EP Lab Digest - April 2008 - (Page 60)

60 NEWS APRIL 2008 he authors write in the March 12 issue of JAMA, “Out-of-hospital cardiac arrest is a major public health problem and a leading cause of death. Although early defibrillation with automated external defibrillators improves survival, early defibrillation is rare and few patients with outof-hospital cardiac arrest survive. In 2004, the average survival of patients with out-of-hospital cardiac arrest was 3 percent in the state of Arizona.” MICR, previously referred to as cardiocerebral resuscitation, is a new approach to out-of-hospital cardiac arrest for emergency medical services (EMS) personnel. MICR focuses on maximizing blood flow to the heart and brain through a series of coordinated interventions, and includes an initial series of 200 uninterrupted chest compressions, rhythm analysis with a single shock, 200 immediate post-shock chest compressions before pulse check or rhythm re-analysis, early administration of epinephrine, and delayed endotracheal intubation (placement of a flexible plastic tube into the trachea for the purpose of ventilating the lungs). Bentley J. Bobrow, MD, of Mayo Clinic, Scottsdale, Arizona, and colleagues investigated New Resuscitation Approach for Out-ofHospital Cardiac Arrest Associated With Increased Survival T Continued from page 1 whether MICR would improve survival from outof-hospital cardiac arrest. Patients with out-of-hospital cardiac arrests in two metropolitan cities in Arizona before and after MICR training of fire department emergency medical personnel were assessed. In a second analysis of protocol compliance, patients from the two metropolitan cities and 60 additional fire departments in Arizona who actually received MICR were compared with patients who did not receive MICR but received standard advanced life support. Among the 886 patients with cardiac arrest in the two metropolitan cities, survival-to-hospital discharge increased from 4 of 218 patients (1.8 percent) in the before MICR training group to 36 of 668 patients (5.4 percent) in the after MICR training group. In the subgroup of 174 patients with a witnessed cardiac arrest and ventricular fibrillation, survival increased from 2 of 43 patients (4.7 percent) in the before MICR training group to 23 of 131 patients (17.6 percent) in the after MICR training group. For the protocol compliance analysis, overall survivalto-hospital discharge occurred in 69 of 1,799 patients (3.8 percent) who did not receive MICR and in 60 of 661 (9.1 percent) who received MICR. Survival with witnessed ventricular fibrillation and cardiac arrest occurred in 46 of 387 patients (11.9 percent) who did not receive MICR and in 40 of 141 patients (28.4 percent) who received MICR. “Why should MICR be associated with improved outcomes after out-of-hospital cardiac arrest? One major contributor to the poor survival rates of patients with out-of-hospital cardiac arrest is prolonged inadequate myocardial and cerebral perfusion. During resuscitation efforts, the forward blood flow produced by chest compressions is so marginal that any interruption of chest compressions is extremely [harmful], especially for favorable neurological outcomes. Excessive interruptions of chest compressions by pre-hospital personnel are common. Therefore, MICR emphasizes uninterrupted chest compressions,” the authors write. “In this study, survival-to-hospital discharge of patients with an out-of-hospital cardiac arrest improved significantly after implementation of MICR as an alternate EMS protocol. These findings require confirmation in randomized trials.” SOURCE: JAMA 2008;299[10]:1158-1165. AtriCure Coolrail Linear Ablation Pen Receives FDA 510(k) Clearance Continued from page 1 he Coolrail ™ linear ablation pen and ORLab™ system were used during a procedure performed by Dr. James R. Edgerton, a prominent cardiac surgeon from the Cardiopulmonary Research Science and Technology Institute of Dallas, Texas. The Coolrail™ linear ablation pen is designed to facilitate the creation of an expanded cardiac ablation lesion set during a minimally invasive off-pump procedure.The ORLab™ system is a mapping, recording and stimulating system that enables electrophysiologists and surgeons to confirm, in the operating room, that the cardiac ablation lines being created are forming electrical barriers, or lines of conduction block. The protocol used for mapping with the ORLab™ system was developed by electrophysiologist Dr. Warren M. Jackman. Dr. James R. Edgerton commented, “We are encouraged by the results of the combined use of T AtriCure’s Coolrail™ pen and ORLab™ system to more effectively perform an expanded cardiac ablation procedure. Based on our previous research, we anticipate that our investigation of these new products will demonstrate improved results in patients with persistent and long-standing persistent atrial fibrillation.” Dr.Warren Jackman commented,“Based on our investigation and collaboration with Dr. Edgerton, I believe that AtriCure’s minimally invasive ablation platform has the potential to become the standard of care for chronic atrial fibrillation patients.” David J. Drachman, President and Chief Executive Officer, said “During 2008 we plan on initiating enrollment in our FDA-regulated clinical trial, RESTORE SR-IIB. This prospective, non-randomized, feasibility trial will enroll 25 patients at five leading U.S. medical centers. The results of RESTORE SR-IIB will be used to design and support U.S. pivotal trials of our minimally invasive sole-therapy ablation system for the treatment of atrial fibrillation.” The FDA has cleared the AtriCure Isolator® bipolar ablation system, including the new Isolator Synergy™ ablation clamps and multifunctional and linear ablation pens, for the ablation of cardiac tissue during surgical procedures. Additionally, the FDA has cleared AtriCure’s multifunctional pen for temporary pacing, sensing, stimulating and recording during the evaluation of cardiac arrhythmias. To date, the FDA has not cleared or approved AtriCure’s products for the treatment of atrial fibrillation. AtriCure’s left atrial appendage clip system has not been approved for commercial use. It is currently being used in clinical evaluations in Europe.

Table of Contents Feed for the Digital Edition of EP Lab Digest - April 2008

EP Lab Digest - April 2008 Pediatric Electrophysiology Medical Relief Work on the Yucatan Peninsula: A Labor of Love EP 101: Considerations for the Elderly EP Patient Contents Letter from the Editor Spotlight Interview: University of Maryland A Summary of the ACC/AHA/Physician Consortium 2008 Clinical Performance Measures for Adults with Nonvalvular Atrial Fibrillation or Flutter Can Psychosocial Characteristics Predict Fatal Outcomes in Patients? Interview with Jonathan S. Steinberg, MD, FACC 10-Minute Interview: Diane D. Sheffield, RN, BSN AED Access for All: An Organization for SCA Survivors New Column: 5 Quick Clues to AV Nodal Reentry Tachycardia CMS 2008 OPPS Final Rule Review New Online AED and CPR Training Opportunities: Q & A with Keith Weaver Highlights from the 5th Annual International Arrhythmia Winter School Email Discussion Group Events Calendar Second Annual Salary Survey Industry News and Products Classifieds Advertisers Index

EP Lab Digest - April 2008

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