Annals of emergency medicine
-
Historical Article
Cardiopulmonary resuscitation research 1960-1984: discoveries and advances.
The 24-year history of cardiopulmonary resuscitation (CPR) can be divided into four eras. The first (1960-1962) was the era of serendipitous discovery and description of "closed-chest cardiac massage" by Kouwenhoven and colleagues. Closed-chest heart massage was combined with artificial ventilation, and became known as CPR. ⋯ The effectiveness had become established through widespread use in coronary care units, catheterization laboratories, and prehospital emergency systems, and open-chest cardiac massage was completely supplanted by CPR in virtually every resuscitation effort. The current era (1976-present) is the era of rediscovery and refinement, beginning with the observation that blood flow and pressure can be generated during cardiac arrest by coughing ("cough CPR"), without actual compression of the chest or heart, and that augmentation of arterial pressure and carotid blood flow resulted from simultaneous compression and ventilation (SCV-CPR or "new CPR"). The current era has provided a new explanation of the mechanism of blood flow during CPR and alternative methods of maintaining perfusion during cardiac arrest.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Standard external CPR (SECPR) steps A, B, and C can maintain the brain's viability if started immediately, but not after prolonged arrest times. "New CPR" (simultaneous ventilation-compression CPR, SVC-CPR) is not suitable for basic life support, and may not be physiologically superior to optimally performed SECPR. The superiority of interposed abdominal compression CPR (IAC-CPR) over SECPR for basic life support is also uncertain. Open-chest CPR is physiologically superior to all external CPR methods studied thus far. ⋯ Barbiturates have been shown to exert no breakthrough effect on outcome after cardiac arrest, but are safe in the hands of those skilled in advanced intensive care. Barbiturates may be of adjunctive value after prolonged cardiac arrest, particularly when used to suppress seizures, facilitate controlled ventilation, and reduce intracranial pressure. Calcium entry blockers have been shown in animal models to improve hemodynamics and cerebral outcome postarrest, but not consistently.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Cardiac output using the currently recommended closed-chest cardiopulmonary resuscitation (CPR) technique is marginal (less than 30% of control), and eventually will result in tissue hypoperfusion and lactic acidemia. Intermittent sodium bicarbonate administration currently is recommended for treatment of this metabolic acidemia, and based on available data recommended dosages are empiric but sound. In this review the potential complications of acidemia and sodium bicarbonate administration are considered from the viewpoint of resuscitation outcome. In our opinion, available data are limited, and further evaluation and consideration of sodium bicarbonate requirements in the resuscitation setting are required.
-
Comparative Study
Circulatory support during cardiac arrest using a pneumatic vest and abdominal binder with simultaneous high-pressure airway inflation.
Animal and clinical studies suggest that blood flow during closed-chest cardiopulmonary resuscitation (CPR) results from phasic intrathoracic pressure fluctuations produced by rhythmic sternal depressions rather than from cardiac compression. Using physiologic observations made in animals and human beings during circulatory collapse and vigorous coughing, a pneumatic thoracic vest garment and abdominal binder device has been designed to emulate "cough CPR." Hemodynamic findings and microsphere regional perfusion observed during cardiac arrest and airway/vest/binder inflation are comparable to those observed during simultaneous chest compression and pulmonary ventilation CPR (SCV-CPR). ⋯ The vest/binder apparatus significantly improved the coronary perfusion gradient and survival. Further studies are in progress to determine the clinical utility of this promising resuscitation adjunct.
-
Maintaining an unobstructed airway and providing adequate oxygenation and CO2 elimination, by artificial means if necessary, are among the highest priorities in all life-threatening circumstances. How this goal can best be met in the prehospital setting has become a controversial issue. The esophageal obturator airway (EOA) frequently is used in the prehospital setting, but its use and effectiveness recently have been criticized. ⋯ Many perceived EOA problems are due to poor mask fit and can be rectified. Although endotracheal intubation is the accepted standard for airway management in the apneic patient, its limitations in the prehospital setting are many. These utilization problems and complications remain undefined and must be addressed.