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Mean levels of coronary perfusion pressure during cardiopulmonary resuscitation (CPR). This pressure was calculated as the difference between the diastolic aortic and right atrial pressures measured simultaneously. Drug administration: In the vasopressin group, a bolus dose (0.4 U/kg) was administered. In the adrenaline group, an initial bolus dose (20g/kg) was given simultaneously with the start of a continuous infusion of adrenaline (10g/kg/min). (Paper II, n = 24)
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To the Editor.—
Recently, The Journal published "Standards for Cardiopulmonary Resuscitation and (CPR) Emergency Cardiac Care (ECC)" (227:833, 1974). Several practical points, often omitted in professional training, need emphasis.Effective CPR requires group organization. Resuscitation teaching usually consists of lectures and of practice in venti...
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... to that following adrenaline infusion (p<0.001). Also, 6 minutes after drug administration the vasopressin-treated group had a higher arterial and jugular pH and lower PCO 2 in arterial, jugular and mixed venous blood (p<0.01). Vasopressin also generated a higher coronary perfusion pressure than con- tinuous adrenaline during CPR (p<0.001) (Fig. 6). This was due to higher diastolic aortic pressure in the vasopressin group. Successful resuscitation was achieved in 12/12 pigs in the vasopressin group, but in 5/12 in the adrenaline group (p=0.005). There were no differences in cortical cerebral blood flow, cerebral oxygen extraction, cardiac output or mean arterial pressure after ...
Citations
A parada cardiorrespiratória é um evento de alta mortalidade. A isquemia cerebral difusa relacionada ao hipofluxo cerebral frequentemente leva à injúria neurológica grave e ao desenvolvimento de estado vegetativo persistente. A hipotermia terapêutica representa um importante avanço no tratamento da encefalopatia anóxica pós-parada cardíaca. Seus efeitos neuroprotetores têm sido amplamente demonstrados em várias situações de isquemia neuronal. Apesar de ser um procedimento associado com redução de mortalidade nesses pacientes, a hipotermia ainda é um tratamento subutilizado no manejo da síndrome pós-ressuscitação. Nosso objetivo é revisar aspectos referentes aos mecanismos de ação da hipotermia e seus efeitos em pacientes críticos reanimados pós- parada cardiorrespiratória e propor um protocolo assistencial simples, que possa ser implantado em qualquer unidade de terapia intensiva.
Objective: The inflammatory response after cardiac surgery increases vascular permeability leading to higher mortality and morbidity in the post operative time. The modified ultrafiltration (MUF) has shown benefits in respiratory and hemodynamic function in pediatric patients. This approach in adults is not well established yet. We hypothesize that modified ultrafiltration may improve respiratory, hemodynamic and coagulation function in adults after cardiac surgeries. Methods: A prospective randomized study was carried out with 37 patients who underwent coronary artery bypass graft surgery (CABG) were randomized either to MUF (n=20) at the end of bypass or to control (no MUF) (n=17). The anesthesia and ICU team were blinded for the group selection. The MUF were carried out for 15 minutes after the end of bypass. The patients' data were taken at beginning of anesthesia, ending of bypass, ending MUF, 24 hours, and 48 hours after surgery. For clinical outcome the pulmonary, hemodynamic and coagulation function were evaluated. Results: We observed lower drain loss in the MUF group compared to control group after 48 hours (598±123 vs. 848±455 ml; p=0.04) and required less red blood cell unit transfusions compared to control group (0.6 ± 0.6 vs.1.6±1.1 units/patient; P=0.03). The MUF group showed lower airway resistance (9.3±0.4 vs. 12.1±0.8 cmH2O.L-1s-1; P=0.04). There were no deaths in both groups. Conclusion: The MUF reduces post operatory bleeding and red blood cells unit transfusion, but with no differences on clinical outcome were observed. The routinely MUF employment was not associated with hemodynamic instability.
Objective:
To assess the level of awareness regarding basic and practical knowledge of cardiopulmonary resuscitation and its importance in the eyes of medical/dental students and doctors.
Methods:
The cross-sectional study was conducted in medical and dental colleges as well as hospitals of Rawalpindi and Islamabad, Pakistan, from June to September 2011. Non-probability convenience sampling was used and structured questionnaires on basic and practical knowledge of the procedure were distributed. The questionnaire had 26 items related to basic and advanced knowledge of the required skills. Doctors were divided into two groups based on their years of service and practice. Those with less than 5 years' experience were grouped as junior doctors, while rest as senior doctors. Descriptive statistics were employed to analyse the data using SPPS version 17 and Microsoft Excel. Percentages were worked out and the results were interpreted.
