Resuscitation
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The key to improving survival from pre-hospital cardiac arrest lies in reducing the time interval between onset of cardiac arrest and defibrillation. Placing automated external defibrillators at strategic points in the community could potentially reduce this time interval, but would necessitate widespread training in defibrillation for lay people in addition to health care workers. There are unanswered questions regarding the ability of lay people to acquire and retain this skill when the training programme is, by necessity, very brief, (otherwise it would not be possible to train large enough numbers of people) and the skill is used infrequently. ⋯ Using stringent assessment criteria, 54% of volunteers passed the assessment at every session. Little difference in acquisition or retention of skills between the nurse and lay volunteers, and the 2- and 4-h course groups was found. It is concluded that brief training in defibrillation for volunteer first-aiders is feasible.
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The aim of this retrospective study was to investigate whether plasma potassium, pH and activated clotting time (ACT), obtained from a central venous blood sample immediately after admission to hospital, could predict outcome in patients with severe accidental hypothermia and cardiocirculatory arrest. Twenty-two patients rewarmed with cardiopulmonary bypass were studied retrospectively (12 patients after avalanche accidents, seven patients after cold water submersion and three patients after prolonged exposure to cold). In 12 patients stable spontaneous circulation could not be restored. ⋯ A decision to continue or terminate resuscitation cannot be based on laboratory parameters. Nevertheless, our data suggest that plasma potassium, central venous pH and ACT on admission can be used to identify hypothermic arrest victims in whom death preceded cooling. If several hypothermic arrest victims are admitted simultaneously after avalanche accidents, these 3 parameters can help not to waste limited cardiopulmonary bypass facilities for patients with no hope of survival.
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Out-of-hospital defibrillation has been shown to improve survival in out-of-hospital cardiac arrests. The maximum performance of defibrillation-based systems is dependent on the proportion of cardiac arrests due to tachyarrhythmias. We reviewed 4248 reported arrests in the Heartstart Scotland database. ⋯ None of the patients with bradycardic arrests survived. Preceding chest pain was noted in 79% of patients subsequently developing ventricular fibrillation as the cause of arrest compared to only 37% of those suffering bradycardic arrests. It would appear that public awareness of the importance of early contact with the emergency services after the onset of chest pain could substantially improve the survival from out-of-hospital arrests.
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The purpose of this study was to examine whether tracheal insufflation of oxygen (TRIO) could be used as a substitute for intermittent positive pressure ventilation (IPPV) during cardiopulmonary resuscitation (CPR) in dogs with orotracheal intubation. Twenty-seven anesthetized, paralyzed and intubated dogs were used. The tip of the insufflation catheter was placed 1 cm distal to the top of the endotracheal tube. ⋯ No significant differences were observed in arterial, pulmonary artery and diastolic right atrial pressures during CPR among the three groups. However, the coronary perfusion pressures in the TRIO group with CPAP always tended to be low during CPR. The present study suggests that TRIO without CPAP should be a promising substitute for IPPV during CPR when IPPV is not feasible.
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Comparative Study
Pentoxifylline alone versus pentoxifylline combined with superoxide dismutase prolongs survival in a rat hemorrhagic shock model.
Pentoxifylline (PTX) and superoxide dismutase (SOD) have each proven effective in improving survival when administered during resuscitation in animal models of hemorrhagic shock. This study was conducted to determine if PTX and SOD combined would have synergistic effectiveness in the treatment of hemorrhagic shock. Sprague-Dawley rats (n = 40) were phlebotomized at 25 ml/kg for 2 min, then subjected to a 45-min ischemic period, and resuscitated with lactated Ringer's solution (LR) (50 ml/kg) over 1 h. ⋯ Animals were randomized into groups to receive one of the following agents during resuscitation: PTX in LR, SOD in LR, a combination of PTX and SOD in LR, or LR alone. PTX or SOD alone were effective in prolonging survival. However, the combination of PTX and SOD did not prolong survival above LR control.