The effects of mechanical versus bag-valve ventilation on gas exchange during cardiopulmonary resuscitation in emergency department patients: A randomized controlled trial (CPR-VENT).

INTRODUCTION: Effective ventilation is crucial for successful cardiopulmonary resuscitation (CPR). Previous studies indicate that higher arterial oxygen levels (PaO2) during CPR increase the chances of successful resuscitation. However, the advantages of mechanical ventilators over bag-valve ventilation for achieving optimal PaO2 during CPR remain uncertain. METHOD: We conducted a randomized trial involving non-traumatic adult cardiac arrest patients who received CPR in the ED. After intubation, patients were randomly assigned to ventilate with a mechanical ventilator (MV) or bag valve ventilation (BV). In MV group, ventilation settings were: breath rate 10/minute, tidal volume 6-7 ml/kg, inspiratory time 1 second, positive end-expiratory pressure 0 cm water, inspiratory oxygen fraction (FiO2) 100%. The primary outcome was to compare the difference in PaO2 from arterial blood gases (ABG) obtained 4-10 minutes later during CPR between both groups. RESULTS: Sixty patients were randomized (30 in each group). The study population consisted of: 57% male, median age 62 years, 37% received bystander CPR, and 20% had an initial shockable rhythm. Median time from arrest to intubation was 24 minutes. The median PaO2 was not significantly different in the BV compared to MV [36.5 mmHg (14.0-70.0) vs. 29.0 mmHg (15.0-70.0), P = 0.879]. Other ABG parameters and rates of return of spontaneous circulation and survival were not different. CONCLUSIONS: In ED patients with refractory cardiac arrest, arterial oxygen levels during CPR were comparable between patients ventilated with MV and BV. Mechanical ventilation is at least feasible and safe during CPR in intubated cardiac arrest patients.

Surgical mask-to-mouth ventilation as an alternative ventilation technique during CPR: A crossover randomized controlled trial.

INTRODUCTION: Chest compression with rescue breathing improves outcomes in cardiac arrest. However, the efficacy of rescue breathing through surgical masks has not been investigated. OBJECTIVE: We aimed to compare the tidal volume generated by mouth-to-mouth ventilation (MMV) with that generated by surgical mask-to-mouth ventilation (SMV), mouth-to-surgical mask ventilation (MSV), and surgical mask-to-surgical mask ventilation (SSV) in a manikin. METHODS: A crossover randomized controlled trial was conducted in 42 medical personnel volunteers randomly assigned to perform four ventilation techniques: MMV (no protective equipment), SMV (participant wearing a mask), MSV (manikin wearing a mask), and SSV, (both participant and manikin wearing a mask). The average tidal volume and the proportion of adequate ventilation, evaluated using a manikin, were compared across different ventilation methods. RESULTS: The average tidal volume of MMV (828 ± 278 ml) was significantly higher than those of the MSV (648 ± 250 ml, P < 0.001) and SSV (466 ± 301 ml, P < 0.001), but not SMV (744 ± 288 ml, P = 0.054). Adequate ventilation was achieved in 144/168 (85.7%) cases in the MMV group, a proportion significantly higher than in the SMV (77.4%, P = 0.02), MSV (66.7%, P < 0.001) and SSV (39.3%, P < 0.001) groups. The willingness to perform SMV was higher than that to perform MMV. CONCLUSIONS: MMV resulted in a superior average tidal volume when compared to both MSV and SSV. However, SMV achieved a comparable average tidal volume to MMV.

Hypertensive emergencies in Asia: A brief review.

Hypertensive emergency is one of the most challenging conditions to treat in the emergency department (ED). From previous studies, about 1%-3% of hypertensive individuals experienced hypertensive emergencies. Its prevalence varied by country and region throughout Asia. Asian populations have more different biological and cultural backgrounds than Caucasians and even within Asian countries. However, there is a scarcity of research on clinical features, treatment, and outcomes in multinational Asian populations. The authors aimed to review the current evidence about epidemiology, clinical characteristics and outcomes, and practice guidelines in Asia. Five observational studies and nine clinical practice guidelines across Asia were reviewed. The prevalence of hypertensive emergencies ranged from .1% to 1.5%. Stroke was the most common target organ involvement in Asians who presented with hypertensive emergencies. Although most hypertensive emergency patients required hospitalization, the mortality rate was low. Given the current lack of data among Asian countries, a multinational data repository and Asian guidelines on hypertensive emergency management are mandatory.

Differential Association Between Significant Coronary Stenosis and Cardiac Troponin T Serial Algorithms in Chronic Kidney Disease Patients Diagnosed with Non-ST-Segment Elevation Acute Coronary Syndromes.

BACKGROUND: High-sensitivity cardiac troponin T (hs-cTnT) is recommended for diagnosing non-ST segment elevation acute coronary syndromes (NSTE-ACS). While the guidelines recommend using the 0,1-hour (hr) and 0,3-hr hs-cTnT algorithms, their efficacy has not been clearly established in chronic kidney disease (CKD) patients. We aimed to assess the differential associations between the two algorithms mentioned above with significant coronary stenosis in CKD patients. METHODS: This was a retrospective cohort study. Patients aged ≥18 years who were diagnosed with NSTE-ACS and had undergone coronary angiogram were recruited. The differential association between significant coronary stenosis and being ruled in based on the 0,1-hr and 0,3-hr hs-cTnT algorithm was analyzed and reported. RESULTS: There were 158 and 160 patients in the CKD and normal renal function groups. Among CKD patients, determinants of significant coronary stenosis were hypertension (OR = 2.68; 95% CI 1.10-6.50) and being ruled in by the 0,3-hr algorithm (OR = 3.65; 95% CI 1.27-10.52). In the normal renal function group, age (OR = 1.04; 95% CI 1.01-1.06), male sex (OR = 2.15; 95% CI 1.09-4.22), and being ruled in by the 0,1-hr algorithm (OR = 3.12; 95% CI 1.20-8.10) were associated with significant coronary stenosis. CONCLUSION: Being ruled in according to the 0,3-hr algorithm was significantly associated with coronary stenosis in CKD patients, making this a likely algorithm of choice in these patients.