Resuscitation
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Comparative Study Clinical Trial
Outcome after cardiac arrest: predictive values and limitations of the neuroproteins neuron-specific enolase and protein S-100 and the Glasgow Coma Scale.
Patients resuscitated from cardiac arrest are at risk of subsequent death or poor neurological outcome up to a persistent vegetative state. We investigated the prognostic value of several epidemiological and clinical markers and two neuroproteins, neuron-specific enolase (NSE) and S-100 protein (S-100), in 97 patients undergoing cardiopulmonary resuscitation (CPR) after non-traumatic cardiac arrest between 1998 and 2002. ⋯ The combination of GCS with the serum levels of both neuroproteins at 72 h after CPR permit a more reliable prediction of outcome in post arrest coma than the single markers alone, independent of the application of anaesthetic agents.
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The report discusses three patients who presented with pulseless electrical activity (PEA), caused by chronic respiratory disease, with bilateral tension pneumothorax. In each case needle decompression failed to relieve the tension and cardiac output was restored only after the insertion of a chest tube.
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A dramatic increase in plasma catecholamines has been demonstrated consistently following cardiac arrest and during CPR. The time course of this initial catecholamine surge after successful resuscitation has not been well studied. The purpose of this study was to measure plasma catecholamines after successful resuscitation and to determine their relationship to post-resuscitation hemodynamics. ⋯ A post-resuscitation adrenergic state is driven by a decline in MAP and PVR. Although seemingly compensatory, it may also contribute to the observed decline in cardiac function.
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The respiratory rate is an early indicator of disease, yet many clinicians underestimate its importance and hospitals report a poor level of respiratory rate recording. We studied the short- and long-term effects of introducing a new patient vital signs chart and the modified early warning score (MEWS), which incorporates respiratory rate on the prevalence of respiratory rate recording in six general wards of our hospital. Prior to the commencement of the study, the average percentage of occupied beds where at least one respiratory rate recording had been made in a single 24-h period was 29.5+/-13.5%. ⋯ The study confirms the long-term beneficial effect of introducing the MEWS system on respiratory rate recording into the general wards of our hospital. As respiratory rate abnormalities are early markers of disease, it is hoped that improved monitoring will have an impact on the nature and timeliness of the response to critical illness. This may have an impact on the future incidence of potentially avoidable cardiac arrest, deaths and unanticipated intensive care unit admission.
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Comparative Study
Effect of hypothermia on transthoracic defibrillation in a swine model.
Induced hypothermia (H) appears a promising intervention to protect the heart and brain after resuscitation from cardiac arrest. However, the influence of H on transthoracic defibrillation energy requirements is not well documented. ⋯ Severe H facilitated transthoracic defibrillation in this swine model. Since impedance rose and current fell during H, the improved shock success must be due to a hypothermia-induced change in the mechanical or electrophysiologic properties of the myocardium. Moderate hypothermia did not alter the energy requirement for defibrillation.