Articles from Resuscitation « metajournal.com

Resuscitation · Jul 2003

Rapid rewarming after mild hypothermia accentuates the inflammatory response after acute volume controlled haemorrhage in spontaneously breathing rats.

Accidental hypothermia is a common companion of trauma/haemorrhage, and several clinical studies have identified reduced body temperature as an independent risk predisposing to increased morbidity and mortality. Accordingly, the majority of trauma care guidelines prescribe early and aggressive rewarming of hypothermic patients. Enzyme reactions are generally downregulated at temperatures below 37 degrees C, including most of those responsible for the inflammatory response. ⋯ The pro-inflammatory cytokines TNF-alpha and IL-6, the anti-inflammatory cytokine IL-10, the organ markers alanine aminotransferase, alpha-glutathione S-transferase and creatinine, as well as organ injury scores were equal in both groups. Three rewarmed rats died prematurely, versus one hypothermic animal. In conclusion, the results suggest that during the early stages after haemorrhagic shock, rapid rewarming from mild hypothermia may have unfavourable effects both on basic haemodynamic variables, and on the internal inflammatory environment of cells and tissues.

Use of advanced life support skills.

The Advanced Life Support (ALS) Provider Course trains healthcare professionals in a standardised approach to the management of a cardiac arrest. In the setting of limited resources for healthcare training, it is important that courses are fit for purpose in addressing the needs of both the individual and healthcare system. This study investigated the use of ALS skills in clinical practice after training on an ALS course amongst members of the cardiac arrest team compared to first responders. ⋯ We believe that the ALS course is more appropriately targeted to members of a cardiac arrest team. In our opinion the recently launched Immediate Life Support course, in parallel with training in the recognition and intervention in the early stages of critical illness, are more appropriate for the occasional or first responder to a cardiac arrest.

Does the Mainz Emergency Evaluation Scoring (MEES) in combination with capnometry (MEESc) help in the prognosis of outcome from cardiopulmonary resuscitation in a prehospital setting?

We present an improved Mainz Emergency Evaluation Scoring (MEES) combined with capnometry. MEES combined with capnometry in a new scoring system MEESc compared with MEES is significantly better and has greater value in predicting survival after cardiopulmonary resuscitation (CPR) in patients with normothermic nontraumatic cardiac arrest. We show that higher pre-CPR and final post-CPR values of partial end-tidal CO(2) pressure (p(et) CO(2)) at the time of the return of spontaneous circulation (ROSC) are connected with improved rate of survival. ⋯ The mean of all the initial values of pet CO2 in patients without ROSC was 2.12 kPa+/-0.68 and the mean of all the final values in patients with ROSC was 3.11 kPa+/-0.55 kPa. Our study shows that the initial and final values of p(et) CO(2) of less than 2.13 kPa are connected with higher mortality rate and the values of less than 1.33 kPa incompatible with survival in normothermic nontraumatic cardiac arrest. We also must not forget the fact that prehospital use of the improved MEESc system enabled more efficient communication between the prehospital and hospital setting.