Hypothermia Post-Cardiac Arrest - Research Paper Example

SECTION #2: Hypothermia Post-cardiac Arrest For the Bernard article: a. Describe the design (retro/pro-spective? randomized This is a prospective randomized controlled study. The study was conducted in current time or prospectively by subjecting 77 patients to treatment with hypothermia or normothermia. The subjects were randomly assigned to such treatments and outcome measures were used to establish results and answers to the questions being raised in this study. b. Describe the study population (area, inclusion criteria)? What was the ‘intervention’? Identify key pieces of ‘data’ collected. The study covered 84 patients who were eligible for enrollment, with 77 of them being finally enrolled in the treatment. Inclusion criteria for this paper included the following: an initial cardiac rhythm of ventricular fibrillation at the time of arrival of ambulance, successful return of spontaneous circulation, persistent coma after the return of spontaneous circulation, and transfer to one of four participating emergency departments. Exclusion criteria included the following: age of less than 18 years for men and 50 years for women, cardiogenic shock (systolic BP of less than 90mmHg despite epinephrine infusion), or possible causes of coma other than cardiac arrest. Patients who were in the hypothermia group underwent initial cooling measures in the ambulance and when they arrived in the hospital, they underwent vigorous cooling in the ED through the application of ice packs around the head, neck, torso, and limbs. As soon as their core temperature reached 33 degrees Celsius, the ice packs were removed and their temperature was maintained until 12 hours from their arrival at the hospital. They were kept sedated and paralyzed with small doses of midazolam and vecuronium to prevent shivering. At 18 hours, the patients were rewarmed for the next 6 hours through external warming methods; they were kept sedated. Those assigned to the normothermia group were also sedated and paralyzed with their target core temperature at 37 degrees Celsius. Passive rewarming was applied on patients if there was mild spontaneous hypothermia on arrival. After 24 hours, patient care based on ICU protocols was applied. Patients who regained consciousness went through extubation and were transferred to the coronary care unit. Active life support was withdrawn for patients who remained deeply comatose for 72 hours. c. What was primary ‘outcome measure’? What was ‘result’? Primary outcome measure was based on survival to hospital discharge with sufficiently good neurologic function to be discharged to home or to a rehabilitation facility. Results revealed that the demographic characteristics of the patients were similar in both groups. Twenty one out of the 43 patients treated with hypothermia survived and presented with a good outcome; 9 out of 34 treated with normothermia presented with a good outcome. Odds ratio for good outcome with hypothermia in relation to normothermia was at 5.25. Hypothermia in general was associated with a lower cardiac index, higher systemic valvular resistance, and hyperglycemia. 2. Briefly describe the HACASG article. In the HACASG article, the authors set forth that cardiac arrest with widespread cerebral ischemia often results to severe neurologic impairment. The authors reviewed whether mild systemic hypothermia increases the rate of neurologic recovery after resuscitation from cardiac arrest caused by ventricular fibrillation. The study revealed that about 75 of the 136 patients in the hypothermia group presented with a favorable outcome; the normothermia group presented with a less favorable outcome. Mortality after 6 months was seen at 41 percent in the hypothermia group and 55 percent in the normothermia group (Holzer, et.al., p. 549). The rate of complication was not different for both groups. The authors concluded that among patients who were successfully resuscitated after cardiac arrest, therapeutic mild hypothermia improved the possibility of favorable neurologic outcomes; it also reduced mortality rates among cardiac arrest patients (Holzer, et.al., p. 549). 3. What is your recommendation for your EMS organization? For a national guideline? I recommend that my EMS organization apply the hypothermia method for cardiac arrest patients. This would help improve the outcomes of their arrest and also improve their survival from cardiac arrest. I also suggest that such methods be applied on a national scale, with health administrators adapting this method in the practice. Policies should be set forth in order to lay this policy out as a potential solution to cardiac arrest patients – to improve their survival and to improve their general outcomes. Worksheet for BLS 005A R4 12 September 2009 Please describe the contents and your impression of the specific Worksheet This worksheet wanted to review if compression only CPR compared with conventional CPR resulted in an increase in adverse outcomes. This question was deemed to be an intervention therapy and covers a new topic. None of the authors had any conflicts of interest in this worksheet. Search strategies included electronic database searches through Medline, Embase, and follow up of quoted references on CPR OR and fatigue, chest compression and