Research Progress and Prospect Analysis of Vascular Interventional Surgical Robot / 中国医疗器械杂志

Vascular interventional surgery is an important means to treat cardiovascular and cerebrovascular diseases, but the particularity of its working environment will bring greater radiation threat to doctors. Vascular interventional surgery robots can effectively improve the working environment of doctors and can provide more stable operations, improve the success rate of surgery. This study mainly introduces the current research status, key technologies, and future application of vascular interventional surgical robots.

Effect of repeated episodes of ventricular fibrillation and defibrillation on arterial acid-base and electrolytes changes in a swine model / 中华急诊医学杂志

Objective:To investigate changes in arterial acid-base and electrolytes after repeated episodes of ventricular fibrillation (VF) and defibrillation in a swine model.Methods:Sixteen Peking white swine, weighting (32±2.5) kg, were placed with temporary pacemaker electrodes via the left femoral vein into the right ventricle after anesthesia. Then VF was electrically induced by using a programmed electrical stimulation instrument. An arterial cannula was inserted into the left femoral artery to measure mean arterial blood pressure and cardiac output using a PiCCO monitor, with blood samples collected. The pigs were randomly divided into two group: the manual defibrillation group (MD, n=8) and the automated external defibrillation group (AED, n=8). The first defibrillation was attempted with the manufacturer’s dose (150 J) for 15 s after the successful induction of VF in the MD group. If spontaneous circulation was not recovered, 2-min chest compression and subsequent defibrillation (200 J) were attempted. For the AED group, the defibrillation was delivered following voice prompts of the AED. After the return of spontaneous circulation, the pig was allowed to stabilize for 30 min, followed by the induction of the next episode of VF. The above process was repeated five times. Arterial blood gas, cardiac biomarkers, and hemodynamic variables were measured at 30 min after the return of spontaneous circulation. Results:All pigs were successfully induced VF five times and defibrillated successfully. There were no significant changes in heart rate and mean arterial blood pressure between the two groups after repeated episodes of VF and defibrillation. Compared with baseline measurements, cardiac output tended to decrease after repeated episodes of VF and defibrillation but was not statistically significant (all P>0.05). There were no significant differences in arterial pH, HCO 3-, sodium, and lactic acid in the two groups between each measurement time point and baseline values after repeated VF (all P>0.05), but potassium levels in the two groups decreased with time, and the difference was statistically significant compared with the baseline measurement (all P<0.05). There were no significant differences in myoglobin, creatine kinase isoenzyme-MB, and cardiac troponin I for the two groups compared with baseline values after repeated episodes of VF and defibrillation or various episodes of VF between the two groups (all P > 0.05). Conclusions:Repeated episodes of VF and defibrillation have no significant effect on pH balance, but significantly decrease blood potassium. Clinical approaches (MD vs. AED) do not affect defibrillation effect, with no significant differences in hemodynamic variables and myocardial injuries.

Characteristics and outcomes of pediatric and adult non-traumatic out-of-hospital cardiac arrest during the COVID-19 pandemic: Descriptive study

Background@#Due to the COVID-19 pandemic, health care for patients who experienced out-of-hospital cardiac arrest (OHCA) has been suboptimal.@*Objective@#To describe the demographic, clinical, and logistical characteristics of patients who experienced OHCA during the peak of the COVID-19 pandemic. @*Design@#Descriptive study. @*Participants@#136 males and 58 females, aged 8 days to 89 years old, who experienced OHCA and were subsequently sent to the emergency department of Southern Philippines Medical Center (SPMC). @*Setting@#Southern Philippines Medical Center, Davao City, March 15 to December 31, 2020. @*Main outcome measures@#Demographic, clinical, and logistical characteristics of patients. @*Main results@#Of the 194 patients, 149 (76.80%) experienced OHCA at home. Among them, 42 (21.65%) received initial CPR at the scene, with 36 (85.71%) of these procedures performed by ambulance crews. Only one (0.52%) patient received automated extracorporeal defibrillation performed by a bystander. There were 147 (75.77%) patients who were transported by private vehicles. The average times for dispatch, response and turnaround of the emergency medical services (EMS) were 8 minutes, 19 minutes, and 56 minutes, respectively. Of the 194 patients, 176 (90.72%) were transported without ongoing resuscitation. Upon arrival at the emergency department, 184 (94.84%) patients had unknown arrest rhythm. Only one (0.52%) patient had a return of spontaneous circulation and was admitted to the ICU. All the other patients expired within 10 to 15 minutes upon arriving at the emergency department.@*Conclusion@#In this study, most OHCAs happened at home, with few receiving CPR at the scene, primarily from ambulance crews. The average EMS response time was 19 minutes. Most patients were transported from the scene without ongoing resuscitation, and had an unknown arrest rhythm upon arrival at the emergency department. All patients expired shortly after arriving at the emergency department.

