RJ FRASCONE - Academia.edu (original) (raw)

Papers by RJ FRASCONE

HAL (Le Centre pour la Communication Scientifique Directe), 2014

International audienc

Prehospital Emergency Care, Sep 10, 2018

We report a case of a 56 year old male in ventricular fibrillation (VF) cardiac arrest for a tota... more We report a case of a 56 year old male in ventricular fibrillation (VF) cardiac arrest for a total of 2 hours and 50 minutes who was diagnosed with ST elevation myocardial infarction (STEMI) during a brief 10 min period of return of spontaneous circulation (ROSC). The patient underwent successful percutaneous coronary intervention (PCI) while receiving mechanical chest compressions for ongoing VF. Our case demonstrates the potential for neurologically intact survival in VF cardiac arrest patients despite prolonged periods of VF who are treated with mechanical CPR and intra-arrest PCI.

Resuscitation, Mar 1, 2020

AIM OF THE STUDY Negative intrathoracic pressure (ITP) during the decompression phase of cardiopu... more AIM OF THE STUDY Negative intrathoracic pressure (ITP) during the decompression phase of cardiopulmonary resuscitation (CPR) is essential to refill the heart, increase cardiac output, maintain cerebral and coronary perfusion pressures, and improve survival. In order to generate negative ITP, an airway seal is necessary. We tested the hypothesis that some supraglottic airway (SGA) devices do not seal the airway as well the standard endotracheal tube (ETT). METHODS Airway pressures (AP) were measured as a surrogate for ITP in seven recently deceased human cadavers of varying body habitus. Conventional manual, automated, and active compression-decompression CPR were performed with and without an impedance threshold device (ITD) in supine and Head Up positions. Positive pressure ventilation was delivered by an ETT and 5 SGA devices tested in a randomized order in this prospective cross-over designed study. The primary outcome was comparisons of decompression AP between all groups. RESULTS An ITD was required to generate significantly lower negative ITP during the decompression phase of all methods of CPR. SGAs varied in their ability to support negative ITP. CONCLUSION In a human cadaver model, the ability to generate negative intrathoracic pressures varied with different SGAs and an ITD regardless of the body position or CPR method. Differences in SGAs devices should be strongly considered when trying to optimize cardiac arrest outcomes, as some SGAs do not consistently develop a seal or negative intrathoracic pressure with multiple different CPR methods and devices.

Anesthesiology, Apr 1, 2014

T HE well-written article by Deras et al., 1 "Fatal Pancreatic Injury Due to Trauma After Success... more T HE well-written article by Deras et al., 1 "Fatal Pancreatic Injury Due to Trauma After Successful Cardiopulmonary Resuscitation With Automatic Mechanical Chest Compression," presents an unfortunate case of a patient with resuscitated cardiac arrest who subsequently died with a pancreatic rupture presumably caused by the LUCAS ™ Chest Compression System (Physio-Control, Redmond, WA). There is a renewed focus on automated cardiopulmonary resuscitation (CPR) in the United States because it provides consistent rates and depths of CPR which have been felt to be crucial to optimize survival. Manual high-quality CPR can be difficult to train and to maintain for a very long time. The LUCAS ™ device does more than just providing consistent, high-quality CPR works; it works by creating a positive intrathoracic pressure when the chest is compressed. This increased pressure is transmitted to the blood inside the heart. The blood then moves from the relatively high pressure inside the heart to the lower pressure of the systemic vasculature. Conversely, when the chest wall recoils, a small, but critical, negative pressure is created which draws blood back into the heart thereby creating preload. These alternating directional changes in intrathoracic pressure result in enhanced cardiac output, demonstrating that the compression and decompression phases of CPR are equally important. A common problem during manual CPR is that the chest does not always recoil because of an increase in chest wall compliance (softens). Although other CPR devices provide consistent compression depth and rate, the LUCAS ™ device, because of its integrated suction cup, is the only automated