Result:
Of the 1000 questionnaires distributed, 646 (64.6%) were received duly filled and represented the study sample. Of the 646 participants, 34 (5.26%) were dentists, 424 (65.63%) were medical students, 92 (14.24%) were doctors and 96 (14.86%) were dental students. Basic knowledge of doctors was found to be better than that of dentists (n = 96; 50% vs. n = 8; 23%). Similarly, the advance knowledge of doctors was better than the dentists (n = 53; 58% vs. n = 11; 31%). The basic knowledge of junior doctors was found to be almost equal to the senior doctors (n = 26; 44.75% vs. n = 15; 45.5%). The advance knowledge of junior doctors was found to be better than the senior doctors (n = 27; 45.37% vs. n = 10; 29.48%). Among the students, 157 (37%) of the medical students had basic knowledge of CPR, while 36 (38%) dental students had basic knowledge of the topic. Medical students had more advanced knowledge (n = 157; 37%) than dental students (n = 34; 35%).
Conclusion:
The awareness of basic and advance knowledge of cardiopulmonary resuscitation skills in medical/dental students and doctors in Rawalpindi and Islamabad was inadequate.
m Falle einer kardiopulmonalen Reanimation können Menschen außerhalb von medizinischen Fachkreisen zur Atemwegssicherung lediglich auf ihre Kenntnisse der Mund-zu-Mund- bzw. Mund-zu-Nase-Beatmung zurückgreifen, welche sie in Basic-Life-Support-Kursen trainiert hatten. Hilfsmittel stehen ihnen bisher nicht zur Verfügung. Im Rahmen dieser prospektiven Untersuchung wurden 141 Laien fernab des medizinischen Mikrokosmos nach einer kurzen Schulung instruiert, vier verschiedene supraglottische Atemwegshilfen an einem Simulationsmodell zu testen, indem sie die entsprechende Maske selbständig einsetzen und mittels eines Ambubeutels ein möglichst suffizientes Atemvolumen insufflierten. Die benötigte Zeit und die Zahl der Versuchsansätze bis zur ersten suffizienten Beatmung, sowie das erreichte Atemvolumen und die Reihenfolge der Devicenutzung wurden ermittelt. Schließlich wurde der persönliche Favorit unter den Atemhilfen, die Motivation für die soeben erprobte Methode des Atemwegsmanagements und weitere Punkte zum Thema kardiopulmonale Reanimation erfragt. Die getesteten Devices waren eine Larynxmaske, eine Cobra, eine LMA Fastrach und ein Larynxtubus. Ein wesentliches Ergebnis war, dass jeder Studienteilnehmer die meisten bereits beim ersten Versuchsansatz nach einer dreiminütigen Einführung in der Lage war, eine erfolgreiche Insertion mit einer suffizienten Beatmung in der Folge zu erreichen. Die statistische Analyse der Messdaten zeigte die eindeutige Überlegenheit der LMA Fastrach gegenüber den anderen drei Masken; auch in der Bewertung der Studienteilnehmer am Ende der Simulation schnitt dieses Device am besten ab. Ferner gaben 90% der Probanden an, diese Methode des Airwaymanagements zu befürworten; 86% könnten, nach eigenen Angaben, dadurch ihre eigene Hemmschwelle im Vergleich zur Mund-Mund-zu-Beatmung reduzieren und so im Falle einer Notfallsituation eher eingreifen. 67% aller Befragten fühlten sich bereits nach dieser kurzen Studienteilnahme zur Atemwegssicherung durch Ambubeutel und Atemhilfe fähig. Diese Ergebnisse zeigen die Notwendigkeit einer Reformation des Basic Life Supports: Eine standardmässige Integration von supraglottischen Atemhilfen, insbesondere der LMA Fastrach, in Erste-Hilfe-Kurse für Laien, stellt einen wissenschaftlichen und Erfolg versprechenden Fortschritt in der präklinischen Notfallmedizin dar. Hiermit kann die Motivation und Effektivität von Rettungsmassnahmen seitens Laien deutlich gebessert werden. In the event of cardiopulmonary resuscitation nonprofessionals can only use mouth-to-mouth- or mouth-to-nose-ventilation for airwaymanagement, which they have learnt in Basic Life Support courses. Airway Devices are not yet available for them. In this prospective study 141 laypersons without any medical experience were instructed to use four different supraglottic airway devices in a simulation model after a short training session. They performed an insertion and ventilation with each device to achieve a sufficient tidal volume. The time required, the number of experimental approaches until the first sufficient ventilation, the achieved tidal volume and