Paro cardiorrespiratorio por electrocución tratado con éxito extrahospitalariamente / Cardiorespiratory Arrest Caused by Electrocution Successfully Treated in an Extra-Hospital Situation / Parada cardiorrespiratória por eletrocussão tratada com sucesso de maneira extra-hospitalar

Resumen Introducción: son pocos los datos documentados sobre los resultados de la reanimación cardiopulmonar en el paro cardiorrespiratorio extrahospitalario por causa de electrocución. El paro cardiorrespiratorio se produce cuando una descarga eléctrica interrumpe de forma abrupta la actividad eléctrica normal del corazón, lo que genera una electrocución y una alteración en los movimientos cardiacos y, por consiguiente, bombeo anormal de sangre y oxígeno a los tejidos. Ello constituye una emergencia clínica que puede ocasionar nefastas consecuencias de no tomarse medidas enérgicas e inmediatas. Presentación del caso: hombre con paro cardiorrespiratorio producido por electrocución y manejado en un ámbito extra-hospitalario, quien respondió con éxito a las maniobras aplicadas. Personal técnico y de salud iniciaron precozmente la reanimación cardiopulmonar y luego fue reforzada por personal médico, que aplicó desflbrilación en dos ocasiones con desflbrilador externo automático (DEA). Con ello se logró recuperar los signos vitales del paciente y trasladarlo a un centro asistencial para continuar su manejo intrahospitalario. Conclusión: la realización de una reanimación precoz y la desfibrilación de pacientes electrocutados, así como las medidas encaminadas a la protección del cerebro, son la norma prioritaria en la asistencia pre-hospitalaria de estos pacientes, quienes son potencialmente recuperables. Por tal razón, es importante que la comunidad, en general, esté preparada y que el personal de salud se reentrene en soporte vital básico, que incluye el manejo del DEA para dar oportunidad de sobrevivir a personas que sufran un paro cardiorrespiratorio extrahospitalario.

Abstract Introduction: There are few the documented data about the cardiopulmonary resuscitation results in the cardiorespiratory arrest extra-hospital due to the electrocution. The cardiorespiratory arrest occurs when the heart's normal electrical activity is abruptly interrupted by electric shocks generated by electrocution, causing the disturbance in the cardiac movements and, consequently, abnormal pumping of blood and oxygen to the tissues. The cardiorespiratory arrest due to electrocution is one clinic emergency that can cause disastrous consequences, if energetic measures are not taken immediately. Case presentation: A man with cardiorespiratory arrest produced by electrocution and managed in an extra-hospital area, who responded successfully to the maneuvers applied. The cardiopulmonary resus-citation maneuvers were precociously started by the health technical staff; next, reinforced by medical it, applying the defibrillation on two occasions, with external automatic defibrillator (AED), recovering the patient's vital signs and allowing his transfer to a healthcare center to continue in-hospital management. Conclusion: The performing of early resuscitation and defibrillation of electrocuted patients, as well as the measures aimed at protecting the brain, are the priority rules in the pre-hospital scene of these patients, who are potentially recoverable. For this reason, it is important that the community, in general, be ready, and the health staff gets trained in basic vital support that includes the management of AED to give the opportunity of surviving to people that suffer a cardiorespiratory arrest.

