ReviewResuscitation highlights in 2020
Section snippets
Epidemiology and outcome
In what has become an efficient model for cost-effectively tracking and comparing national outcomes from out-of-hospital cardiac arrest (OHCA), the EuReCa two study documented cardiac arrest outcomes in 28 European countries during a three-month period in 2017.8 The analysis included 37,054 OHCAs from a combined population of almost 179 million citizens. As noted in previous EuReCa registry analyses, there was considerable variation in outcomes amongst participating nations. For example,
Rapid response systems
Avoidable deaths in United Kingdom (UK) National Health Service (NHS) hospitals were described as “the equivalent of an aircraft falling out of the sky every single week” by former Health Secretary Jeremy Hunt in January 2020.44 In an important study, the association between nurse staffing levels and a failure to respond to patients with deranged physiology was evaluated.45 Data, including nurse staffing, from 32 general wards of an acute hospital in England were analysed over a 3-year period
Basic life support
High quality CPR remains a cornerstone of effective basic life support (BLS). ILCOR led a scoping review to identify if there is any new evidence which might require an update to existing guidelines. The review identified 22 clinical studies addressing compression rate, depth, chest wall recoil and leaning.49 None of the studies reported findings that were sufficient to change practice.2
Public access defibrillation remains one of the most effective treatments for cardiac arrest, yet still too
Drugs
The precise role and value of both vasopressors (adrenaline) and antiarrhythmic drugs (amiodarone or lidocaine) during cardiac arrest remains controversial and the evidence suggests that they are most likely to beneficial when given early after cardiac arrest.3, 58, 59 A systematic review and meta-analysis of beta-blockade for refractory VF/pulseless ventricular tachycardia (pVT) cardiac arrest identified three observational studies with a total of 115 patients.60 Proponents of beta-blockade
Paediatric resuscitation
Patient characteristics and clinical outcome after paediatric IHCA have been documented over a seven-year period among acute children’s hospitals and acute general hospitals participating in the National Cardiac Arrest Audit (NCAA) in the UK.70 Among 1456 patients with 1580 events, the overall rates of ROSC were 69.1% with unadjusted survival to hospital discharge of 54.2%. A difference in outcomes was observed between children’s hospitals and acute general hospitals with ROSC rates of 79.1%
Neonatal resuscitation
A systematic review and meta-analysis on the use of tracheal suctioning of meconium at birth for non-vigorous infants identified four RCTs that included 581 patients and one observational study (n = 231).74 No significant differences in survival to discharge were observed between neonates treated with immediate tracheal intubation and suctioning compared with those treated with immediate resuscitation without intubation. It was concluded that for non-vigorous newborns there is insufficient
Trauma
A systematic review and meta-analysis of paediatric traumatic OHCA identified 19 articles across a population of 15.2 million.77 Nine studies were assessed as low quality. Overall pooled survival to hospital discharge or 30-day survival for the EMS-treated cases was 1.2%. The pooled rate of ROSC in four studies was 22.1%, and the pooled rate of event survival was 18.8%. The pooled incidence of EMS-treated paediatric traumatic OHCA was 1.6 cases per 100,000 person-years. The authors concluded
Targeted temperature management
There remains uncertainty about the best method of inducing and maintaining temperature control during targeted temperature management (TTM). Two systematic reviews and meta-analyses documented the evidence for the effectiveness of intravascular versus surface temperature management strategies for providing TTM in comatose post-cardiac arrest patients.79, 80 The first of these reviews included 12 studies (two RCTs and 10 observational studies) and documented no significant difference in
Prognostication
Prognostication of neurological outcome among comatose post-cardiac arrest patients continues to challenge clinicians. This is a rapidly evolving field and many more studies on this topic were published in Resuscitation during 2020.89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103
Current guidelines advocate multimodal prognostication to minimise false predictions of a poor outcome, which could lead to premature withdrawal of life sustaining treatment (WLST). The prospective
Credit author statement
All authors have contributed to the writing of the draft and approval of the manuscript.
Conflicts of interest
JPN is Editor-in-Chief of Resuscitation. He is a co-investigator for two National Institute of Health Research (NIHR) funded studies: AIRWAYS-2 and PARAMEDIC-2.
JPO, MJAP, GDP and JS are Editors of Resuscitation
JPO serves as Cardiac Co-Chair for the National Institutes of Health-sponsored Resuscitation Outcomes Consortium (ROC). He serves as the Virginia Commonwealth University Principal Investigator for the National Institutes of Health-sponsored Neurological Emergency Treatment Trials Network
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