fatigue, and similar search words. Inclusion criteria included patients undergoing chest compressions given mechanically or using feedback devices. There were 456 papers complying with inclusion criteria with 25 of them reviewed and 7 deemed relevant to the question. The review also provided a summary of the different materials cited. The summary featured the important elements of each research and the level of evidence for each research was also presented by the author. The reviewer also presented a review of the risks and benefits for each research included in this worksheet. The worksheet presented the results of the search and rated the different evidence found in terms of credibility and validity for the question raised. The worksheet also presented a summary of the different materials cited for this worksheet. My impression on this worksheet is that it highlights an important issue in BLS and in CPR. It gives a thorough review of materials which help provide answers to the issue raised. The worksheet also provides studies which are relevant to the subject matter – particularly focusing on the resources which can help the process of research. The worksheet is comprehensive and detailed enough to answer the relevant research questions. This worksheet is relevant in the sense that it helps provide an evidence base for BLS and for CPR in general. Worksheet 2: BLS-006A 01-Feb-2010.doc This worksheet seeks to answer the PICO question: in adult and pediatric patients with cardiac arrest (out of hospital and in hospital) (P), does any specific compression depth (I) as opposed to standard care (ie. Depth specified in treatment algorithm) (C), improve outcome (O)? This question is also a review of an intervention and is a revision of an existing worksheet. The study does not state if there is a conflict of interest disclosures relevant to this worksheet. Search strategies included a search of the electronic databases like PubMed from January 2004-November 2009; Ovid Medline from January 2004 to November 2009. Search queries included queries on “chest compressions” and “depth” in all fields; and “depth and heart massage” in all fields; as well as cardiopulmonary resuscitation methods and heart arrest with 112 hits all in all. Inclusion criteria included human, surrogate, animal and mathematical model studies; exclusion criteria included articles which did not address chest compression depths. There were 34 studies which met the inclusion criteria. My impression on this worksheet is that it also presents a thorough review of the studies which are relevant to the current issue being settled in this worksheet. The reviewer presents a comprehensive assessment of each study by providing summaries for each material and rating such material based on their level of evidence. The reviewer also discussed the evidence presented by the different authors in the studies included in this worksheet taking particular notice of the results which help answer, one way or another, the question being raised in this research. The level of evidence was rated for each study and the ratings were based on fair and equitable standards of measure. After the studies were rated, recommendations for the practice were also made. Such recommendations were based on the results established in this paper and on the relevant details established by each article cited. Worksheet 3: BLS-008B 09-Mar-2010 Jacobs.doc This worksheet sought to answer the following PICO question: In adult and pediatric patients with cardiac arrest (out-of-hospital and in-hospital) (P), does the interruption of CPR to check circulation (I) as opposed to no interruption of CPR (C), improve outcome (O)? This question reviews an intervention or therapy and it is a revision of an existing worksheet. There is no conflict of interests specific to this question. The search strategy for this worksheet included an electronic database search with searches limited to articles in peer reviewed journal between 1966 and 2008, in the English language, and with abstracts. Databases such as the PubMed, Cochrane Library, Embase, OvidSP, and Google Scholar were included in this search. Their queries included search terms like “heart arrest” resuscitation, and pulse check. Inclusion standards were adult and pediatric populations, human and animal studies, metanalyses, manikins and surrogate mathematical models. Excluded materials were the non-English articles, single case reports, reviews articles, and editorials. There were 155 articles excluded and 13 new articles included. My impression of this worksheet is that it also provides a thorough review of BLS and of CPR. In the same tradition as the two previous worksheets, the reviewers were able to deconstruct and extract important details from a variety of materials. From such extraction, they were able to gain relevant and reliable evidence for the current question being raised by this research. All in all, this study was able to present studies with a high level of evidence. It is important to establish these types of research because they help provide a reliable basis for application into practice. This worksheet was unrelenting in its review of the relevant studies, and in the end, the potential impact of such studies were beneficial in answering the question being raised by this worksheet. Read More