Resumo Introdução: são poucos os dados documentados sobre os resultados da reanimação cardiopulmonar na parada cardiorrespiratória extra-hospitalar por causa de eletrocussão. A parada cardiorrespiratória se produz quando a atividade elétrica normal do coração é interrompida abruptamente pela descarga elétrica que gera a eletrocussão causando alterado nos movimentos cardíacos e por conseguinte bombeamento anormal de sangue e oxigeno aos tecidos. A parada cardiorrespiratória causada por eletrocussão é uma emergência clínica que pode ocasionar nefastas consequências, de não tomar medidas enérgicas e imediatas. Apresentação do caso: homem com parada cardiorrespiratória, produzida por eletrocussão e manejado em um âmbito extra-hospitalar, quem respondeu com sucesso ás manobras aplicadas. A rearrumação cardiopulmonar foi iniciada precocemente por pessoal técnico de saúde, posteriormente reforjadas por pessoal médico, aplicando a desfibrilação em duas ocasiões, com desfibrilador automático externo (DEA), recuperando os signos vitais do paciente e permitindo seu traslado e um centro assistencial para continuar manejo intra-hospitalar. Conclusão: a realizado de uma rearrumação precoce e desfibrilação de pacientes eletrocutados, assim como as medidas encaminhadas á proteção do cérebro, são a norma prioritária na assistência pré-hospitalar destes pacientes, os quais são potencialmente recuperáveis; por esta razão é importante que a comunidade, em geral, esteja preparada e que o pessoal de saúde se retreine em suporte vital básico que inclua o manejo do DEA para dar oportunidade de sobrevida a pessoas que sofram uma parada cardiorrespiratória extra-hospitalar.

Cardio protected areas in Mexico / Áreas cardioprotegidas en México

Abstract Sudden cardiac death (SCD) remains a major public health problem. Fortunately, with timely access to early defibrillation and high-quality cardiopulmonary resuscitation, an improvement in survival of victims of sudden death has been demonstrated. Efforts made in different countries to create programs for access to public defibrillation have shown great benefits in counteracting mortality associated with this type of event. Hence, we need more programs (such as cardio protected environments) and changes in public health policies. The objective of this work is to raise awareness among the population and decision makers, of importance establishing this type of programs in our country since there continues to be high mortality associated with SCD in our countrymen.

Resumen La muerte súbita cardíaca es todavía un problema importante de salud pública. Por fortuna, con un acceso oportuno a una desfibrilación temprana y una reanimación cardiopulmonar de alta calidad, se ha demostrado una mejoría en la sobrevida de las víctimas de muerte súbita. Los esfuerzos realizados en deferentes países para crear programas de acceso a la desfibrilación pública han mostrado grandes beneficios en contrarrestar la mortalidad relacionada con este tipo de episodios. Se necesitan más programas (como espacios cardioprotegidos) y cambios en las políticas de salud pública. El objetivo de este trabajo es poder concientizar a la población y a los tomadores de decisiones de la importancia de establecer este tipo de programas en el país, ya que aún existe una alta mortalidad relacionada con la muerte cardíaca súbita.

Reanimación cardiopulmonar en pacientes con enfermedad por COVID-19 en el ambiente hospitalario / Cardiopulmonary resuscitation in patients with COVID-19 in the hospital environment

Resumen: La pandemia COVID-19 nos ha obligado a replantearnos la manera en la que practicamos algunos aspectos de la medicina. La reanimación cardiopulmonar es una práctica que genera partículas en aerosol provenientes de la vía aérea, lo cual incrementa el riesgo de contagio por SARS-CoV-2. En esta revisión se consultan las recomendaciones internacionales sobre el tema, se definen momentos de alto riesgo y se establecen recomendaciones sobre compresiones, ventilación, terapia eléctrica e incluso farmacológica en pacientes con paro cardíaco y con diagnóstico de COVID-19, buscando no sólo el bienestar del paciente, sino también la seguridad del personal de salud.

Abstract: The COVID-19 pandemic has forced us to rethink the way we practice some aspects of medicine. Cardiopulmonary resuscitation is a practice that generates aerosol particles from the airway, which increases the risk of SARS-CoV-2 infection. In this review, the international recommendations on the subject are consulted, high-risk moments are defined and recommendations are established on compressions, ventilation, electrical therapy and even pharmacology in patients with cardiac arrest and with a diagnosis of COVID-19, seeking not only the well-being of the patient, but also the safety of health personnel.

