Resuscitation
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Our purpose was to determine if core hypothermia influences physiological responses to norepinephrine (NE); and if rewarming reverses these effects. Animals were instrumented to measure mean arterial pressure (MAP) and cardiac output (CO). Core temperature was manipulated from 37.5 degrees C (normothermia), to 30 degrees C (hypothermia) and the back to 37.5 degrees C (rewarming) using an external arterial-venous femoral shunt. ⋯ The response to NE during hypothermia was a significant increase in MAP only at doses of 1 microg kg(-1) per min (P = 0.03) and 5 microg kg(-1) per min (P = 0.01). The response to NE after rewarming was a significant increase in MAP only at a dose of 5 microg kg(-1) per min (P = 0.03). This study shows that core hypothermia causes a change in physiological response to NE that rewarming does not reverse.
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Comparative Study
Improved haemodynamics with increased compression-decompression rates during ACD-CPR in pigs.
The haemodynamic effects of variations in the compression-decompression frequency, 60, 90 and 120 min(-1) during ACD-CPR, were tested in a randomized cross-over design during ventricular fibrillation (VF) in 12 anaesthetized pigs (17-22 kg) using an automatic hydraulic chest compression-decompression device. There were significant increases with increasing frequency for mean (+/- S. D.) carotid blood flow (17 +/- 5, 25 +/- 9 and 36 +/- 12 ml min(-1), transit time flow probe), cerebral blood flow (17 +/- 7, 30 +/- 17 and 40 +/- 13 ml min(-1) 100 g(-1), radionuclide microspheres) and mean aortic pressure (34 +/- 8, 37 +/- 10 and 43 +/- 7 mmHg), respectively. ⋯ Renal and hepatic blood flow also increased with increasing rate. No significant differences in the expired CO2 levels were observed. In conclusion increasing the compression-decompression frequency from 60 to 90 and 120 min(-1) improved the haemodynamics during ACD-CPR in a pig model with VF.
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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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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.