Resuscitation
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Anaesthetic residents used bag valve mask (BVM) or mouth mask (MM) ventilation, both with an O2 flow of 15 l min-1 to ventilate 30 ASA I or II anaesthetised patients for 4 min prior to endotracheal intubation. Mean nasopharyngeal O2 was higher with BVM (BVM 95% (S. D. 3%) MM 54% (S. ⋯ Gastric insufflation was detected in two MM and two BVM patients. This tended to be more severe with MM ventilation. Although MM ventilation has some important disadvantages it can be used effectively by resuscitators with little or no experience in its use.
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Comparative Study
Influence of age on the survival rate of out-of-hospital and in-hospital resuscitation.
During a 9-year period 1472 cardiopulmonary resuscitations were analysed. Five-hundred seventy-two were in-hospital and 898 out-of-hospital resuscitations. Of the out-of-hospital resuscitations 495 (55.1%) patients were less than 70 years and 403 (44.9%) older than 70 years. ⋯ The statistical analysis of the out-of-hospital resuscitations indicates no significant difference in the survival rate of patients younger than 70 years compared to those above 70 years. The survival rate however for patients above 70 years in the in-hospital group was significantly worse, probably attributed to multimorbidity of the older in-hospital patients. The results in our study indicate that old age is not a determinant of prognosis or outcome after CPR.
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The Heartstart Scotland project for out-of-hospital defibrillation covers the whole of Scotland, a population of approximately 5,102,400 (14.9% > 65 years, 48.3% male). All 395 ambulances in Scotland have been equipped with an automated external defibrillator and crews are trained in basic cardiopulmonary resuscitation and defibrillator use (EMT-D). Between 1 May 1990 and 30 April 1991 a total of 1700 cardiac arrests was reported by the ambulance service. ⋯ If the cardiac arrest was witnessed by the ambulance crew and required defibrillation, survival to discharge was 39%. Of bystander witnessed arrests reached while still in VF (n = 643), 11% were discharged alive. Patients who were defibrillated within 4 min of arrest had a 43% survival rate to hospital discharge.
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In November 1992 the European Resuscitation Council issued new guidelines which included the description of a modified recovery position. Anecdotal reports have suggested that this 'new' position may result in obstructed venous return in the dependent arm. The findings of a small study to evaluate the 'new' recovery position are reported here. ⋯ In the 'new' position 67% of the study group developed signs of venous or venous and arterial obstruction; no such complication was encountered when the same individuals were placed in the semi-prone recovery position. The need to position unconscious persons in some form of recovery position is emphasised, however, the suggestion that the semi-prone position be re-adopted is offered for discussion. Alternatively, adequate monitoring of perfusion and venous drainage in the dependent limb must be undertaken if the 'new' recovery position is chosen.
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Defibrillation of patients with primary ventricular fibrillation (VF) results in a variety of rhythm changes. We analysed these changes in rhythm in 200 patients, using the American Heart Association's recommendation of two defibrillations prior to drug therapy. Sixty-three (31.5%) patients were immediate survivors with 38 (19%) being discharged from hospital alive. ⋯ Seventeen percent (34) of patients were defibrillated to sinus rhythm after the first defibrillation and 14% (19) after the second, with similar hospital discharge rates (62% and 58%, respectively). Sixty percent (32) of patients in sinus rhythm, after two defibrillations, were discharged alive, compared to only 4% (6) of those patients not in sinus rhythm after two defibrillations. Our data provide new information on rhythm changes during resuscitation and supports the need for the earliest possible initiation of basic life support and defibrillation to improve survival from cardiac arrest due to ventricular fibrillation.