Recent advances in external cardiac defibrillation techniques / 生物医学工程学杂志

As an important medical electronic equipment for the cardioversion of malignant arrhythmia such as ventricular fibrillation and ventricular tachycardia, cardiac external defibrillators have been widely used in the clinics. However, the resuscitation success rate for these patients is still unsatisfied. In this paper, the recent advances of cardiac external defibrillation technologies is reviewed. The potential mechanism of defibrillation, the development of novel defibrillation waveform, the factors that may affect defibrillation outcome, the interaction between defibrillation waveform and ventricular fibrillation waveform, and the individualized patient-specific external defibrillation protocol are analyzed and summarized. We hope that this review can provide helpful reference for the optimization of external defibrillator design and the individualization of clinical application.

Assessment of Awareness and Attitudes Regarding Automated External ‎Defibrillators (AED) In Sports Facilities in Jeddah, Saudi Arabia

Background: Sudden cardiac death (SCD) is a leading cause of death in young athletes. Most of those events occur during exercise and insports facilities. We sought to assess awareness and attitudes towards automated external defibrillators (AED) in sports facilities in Jeddah,Saudi Arabia. Methods: The survey included 293 individuals who attend 18 different sports facilities in Jeddah, Saudi Arabia to estimatethe overall knowledge level of CPR and AED usage and determine general attitudes toward intervening in the setting of sudden cardiacarrest (SCA). We included adult participants who were 18 years of age or older. After explaining the aim of our study, each participant wasconsented to participate in the survey. The survey included 33 questions to assess demographic characteristics, knowledge, and skills ofCPR, confidence to perform CPR and to use AED. Results: A total of 293 candidates completed the questionnaire. Mean age was 28.33 ±8.22 years. Only 19 candidates who worked in sports facilities agreed to participate in our survey, of those only 10 participants hadprevious CPR training but only 8 (42.1%) had the self-confidence to do CPR and use AED. Of individuals who participated in the survey,110 (37%) of them indicated that they were more likely to intervene in an SCA after receiving the proper training. 140 (47.7%) participantsof our cohort were reluctant to perform CPR because they were anxious about harming the arrested patient. 108 (36%) of our cohort couldexplain the purpose of using AED. Unfortunately, 101 (34.5%) of our sample did not know the number of Red Crescent for emergency calls.73 (53.7%) of the total 136 participants who received CPR training before stated that they are able to use AED. Our survey showed that264 (90.1%) wished to receive BLS training course if it was announced in order to qualify them for performing CPR and applying AED.Conclusion: Our survey showed insufficient knowledge in all aspects of CPR skills and inadequate knowledge of AED and its purpose ofuse in sports facilities in Jeddah. We recommend initiating an effective national public campaign to increase the public awareness of theimportance of CPR and AED performance using different pathways for education through media and new legislations.

Pre-hospital epidemiological characteristics in out-of-hospital cardiac arrest: who had shockable initial rhythms / 中华急诊医学杂志

Objective@#Victims with shock-able initial arrest rhythms (ventricular fibrillation or pulse-less ventricular tachycardia, VF/VT) have much better outcomes from out-of-hospital cardiac arrest (OHCA) than those with non-shock-able initial rhythms (pulse-less electrical activities, PEA or asystole). Prompt defibrillation is believed pivotal to terminate lethal shock-able arrest rhythms. In this study, we were to identify those pre-hospital epidemiological factors which were associated with likelihood of shock-able rhythms first recorded when out-of-hospital cardiac arrest occurred.@*Methods@#A multicenter, secondary, retrospective and observational analysis was performed on all adult non-traumatic OHCA in the Resuscitation Outcome Consortium (ROC) PRIMED study from June 2007 through November 2009. Of a total of 17 177 OHCA cases in PRIMED study, 13 421 of them were enrolled in this study when those OHCA patients with DNR order, or initial rhythms unknown, or arrest caused by obvious cause were excluded. We reported their demographics and episode characteristics for all enrolled cases. Multivariable logistic regression was employed to identify factors which were associated with likelihood of VF/VT recorded as shock-able initial rhythms.@*Results@#Among 13 421 adult non-traumatic OHCA cases with initial rhythms recorded, 3 527 (26.3%) of them had shock-able rhythms, while 9 894 (73.7%) patients were in non-shock-able rhythms. Of the OHCA with shock-able arrest rhythms, 1 850(52.5%) obtained return of spontaneous circulation (ROSC) in the field, while 912 (25.9%) survived to hospital discharge. On the other hand, 2489(25.2%) of the OHCA with non-shock-able arrest rhythms obtained ROSC in the field, while 325 (3.3%) of them survived to hospital discharge. Multivariable regression analysis revealed those factors which indicated likelihood of shock-able rhythms recorded were: age(OR: 0.991,95%CI 0.988-0.993), male gender (OR1.887,95%CI1.718-2.073), pre-hospital Emergency Medical System(EMS) response time(OR0.950,95%CI 0.931-0.970), cardiac arrest witnessed by EMS providers(OR1.709,95%CI 1.423-2.054) or bystander(OR3.199,95%CI 2.921-3.504) and those with bystanders CPR (OR1.357,95%CI 1.239-1.487),public place of cardiac arrest (OR2.705,95%CI 2.437-3.003).@*Conclusions@#Some demographics and pre-hospital characteristics were proved associated with likelihood of shock-able arrest rhythms first recorded in OHCA victims, which might help develop corresponding strategies to deliver prompt shock on initially shock-able patients and improve their outcomes.

