Annals of emergency medicine
-
Although hypothermia has been described as an emergency in suspended animation, severe degrees of hypothermia mandate appropriate aggressive intervention. Because of cardiac instability with core temperature below 28 C, aggressive invasive rewarming by F-F partial bypass is often ideal in this setting. ⋯ If the only definite criterion for diagnosis of death in hypothermia is failure to respond to resuscitation and rewarming, successful resuscitation must carefully balance aggressive and gentle interventions. Because CPR protocols involve legal as well as medical questions, additional prospective data are especially critical for resolving controversies in the initial management of profound exposure hypothermia.
-
To test the efficacy of transcutaneous pacing in prehospital bradyasystolic arrest, we applied an external transcutaneous pacing device to patients with asystole, pulseless idioventricular rhythms (PIVR), and pulseless bradycardias. Pacemaker units were carried by emergency medical services (EMS) physicians and specially trained EMS personnel. Patients were followed to determine hospital course and outcome. ⋯ The average time to application of the pacing device was 29 minutes after loss of pulse. Our data strongly suggest that delayed use of the transcutaneous pacing device does not improve the dismal survival rates of patients who suffer bradyasystolic cardiac arrest. Further studies should be directed toward investigating survival rates in patients paced immediately after the onset of cardiac arrest.
-
Approximately 25% of patients in prehospital cardiac arrest present in bradyasystolic rhythms, and their long-term prognosis is very poor. Our study was undertaken to determine the utility of immediate emergency department (ED) external cardiac pacing in this situation. Twenty patients presenting with bradyasystolic prehospital cardiac arrest were entered in the study. ⋯ An increase in the rate of bradycardia and pulseless idioventricular rhythms that was independent of electrical capture or pharmacologic therapy was noted occasionally. Although survival was not enhanced using the AEDP, the device was reliable, easy to use, and free of complications. External cardiac pacing warrants further investigation in the prehospital setting.