Resuscitation
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The factors influencing the decision to initiate resuscitation in prehospital cardiac arrest patients encountered in bradyasystole due to presumed heart disease were studied. For this purpose, the characteristics and circumstances of arrest of the patients encountered in asystole and electromechanical dissociation, seen by a physician-staffed prehospital emergency care unit in a tiered emergency medical system, were reviewed. During the study period, resuscitation was initiated in 83 bradyasytolic patients. ⋯ For the patients with a witnessed arrest, the delay before treatment was initiated also affected the decision. Successful resuscitation and survival of the patients was similar to earlier reports. The results provide guidelines in the decision making of initiation of resuscitation when developing our emergency care system into one with non-physicians as advanced life support providers.
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Comparative Study
Clinical experience with three different defibrillators for resuscitation of out of hospital cardiac arrest.
Three defibrillators, one manual and two different semiautomatic, were prospectively compared during a one year period for out-of-hospital use by ordinary ambulance personnel with short additional training. Eighty-three cardiac arrest patients were treated with one of two different semiautomatic defibrillators and 26 by an ordinary manual defibrillator. Twenty-nine were found in ventricular fibrillation. ⋯ There were no differences in conversion rate or in the clinical outcome between the three defibrillators tested. Both semiautomatic defibrillators tested seemed to be safe, reliable and cost-effective. The low survival rate found is most certainly due to a long ambulance delay.
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Dye dilution curves have been used to calculate cardiac output under conditions of normal circulation. Unfortunately, these curves cannot be integrated easily to determine cardiac output under the low flow states of CPR. The time to initial dye appearance (circulation time), may be useful in judging relative changes in flow when studying experimental resuscitation techniques. ⋯ There was no correlation with the arterial-venous PO2 gradient. There were significant correlations between the circulation time and both the A-V PCO2 and the A-V pH gradients. We conclude that dye circulation times may be used to gauge relative changes in blood flow during CPR, particularly in laboratory investigations involving repeated measurements.
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Neostigmine was first used 50 years ago to treat sinus tachycardia and paroxysmal auricular tachycardia. Then there were reports of successful treatment by neostigmine of other forms of supraventricular tachycardias. However, reports of sudden death using neostigmine for reversal of neuromuscular blockade at the end of an operation, which were not properly treated with atropine abandoned the use of neostigmine as an antiarrhythmic drug. ⋯ It gave an immediate bradycardic effect in all three patients. The use of a low-dose neostigmine intravenously for an immediate treatment of supraventricular tachycardia is a novel suggestion. It has to be further evaluated and compared to the conventional drugs used like digoxin, verapamil, propranolol or esmolol.
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The authors analysed a series of 557 consecutive patients who suffered cardiorespiratory arrest at the Dante Pazzanese Institute of Cardiology (DPIC) during a period of 5 years in order to examine factors predicting successful resuscitation and long-term survival. Cardiopulmonary resuscitation (CPR) maneuvers were tried in 536 patients, with the following results: 284 patients (53%) died immediately, another 102 (19%) died within the first 24 h after the cardiac arrest and 150 patients (28%) survived more than 24 h. Among these, 65 (12.1%) died in the first month after cardiac arrest and other 29 (5.4%) died after that period. ⋯ None of the 49 patients with cyanotic congenital heart disease survived. The heart arrest was mostly caused by heart failure (55.8%) and primary arrhythmia (17.2%) in the whole group, whereas the survivor group showed primary arrhythmia in 81.7% and heart failure in 7.3%. In those patients where the initial mechanism of cardiac arrest was ventricular fibrillation, 33.2% survived more than 1 month, while among those on ventricular asystole, only 3.4% survived more than 1 month.