Circulation, Mar 17, 2020

Background: The likelihood of neurologically favorable survival declines with prolonged resuscita... more Background: The likelihood of neurologically favorable survival declines with prolonged resuscitation. However, the ability of extracorporeal cardiopulmonary resuscitation (ECPR) to modulate this decline is unknown. Our aim was to examine the effects of resuscitation duration on survival and metabolic profile in patients who undergo ECPR for refractory ventricular fibrillation/ventricular tachycardia out-of-hospital cardiac arrest. Methods: We retrospectively evaluated survival in 160 consecutive adults with refractory ventricular fibrillation/ventricular tachycardia out-of-hospital cardiac arrest treated with the University of Minnesota (UMN) ECPR protocol (transport with ongoing cardiopulmonary resuscitation [CPR] to the cardiac catheterization laboratory for ECPR) compared with 654 adults who had received standard CPR in the amiodarone arm of the ALPS trial (Amiodarone, Lidocaine, or Placebo Study). We evaluated the metabolic changes and rate of survival in relation to duration of CPR in UMN-ECPR patients. Results: Neurologically favorable survival was significantly higher in UMN-ECPR patients versus ALPS patients (33% versus 23%; P =0.01) overall. The mean duration of CPR was also significantly longer for UMN-ECPR patients versus ALPS patients (60 minutes versus 35 minutes; P <0.001). Analysis of the effect of CPR duration on neurologically favorable survival demonstrated significantly higher neurologically favorable survival for UMN-ECPR patients compared with ALPS patients at each CPR duration interval <60 minutes; however, longer CPR duration was associated with a progressive decline in neurologically favorable survival in both groups. All UMN-ECPR patients with 20 to 29 minutes of CPR (8 of 8) survived with neurologically favorable status compared with 24% (24 of 102) of ALPS patients with the same duration of CPR. There were no neurologically favorable survivors in the ALPS cohort with CPR ≥40 minutes, whereas neurologically favorable survival was 25% (9 of 36) for UMN-ECPR patients with 50 to 59 minutes of CPR and 19% with ≥60 minutes of CPR. Relative risk of mortality or poor neurological function was significantly reduced in UMN-ECPR patients with CPR duration ≥60 minutes. Significant metabolic changes included decline in pH, increased lactic acid and arterial partial pressure of carbon dioxide, and thickened left ventricular wall with prolonged professional CPR. Conclusions: ECPR was associated with improved neurologically favorable survival at all CPR durations <60 minutes despite severe progressive metabolic derangement. However, CPR duration remains a critical determinate of survival.

The journal of trauma and acute care surgery, Aug 31, 2020

contributed to data analysis and data interpretation. Alexandra Dixon contributed to writing of t... more contributed to data analysis and data interpretation. Alexandra Dixon contributed to writing of the manuscript.

$Research paper thumbnail of Enfermedad coronaria en pacientes con paro cardiaco extrahospitalario por fibrilación ventricular refractaria al tratamiento$

JACC. Edición en español, Feb 1, 2018

Este trabajo fue financiado por una donación filantrópica de la Familia Bakken y del Robert K. Ed... more Este trabajo fue financiado por una donación filantrópica de la Familia Bakken y del Robert K. Eddy Endowment for Resuscitation Medicine. El Dr. Benditt ha sido consultor de Medtronic y Zoll; y posee acciones de Medtronic y Abbott. El Dr. Lurie tiene una patente para dispositivos de compresión-descompresión activa y umbral de impedancia por los que recibe derechos de autor; y es consultor de Zoll. El Dr. Aufderheide ha sido investigador principal de estudios patrocinados por JDP Therapeutics y la Hospital Quality Foundation. Todos los demás autores no tienen ninguna relación que declarar que sea relevante respecto al contenido de este artículo.

