Annals of emergency medicine
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When the abdomen is compressed manually in counterpoint to the rhythm of chest compression, in the performance of interposed abdominal compression-CPR, artificial circulation is approximately doubled in animal experiments and in electronic models of the circulatory system. These studies suggest that external manual compression of the abdominal aorta acts like an intra-aortic balloon pump to increase aortic pressure, whereas external manual compression of the abdominal veins acts to prime the right heart and pulmonary vessels before the next chest compression. ⋯ Several clinical studies of this technique have shown promising results including improved hemodynamics, resuscitation success, and survival. The history of interposed abdominal compression-CPR research suggests a number of principles that may be useful in the development of other new methods for the management of cardiac arrest, including the virtues of vigorously pursuing a new idea suggested by serendipitous observations, developing and refining a working hypothesis as to pathophysiologic mechanisms, working in interdisciplinary groups, refining a novel technique in stages as experience is gained, and recognizing the need for staged phase 1, 2, and 3 clinical trials in the context of the approximately ten-year gestation period from laboratory inspiration to clinical practice.
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Estimating the duration of ventricular fibrillation may help determine the best initial therapy and provide estimates of the most appropriate dose of epinephrine to administer during cardiac arrest and resuscitation. In addition, estimating this time can provide a more sound methodologic approach to stratifying patients in the analysis of cardiac arrest studies. In an initial series of studies in swine, we attempted to determine whether changes in the frequency or amplitude (power) of the ventricular fibrillation ECG signal during cardiac arrest could be used to estimate this time. ⋯ We recently characterized the time course of the median frequency during ventricular fibrillation in human beings. The median frequency was extracted from each four-second segment of the ventricular fibrillation ECG recordings and plotted versus time from the onset of cardiac arrest. The median frequency in human beings followed a repeatable time course during ventricular fibrillation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Review Comparative Study
The complexity of comparing different EMS systems--a survey of EMS systems in Europe.
In Europe, emergency medical care has developed since the Middle Ages in each country, even within regions of a country, resulting in a patchwork of definitions, legislations, and systems. As a consequence, emergency medical care was implemented differently according to sociocultural, geographic, political, and religious differences between and within individual European countries. The objective of this survey was to describe the emergency medical services (EMS) systems in place throughout Europe, the type and qualification of the personnel, citizen-CPR knowledge, and experiences with automated external defibrillator programs. ⋯ To describe the EMS system, a uniform nomenclature is required. The Utstein "template" style could be proposed as the guideline to describe individual systems. The European Resuscitation Council could contribute in coordinating and standardizing the various aspects of emergency medical care in Europe, with detailed registration, medical coordination, and medical regulation being the principal working rules.
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To add to our understanding of survival rates in out-of-hospital cardiac arrest studies, we examined the incidence of cardiac arrest in the published literature. We specifically estimated if incidence rates are uniform between communities and if any relationship exists between incidence and the reported survival rates. ⋯ The marked variations in incidence and inverse relationship between incidence and survival could be due to true variation in risk among the populations reported (ie, some populations may be older or sicker than others). Also, different research methodologies may create artifactual differences among studies as standards for designing studies, terminology, and reporting data have not been uniform. Therefore, these findings may reflect methodological differences and true epidemiological differences among communities. Future reports should include a method, such as an incidence/survival nomogram, to analyze survival rates while taking into account the community incidence rate of cardiac arrest. Further analysis of incidence and survival is necessary to improve intersystem comparisons, a prerequisite to sound decisions about cardiac arrest treatment, health policy, and allocation of resources.