Category Archives: Uncategorized

Cardiac Procedures in the Resuscitated Comatose Patient

July 9th, 2015 by

With some of the latest literature, the recommendation has been to transfer patients with STEMI post resuscitation if they are responsive. This latest article from the Journal of the American College of Cardiology just published this gem that talks about what we do if they are still comatose!

This algorithm starts pre-hospitally. Return of circulation occurs and we transport to the nearest hospital. Within 10 minutes, the physician is to have a 12-lead ECG done and initiate mild therapeutic hypothermia (like the studies suggest, avoiding fever is the goal).

So, now we see the massive STEMI. As the previous literature suggests, we push these guys for emergent angiography and PCI should the patient not have unfavourable conditions. Nothing changes here.

What about those patients  that the physician finds that is non-STEMI?

They introduce the “ACT” abbreviation. Essentially, Assess for unfavourable resuscitation features. Consult with cardiology and intensive care.  Transport to cath lab once the decision has been made for angiography.

What is an unfavourable feature you might ask? Well, they include the following:

  • Unwitnessed arrest
  • Initial rhythm: Non-VF
  • No bystander CPR
  • >30 min to ROSC
  • Ongoing CPR
  • pH <7.2
  • Lactate >7
  • Age >85
  • End stage renal disease
  • Noncardiac causes (e.g.,traumatic arrest)

(Rab et al. 2015, p. 64)

With multiple unfavourable features, the patient should be considered for individualised care. Those who are deemed suitable should be sent for early angiogram and PCI.

We may start to see this coming into play within your local ED. What are your local policies and procedures involving this?

As practitioners, remember the value of your history. We can relay important information, such as down time, bystander CPR, initial rhythm and so on.

“Successfully resuscitated comatose patients represent a heterogeneous population with a baseline survival rate of only 25%. With hypothermia and PCI, survival improves to 60%, with favorable neurological outcomes achieved in 86% of survivors” (Rab et al. 2015, p. 63)

Rab, T., Kern, K., Tamis-Holland, J., Henry, T., McDaniel, M., & Dickert, N. et al. (2015). Cardiac Arrest. Journal Of The American College Of Cardiology, 66(1), 62-73. doi:10.1016/j.jacc.2015.05.009

Should we be cooling kids?

June 17th, 2015 by

Post arrest hypothermia study says no!

The debate has been happening for a while now! Do we actively cool or not? Well, many guidelines have us pushing our patients for that deep hypothermia to below 33 degrees. Nielson in 2013, found that patient outcomes did not change with the maintaining normothermia when compaired to hypothermia.

So fever is bad, and we ultimately need to avoid it.

While the debate continues with adults, there has been little evidence with pediatrics surrounding this.

Until now!

In an article published in the New England Journal of Medicine, Moler et al (2015) find that “in comatose children who survived out-of-hospital cardiac arrest, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit in survival with a good functional outcome at 1 year”.

Here is a link to the abstract

This study showed there was a difference, however not significant. Perhaps a larger study would be required. Let me know your thoughts in the comment section!


Moler, Frank W. et al. ‘Therapeutic Hypothermia After Out-Of-Hospital Cardiac Arrest In Children’.New England Journal of Medicine 372.20 (2015): 1898-1908. Web. 17 June 201

Nielsen et al. Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest NEJM 2013;epub Nov 17, 2013

Quiz: Ontario ALS 2011 #2

June 29th, 2012 by

This quiz focuses on the PCP portion of the new ALS. It will help you solidify your knowledge and application skills.

Quiz: Ontario ALS 2011 #1

June 28th, 2012 by

This quiz is based on the introduction section of the ALS, BUT it is still very important so don’t just pass it by! The quiz includes important elements of the ALS and may help to point out some differences between the old version and the new one.

Blood clot risk halved for patients checking their own Warfarin dose

December 1st, 2011 by

University of Oxford – Patients who monitor their own treatment with warfarin or other blood-thinning drugs reduce their risk of developing blood clots by half, an Oxford University study has found.

Taking charge of their own treatment can empower patients, improve the quality of treatment and be more convenient. The researchers say their findings confirm that self-monitoring of warfarin is safe for suitable patients of all ages.

The results are published in the medical journal The Lancet.

‘Warfarin is used for a number of conditions to prevent the blood clotting,’ explains Dr Carl Heneghan, who led the work at the Department of Primary Health Care at Oxford University. ‘These conditions include atrial fibrillation, treatment of deep-vein thrombosis and patients with artificial heart valves.’

In the UK, it is thought that around 1 million people are eligible for blood-thinning drugs, or anticoagulants, with demand set to rise further due to the ageing population.

But the use of anticoagulants needs regular monitoring to make sure the dose remains within the right range.