The American journal of emergency medicine
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Presently, there is no reliable noninvasive method of assessing the adequacy of cardiopulmonary resuscitation (CPR). Studies of animals have shown that during prolonged arrest the coronary perfusion pressure (CPP) is correlated with successful resuscitation. During previous studies it appeared that expired PCO2 correlated with CPP. ⋯ A correlation coefficient of 0.78 was calculated based on 368 data points for eight dogs (P less than 0.01). The results of this study indicate that expired PCO2 is positively correlated with CPP in the canine model of CPR. Inasmuch as CPP correlates with survival in prolonged CPR, the noninvasive measurement of PCO2 may be a useful method of assessing the adequacy of CPR.
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Comparative Study
Survival of out-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation.
Records on 1,297 people with witnessed out-of-hospital cardiac arrest, caused by heart disease and treated by both emergency medical technicians (EMTs) and paramedics, were examined to determine whether or not early cardiopulmonary resuscitation (CPR) initiated by bystanders independently improved survival. Bystanders initiated CPR for 579 patients (bystander CPR); for the remaining 718 patients, CPR was delayed until the arrival of EMTs (delayed CPR). Survival was significantly better (P less than 0.05) in the bystander-CPR group (32%) than in the delayed-CPR group (22%). ⋯ The authors conclude that early initiation of CPR by bystanders significantly improves survival from out-of-hospital cardiac arrest, and they suggest that it may do so by prolonging the duration of VF after collapse and by increasing cardiac susceptibility to defibrillation. The benefit of this early CPR, however, appears to exist within a rather narrow window of effectiveness. It must be started within 4-6 minutes from the time of collapse and must be followed within 10-12 minutes of the collapse by advanced life support in order to be effective.
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Randomized Controlled Trial Comparative Study Clinical Trial
Pre-hospital IAC-CPR versus standard CPR: paramedic resuscitation of cardiac arrests.
Recent studies evaluating interposed abdominal compression cardiopulmonary resuscitation (IAC-CPR) have demonstrated a significant increase in cardiac output, mean arterial pressure, and cerebral perfusion, as compared with standard CPR. A clinical evaluation of IAC-CPR effectiveness on resuscitation outcome has not been reported. A prospective randomized study comparing IAC-CRP with standard CPR for resuscitation of prehospital cardiopulmonary arrest was undertaken using the Milwaukee County Paramedic System. ⋯ To determine whether abdominal compression increases regurgitation, the frequency of emesis before and after intubation was analyzed. No significant difference was found between the IAC-CPR and standard CPR groups. Thus, IAC-CPR applied by paramedics in the field to patients following intubation does not improve cardiac resuscitation rates.
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This study was undertaken to determine the effect of interposed abdominal compressions (IAC) during cardiopulmonary resuscitation (CPR) on gastric insufflation when the airway is not secured with an endotracheal tube. A canine model was used in which a common ventilation pressure was applied to separate cuffed esophageal and tracheal tubes. Gas entering the stomach was collected by a pre-placed gastrostomy tube leading to a bell spirometer. ⋯ During standard CPR, measurable gastric gas volume was collected in 28 of 30 trials (mean 215 +/- 93 ml/ventilation). During IAC-CPR, in which abdominal pressure was maintained during ventilation after every 5th chest compression, measurable gastric gas was collected in 15 of 30 trials (mean 40 +/- 11 ml/ventilation). Interposed abdominal compressions as an adjunct to standard CPR may not only be of hemodynamic benefit, but may also reduce the incidence of gastric insufflation and attendant complications.