The Future of CPR

From EmCrit:

I got to interview two cutting edge researchers on what CPR will look like in the next decade; their answers were fascinating. Note: None of this is ready for clinical use–this may be the future, it is not the present

Flow-Enhanced CPR

They discuss the use of the impedance threshold device and the active-compression/decompression device to augment flow during CPR. See the results of the ResQ trial listed below to see what this does in cardiac arrest patients.

Reperfusion Injury Protection

Stutter CPR is giving 3 cycles of 20 seconds of compressions/ventilations, 20 seconds of pause. In pigs, this has markedly reduced the reperfusion injury when resuscitating a patient with prolonged arrest.

New Medications

Sodium nitroprusside (in addition to small doses of epi and flow-enhanced CPR) increases flow to the heart and the brain. May also blunt reperfusion injury to heart and brain. In addition adenosine and cyclosporine A may have a role as well.

Soccer player “was in effect dead for 78 minutes despite 15 heart shocks”

From CNN:

Bolton Wanderers midfielder Fabrice Muamba did not respond to 15 defibrillator shocks and was in effect dead for 78 minutes before his heart started beating again, doctors who treated him have revealed.

The 23-year-old has improved significantly since suffering a cardiac arrest during an English FA Cup match last Saturday but is still in intensive care with his condition described as serious.

Muamba is responding appropriately to questions though, speaking in both French and English, and has been joking with some of his many visitors.

State Boards of Medicine Reviewing and Acting On Accusations of Inappropriate Use of the Internet by Physicians

From MedPage Today:

Most state medical boards have received — and acted on — complaints about physicians’ online behavior, a survey showed.

Of 48 state medical boards responding to the survey, all but four indicated that they had received reports of “online professionalism violations” at some point, such as prescribing drugs over the Internet without seeing the patients or misrepresenting credentials, according to S. Ryan Greysen, MD, of the University of California San Francisco, and colleagues.

Most of the complaints led to disciplinary proceedings or consent orders, Greysen and colleagues reported in a research letter published in the March 21 Journal of the American Medical Association.

TNKase Superior to Activase for Ischemic Stroke

From MedPage Today:

A genetically engineered clot-buster improved clinical outcomes compared with standard thrombolytic therapy in a selected population of people with ischemic strokes, researchers reported.

In an open-label phase IIb randomized trial, tenecteplase (TNKase) also did better than alteplase (Activase) in re-establishing blood flow to the affected brain regions, according to Mark Parsons, MD, of John Hunter Hospital in Newcastle, Australia, and colleagues.

Both drugs were equally safe, Parsons and colleagues reported in the March 22 issue of the New England Journal of Medicine.