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  1. Article ; Online: In-hospital cardiac arrest.

    Soar, Jasmeet

    Current opinion in critical care

    2023  Volume 29, Issue 3, Page(s) 181–185

    Abstract: Purpose of review: To describe our knowledge about in-hospital cardiac arrest (IHCA) including recent developments.: Recent findings: Improving trends in IHCA outcomes appear to have stalled or reversed since the COVID-19 pandemic. There are ... ...

    Abstract Purpose of review: To describe our knowledge about in-hospital cardiac arrest (IHCA) including recent developments.
    Recent findings: Improving trends in IHCA outcomes appear to have stalled or reversed since the COVID-19 pandemic. There are disparities in care based on patient sex, ethnicity and socioeconomic status that need to be tackled. The increased use of emergency treatment plans that include do-not attempt cardiopulmonary resuscitation recommendations will help to decrease the number of resuscitation attempts. System approaches and strong local leadership through resuscitation champions can improve patient outcomes.
    Summary: In-hospital cardiac arrest is a global health problem with a 25% survival in high-income settings. There remain significant opportunities to both decrease the incidence of, and outcomes from IHCA.
    MeSH term(s) Humans ; Pandemics ; COVID-19/complications ; Heart Arrest/therapy ; Heart Arrest/etiology ; Cardiopulmonary Resuscitation ; Hospitals
    Language English
    Publishing date 2023-03-20
    Publishing country United States
    Document type Review ; Journal Article
    ZDB-ID 1235629-3
    ISSN 1531-7072 ; 1070-5295
    ISSN (online) 1531-7072
    ISSN 1070-5295
    DOI 10.1097/MCC.0000000000001035
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  2. Article ; Online: NAP7 and airway management: as important as life and death.

    Cook, T / Oglesby, F / Soar, J

    Anaesthesia

    2024  Volume 79, Issue 5, Page(s) 548–549

    MeSH term(s) Humans ; Airway Management ; Airway Obstruction ; Intubation, Intratracheal
    Language English
    Publishing date 2024-02-06
    Publishing country England
    Document type Letter
    ZDB-ID 80033-8
    ISSN 1365-2044 ; 0003-2409
    ISSN (online) 1365-2044
    ISSN 0003-2409
    DOI 10.1111/anae.16246
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  3. Article ; Online: Emergency treatment of peri-operative anaphylaxis: Resuscitation Council UK algorithm for anaesthetists.

    Dodd, A / Turner, P J / Soar, J / Savic, L

    Anaesthesia

    2024  Volume 79, Issue 5, Page(s) 535–541

    Abstract: Peri-operative anaphylaxis is a rare but potentially catastrophic event which must be considered whenever unexpected and significant cardiovascular or respiratory compromise occurs during anaesthesia. The Resuscitation Council UK algorithm for peri- ... ...

    Abstract Peri-operative anaphylaxis is a rare but potentially catastrophic event which must be considered whenever unexpected and significant cardiovascular or respiratory compromise occurs during anaesthesia. The Resuscitation Council UK algorithm for peri-operative anaphylaxis highlights the importance of early intravenous adrenaline and fluid resuscitation and provides guidance on the treatment of refractory anaphylaxis and immediate follow-up. This algorithm is endorsed by the Royal College of Anaesthetists, Association of Anaesthetists, British Society of Allergy and Clinical Immunology and Clinical Immunology Professional Network of the British Society for Immunology. This document was produced by the Perioperative Allergy Network steering committee in collaboration with the Resuscitation Council UK.
    MeSH term(s) Humans ; Anaphylaxis/therapy ; Epinephrine/therapeutic use ; Resuscitation ; Anesthetists ; United Kingdom
    Chemical Substances Epinephrine (YKH834O4BH)
    Language English
    Publishing date 2024-01-11
    Publishing country England
    Document type Journal Article
    ZDB-ID 80033-8
    ISSN 1365-2044 ; 0003-2409
    ISSN (online) 1365-2044
    ISSN 0003-2409
    DOI 10.1111/anae.16206
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  4. Article ; Online: Epinephrine for cardiac arrest: knowns, unknowns and controversies.

    Soar, Jasmeet

    Current opinion in critical care

    2020  Volume 26, Issue 6, Page(s) 590–595

    Abstract: Purpose of review: The aim of this study was to describe our knowledge about the use of epinephrine in cardiac arrest and discuss the unknowns and current controversies.: Recent findings: A recent large, well conducted, double-blind, randomized ... ...

