Resuscitation
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The prevalence of different CPR techniques and the use of adjuncts during the resuscitation attempt by the members of the emergency medical service (EMS) system [bystander, emergency medical technician (EMT), ward nurse, tiered nurse or paramedic, mobile intensive care unit (MICU) has been registrated prospectively during a 5-year period by 7 major Belgian EMS systems. A total of 4548 cardiac arrests have been registered, 3083 happened outside and 1465 inside the hospital. Evaluation of the methods used for assessment of quality of the CPR techniques revealed that this approach was biased both by the status of the health care provider and by the outcome of the patient. ⋯ EMT and ward nurses apply mainly the bag-valve-mask technique. The bag-valve-tube technique is more frequently used by nurses of a tiered system. The MICU-team applies usually the bag-valve-mask prior to intubation.
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Outcome of cardiac arrest (CA) is very much influenced by pre-CPR conditions. To assess the importance of these pre-CPR factors, an analysis of the Belgian CPCR registry was made according to some pre-CPR conditions. In this registry, several variables related to pre-arrest, arrest, CPR and post CPR period have been recorded in 4548 patients. ⋯ In the out-of-hospital setting the type of CA was 25% VF (LTS, 77%), 65% asystole (LTS, 4%) and 10% EMD (LTS, 3%). Outcome of the subgroup out-of-hospital, witnessed, VF is comparable to other reports. This sub-group seems to us the most appropriate for clinical trials.
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The hospital of Brugge relies on selection of the emergency calls and sends a Mobile Intensive Care Unit (MICU) whenever cardiac arrest (CA) is suspected. The University Hospital of Leuven does no selection of calls and responds to every emergency call by sending an ambulance with an advanced life support (ALS) trained nurse. The MICU is called when the ambulance crew recognizes the emergency to be a CA. ⋯ On the contrary, low versus high bicarbonate dosage has hardly any influence on immediate success (restoration of spontaneous circulatory activity) but low bicarbonate dosage favours long-term success (survival accompanied by recuperation of brain function). Our data support a negative effect on long-term survival with recuperation of consciousness from infusion of more than 1 mEq/kg body weight of sodium-bicarbonate during CPR. No final conclusions can be drawn so far as to the mechanisms of this negative effect at the level of the brain.
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CPR should be initiated in any patient who has a cardiac arrest. This might improve overall outcome but implies that CPR is started in patients without any virtual chance for long-term survival (LTS). The aim of this study is, by analysing retrospectively 2713 out-of-hospital cardiac arrests (CA), to identify indices which might be of help in the decision making to continue or to discontinue CPR. ⋯ Other patients in EMD or asystole without pupil reaction to light during CPR (1373/2713) but with efficient ECC should be resuscitated for more than 30 min, especially if the patient is gasping during CPR (LTS 27/1373). Patients in EMD or asystole on arrival of the MICU with pupil reaction to light during CPR (236/2713) should have an ALS-time of at least 45 min (LTS 42/236). Cardiac arrests in ventricular fibrillation (VF) (699/2713) should be resuscitated for at least 45 min, especially when gasping during CPR (LTS 119/699).
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An association between high glycemia on admission after resuscitation from an out-of-hospital cardiac arrest and poor neurological recovery has been reported. It remains controversial whether the high glycemia on admission causes the poor outcome or is just an epiphenomenon. The Cerebral Resuscitation Study Group therefore registered the glycemia on admission in 417 patients resuscitated after an out-of-hospital cardiac arrest. ⋯ However, there is a positive but weak correlation between the dose of adrenaline administered during CPR and the glycemia on admission. This indicates that the higher glycemia on admission in patients with a poor outcome may, at least in part, be due to CPR parameters, such as the amount of adrenaline used, that are linked with a bad prognosis. However, it cannot be excluded that a high glycemia contributes to the brain damage after cardiac arrest.