$Research paper thumbnail of Abstract 13071: Supraglottic Airway Devices Are Associated With Asphyxial Physiology Upon Arrival for ECPR in Patients With Refractory OHCA Treated With Prolonged CPR$

Circulation, 2021

Introduction: Multiple clinical trials have failed to show significant differences in survival be... more Introduction: Multiple clinical trials have failed to show significant differences in survival between use of endotracheal intubation (ETI) and supraglottic airway devices (SGA) in patients with out-of-hospital cardiac arrest (OHCA). However, treatment in these trials was limited to standard ACLS, which favors short duration of CPR. We sought to compare the physiological effect of ETI versus SGA use in patients treated with prolonged CPR and extracorporeal pulmonary resuscitation (ECPR) for refractory ventricular fibrillation/ventricular tachycardia (VT/VF) by the Minnesota Mobile Resuscitation Consortium (MMRC). Methods: Consecutive refractory VT/VF OHCA patients transported by the MMRC to the University of Minnesota for ECPR between 2015 and 2021 were included in this retrospective analysis. Patients were considered ineligible for ECPR if they failed specific arterial blood gas metabolic criteria (lactic acid >18 mmol/L, PaO2 <50 mmHg, and ETCO2 <10 mmHg). Metabolic param...

JEMS : a journal of emergency medical services, 2017

Circulation, 2016

Introduction: Gasping has been found to be common after cardiac arrest and associated with increa... more Introduction: Gasping has been found to be common after cardiac arrest and associated with increased survival to discharge for out-of-hospital cardiac arrests (OHCA). Active compression decompression (ACD) plus an impedance threshold device (ITD) improves brain blood flow and survival to hospital discharge with favorable neurologic function after OHCA compared with standard CPR (S-CPR). Hypothesis: We assessed the association of gasping during CPR on 1-year survival. Methods: The ResQTrial data, which compared ACD+ITD versus S-CPR, was used for these analyses. Nearly all one-year survivors had normal brain function. We included all evaluable subjects in the run-in and pivotal phases of the trial. Beginning in January 2007, the original case report forms were modified to include whether or not spontaneous gasping or breathing was observed at anytime during CPR. A logistic regression analysis was performed. Odds ratios (OR) were adjusted for ResQTrial study intervention arm, pre-speci...

Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, Jan 18, 2017

Invasively monitoring blood pressure through the IO device has not been thoroughly demonstrated. ... more Invasively monitoring blood pressure through the IO device has not been thoroughly demonstrated. This study attempted to establish baseline values of IO pressure in a healthy human population. This was a prospective, healthy volunteer, observational study. Participants had two IO devices placed (humerus and tibia), and participant IO pressures, vital signs, and pain scores were monitored for up to 60 minutes. Participants were contacted at 24-hours and 7 days post-testing to assess for adverse events. Summary statistics were calculated for systolic, diastolic, and mean humeral and tibial IO pressure. The ratio of IO to non-invasive blood pressure was calculated, and Bland Altman plots were created. The slope (linear) of the mean humeral and the tibial IO pressures were also calculated. Fifteen subjects were enrolled between April and July 2015. Fourteen of 15 humeral IOs were placed successfully (93.3%) and all 15 of the tibial IOs were placed successfully. Mean tibial systolic, dia...

JAMA, 2012

XPERIMENTAL AND CLINICAL studies have shown intravenous glucose-insulin-potassium (GIK) to have 2... more XPERIMENTAL AND CLINICAL studies have shown intravenous glucose-insulin-potassium (GIK) to have 2 types of benefits in cardiac ischemic syndromes. One is protecting against myocardial injury by providing metabolic support to ischemic myocardium, which should limit progression Author Affiliations are listed at the end of this article.

Critical Care Explorations, 2020

Objectives: To construct a highly detailed yet practical, attainable roadmap for enhancing the li... more Objectives: To construct a highly detailed yet practical, attainable roadmap for enhancing the likelihood of neurologically intact survival following sudden cardiac arrest. Design, Setting, and Patients: Population-based outcomes following out-of-hospital cardiac arrest were collated for 10 U.S. counties in Alaska, California, Florida, Ohio, Minnesota, Utah, and Washington. The 10 identified emergency medical services systems were those that had recently reported significant improvements in neurologically intact survival after introducing a more comprehensive approach involving citizens, hospitals, and evolving strategies for incorporating technology-based, highly choreographed care and training. Detailed inventories of in-common elements were collated from the ten 9-1-1 agencies and assimilated. For reference, combined averaged outcomes for out-of-hospital cardiac arrest occurring January 1, 2017, to February 28, 2018, were compared with concurrent U.S. outcomes reported by the wel...

