Resuscitation
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After successful resuscitation from cardiac arrest, prolonged contractile failure has been demonstrated in animal experiments. No systematic evaluation of myocardial contractility following successful resuscitation after human cardiac arrest exists. The aim of this study was to assess left ventricular contractility following human cardiac arrest with successful resuscitation. ⋯ The four control patients had normal left ventricular contractility on arrival (z 0.0, range - 0.9-0.8) and after 24 h (z 0.7, range - 1.5-2.7). In conclusion non-invasive wall stress analysis can be applied to quantitate systolic left ventricular function, which was severely compromised in most patients within the first 24 h after successful resuscitation. Whether depression of left ventricular function is caused by cardiac arrest itself or by the underlying disease remains speculative.
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Advanced life support (ALS) requires several different skills and the recall of complex information. The personal computer is an ideal tool for the teaching of factual information. We have developed a computer programme that simulates a variety of cardiac arrest scenarios. ⋯ Each action elicits a comment that is based upon the current European Resuscitation Council guidelines. This is then hyperlinked to an extensive help file that includes the text of the guidelines, diagrams, pictures and algorithms that aid the user in the learning of ALS skills in association with existing teaching programmes. ResusSim 98 runs under Windows 3.1, Windows 95/98 and Windows NT 4.0.
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Randomized Controlled Trial Clinical Trial
Modification of the closed circuit underwater breathing apparatus LAR V makes it suitable for cardiopulmonary resuscitation (CPR).
This pilot study was carried out in order to determine whether or not a modified closed circuit underwater oxygen rebreathing device could serve as an adjunct for ventilation during CPR in remote locations. As a control a common self-inflating bag valve ventilation device was used. ⋯ This modification of the LAR V makes it suitable for CPR performed by military divers when conventional ventilatory devices are not available. It would be necessary, however, to teach the proper use of the modified ventilation mode and to provide repeated training.
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Comparative Study Clinical Trial
A comparison of transthoracic impedance using standard defibrillation paddles and self-adhesive defibrillation pads.
The success of defibrillation is related to transmyocardial current. This current is inversely proportional to transthoracic impedance (TTI). A similar TTI between different pads and paddles is important to deliver a consistent therapeutic dose to all subjects. ⋯ Differences in TTI between A, B and C were small and probably of no clinical significance. TTI in group D is significantly larger. Although transmyocardial current is related to TTI, the relationship is complex and differences in TTI alone cannot predict the outcome from defibrillation.
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Clinical Trial
Preliminary clinical outcome study of mild resuscitative hypothermia after out-of-hospital cardiopulmonary arrest.
The effects of mild hypothermia (MH) were investigated. From 1995 to 1996, 28 adult patients with out-of-hospital cardiopulmonary arrest (CPA) had return of spontaneous circulation and survived for more than two days. Thirteen patients were in the MH group. ⋯ Eleven of 13 MH patients, as compared to 6/15 controls developed pneumonia. Our study, although preliminary, suggests that MH might confer improved outcome, as has been shown in animal models, after CPA. This treatment is associated with an increase in pneumonic complications.