Pre-hospital epidemiological characteristics in out-of-hospital cardiac arrest: who had shockable initial rhythms / 中华急诊医学杂志

Objective Victims with shock-able initial arrest rhythms (ventricular fibrillation or pulse-less ventricular tachycardia,VF/VT) have much better outcomes from out-of-hospital cardiac arrest (OHCA) than those with non-shock-able initial rhythms (pulse-less electrical activities,PEA or asystole).Prompt defibrillation is believed pivotal to terminate lethal shock-able arrest rhythms.In this study,we were to identify those pre-hospital epidemiological factors which were associated with likelihood of shock-able rhythms first recorded when out-of-hospital cardiac arrest occurred.Methods A multicenter,secondary,retrospective and observational analysis was performed on all adult non-traumatic OHCA in the Resuscitation Outcome Consortium (ROC) PRIMED study from June 2007 through November 2009.Of a total of 17 177 OHCA cases in PRIMED study,13 421 of them were enrolled in this study when those OHCA patients with DNR order,or initial rhythms unknown,or arrest caused by obvious cause were excluded.We reported their demographics and episode characteristics for all enrolled cases.Multivariable logistic regression was employed to identify factors which were associated with likelihood of VF/VT recorded as shock-able initial rhythms.Results Among 13 421 adult non-traumatic OHCA cases with initial rhythms recorded,3 527 (26.3％) of them had shock-able rhythms,while 9 894 (73.7％) patients were in non-shock-able rhythms.Of the OHCA with shock-able arrest rhythms,1 850(52.5％) obtained return of spontaneous circulation (ROSC) in the field,while 912 (25.9％) survived to hospital discharge.On the other hand,2489(25.2％) of the OHCA with non-shock-able arrest rhythms obtained ROSC in the field,while 325 (3.3％) of them survived to hospital discharge.Multivariable regression analysis revealed those factors which indicated likelihood of shock-able rhythms recorded were:age(OR:0.991,95％CI 0.988-0.993),male gender (OR1.887,95％CI1.718-2.073),pre-hospital Emergency Medical System(EMS) response time(OR0.950,95％CI 0.931-0.970),cardiac arrest witnessed by EMS providers(OR 1.709,95％CI 1.423-2.054) or bystander(OR3.199,95％CI 2.921-3.504) and those with bystanders CPR (OR1.357,95％CI 1.239-1.487),public place of cardiac arrest (OR2.705,95％CI 2.437-3.003).Conclusions Some demographics and pre-hospital characteristics were proved associated with likelihood of shock-able arrest rhythms first recorded in OHCA victims,which might help develop corresponding strategies to deliver prompt shock on initially shock-able patients and improve their outcomes.

Design of intelligent detecting system for defibrillator battery / 中国医学装备

Objective:To construct intelligent detecting system for defibrillator battery so as to enhance detection efficiency of battery and ensure the therapeutic effect in clinical works.Methods:Based on the analysis for the demand of defibrillator battery, the intelligent detection system of the defibrillator battery was constructed by means of automatic program control, database management, signal collection with high precision and so on.Results:The system realized series of functions included of parameter setting, planning, parameter collection and report management in the process of detecting defibrillator battery.The whole process standardization management was realized in defibrillator battery management, so the automatic level of detection was improved.Conclusion:The designed detection system of defibrillator battery can standardize the management of defibrillator battery, and can enhance the qualities of diagnosis and treatment of hospital and the work efficiency of hospital.

