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CPR for cardiac arrest should be performed ‘for 35 minutes’

By Dermot - 23rd Sep 2015 | 10 views

Dr Goto and colleagues studied nearly 17,000 patients and found that almost all survivals were achieved within 35 minutes and longer CPR resulted in little benefit.

They found that the probability of survival declined with each minute of CPR and that 99.1 per cent of all survivors and 99.2 per cent of all survivors with favourable neurological outcomes had return of spontaneous circulation within 35 minutes of emergency medical services (EMS)-administered CPR.

“The decision regarding when to stop resuscitation efforts is one of the biggest challenges for EMS personnel or clinicians,” Dr Goto told the Congress. “However, the appropriate duration of CPR in not clear. Clinicians have raised concerns that lengthy resuscitation efforts might be futile.”

He continued: “Our study shows that EMS personnel or clinicians should continue CPR for at least 35 minutes in patients who suffer cardiac arrest outside the hospital … we hope that our findings give EMS personnel and clinicians the confidence that if they stop CPR after 35 minutes, they have done everything they can do for a patient. This should help them know when it is appropriate to move on to the next medical emergency.”


<h3 class=”HeadC20MIstyles”>‘Safe’ air pollution levels linked with higher MI risk  <strong> </strong></h3>

New research released at the European Society of Cardiology (ESC) Congress 2015 in London has shown that air pollution presents a significant risk of severe myocardial infarction (MI), despite being considered within ‘safe’ European levels.

Dr Jean-Francoise Argacha, Cardiologist at the University Hospital Brussels, Belgium, and his team looked at the effects of short-term exposure to air pollution on the risk of ST-segment elevation myocardial infarction (STEMI). Dr Argacha commented at the Congress: “Dramatic health consequences of air pollution were first described in Belgium in 1930 after the Meuse Valley fog. Nowadays, the World Health Organisation (WHO) considers air pollution as one of the largest avoidable causes of mortality.”

He told the Congress that STEMI hospitalisation was used as a proxy indicator and “the association between STEMI and air pollution was observed within one day of exposure”.

Dr Argacha added: “This was despite the fact that concentrations of air pollutants were within the European air quality standard.” Noting that men were most severely affected, he commented that “it is possible that only men were affected because of the under-representation of women in our study population, less than 25 per cent.

“Nevertheless, previous studies have demonstrated that blood pressure, arterial stiffness and heart rate variability abnormalities secondary to air pollution exposure are more pronounced in men. Sex differences in obesity and blood inflammation may worsen air pollutant effects but this hypothesis requires further investigation.”

He concluded: “This is the first study to examine the effects of air pollution on STEMI occurrence at a national level using a prospective observational registry of unselected patients. We found that particulate and NO2 air pollution, at levels below the European limits, are associated with an increased risk of STEMI.”

The overall theme of the ESC Congress 2015 was ‘Environment and the Heart’.


<h3 class=”HeadB25MIstyles”>Improvements in CVD rates are under threat from obesity<strong> </strong></h3>

New research released at the recent ESC Congress in London has shown that while better prevention and treatment have slowed the rates of heart disease in the UK over the past four decades, this trend is under serious threat from the rising rates of obesity.

A team comprised of researchers from the University of Oxford, London School of Hygiene and Tropical Medicine and University College Hospital London, looked at 50,000 civil servants who died over a period of approximately 30 years and saw a decline in cardiovascular deaths, largely due to a decline in ischaemic heart disease.

However, the authors stressed that the obesity epidemic over the past 20 years could have a serious impact on the decline in mortality.

Author Prof Christi Deaton, Florence Nightingale Foundation Professor at the Cambridge Institute of Public Health, told the Congress: “At least 50 per cent of the decrease in CVD mortality is due to better prevention and we can probably prevent about 80 per cent of CVD from occurring by leading healthier lives.

“[But] people are starting to worry because we are seeing an increase in diabetes and obesity at younger ages. If you are obese as a child, there is a high probability that you will remain so later in life. Alarmingly, the UK has the fastest-growing obesity rates in Europe.”


<h3 class=”HeadB25MIstyles”>Young women with diabetes shown to have a six-fold increased risk of heart attack<strong></strong></h3>

Results of a study in more than 7,000 women, the results of which were presented at the ESC Congress 2015, revealed that women aged 45 years and younger with diabetes have a six-fold increased risk of suffering a heart attack.

Author Prof Hanna Szwed of the Institute of Cardiology in Warsaw, Poland, told the delegates that “cardiovascular diseases (CVDs) affect mainly the elderly, but for many years an increase in incidence has been observed in young people as well, regardless of gender. The WHO estimates that CVDs cause more than 52 per cent of all deaths in women and that number continues to rise”.

The study used three national registries and the average age among MI patients was 42 years. While four-out-of-five classic risk factors were independent predictors of MI in young women, the strongest predictor was diabetes, increasing the risk by six-fold.

Arterial hypertension increased risk by four-fold, while hypercholesterolaemia increased risk by three times and current smoking by 1.6 times. However, there was no statistical difference for obesity expressed by body mass index.