Annals of Emergency Medicine, 2015

Critical Care Medicine, 2015

Circulation, Nov 25, 2014

<jats:p> <jats:bold>Background:</jats:bold> Cardiac arrest patients that have b... more <jats:p> <jats:bold>Background:</jats:bold> Cardiac arrest patients that have been successfully resuscitated from shockable rhythms have a high prevalence of thrombotic and/or flow limiting coronary occlusion regardless of the presence of STEMI on the ECG. In 2012, the Minnesota Resuscitation Consortium (MRC) developed an organized approach for all those patients to gain early access to the cardiac catheterization laboratory (CCL). We report the two-year outcomes. </jats:p> <jats:p> <jats:bold>Methods:</jats:bold> Eleven metropolitan hospitals with 24/7 PCI capabilities agreed to provide early (within 2 hours of arrival to the emergency department) access to the CCL for all patients that were successfully resuscitated from VF/VT arrest regardless of the presence or absence of STEMI on the surface ECG. Inclusion criteria were: witnessed or un-witnessed, age >18 and <70, cardiac arrest of presumed cardiac etiology, comatose or conscious patients. Patients with PEA or asystole, known DNR/DNI, non-cardiac etiology, significant bleeding of any cause, terminal disease were excluded. Patient outcomes were recorded in the state database Cardiac Arrest Registry to Enhance Survival. </jats:p> <jats:p> <jats:bold>Results:</jats:bold> A total of 370 patients were resuscitated and met the inclusion criteria. Of those, 313 (85%) patients were taken to the CCL per protocol. The mean age was 55.5 years, 77% were men and 79% had witnessed arrest. Only 57 patients (15%) did not gain access to the CCL. Of the 313 patients that had early coronary angiography a total of 47% received primary angioplasty and had at least one vessel disease and 5% received coronary artery bypass. All comatose patients received therapeutic hypothermia and 35% received and implantable cardiac defibrillator. A total of 235/313 (75%) were discharged alive and of those 222/235 (94.5%) were discharged neurologically intact with a CPC of 1. Of the patients that did not gain access to the CCL, 46% (26/57) were discharged alive and of those 73% (19/26) had CPC of 1 [OR: 3.63; 2.03-6.5, p< 0.001]. </jats:p> <jats:p> <jats:bold>Conclusions:</jats:bold> Over the first two years of implementation, the MRC protocol for early access to the CCL in resuscitated patients from shockable rhythm was associated with 75% survival to hospital discharge and excellent neurological outcomes in a large metropolitan area and real-life clinical practice. </jats:p>

Resuscitation, Jan 24, 2018

The objectives were: 1) replicate key elements of Head Up (HUP) cardiopulmonary resuscitation (CP... more The objectives were: 1) replicate key elements of Head Up (HUP) cardiopulmonary resuscitation (CPR) physiology in a traditional swine model of ventricular fibrillation (VF), 2) compare HUP CPR physiology in pig cadavers (PC) to the VF model 3) develop a new human cadaver (HC) CPR model, and 4) assess HUP CPR in HC. Nine female pigs were intubated, and anesthetized. Venous, arterial, and intracranial access were obtained. After 6 min of VF, CPR was performed for 2 min epochs as follows: Standard (S)-CPR supine (SUP), Active compression decompression (ACD) CPR + impedance threshold device (ITD-16) CPR SUP, then ACD + ITD HUP CPR. The same sequence was performed in PC 3 h later. In 9 HC, similar vascular and intracranial access were obtained and CPR performed for 1 min epochs using the same sequence as above. The mean cerebral perfusion pressure (CerPP, mmHg) was 14.5 ± 6 for ACD + ITD SUP and 28.7 ± 10 for ACD + ITD HUP (p = .007) in VF, -3.6 ± 5 for ACD + ITD SUP and 7.8 ± 9 for ACD ...