Annals of emergency medicine
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In contrast to the current consensus that governs the mechanics of prehospital advanced cardiac life support (ACLS), uniform criteria for determining when to initiate, withhold, or terminate ACLS in the field do not exist. Most emergency medical services (EMS) permit paramedics and other prehospital providers to withhold resuscitation when the victim obviously is dead, but the accuracy and appropriateness of this judgement in the field have not been subjected to empiric research. Do-not-resuscitate orders on patients in community settings often are problematic when paramedics and other prehospital providers are governed by standing orders that require them to initiate CPR when it is indicated medically. ⋯ Currently, few services permit paramedics to terminate ACLS in the field when such efforts fail to achieve return of spontaneous circulation. Studies have demonstrated convincingly that the rapid transport of such patients for further attempts at resuscitation in the hospital yields dismal rates of survival. The costs, risks, and benefits of this practice in community settings must be reviewed carefully to allocate EMS resources in an optimal manner.
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The Utstein style for uniform reporting of data from out-of-hospital cardiac arrest was developed to solve a major problem in resuscitation research. Outcome measures related to cardiac arrest are difficult to evaluate or compare because there have been no uniform definitions or uniform agreements on what data to report. Widespread acceptance of the Utstein style will lead to a better understanding of out-of-hospital cardiac arrest.
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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)