Resuscitation
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Comparative Study
Mild hypothermia after cardiac arrest in dogs does not affect postarrest cerebral oxygen uptake/delivery mismatching.
To compare measurements of cerebral arteriovenous oxygen content differences (oxygen extraction ratios, oxygen utilization coefficients) in dogs after cardiac arrest, resuscitated under normothermia vs. mild hypothermia for 1-2 h or 12 h. ⋯ After prolonged cardiac arrest, critically low cerebral venous O2 values suggest inadequate cerebral O2 delivery. Brief or prolonged mild hypothermia after arrest does not mitigate the postarrest cerebral O2 uptake/delivery mismatching.
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Comparative Study
Resuscitation time limits in experimental pulseless electrical activity cardiac arrest using cardiopulmonary bypass.
The objective of this study was to determine the time limits of resuscitation following increasing intervals of untreated pulseless electrical activity using cardiopulmonary bypass as the resuscitation tool. ⋯ Cardiopulmonary bypass is effective at restoring spontaneous circulation when used early in asphyxial pulseless electrical activity cardiac arrest. Cardiopulmonary bypass is less effective when used after 15 min of pulseless electrical activity with no survivors following 20 min of arrest.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Early defibrillation by emergency physicians or emergency medical technicians? A controlled, prospective multi-centre study.
In a controlled, prospective multi-centre study, defibrillation by emergency medical technicians (EMTs) was compared with the current standard of care in Germany--defibrillation by emergency physicians (EPs)-in order to answer the following questions: can EMTs in a two-tiered emergency medical services (EMS) system with physicians in the field defibrillate earlier than, and as safely as EPs? Does defibrillation by EMTs (study group) affect survival rate and long-term prognosis of patients in ventricular fibrillation (VF), as compared with the current national standards in resuscitation (basic cardiopulmonary resuscitation (CPR) by EMTs, and defibrillation by physicians: control group? ⋯ In our study, EMT defibrillation was equally effective as defibrillation by EPs, but failed to improve survival rates or long-term outcome of patients in VF significantly, compared to EP defibrillation. Due to a reduction in the time intervals from collapse to defibrillation and to ROSC, as well as in adrenalin doses, by EMT-defibrillation, EMTs in Germany should defibrillate if they reach a patient prior to an EP, provided they have received continuous medical training and supervision.
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Using 14 mongrel dogs, we investigated the correlation between arteriovenous differences of PCO2 (AVD-CO2) and cardiac output (CO) during CPR. Ventricular fibrillation was induced by an electrical current and the respirator was stopped for 5 min. Cardiopulmonary resuscitation (CPR) was performed during the next 10 min and CO was measured with simultaneous arterial and venous blood gas analysis. ⋯ AVD-CO2 in the low CO group was 39.8 +/- 5.7 mmHg and that of the high group was 27.4 +/- 14.8 mmHg (mean +/- S. D., P < 0.05). In conclusion, AVD-CO2 showed an inverse result with the degree of CO during CPR.
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The ability to predict outcomes of cardiac arrest before starting cardiopulmonary resuscitation (CPR) would be useful for discussions of resuscitation with elders and their families. We thought CPR outcome might be dependent on the severity of pre-existing illnesses. The APACHE II is a severity-of-illness (SOI) scale based, in part, on physiologic parameters whereby points are given for degree of deviation from normal. ⋯ For the young cohort (n = 126; age, < 70; mean age, 59 +/- 8), mean admission APACHE II was 16.5 +/- 7.9 and pre-arrest APACHE II regression analysis.2+ carried out with both APACHE II scores and factors previously correlated with CPR outcome. Witnessed arrests and those requiring a low number of medications were most likely to result in immediate success (restoration of blood pressure) and in a live discharge. APACHE II score (24 h pre-arrest) was associated with live discharge in the regression analysis.(ABSTRACT TRUNCATED AT 250 WORDS)