“The lack of a correlation with obesity could be because the overwhelming influence of diabetes in this population,” Prof Szwed said. “We also found that the risk of MI in young women increased with the number of co-existing factors.

“We found that the risk factor profile in young women with MI was similar to the older population, apart from the greater occurrence of tobacco smoking in young women. This finding correlates with other research, which shows that smoking is a growing problem in young women. This is clearly an area where prevention efforts are needed.”


<h3>Dissolvable stents perform well against metal stents, finds new study</h3> <p class=”HeadB25MIstyles”><strong></strong>

<p class=”bodytextDROPCAPregularMIstyles”>Anew study has suggested that a drug-eluting coronary ‘scaffold’ stent made from bioresorbable material had similar efficacy and safety when compared with metal stents in patients who underwent percutaneous coronary intervention (PCI).

The results, from the ABSORB Japan study, were presented at the recent ESC Congress 2015 in London.

To date, there has been little long-term clinical and angiographic follow-up of bioresorbable vascular scaffolds (BVS) compared to metal stents but ABSORB Japan used 38 centres in an effort to show non-inferiority, in an effort to support regulatory approval of BVS in Japan.

The two-arm trial succeeded in showing non-inferiority of BVS compared to metal stents.

“These results support the feasibility of BVS to potentially improve the long-term outcomes of patients,” according to Dr Takeshi Kimura, Principal Investigator at the Kyoto University Hospital, Japan.

“BVS demonstrated a similar 12-month clinical safety and efficacy profile as the metal stent, with comparable 13-month angiographic outcomes. These results are consistent with a few previous studies reporting either a 12-month clinical outcome or nine-month angiographic outcome, supporting the feasibility of BVS use to potentially improve the long-term outcomes of patients undergoing PCI.”


<h3 class=”HeadC20MIstyles”>‘No endothelial effects’ from low-caffeine energy drinks <strong></strong></h3>

Researchers from Ankara University in Turkey presented findings at the ESC Congress 2015 which suggest that energy drinks with limited caffeine content do not adversely impact cardiovascular functions.

The team looked at the long-term consequences of energy drinks on cardiovascular health by measuring endothelial dysfunction.

Thirty health volunteers had brachial artery flow-mediated dilation (FMD) measured before consuming a 355ml energy drink, which contained 53.25mg of caffeine and again 60 minutes after the drink was taken. Heart rate values, diastolic blood pressure and systolic blood pressure were similar before and after consumption and there was a 1.58 per cent absolute decrease in FMD levels.

“It is well known that endothelial dysfunction plays an important role in the pathogenesis of atherosclerosis, hypertension and diabetes and could facilitate the atherosclerotic events that occur in late life,” said Dr Cetin Erol, one of the researchers. “It can be used as an early warning signal, since it begins well before other morphological changes.”

However Dr Erol added an important caveat to the study results — Turkey is one of the only countries to set a legal limit on the amount of caffeine and taurine in energy drinks. “According to our study, energy drinks with limited caffeine and taurine content don’t seem to have any influence on endothelial function,” said Dr Erol. “But these results should be interpreted with caution, since the amount of caffeine and taurine in our protocol was lower than that used in commercially-available products in many other countries.”

He concluded by urging cardiologists to always ask about energy drink consumption in young patients.

Despite previous case reports warning that energy drinks can lead to ST segment elevation, aortic dissection, increased blood pressure and platelet activity, takotsubo cardiomyopathy and fatal arrhythmias, it is estimated that more than 30 per cent of 12-to-19-year-olds consume energy drinks regularly


<h3>Device used in sleep apnoea treatment found to increase risk of mortality in heart failure patients</h3> <p class=”HeadC18MIstyles”><strong></strong>

Clinicians have issued a warning that a device known as the adaptive servo-ventilation therapy increases mortality in heart failure patients with reduced ejection fraction, in research results released at the ESC Congress 2015 and published simultaneously in the <em>New England Journal of Medicine.</em>

A hotline session at the Congress heard how “lives will be saved” by what was described as “game-changing” research, the ‘Treatment of Sleep-Disordered Breathing with Predominant Central Sleep Apnoea by Adaptive Servo Ventilation in Patients with Heart Failure and Reduced Ejection Fraction (SERVE-HF)’ study.

One of the researchers, Dr Martin Cowie from Imperial College London, cautioned that the results could not be generalised to patients with preserved ejection fraction or obstructive sleep apnoea, but commented: “This study has changed our understanding of sleep-disordered breathing in systolic heart failure — the text books will have to be rewritten.”

The study was conducted in 1,325 patients across 91 centres in 11 countries, including the UK, Germany, France and Australia. ASV uses a non-invasive ventilator to treat apnoea by delivering servo-controlled inspiratory pressure support via a face mask, as well as expiratory positive airway pressure.

Dr Cowie said the manufacturers have now issued a “global safety notice” and again warned that the device must not be used in patients with central sleep apnoea and reduced ejection fraction heart failure.

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