October 4, 2019
Earlier this week, results from the HYPERION trial were published in the New England Journal of Medicine. Drs. Abella and Teran discuss the use of TTM for patients resuscitated from cardiac arrest with a non-shockable initial rhythm.
- Lascarrou JB et at., “Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm.” N Engl J Med. 2019 Oct 2.https://www.ncbi.nlm.nih.gov/pubmed/31577396
- Perman SM et al., “The Utility of Therapeutic Hypothermia for Post-Cardiac Arrest Syndrome Patients With an Initial Nonshockable Rhythm.” Circulation. 2015 Dec 1;132(22):2146-51. https://www.ncbi.nlm.nih.gov/pubmed/26572795
- Grossestreuer AV et al., “Magnitude of temperature elevation is associated with neurologic and survival outcomes in resuscitated cardiac arrest patients with postrewarming pyrexia.” J Crit Care. 2017 Apr;38:78-83. https://www.ncbi.nlm.nih.gov/pubmed/27866109
- Neilsen N et al., “Targeted temperature management at 33°C versus 36°C after cardiac arrest.” N Engl J Med. 2013 Dec 5;369(23):2197-206.https://www.ncbi.nlm.nih.gov/pubmed/24237006
September 20, 2019
Following the success of Episode 6, which discussed the scientific evidence for ECMO in cardiac arrest, we decided to take a deeper look at the implementation of ECMO in the ED. Drs. Felipe Teran and Joseph Tonna discuss the utilization of ECMO for refractory cardiac arrest, the expansion of hospital ECMO programs to the emergency department and implementation of an ECMO program for cardiac arrest. This episode was recorded on location in Salt Lake City, Utah.
- Tonna JE et al., “Practice characteristics of Emergency Department extracorporeal cardiopulmonary resuscitation (eCPR) programs in the United States: The current state of the art of Emergency Department extracorporeal membrane oxygenation (ED ECMO).” Resuscitation. 2016 Oct;107:38-46. https://www.ncbi.nlm.nih.gov/pubmed/27523953
- Tonna JE et al., “Development and Implementation of a Comprehensive, Multidisciplinary Emergency Department Extracorporeal Membrane Oxygenation Program.” Ann Emerg Med. 2017 Jul;70(1):32-40. https://www.ncbi.nlm.nih.gov/pubmed/28139304
September 6, 2019
Drs. Teran and Abella discuss the role of TTM for patients following cardiac arrest caused by opioid overdose. Several recent observational studies are reviewed to understand the demographics of patients who suffer opioid-related cardiac arrest, their outcomes, and whether TTM may be beneficial during post-arrest for these patients.
- Salcido DD et al, “Regional incidence and outcome of out-of-hospital cardiac arrest associated with overdose.” Resuscitation 2016; 99:13-19.http://dx.doi.org/10.1016/j.resuscitation.2015.11.010
- Katz AZ et al, “Outcomes of patients resuscitated from cardiac arrest in the setting of drug overdose.” Resuscitation 2015; 94:23-27.http://dx.doi.org/10.1016/j.resuscitation.2015.06.015
- Khan S et al, “Impact of Targeted Temperature Management on ED Patients with Drug Overdose–Related Cardiac Arrest.”, Journal of Medical Toxicology 2019; 15:22–29. https://doi.org/10.1007/s13181-018-0686-0
August 23, 2019
Following resuscitation from cardiac arrest, accurate evaluation of neurological recovery can help guide patient care and family decisions. In this podcast, Drs. Teran and Abella discuss a recent investigation into the use of MRI imaging in prognostication following resuscitation from arrest.
Key reading for this podcast:
Wallin E et al, "Acute brain lesions on magnetic resonance imaging in relation to neurological outcome after cardiac arrest."Acta Anaesthesiol Scand. 2018 May;62(5):635-647. doi: 10.1111/aas.13074. https://www.ncbi.nlm.nih.gov/pubmed/29363101
August 9, 2019
Episode 8 – Oxygen Delivery After Cardiac Arrest Resuscitation
During cardiac arrest resuscitation, most patients are intubated and placed on 100% oxygen. In this podcast, Drs. Teran and Abella discuss recent investigations that suggest that too much oxygen may worsen post-arrest injury. Global resuscitation guidelines suggest down-titration of oxygen as tolerated to maintain adequate O2 saturation, but it’s not clear how well this is done- many patients are left on high oxygen “dose” for hours.
Key readings for this podcast:
- Robert BW et al, “Association Between Early Hyperoxia Exposure After Resuscitation From Cardiac Arrest and Neurological Disability: Prospective Multicenter Protocol-Directed Cohort Study.” Circulation. 2018 May 15;137(20):2114-2124. https://www.ncbi.nlm.nih.gov/pubmed/29437118
- Kilgannon JH et al, “Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality.” JAMA. 2010 Jun 2;303(21):2165-71. https://www.ncbi.nlm.nih.gov/pubmed/20516417
July 19, 2019
Drs. Felipe Teran and Ben Abella discuss an important recent publication in Annals of Emergency Medicine by Elmer et al, in which some of the strongest evidence to date are presented that support the concept of “cardiac arrest centers”, much like trauma or stroke centers. This has been proposed before (Nichol G et al, Circulation 2010 – see below) – but evidence is now accumulating in support of the idea.
- Nichol G et al, “Regional systems of care for out-of-hospital cardiac arrest: A policy statement from the American Heart Association.”, Circulation 2010;121:709-29. https://www.ncbi.nlm.nih.gov/pubmed/20075331
- Elmer J et al, “Long-Term Outcomes of Out-of-Hospital Cardiac Arrest Care at Regionalized Centers.”, Ann Emerg Med 2019; 73:29-39. https://www.ncbi.nlm.nih.gov/pubmed/30060961
July 5, 2019
Drs. Benjamin Abella, John Greenwood and Felipe Teran discuss the use of ECMO (extra corporeal membrane oxygenation) for cardaic arrest patients.
Weisfeldt ML, Becker LB. Resuscitation after cardiac arrest: a 3-phase time-sensitive model. JAMA. 2002 Dec 18;288(23):3035-8. https://doi.org/10.1001/jama.288.23.3035
June 14, 2019
Dr. Felipe Teran discusses with Dr. Ramani Balu the importance of post-arrest neurological monitoring.
The Online TTM Course is now OPEN! Visit upenn.cloud-cme.com/ttmonline for more information or to register.
April 12, 2019
Dr. Abella discusses neuroprognostication following cardiac arrest and how long to continue care before considering withdrawl.
TTM Academy: www.med.upenn.edu/resuscitation/ttm-academy.html
For updates: text TTM to 31996 or email TTMtraining@pennmedicine.upenn.edu
** TTM Academy podcasts are intended for medical education only and should not be used for clinical decision making.