Resuscitation
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Randomized Controlled Trial Clinical Trial
Rescuer's work capacity and duration of cardiopulmonary resuscitation.
Specific training in the techniques of cardiopulmonary resuscitation (CPR) has been the major aim of CPR education for both health care professionals and lay people over the past few decades. We performed a randomized trial to evaluate individual physiological parameters of 12 professional rescuers influencing duration and quality of standard CPR and active compression-decompression CPR. CPR duration was assessed according to individual work capacity after grouping rescuers as untrained and trained individuals, according to their work capacity of up to and including 100% and over 100%. ⋯ No changes in the forces of compression and decompression were measured during active compression-decompression CPR, thus demonstrating maintenance of constant CPR quality. Duration of resuscitation was influenced by the CPR method performed and by the individual work capacity (P = 0.004 and P = 0.027, respectively). We conclude that the duration of CPR depends both on the method applied and the rescuers' individual work capacity and recommend improvement of work capacity by aerobic training especially for professional rescuers.
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Randomized Controlled Trial Clinical Trial
Active compression-decompression resuscitation: a prospective, randomized study in a two-tiered EMS system with physicians in the field.
Improved cardiopulmonary circulation with active compression-decompression cardiopulmonary resuscitation (ACD-CPR) has been demonstrated in studies using different animal models and a small number of humans in cardiac arrest (CA). However, prehospital studies have shown both positive and no extra benefit of ACD-CPR on return of spontaneous circulation (ROSC), hospital admission and discharge rates. The aim of our prospective study was to compare standard manual CPR (S-CPR) with ACD-CPR as the initial technique of resuscitating patients with out-of-hospital CA, with respect to survival rates and neurological outcome. ⋯ Concerning complications of CPR, there was no difference between the groups. In our two-tiered EMS system with physician-staffed ambulances, ACD-CPR neither improved nor impaired survival rates and neurological prognosis in patients with out-of-hospital cardiac arrest. The new CPR technique did not increase the complications associated with the resuscitation effort.
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This study was designed to assess the interference by closed-chest cardiopulmonary resuscitation (CPR) on the ventricular fibrillation (VF) ECG signal in a porcine model of cardiac arrest and to elucidate which variable of VF spectral analysis reflects best myocardial blood flow and resuscitation success during CPR. Fourteen domestic pigs were allocated to receive either 0.4 U/kg vasopressin (n = 7) or 10 ml saline (n = 7) after 4 min of VF and 3 min of CPR. Using radiolabeled microspheres, myocardial blood flow was determined during CPR before, and 90 s and 5 min after, drug administration. ⋯ The best correlation between myocardial blood flow and fibrillation frequency was found at a median frequency range of 4.3-35 Hz. We conclude that spectral analysis of VF can provide reliable information relating to successful resuscitation. In this model after elimination of oscillations due to mechanical CPR, median fibrillation frequency best reflects the probability of resuscitation success.
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Review
Future directions for resuscitation research. IV. Innovative advanced life support pharmacology.
The topics discussed in this session include a partial review of laboratory and clinical studies examining the effects of adrenergic agonists on restoration of spontaneous circulation after cardiac arrest, the effects of varying doses of epinephrine, and the effects of novel vasopressors, buffer agents (NaHCO3, THAM, 'Carbicarb') and anti-arrhythmics (lidocaine, bretylium, amiodarone) in refractory ventricular fibrillation. Novel therapeutic approaches include titrating electric countershocks against electrocardiographic power spectra and of preceding the first countershocks with single or multiple drug treatments. These approaches need to be investigated further in controlled animal and patient studies. ⋯ Many studies on the above treatments have yielded conflicting results because of differences between healthy hearts of animals and sick hearts of patients, differences in arrest (no-flow) times and cardiopulmonary resuscitation (CPR) (low-flow) times, different pharmacokinetics, different dose/response requirements, and different timing of drug administration during low-flow CPR versus during spontaneous circulation. The need to stabilize normotension and prevent rearrest by titrated novel drug administration, once spontaneous circulation has been restored, requires research. Most of the above topics require some re-evaluation in clinically realistic animal models and in cardiac arrest patients, especially by titration of old and new drug treatments against variables that can be monitored continuously during resuscitation.