New insight on the relationship between lethal electrical fields versus cardiomyocyte orientation

Abstract Introduction Cardiovascular diseases represent a major cause of death world-wide and one of their greatest complications is the development of cardiac arrhythmias, in which ventricular fibrillation (VF) stands out as the most severe one. The only therapy that reverses VF is defibrillation. However defibrillatory shock is capable of killing heart cells and it is known that the orientation of the cell major axis with respect to the electrical field (E) direction is a determining factor for cellular excitation and injury, which is leading to the development of new defibrillation protocols. The aim of this work is to fill the gap in information about cell lethality for intermediate cell orientation angles. Methods Ventricular myocytes were extracted from adult male Wistar rats and the cells were plated in a chamber for perfusion and stimulation with bipolar voltage pulses to determine the stimulation threshold (ET). Then, monopolar stimulus was applied and amplitude was increased until cell lethal injury. This protocol was performed on four experimental groups: cells oriented at 0°, 30°, 60° and 90°, with respect to E direction. Results 87 cells were analyzed and an increase in amplitude of E associated with 50% lethality (E50) was verified as the direction of E application and cell major axis orientation departed. Conclusion Taken the same probability of lethality, our data suggest a nonlinear increase of E amplitude from 0° to 90° similar to that of ET. These in-between data had not yet been shown and are important for service-based future defibrillation protocols.

Research Progress of External Defibrillation Technique and Its Application / 中国医疗器械杂志

Defibrillator is an important first aid equipment with people attach importance to life and health in today, people pay more attention to the development of defibrillator. This paper reviews the development history of the defibrillator, gives a brief introduction to the structure and working principle of the defibrillator, and then analyzes the key technology of defibrillator, compares the mainstream products on the market and prospects the development trend of defibrillator.

The detection and data analysis of delivered energy of cardiac defibrillator / 中国医学装备

Objective:To adopt defibrillation analyzer to detect performance of delivered energy of cardiac defibrillator and to reveal its relevant changing regular, and carry out scientific verification so as to take the detection data to play a role in the maintenance work of equipment.Methods: According to National Metrological technical specification "JJF 1149-2014 Calibration Specification for Cardiac Defibrillators", the FLUKE IMPULSE 7000DP Defibrillator Analyzer was applied to obtain data, and then a comprehensive analysis method with graphs and table was used to analyze these test data.Results: Through analyzed the detection data of delivered energy to grasp the whole performance situation of using equipment and to enhance the cognition of technique and application level for Defibrillator Analyzer.Conclusion: Through analyzes data to find out the changing regular of delivered energy and the difference phenomenon of detection data distribution, and to elaborate the reason of phenomenon or influence factor. Through detects performance to screen out the poorest equipment of delivered energy so as to avoid medical risk that comes from hidden danger of equipment performance in the process of clinical therapy.

Defibrillation energy measurement and result uncertainty assessment in quality control of defibrillator / 医疗卫生装备

Objective To explore the application of defibrillation energy measurement and result uncertainty assessment to defibrillator quality control.Methods The released energy of the defibrillator was measured in standardized technology and environmental conditions,and uncertainty assessment was carried out according to the criteria JJF 1059-2012 Assessment and expression of measurement uncertainty,and then the quality of the defibrillator was executed based on uncertainty.Results Uncertainty assessment contributed to the evaluation of the defibrillator quality,and provided guidance to medical engineering departments in the defibrillator quality control.Conclusion Uncertainty assessment of the defibrillation energy measurement facilitates the quality control,and thus can be promoted in the quality control of other likely medical devices such as respirator,infusion pump and electrosphygmomanometer.

Rhythm analysis in CPR / 中华危重病急救医学

It's necessary to interrupt cardiopulmonary resuscitation (CPR) for a reliable automatic external defibrillator (AED) rhythm analysis, because the mechanical activity from the chest compressions introduces artifacts in the electrocardiogram (ECG) that substantially lower the capacity of an AED to judge cardio-electric rhythm. However, repeated interruptions of compression will reduce the quality of CPR, which in turn affect the prognosis of patients with cardiac arrest (CA). In order to improve the quality of CPR, reduce the interruptions of chest compression and implement accurate defibrillation, people have made many efforts on identifying ECG rhythm in CPR. The studies can be grouped into two broad categories: those based on the artificial mixture of ECG data and CPR artifacts and those based on CA data recorded during CPR. This article introduced researches for rhythm recognition in CPR, including sources and characteristics of CPR artifacts, methods of rhythm analysis, and provided a basis for the study of how to improve the accuracy of cardio-electric rhythm recognition.