    Abstract Purpose of review: The aim of this study was to describe our knowledge about the use of epinephrine in cardiac arrest and discuss the unknowns and current controversies.
    Recent findings: A recent large, well conducted, double-blind, randomized placebo-controlled trial of over 8000 patients with out-of-hospital cardiac arrest (PARAMEDIC-2) showed that epinephrine increased return of spontaneous circulation and survival to hospital discharge. The trial's secondary outcomes have raised concerns that epinephrine increases the number of brain damaged survivors. Systematic review and meta-analysis suggest that epinephrine has more pronounced effects for nonshockable rhythms, when given early, and probably increases the number of both good and poor survivors. There remains uncertainty about the optimal use of epinephrine in terms of patient groups, rhythms, dose and timing.
    Summary: Epinephrine still has a role in the treatment of cardiac arrest; the best way to use epinephrine remains uncertain.
    MeSH term(s) Cardiopulmonary Resuscitation ; Epinephrine ; Humans ; Meta-Analysis as Topic ; Out-of-Hospital Cardiac Arrest/drug therapy ; Patient Discharge ; Randomized Controlled Trials as Topic ; Systematic Reviews as Topic
    Chemical Substances Epinephrine (YKH834O4BH)
    Language English
    Publishing date 2020-10-27
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1235629-3
    ISSN 1531-7072 ; 1070-5295
    ISSN (online) 1531-7072
    ISSN 1070-5295
    DOI 10.1097/MCC.0000000000000763
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  5. Article ; Online: Peri-operative cardiac arrest in the older frail patient as reported to the 7th National Audit Project of the Royal College of Anaesthetists.

    Moppett, I K / Kane, A D / Armstrong, R A / Kursumovic, E / Soar, J / Cook, T M

    Anaesthesia

    2024  

    Abstract: Frailty increases peri-operative risk, but details of its burden, clinical features and the risk of, and outcomes following, peri-operative cardiac arrest are lacking. As a preplanned analysis of the 7th National Audit Project of the Royal College of ... ...

    Abstract Frailty increases peri-operative risk, but details of its burden, clinical features and the risk of, and outcomes following, peri-operative cardiac arrest are lacking. As a preplanned analysis of the 7th National Audit Project of the Royal College of Anaesthetists, we described the characteristics of older patients living with frailty undergoing anaesthesia and surgery, and those reported to the peri-operative cardiac arrest case registry. In the activity survey, 1676 (26%) of 6466 patients aged > 65 y were reported as frail (Clinical Frailty Scale score ≥ 5). Increasing age and frailty were both associated with increasing comorbidities and the proportion of surgery undertaken as an emergency. Except in patients who were terminally ill (Clinical Frailty Scale score 9), increasing frailty was associated with an increased proportion of complex or major surgery. The rate of use of invasive arterial blood pressure monitoring was associated with frailty only until Clinical Frailty Scale score 5, and then plateaued or fell. Of 881 cardiac arrests reported to the 7th National Audit Project, 156 (18%) were in patients aged > 65 y and living with frailty, with an estimated incidence of 1 in 1204 (95%CI 1 in 1027-1412) and a mortality rate of 1 in 2020 (95%CI 1 in 1642-2488), approximately 2.6-fold higher than in adults who were not frail. Hip fracture, emergency laparotomy, emergency vascular surgery and urological surgery were the most common surgical procedures in older patients living with frailty who had a cardiac arrest. We report a high burden of frailty within the surgical population, requiring complex, urgent surgery, and the extent of poorer outcomes of peri-operative cardiac arrest compared with patients of the same age not living with frailty.
    Language English
    Publishing date 2024-03-31
    Publishing country England
    Document type Journal Article
    ZDB-ID 80033-8
    ISSN 1365-2044 ; 0003-2409
    ISSN (online) 1365-2044
    ISSN 0003-2409
    DOI 10.1111/anae.16267
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  6. Article ; Online: Peri-operative cardiac arrest due to suspected anaphylaxis as reported to the 7th National Audit Project of the Royal College of Anaesthetists.

    Cook, T M / Kane, A D / Armstrong, R A / Kursumovic, E / Soar, J

    Anaesthesia

    2024  Volume 79, Issue 5, Page(s) 498–505

    Abstract: The 7th National Audit Project (NAP7) of the Royal College of Anaesthetists studied peri-operative cardiac arrest. Among 59 cases reported as possible anaphylaxis, 33 (56%) were judged to be so by the review panel with high or moderate confidence. Causes ...

