Pulseless electrical activity historical perspective: Difference between revisions
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{{Pulseless electrical activity}} | {{Pulseless electrical activity}} | ||
{{CMG}}; {{AE}} {{KGH}} | |||
==Overview== | ==Overview== | ||
Pulseless | Pulseless electrical activity as the main approach for [[sudden cardiac arrest]] (SCA) was not completely studied until the middle of the 1980's. The explanation for this, is that [[ventricular fibrillation]] (VF) and [[ventricular tachycardia]] (VT), were the main causes for the morbidity and mortality of SCA. However there has been a change in approaching the causes of SCA, pointing to PEA as the initial rhythm leading to SCA. | ||
==Historical Perspective== | ==Historical Perspective== | ||
The first approach against trying to decrease mortality due to SCA, was to target tachyarrhythmias, especially ventricular fibrillation (VF) and ventricular tachycardia (VT). This was mainly achieved by the improvements in CPR techniques, the availability of defibrillators to lay responders and the use of implantable cardioverter- defibrillators. Nevertheless, there is and increase in prevalence of PEA and asystolia, which makes them now more frequent than VT and VF. There is still not clear if this can be due to a proportional increase, rather than an absolute increase in cases of PEA. Studies suggest that there is a need to change this approach, because of the increased proportion of PEA cases, and mainly because of the better | The first approach against trying to decrease mortality due to SCA, was to target tachyarrhythmias, especially [[ventricular fibrillation]] (VF) and [[ventricular tachycardia]] (VT). This was mainly achieved by the improvements in [[CPR]] techniques, the availability of defibrillators to lay responders and the use of implantable cardioverter- defibrillators. Nevertheless, there is and increase in prevalence of PEA and asystolia, which makes them now more frequent than VT and VF. There is still not clear if this can be due to a proportional increase, rather than an absolute increase in cases of PEA. Studies suggest that there is a need to change this approach, because of the increased proportion of PEA cases, and mainly because of the better outcomes for survival in PEA patients, than those with VF/VT <ref name="pmid21060069">{{cite journal| author=Teodorescu C, Reinier K, Dervan C, Uy-Evanado A, Samara M, Mariani R et al.| title=Factors associated with pulseless electric activity versus ventricular fibrillation: the Oregon sudden unexpected death study. | journal=Circulation | year= 2010 | volume= 122 | issue= 21 | pages= 2116-22 | pmid=21060069 | doi=10.1161/CIRCULATIONAHA.110.966333 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21060069 }} </ref> <ref name="pmid24297818">{{cite journal| author=Myerburg RJ, Halperin H, Egan DA, Boineau R, Chugh SS, Gillis AM et al.| title=Pulseless electric activity: definition, causes, mechanisms, management, and research priorities for the next decade: report from a national heart, lung, and blood institute workshop. | journal=Circulation | year= 2013 | volume= 128 | issue= 23 | pages= 2532-41 | pmid=24297818 | doi=10.1161/CIRCULATIONAHA.113.004490 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24297818 }} </ref>. Deeper studies will achieve ultimately a better therapeutic strategy, leading to better patient outcomes and a subsequent impact in overall mortality due to SCA. | ||
There was a workshop created by Myerburg from a National Heart, Lung, and Blood Institute <ref name="pmid24297818">{{cite journal| author=Myerburg RJ, Halperin H, Egan DA, Boineau R, Chugh SS, Gillis AM et al.| title=Pulseless electric activity: definition, causes, mechanisms, management, and research priorities for the next decade: report from a national heart, lung, and blood institute workshop. | journal=Circulation | year= 2013 | volume= 128 | issue= 23 | pages= 2532-41 | pmid=24297818 | doi=10.1161/CIRCULATIONAHA.113.004490 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24297818 }} </ref> as an attempt to record the current knowledge and direct the future research in the field. This workshop also described some of the pathophysiology of PEA, which may translate to improved clinical care. | There was a workshop created by Myerburg from a National Heart, Lung, and Blood Institute <ref name="pmid24297818">{{cite journal| author=Myerburg RJ, Halperin H, Egan DA, Boineau R, Chugh SS, Gillis AM et al.| title=Pulseless electric activity: definition, causes, mechanisms, management, and research priorities for the next decade: report from a national heart, lung, and blood institute workshop. | journal=Circulation | year= 2013 | volume= 128 | issue= 23 | pages= 2532-41 | pmid=24297818 | doi=10.1161/CIRCULATIONAHA.113.004490 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24297818 }} </ref> as an attempt to record the current knowledge and direct the future research in the field. This workshop also described some of the pathophysiology of PEA, which may translate to improved clinical care. | ||
