Circulation. 2007;116:2893
doi: 10.1161/CIRCULATIONAHA.107.187683
(Circulation. 2007;116:2893.)
© 2007 American Heart Association, Inc.
Issue Highlights
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EFFECTIVENESS OF BYSTANDER-INITIATED CARDIAC-ONLY RESUSCITATION FOR PATIENTS WITH OUT-OF-HOSPITAL CARDIAC ARREST, by Iwami et al.
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and
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SURVIVAL IS SIMILAR AFTER STANDARD TREATMENT AND CHEST COMPRESSION ONLY IN OUT-OF-HOSPITAL BYSTANDER CARDIOPULMONARY RESUSCITATION, by Bohm et al.
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Cardiopulmonary resuscitation (CPR) is often performed by bystanders
who do not have advanced medical training. There is a question
about the efficacy of the addition of rescue breathing to chest
compressions in terms of survival and outcomes. Additionally,
bystanders may be more hesitant to perform mouth-to-mouth breathing,
which may delay or limit cardiac resuscitation. In this issue
of
Circulation, 2 separate articles by Iwami and colleagues
and Bohm and colleagues address these important topics. Iwami
and colleagues report a prospective Japanese population-based
5-year observational study of consecutive patients who developed
cardiac arrest out of hospital and received attempted CPR by
emergency responders. They analyzed outcomes in nearly 5000
witnessed cardiac arrests and found similar rates for survival
with a good neurological outcome in those victims who, within
15 minutes of arrest, received either conventional CPR or cardiac-only
CPR without addition of rescue breathing. Unfortunately, the
survival with favorable neurological outcome rate was only 4%
to 5% in both groups. Not surprisingly, survival with good neurological
outcome was very poor among victims who received CPR more than
15 minutes after cardiac arrest. Bohm and colleagues describe
the results of a Swedish cardiac arrest registry, evaluating
the 1-month survival in victims who received bystander standard
CPR compared with that of cardiac arrest victims receiving bystander
cardiac-only resuscitation. In this 15-year study, most of the
11|275 patients received standard CPR, with only 10% receiving
chest compressions only. However, the authors also found no
difference in the 1-month survival rate, which was approximately
7% overall. The results of both of these studies are concordant.
They support the use of early cardiac resuscitation and suggest
that mouth-to-mouth breathing may not have significant additional
benefit if chest compressions are promptly initiated. These
studies may have important implications in terms of guidelines
for bystander resuscitation, CPR training, and public health.
See pp 2900 and 2908 (and editorial p
2894).
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PRASUGREL COMPARED WITH HIGH LOADING- AND MAINTENANCE-DOSE CLOPIDOGREL IN PATIENTS WITH PLANNED PERCUTANEOUS CORONARY INTERVENTION: THE PRASUGREL IN COMPARISON TO CLOPIDOGREL FOR INHIBITION OF PLATELET ACTIVATION AND AGGREGATION–THROMBOLYSIS IN MYOCARDIAL INFARCTION 44 TRIAL, by Wiviott et al.
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For patients with acute coronary syndromes, and particularly
for those undergoing percutaneous intervention (PCI), the use
of clopidogrel has evolved toward higher loading doses and potentially
higher maintenance dosing. This practice is driven by the desire
to achieve greater levels of platelet inhibition and to overcome
the specter of resistance. Recent data from the very large randomized
controlled TRITON-TIMI 38 study demonstrated that prasugrel,
a potent thienopyridine, reduced rates of ischemic events but
resulted in a small increase in risk of major bleeding in patients
with acute coronary syndromes and PCI compared with standard
dose clopidogrel. In this issue of
Circulation, Wiviott and
colleagues compare inhibition of platelet aggregation with prasugrel
to that of high dose clopidogrel in patients undergoing PCI
in the PRINCIPLE-TIMI 44 study. At 2 important time points (6
hours after loading and 14 days into maintenance), the use of
prasugrel was associated with a greater degree of inhibition
of platelet aggregation than was clopidogrel, a finding that
emerged very early and was seen at all time points. These data
suggest that this agent can allow more potent platelet inhibition
than even aggressive current strategies, and they provide an
underlying mechanism for the clinical findings in the TRITON
study. See p
2923.
Visit http://circ.ahajournals.org
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Cardiology Patient Page
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New Concepts of Cardiopulmonary Resuscitation for the Lay Public:
Continuous-Chest-Compression CPR. See p
e566.
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Images in Cardiovascular Medicine
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Right Atrial Mass in a Patient With T-Cell Chronic Lymphocytic
Leukemia: An Unusual Mechanism of Thrombus Formation. See p
e569.
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Correspondence.
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See p
e573.
Related Articles:
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Continuous-Chest-Compression Cardiopulmonary Resuscitation for Cardiac Arrest
- Gordon A. Ewy
Circulation 2007 116: 2894-2896.
[Full Text]
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New Concepts of Cardiopulmonary Resuscitation for the Lay Public: Continuous-Chest-Compression CPR
- Gordon A. Ewy
Circulation 2007 116: e566-e568.
[Full Text]
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Right Atrial Mass in a Patient With T-Cell Chronic Lymphocytic Leukemia: An Unusual Mechanism of Thrombus Formation
- L. Bonanni, F. Adami, A. Angelini, C. Gurrieri, A. Cutolo, A. Ponchia, F. Corbetti, G. Thiene, and G. Semenzato
Circulation 2007 116: e569-e572.
[Full Text]
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Letter by Poullis and Warwick Regarding Article, "Paradoxical Low-Flow, Low-Gradient Severe Aortic Stenosis Despite Preserved Ejection Fraction Is Associated With Higher Afterload and Reduced Survival"
- Michael Poullis and Richard Warwick
Circulation 2007 116: e573.
[Full Text]
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Prasugrel Compared With High Loading- and Maintenance-Dose Clopidogrel in Patients With Planned Percutaneous Coronary Intervention: The Prasugrel in Comparison to Clopidogrel for Inhibition of Platelet Activation and Aggregation–Thrombolysis in Myocardial Infarction 44 Trial
- Stephen D. Wiviott, Dietmar Trenk, Andrew L. Frelinger, Michelle O’Donoghue, Franz-Josef Neumann, Alan D. Michelson, Dominick J. Angiolillo, Hanoch Hod, Gilles Montalescot, Debra L. Miller, Joseph A. Jakubowski, Richard Cairns, Sabina A. Murphy, Carolyn H. McCabe, Elliott M. Antman, Eugene Braunwald for the PRINCIPLE-TIMI 44 Investigators
Circulation 2007 116: 2923-2932.
[Abstract]
[Full Text]
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EFFECTIVENESS OF BYSTANDER...
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