    Abstract The 7th National Audit Project (NAP7) of the Royal College of Anaesthetists studied peri-operative cardiac arrest. Among 59 cases reported as possible anaphylaxis, 33 (56%) were judged to be so by the review panel with high or moderate confidence. Causes in excluded cases included: isolated severe hypotension; bronchospasm; and oesophageal intubation. Severe bronchospasm leading to cardiac arrest was uncommon, but notably in one case led to a reported flat capnograph. In the baseline survey, anaesthetists estimated anaphylaxis as the cause of 10% of cases of peri-operative cardiac arrests and to be among the four most common causes. In a year-long registry of peri-operative cardiac arrest, suspected anaphylaxis was the seventh most common cause accounting for 4% of reports. Initial management was most often with low-dose intravenous adrenaline, and this was without complications. Both the NAP7 baseline survey and case registry provided evidence of reluctance to starting chest compressions when systolic blood pressure had fallen to below 50 mmHg and occasionally even when it was unrecordable. All 33 patients were resuscitated successfully but one patient later died. The one death occurred in a relatively young patient in whom chest compressions were delayed. Overall, peri-operative anaphylaxis leading to cardiac arrest occurred with a similar frequency and patterns of presentation, location, initial rhythm and suspected triggers in NAP7 as in the 6th National Audit Project (NAP6). Outcomes in NAP7 were generally better than for equivalent cases in NAP6.
    MeSH term(s) Humans ; Anaphylaxis/epidemiology ; Anaphylaxis/etiology ; Anaphylaxis/therapy ; Bronchial Spasm ; Epinephrine ; Heart Arrest/etiology ; Heart Arrest/therapy ; Anesthetists
    Chemical Substances Epinephrine (YKH834O4BH)
    Language English
    Publishing date 2024-01-11
    Publishing country England
    Document type Journal Article
    ZDB-ID 80033-8
    ISSN 1365-2044 ; 0003-2409
    ISSN (online) 1365-2044
    ISSN 0003-2409
    DOI 10.1111/anae.16229
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  7. Article ; Online: Independent sector and peri-operative cardiac arrest as reported to the 7th National Audit Project of the Royal College of Anaesthetists.

    Cook, T M / Kane, A D / Bouch, C / Armstrong, R A / Kursumovic, E / Soar, J

    Anaesthesia

    2024  Volume 79, Issue 4, Page(s) 380–388

    Abstract: The 7th National Audit Project (NAP7) of the Royal College of Anaesthetists studied peri-operative cardiac arrest including those that occurred in the independent healthcare sector, which provides around 1 in 6 NHS-funded care episodes. In total, 174 (39% ...

    Abstract The 7th National Audit Project (NAP7) of the Royal College of Anaesthetists studied peri-operative cardiac arrest including those that occurred in the independent healthcare sector, which provides around 1 in 6 NHS-funded care episodes. In total, 174 (39%) of 442 independent hospitals contacted agreed to participate. A survey examining provider preparedness for cardiac arrest had a response rate of 23 (13%), preventing useful analysis. An activity survey with 1912 responses (from a maximum of 45% of participating hospitals) showed that, compared with the NHS caseload, the independent sector caseload was less comorbid, with fewer patients at the extremes of age or who were severely obese, and with a large proportion of elective orthopaedic surgery undertaken during weekday working hours. The survey suggested suboptimal compliance rates with monitoring recommendations. Seventeen reports of independent sector peri-operative cardiac arrest comprised 2% of NAP7 reports and underreporting is likely. These patients were lower risk than NHS cases, reflecting the sector's case mix, but included cases of haemorrhage, anaphylaxis, cardiac arrhythmia and pulmonary embolus. Good and poor quality care were seen, the latter including delayed recognition and treatment of patient deterioration, and poor care delivery. Independent sector outcomes were similar to those in the NHS, though due to the case mix, improved outcomes might be anticipated. Assessment of quality of care was less often favourable for independent sector reports than NHS reports, though assessments were often uncertain, reflecting poor quality reports. Overall, NAP7 is unable to determine whether peri-operative care relating to cardiac arrest is more, equally or less safe than in the NHS.
    MeSH term(s) Humans ; Elective Surgical Procedures ; Heart Arrest/epidemiology ; Heart Arrest/therapy ; Anaphylaxis ; Anesthetists ; Obesity
    Language English
    Publishing date 2024-01-04
    Publishing country England
    Document type Journal Article
    ZDB-ID 80033-8
    ISSN 1365-2044 ; 0003-2409
    ISSN (online) 1365-2044
    ISSN 0003-2409
    DOI 10.1111/anae.16175
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  8. Article ; Online: Temperature control after cardiac arrest: friend or foe.

    Nolan, Jerry P / Soar, Jasmeet

    Current opinion in critical care

    2023  Volume 28, Issue 3, Page(s) 244–249

    Abstract: Purpose of review: Most patients who are successfully resuscitated after cardiac arrest are initially comatose and require mechanical ventilation and other organ support in an ICU. Best practice has been to cool these patients and control their ... ...