the order of device using were identified. Finally, the study participants were asked about their personal favorite device, their opinion concerning the just-tested method of airwaymanagement and other similar issues of cardiopulmonary resuscitation. The devices tested were a Laryngeal Mask Airway, a Cobra PLA, a LMA Fastrach and a Laryngeal Tube. A key finding was, that each study participant was able to perform a succesfull insertion and a sufficient ventilation after a short three-minute introduction most of them even on the first attempt. Statistical analysis of the data and the personal opinion of study participants after the simulation showed the clear superiority of the LMA Fastrach. Furthermore, 90 percent of the laypersons participated explained to support this method of airwaymanagement, 86 percent affirmed to reduce their own inhibitions as compared to mouth-to-mouth-ventilationin the case of emergency. 67 percent felt to be able of this method only after this short trainig. These results show the necessity of a reform of Basic Life Support: A standardized integration of supraglottic airway devices into Basic Life Support in particular the LMA Fastrach constitutes a scientific and favorable progress in pre-clinical emergency medicine. This can improve the motivation and effectiveness of resuscitation by laypersons noticeably.
Conventional defibrillators which stored no more than 400 J and used damped sine wave pulses defibrillated 240 of 253 (95%) episodes of ventricular fibrillation (VF) in 94 prospectively assessed resuscitations in 88 adults. Shocks of 80--240 J (under 3 J/kg) delivered to the chest wall defibrillated more often than higher energy levels. Defibrillation rate did not correlate with weight. Defibrillation was determined by the diagnosis and setting in which VF occurred. Patients with acute myocardial infarction (AMI) and primary VF or with coronary disease and no AMI defibrillated more easily than patients with AMI and secondary VF or with no coronary disease. VF in a terminal patient (agonal VF) defibrillated less often than VF in other clinical situations. Age, weight, delivered energy, duration of pulse wave, and duration of VF had little, if any, influence on rate of defibrillation. These data fail to support the use of more expensive, high-output defibrillators sold by 11 or 14 American manufactures.
GA,Geddes LA,Bourland JD, Korom-pai FL, Rubio PA: The electrical dose for direct ventriculardefibrillation in man. J Thorac Cardiovasc Surg75: 224, 197836. Ewy GA: Subject dependent factors in ventricular defibrilla-tidn. In Current Problems in Cardiology, vol 2 ( 1), edited byHarvey WP. Chicago, Year Book Medical Publishers, 1978,p4737. Ewy GA, Tacker WA Jr: Transchest electrical ventriculardefibrillation. AmHeart J 91: 403, 197638. DiCola VC, Freedman GS, Downing SE, Zaret BL: Myocar-dial uptakeoftechnetium-99mstannous pyrophosphate follow-ing direct current transthoracic countershock. Circulation 54:980, 197639. Lown B, Neuman J, Amarasingham R, Berkovits BV: Com-parison of alternating current with direct current electroshockacross the closed chest. AmJ Cardiol 10: 223, 196240. Peleska B: Cardiacarrhythmias followingcondenserdischargesandtheir dependenceuponstrength ofcurrentandphaseofcar-diac cycle. Circ Res 13: 21, 196341. GoldJH,
A ten-year review of the incidence of cardiac arrest in the operating suite at the St. Boniface General Hospital has been presented. Seventy cardiac arrest occurred during this period, and 29 were permanently resuscitated for a survival rate of 41.4 per cent. This rate compares favourably with the published experince of other centres. It does not, however, reflect an improvement over the survival rates published prior to 1960, a point in time when direct cardiac compression for the management of these cases was virtually abandoned in favor of external cardiac compression. To improve survival, a plea is made for return to early use of thoracotomy and direct cardiac compression in the treatment of cardiac arrest in the operating room. To accomplish this end all surgeons and anaesthetists should become familiar not only with the techniques required for these procedures, but also with the prevention and management of any associated complications.
