), ICU survival rate 50%]. Whatever was the ECLS indication, correlations between arterial and venous lactate (R2 = 0.78), bicarbonate (R2 = 0.85), base excess (R2 = 0.92), pH (R2 = 0.88), and PCO2 (R2 = 0.49) were correct (p < 0.0001). In contrast to the low-flow duration, none of these parameters were significantly associated with the 24-h survival rate in CA patients. In the multivariate analysis, only the arterial lactate concentration at the time of cannulation [9.4 mmol/l (6.3–12.2)] was a predictive factor of ICU survival in RCS patients [odds ratio 16 (1.1–234.3) for lactate concentrations >8 mmol/l]. Conclusions: Despite good correlations between arterial and venous parameters, only the arterial lactate measurement could predict survival in refractory cardiac failure bur not in refractory CA. doi:10.1016/j.resuscitation.2010.09.099
Post Resuscitation Care AS084
doi:10.1016/j.resuscitation.2010.09.097
Regional TNF␣ mapping in the brain reveals the striatum as a neuroinflammatory target after ventricular fibrillation cardiac arrest in rats
AS082
Janata A. 1 , Drabek T. 1 , Stezoski J.P. 1 , Janesko-Feldman K. 1 , Magnet I.A.M. 2 , Tisherman S.A. 1 , Popp E. 3 , Kochanek P.M. 1
Effect of the implantation of a mechanic chest compressor (LUCAS® ) in organs perfussion and transplant rate from donors after cardiac death (DCD) Maastricht type II Carmona F. 1 , Ruiz A. 2 , Palma P. 1 , Soto A. 1 , Cadenas R. 1 , Alberola M. 2 , Paredes D. 2 1 Sistema 2
d’Emergències Mediques (SEM), Barcelona, Spain Transplant Coordination Unit, Hospital Clínic i Provincial de Barcelona, Spain
Purpose: To analyze the impact of a mechanic chest compressor (LUCAS® ) during the transport of the potential DCD to hospital in organs perfussion and the procurement and transplant of organs. Methods: Prospective and comparative study of potential DCD from January 2006 until January 2010. From all the cardiac arrest where resuscitation was attempted with standard advanced life support with manual chest compressions, potential DCD where reanimation during hospital transport continued with manual chest-compressions (CPRm) or using LUCAS® device were compared. DCD selection criteria were: age ? 65, time of asystolia without reanimation under 30 min, total warm ischemia time under 150 min, no absolute contraindications for donation. Age, sex, procured organs, trans-
1 Safar 2 3
Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, USA Medical University of Vienna, Vienna, Austria Deparment of Anesthesiology, University of Heidelberg, Heidelberg, Germany
Purpose of the study: Neuroinflammation contributes to delayed neuronal death after cardiac arrest (CA). In a rat model of ventricular fibrillation (VF) CA, we tested the hypothesis that brain regions are differentially affected by inflammation, as reflected by brain tissue levels of tumor necrosis factor (TNF)␣. Materials and methods: Using isoflurane anesthesia, adult male rats were intubated, cannulated and randomized to 6 (CA6) or 8 (CA8) of VF or sham (anesthesia and surgery only) group. Body temperature was maintained at 37.0 ◦ C. Resuscitation was performed with drugs (epinephrine, sodium bicarbonate), mechanical ventilation and manual chest compressions (200/min). 3 h after restoration of spontaneous circulation, tissue samples of cortex, striatum, hippocampus and cerebellum were obtained for ELISA. Results: TNF␣-levels [pg/mg protein, mean ± SD; sham/CA6/CA8] were in the cerebellum 0.13 ± 0.1/0.48 ± 0.22/0.47 ± 0.14, in the hippocampus 0.16 ± 0.12/0.33 ± 0.19/0.27 ± 0.11, in the striatum 0.22 ± 0.14/1.34 ± 0.37/1.31 ± 0.38 and in the cortex 0.11 ± 0.07/0.37 ± 0.23/0.31 ± 0.08. CA6 and CA8 caused a significant increase in TNF␣ vs. sham in the cortex (p = 0.028), cerebellum (p = 0.009) and striatum