    Abstract Purpose of review: Most patients who are successfully resuscitated after cardiac arrest are initially comatose and require mechanical ventilation and other organ support in an ICU. Best practice has been to cool these patients and control their temperature at a constant value in the range of 32-36 oC for at least 24 h. But the certainty of the evidence for this practice is increasingly being challenged. This review will summarize the evidence on key aspects of temperature control in comatose postcardiac arrest patients.
    Recent findings: The Targeted Temperature Management 2 (TTM-2) trial documented no difference in 6-month mortality among comatose postcardiac arrest patients managed at 33 oC vs. targeted normothermia. A systematic review and meta-analysis completed by the Advanced Life Support (ALS) Task Force of the International Liaison Committee on Resuscitation (ILCOR) concluded that temperature control with a target of 32-34 °C did not improve survival or favourable functional outcome after cardiac arrest. Two observational studies have documented an association between predicted moderate hypoxic-ischaemic brain injury and better outcome with temperature control at 33-34 oC compared with 35-36 oC.
    Summary: We suggest actively preventing fever by targeting a temperature 37.5 oC or less for those patients who remain comatose following return of spontaneous circulation (ROSC) after cardiac arrest.
    MeSH term(s) Cardiopulmonary Resuscitation ; Coma/etiology ; Coma/therapy ; Heart Arrest/complications ; Heart Arrest/therapy ; Humans ; Hypothermia, Induced ; Temperature
    Language English
    Publishing date 2023-07-01
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1235629-3
    ISSN 1531-7072 ; 1070-5295
    ISSN (online) 1531-7072
    ISSN 1070-5295
    DOI 10.1097/MCC.0000000000000943
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  9. Article ; Online: Judgements of quality of care in NAP7: a clarification from the authors.

    Cook, Tim M / Lucas, D N / Soar, Jasmeet

    Anaesthesia

    2024  Volume 79, Issue 6, Page(s) 668

    MeSH term(s) Humans ; Quality of Health Care
    Language English
    Publishing date 2024-03-22
    Publishing country England
    Document type Letter
    ZDB-ID 80033-8
    ISSN 1365-2044 ; 0003-2409
    ISSN (online) 1365-2044
    ISSN 0003-2409
    DOI 10.1111/anae.16286
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  10. Article ; Online: Antiarrhythmic drug therapy during cardiopulmonary resuscitation: should we use it?

    Soar, Jasmeet

    Current opinion in critical care

    2018  Volume 24, Issue 3, Page(s) 138–142

    Abstract: Purpose of review: The optimal antiarrhythmic drug therapy (amiodarone or lidocaine) in the treatment of ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) cardiac arrest that is refractory to defibrillation is uncertain. This article ... ...

    Abstract Purpose of review: The optimal antiarrhythmic drug therapy (amiodarone or lidocaine) in the treatment of ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) cardiac arrest that is refractory to defibrillation is uncertain. This article reviews the evidence for and against these drugs, alternatives treatments for refractory VF/pVT and aims to define the role of antiarrhythmic drugs during cardiopulmonary resuscitation (CPR).
    Recent findings: A large randomized controlled trial that compared amiodarone, lidocaine and saline 0.9% sodium chloride for the treatment of refractory VF/pVT out-of-hospital cardiac arrest reported no difference in survival to hospital discharge or neurological outcome. In patients with witnessed arrest, survival was improved with antiarrhythmic drugs compared to saline.
    Summary: The benefit of antiarrhythmic drugs appears to be for those patients in whom initial early CPR and defibrillation attempts fail and the antiarrhythmic drug is given early. There does not appear to be any clear survival benefit for any one particular drug and other factors such as availability and cost should be considered when deciding which drug to use. Furthermore, other interventions (e.g. percutaneous coronary intervention and extra-corporeal CPR) may provide additional survival benefit when defibrillation attempts and antiarrhythmic drugs are not effective.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Amiodarone/standards ; Amiodarone/therapeutic use ; Anti-Arrhythmia Agents/standards ; Anti-Arrhythmia Agents/therapeutic use ; Arrhythmias, Cardiac/drug therapy ; Cardiopulmonary Resuscitation/standards ; Female ; Humans ; Lidocaine/standards ; Lidocaine/therapeutic use ; Male ; Middle Aged ; Out-of-Hospital Cardiac Arrest/drug therapy ; Practice Guidelines as Topic ; Survival Rate ; Tachycardia, Ventricular/drug therapy
    Chemical Substances Anti-Arrhythmia Agents ; Lidocaine (98PI200987) ; Amiodarone (N3RQ532IUT)
    Language English
    Publishing date 2018-03-21
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1235629-3
    ISSN 1531-7072 ; 1070-5295
    ISSN (online) 1531-7072
    ISSN 1070-5295
    DOI 10.1097/MCC.0000000000000498
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