Resuscitation
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Based upon an anecdotal report of successful resuscitation using a toilet plunger, Cohen and co-workers have developed and investigated a hand-held suction cup as an adjunct to standard manual CPR. This new method, called active compression-decompression cardiopulmonary resuscitation, utilizes a device which is placed over the mid-sternum, approximately 1-2 inches above the lower rib cage border. Active compression-decompression cardiopulmonary resuscitation is then performed in accordance with American Heart Association guidelines at a rate equal to 80-100/min using a 50% duty cycle and compression depth of 1.5-2.0 inches. ⋯ Improved resuscitation success has also been documented in human subjects after in-hospital and pre-hospital cardiac arrest. Active compression-decompression cardiopulmonary resuscitation is a simple method which utilizes a hand held suction cup as an interface between rescuer and victim during closed chest circulatory support. This method allows for standard manual cardiopulmonary resuscitation with the addition of active chest wall decompression and appears to be a beneficial adjunct to standard manual cardiopulmonary resuscitation.
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Comparative Study
Prediction of failure to survive following in-hospital cardiopulmonary resuscitation: comparison of two predictive instruments.
The purpose of this study is to compare two clinical predictive rules, the pre-arrest-morbidity (PAM) index and the prognosis-after-resuscitation (PAR) score, which predict failure to survive following in-hospital cardiopulmonary resuscitation (CPR). The study population consisted of 274 consecutive adult patients who underwent CPR at University College Hospital in Galway, Ireland over a 2-year period. The PAM and PAR scores were calculated from the most recent data available for each variable prior to cardiac arrest. ⋯ The PAR score also had a greater area under the ROC curve, although this difference was not statistically significant (P = 0.07). In summary, the PAR score performed better than the PAM index in the identification of patients who are unlikely to survive following CPR. Although further confirmation is necessary, it may provide useful prognostic information to physicians and patients involved with decisions about do-not-resuscitate orders.
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Thrombolytic therapy has proved to be efficacious in the treatment of massive and fulminant pulmonary embolism (PE), but thrombolysis has been considered as contraindicated during cardiopulmonary resuscitation (CPR). This review on the administration of thrombolytic agents in patients who have suffered massive PE necessitating CPR summarises 14 anecdotal reports and three case series involving 34 patients. The case series revealed an overall initial survival rate of 55-100% following bolus administration of thrombolytic agents. ⋯ Surgery may be restricted to hospitals with ready access to extracorporeal circulation. We conclude that early administration of thrombolytic agents during PE necessitating CPR may help to reduce mortality. We favour the administration of urokinase (2- to 3,000,000-U bolus) or rt-PA.
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A large proportion of patients who suffer out-of-hospital cardiac arrest have asystole as the initial recorded arrhythmia. Since they have a poor prognosis, less attention has been paid to this group of patients. ⋯ Of all the patients with out-of-hospital cardiac arrest, 35% were found in asystole. Of these, 7% were hospitalized alive and 2% could be discharged from hospital. Efforts should be made to improve still further the interval between collapse and arrival of the first ambulance.