2024 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.
Greif R, Bray JE, Djärv T and al.. | Circulation. 2024 Dec 10;150(24):e580-e687
DOI: https://doi.org/10.1161/cir.0000000000001288  | Télécharger l'article au format  
Keywords: AHA Scientific Statements; ILCOR; advanced life support; basic life support; cardiac arrest; first aid; neonatal; resuscitation.

ILCOR SUMMARY STATEMENTS

Editorial : This is the eighth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recent published resuscitation evidence reviewed by the International Liaison Committee on Resuscitation task force science experts. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations.

Conclusion : Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research.

Conclusion (proposition de traduction) : Des informations sur les délibérations des groupes de travail sont fournies dans les sections Justification et Faits marquants du cadre des données probantes à la décision. En outre, les groupes de travail dressent la liste des lacunes de connaissances prioritaires pour la poursuite de la recherche.

Increased rate of anoxic brain damage with laryngeal tube compared to endotracheal intubation in patients with shockable out-of-hospital cardiac arrest - Experience from the HAnnover COoling REgistry (HACORE).
Garcheva V, Sanchez Martinez C, Adel J, Pfeffer TJ, Akin M, Bauersachs J, Schäfer A. | Resuscitation. 2024 Dec;205:110416
DOI: https://doi.org/10.1016/j.resuscitation.2024.110416  | Télécharger l'article au format  
Keywords: Anoxic brain damage; Cardiac arrest; Cardiopulmonary resuscitation; Neurological outcome; Supraglottic airway device.

SHORT PAPER

Introduction : Supraglottic airway devices such as the laryngeal tube (LT) are recommended in current guidelines for simplified airway management in patients during and immediately after out-of-hospital cardiac arrest (OHCA). Trials evaluating LTs included predominantly OHCA patients with non-shockable rhythms and low survival rates. Hence, LTs are widely used, but their impact on preventing hypoxic brain damage during resuscitation has not been evaluated yet.

Méthode : We analysed 452 OHCA-patients with shockable-rhythms from the HAnnover COoling REgistry (HACORE) who had return of spontaneous circulation prior to transport. Of those, 405 patients received primary airway management by endotracheal intubation (ETI) and 47 by LT. Patients were afterwards treated according to the Hannover Cardiac Resuscitation Algorithm (HaCRA) applying a strict post-resuscitation management including therapeutic hypothermia and avoiding routine prognostication.

Résultats : While mortality in this group was moderate with both airway strategies (ETI 29 % vs LT 34 %, p = 0.487), the rate of anoxic brain damage was much higher in the LT compared to the ETI group (38 % vs 21 %, p = 0.011). Survivors in the ETI group were more likely to have good neurological outcome (cerebral performance category 1&2) compared to the LT group (35 % vs 17 %, p = 0.013). Pneumonia was more common in the LT vs ETI group (81 % vs 53 %, p < 0.001).

Conclusion : While the original prehospital pragmatic trials comparing LT to ETI mostly included patients with non-shockable rhythm in settings with high mortality, our analysis is based on a real-world registry and focuses on successfully resuscitated patients, whose cause of arrest was most probably not due to hypoxia. In this cohort, use of LT was associated with a higher rate of anoxic brain damage and worse functional neurological outcome compared to use of ETI.

Conclusion (proposition de traduction) : Alors que les essais pragmatiques préliminaires en préhospitalier comparant le masque laryngé à l'intubation endotrachéale incluaient principalement des patients avec un rythme non choquable dans des contextes de mortalité élevée, notre analyse est basée sur un registre du monde réel et se concentre sur des patients réanimés avec succès, dont la cause de l'arrêt n'était très probablement pas due à l'hypoxie. Dans cette cohorte, l'utilisation d'un masque laryngé était associée à un taux plus élevé de lésions cérébrales anoxiques et à un résultat neurologique fonctionnel plus mauvais que l'utilisation de l'intubation endotrachéal.