Resuscitation
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Biography Historical Article
The resuscitation greats: Douglas Chamberlain CBE DSc (Hon) FRCP FRCA FACC FESC--a man for all decades of his time.
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To investigate the implementation of mild therapeutic hypothermia (MTH) after cardiac arrest into clinical practice. ⋯ MTH is underused in German ICUs. Centres which use MTH widely follow the recommendations of ILCOR with respect to the indication and timing of cooling. In hospitals that use MTH the technique is considered to be safe and inexpensive. More efforts are needed to promote this therapeutic option and hypothermia since MTH has now been included into European advanced cardiovascular life support protocols.
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The majority of victims who experience out-of-hospital cardiac arrest (OHCA) have ventricular fibrillation (VF) as the presenting rhythm and are thought to have a cardiac etiology for their arrest. Over the past decade, the incidence of VF OHCA has declined. The aims of this study were to describe the epidemiology of OHCA of non-cardiac origin in Olmsted County MN and to determine the trends that have occurred over time. ⋯ Over the study period, 21.7% of OHCAs were non-cardiac in origin. PEA was the most common presenting rhythm and respiratory failure the most common etiology. 8.9% of patients survived. The decreasing number of VF arrests may be a contributing factor to the increasing proportion of OHCAs of non-cardiac etiology observed in the out-of-hospital setting.
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The response to exchange transfusion with red blood cells (RBCs) saturated with carbon monoxide (CO) in amelioration of microvascular function and providing tissue protection in hemorrhagic shock resuscitation was investigated in the hamster chamber window model. Shock was induced by the withdrawal of 50% of blood volume (BV). Blood volume was restored 1 h after hemorrhage with a single volume infusion (resuscitation) of 25% BV with fresh RBCs (saturated or unsaturated with CO) suspended in human serum albumin (HSA). ⋯ CO saturated blood partially mitigated cell injury at 8 h after resuscitation. The precise cellular mechanisms involved require further elucidation. CO is a novel experimental strategy to improve tissue viability and requires the appropriated preclinical studies to confirm its efficacy.