*Although the [[The electrocardiogram|ECG f]]<nowiki/>indings of Brugada syndrome were first reported among survivors of cardiac arrest in 1989, it was only in 1992 that the Brugada brothers recognized it as a distinct [[clinical]] entity, causing sudden [[death]] by causing [[ventricular fibrillation]]<ref>Martini B, Nava A, Thiene G, Buja GF, Canciani B, Scognamiglio R, Daliento L, Dalla Volta S. Ventricular fibrillation without apparent heart disease: description of six cases. Am Heart J 1989 Dec;118(6):1203-9 PMID 2589161</ref><ref>Brugada P, Brugada J. Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. A multicenter report. J Am Coll Cardiol. 1992 Nov 15;20(6):1391-6. PMID 1309182</ref> | |||
==References== | ==References== | ||
Latest revision as of 22:37, 12 May 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Karol Gema Hernandez, M.D. [2]
Overview
Pulseless electrical activity as the main approach for sudden cardiac arrest (SCA) was not completely studied until the middle of the 1980's. The explanation for this, is that ventricular fibrillation (VF) and ventricular tachycardia (VT), were the main causes for the morbidity and mortality of SCA. However there has been a change in approaching the causes of SCA, pointing to PEA as the initial rhythm leading to SCA.
Historical Perspective
The first approach against trying to decrease mortality due to SCA, was to target tachyarrhythmias, especially ventricular fibrillation (VF) and ventricular tachycardia (VT). This was mainly achieved by the improvements in CPR techniques, the availability of defibrillators to lay responders and the use of implantable cardioverter- defibrillators. Nevertheless, there is and increase in prevalence of PEA and asystolia, which makes them now more frequent than VT and VF. There is still not clear if this can be due to a proportional increase, rather than an absolute increase in cases of PEA. Studies suggest that there is a need to change this approach, because of the increased proportion of PEA cases, and mainly because of the better outcomes for survival in PEA patients, than those with VF/VT [1] [2]. Deeper studies will achieve ultimately a better therapeutic strategy, leading to better patient outcomes and a subsequent impact in overall mortality due to SCA.
There was a workshop created by Myerburg from a National Heart, Lung, and Blood Institute [2] as an attempt to record the current knowledge and direct the future research in the field. This workshop also described some of the pathophysiology of PEA, which may translate to improved clinical care.
- Although the ECG findings of Brugada syndrome were first reported among survivors of cardiac arrest in 1989, it was only in 1992 that the Brugada brothers recognized it as a distinct clinical entity, causing sudden death by causing ventricular fibrillation[3][4]
References
- ↑ Teodorescu C, Reinier K, Dervan C, Uy-Evanado A, Samara M, Mariani R; et al. (2010). "Factors associated with pulseless electric activity versus ventricular fibrillation: the Oregon sudden unexpected death study". Circulation. 122 (21): 2116–22. doi:10.1161/CIRCULATIONAHA.110.966333. PMID 21060069.
- ↑ 2.0 2.1 Myerburg RJ, Halperin H, Egan DA, Boineau R, Chugh SS, Gillis AM; et al. (2013). "Pulseless electric activity: definition, causes, mechanisms, management, and research priorities for the next decade: report from a national heart, lung, and blood institute workshop". Circulation. 128 (23): 2532–41. doi:10.1161/CIRCULATIONAHA.113.004490. PMID 24297818.
- ↑ Martini B, Nava A, Thiene G, Buja GF, Canciani B, Scognamiglio R, Daliento L, Dalla Volta S. Ventricular fibrillation without apparent heart disease: description of six cases. Am Heart J 1989 Dec;118(6):1203-9 PMID 2589161
- ↑ Brugada P, Brugada J. Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. A multicenter report. J Am Coll Cardiol. 1992 Nov 15;20(6):1391-6. PMID 1309182