Singapore Defibrillation Guidelines 2016

The most common initial rhythm in a sudden cardiac arrest is ventricular fibrillation or pulseless ventricular tachycardia. This is potentially treatable with defibrillation, especially if provided early. However, any delay in defibrillation will result in a decline in survival. Defibrillation requires coordination with the cardiopulmonary resuscitation component for effective resuscitation. These two components, which form the key links in the chain of survival, have to be brought to the cardiac victim in a timely fashion. An effective chain of survival is needed in both the institution and community settings.

Role of peak current in conversion of patients with ventricular fibrillation

<p><b>INTRODUCTION</b>Peak currents are the final arbiter of defibrillation in patients with ventricular fibrillation (VF). However, biphasic defibrillators continue to use energy in joules for electrical conversion in hopes that their impedance compensation properties will address transthoracic impedance (TTI), which must be overcome when a fixed amount of energy is delivered. However, optimal peak currents for conversion of VF remain unclear. We aimed to determine the role of peak current and optimal peak levels for conversion in collapsed VF patients.</p><p><b>METHODS</b>Adult, non-pregnant patients presenting with non-traumatic VF were included in the study. All defibrillations that occurred were included. Impedance values during defibrillation were used to calculate peak current values. The endpoint was return of spontaneous circulation (ROSC).</p><p><b>RESULTS</b>Of the 197 patients analysed, 105 had ROSC. Characteristics of patients with and without ROSC were comparable. Short duration of collapse < 10 minutes correlated positively with ROSC. Generally, patients with average or high TTI converted at lower peak currents. 25% of patients with high TTI converted at 13.3 ± 2.3 A, 22.7% with average TTI at 18.2 ± 2.5 A and 18.6% with low TTI at 27.0 ± 4.7 A (p = 0.729). Highest peak current conversions were at < 15 A and 15-20 A. Of the 44 patients who achieved first-shock ROSC, 33 (75.0%) received < 20 A peak current vs. > 20 A for the remaining 11 (25%) patients (p = 0.002).</p><p><b>CONCLUSION</b>For best effect, priming biphasic defibrillators to deliver specific peak currents should be considered.</p>

The National Resuscitation Council, Singapore, and 34 years of resuscitation training: 1983 to 2017

Training in the modern form of cardiopulmonary resuscitation (CPR) started in Singapore in 1983. For the first 15 years, the expansion of training programmes was mainly owing to the interest of a few individuals. Public training in the skill was minimal. In an area of medical care where the greatest opportunity for benefit lies in employing core resuscitation skills in the prehospital environment, very little was being done to address such a need. In 1998, a group of physicians, working together with the Ministry of Health, set up the National Resuscitation Council (NRC). Over the years, the NRC has created national guidelines on resuscitation and reviewed them at five-yearly intervals. Provider training manuals are now available for most programmes. The NRC has set up an active accreditation system for monitoring and maintaining standards of life support training. This has led to a large increase in the number of training centres, as well as recognition and adoption of the council's guidelines in the country. The NRC has also actively promoted the use of bystander CPR through community-based programmes, resulting in a rise in the number of certified providers. Improving the chain of survival, through active community-based training programmes, will likely lead to more lives being saved from sudden cardiac arrest.

The role of dispatch in resuscitation

The role of the dispatch centre has increasingly become a focus of attention in cardiac arrest resuscitation. The dispatch centre is part of the first link in the chain of survival because without the initiation of early access, the rest of the chain is irrelevant. The influence of dispatch can also extend to the initiation of bystander cardiopulmonary resuscitation, early defibrillation and the rapid dispatch of emergency ambulances. The new International Liaison Committee on Resuscitation, the American Heart Association and, especially, the European Resuscitation Council 2015 guidelines have been increasing their emphasis on dispatch as the key to improving out-of-hospital cardiac arrest survival.