Resuscitation
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Because closed chest cardiopulmonary resuscitation (CCCPR) achieve restoration of spontaneous circulation (ROSC) in less than 50% of cases, and because of the apparent physiological superiority of open-chest cardiopulmonary resuscitation (OCCPR), we evaluated OCCPR in out-of hospital cardiac arrest in cases who did not respond to standard external cardiopulmonary resuscitation with advanced life support. Over a period of 12 years, OCCPR was performed in 33 patients with out-of-hospital cardiac arrest arising from different causes, after unsuccessful attempts to achieve ROSC with CCCPR efforts over 7-121 min (median 25 min). With OCCPR, ROSC was achieved in 13/33 patients. ⋯ Our data suggest that OCCPR is more effective than CCCPR in achieving ROSC outside hospital in patients with major cardiac disease and prolonged arrest. OCCPR is feasible in the out-of-hospital setting. Survival without neurological deficit cannot be expected when CCCPR with no-flow is continued beyond 25 min.
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Case Reports
Exogenous surfactant therapy in a patient with adult respiratory distress syndrome after near drowning.
A 24-year-old woman developed adult respiratory distress syndrome (ARDS) after near-drowning due to attempted suicide. Conventional mechanical ventilation together with prone positioning and inhaled nitric oxide could not provide sufficient oxygenation. Surface tension data (gamma min = 27 dyn/cm, stability index = 0.341) from a lavage sample supported the hypothesis that the surfactant function of this patient was drastically reduced due to a washout effect by aspiration of fresh water. ⋯ Surfactant application apparently led to a significant improvement of the respiratory function. However, the outcome could not be influenced positively. The high cost of surfactant therapy prevents the more widespread early administration in patients at risk.
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Clinical Trial
Poor correlation of mouth-to-mouth ventilation skills after basic life support training and 6 months later.
The purpose of the present study was to evaluate the cardiopulmonary resuscitation (CPR) skills of medical students after a 2-h basic life support class (n = 129) and 6 months later (n = 113). Mean +/- SD written test score decreased from 6.4 +/- 0.7 to 6.2 +/- 0.8 (P = 0.03). Mean +/- SD breaths delivered before CPR decreased from 2.9 +/- 0.6 to 2.2 +/- 1.2 (P = 0.0001), ventilation rate increased from 12.2 +/- 1.9 to 14.3 +/- 5.0 breaths/min (P = 0.0001), tidal volume increased from 0.75 +/- 0.2 to 0.8 +/- 0.31 (P = 0.11), minute ventilation from 9.1 +/- 2.6 to 10.8 +/- 3.61 (P = 0.0001), and stomach inflation from 13 +/- 22 to 18 +/- 27% of CPR breaths (P = 0.11). ⋯ In summary, ventilation skills were unpredictable; there was only a 5% chance that a given student would achieve the same mouth-to-mouth ventilation performance in both the BLS class and 6 months later. Despite the respiratory mechanics of the CPR manikin which prevented stomach inflation much better than an unconscious patient with an unprotected airway, stomach inflation occurred repeatedly. Teachers of basic life support classes need to consider the respiratory mechanics of the CPR manikin being used to assure clinically realistic and appropriate mouth-to-mouth ventilation skills.
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This paper reports, consistent with Utstein Style definitions, 13 years experience observing out-of-hospital cardiac arrest survivors' prognosis, longevity and functional status. We report for all patients, available outcome information for out-of-hospital cardiac arrest survivors in Göteborg Sweden between 1980 and 1993. Patients were followed for at least 1 year and some for over 14 years. ⋯ Cerebral performance categories (CPC) scores were: At hospital discharge N = 324; Data available for 320-1 = 53% (n = 171), 2 = 21% (n = 66), 3 = 24% (n = 77), 4 = 2% (n = 6). One year post arrest N = 263; Data available for 212-1 = 73% (n = 156), 2 = 9% (n = 18), 3 = 17% (n = 36), 4 = 1% (n = 2). Overall, 21% (n = 61) of cardiac arrest survivors died during the first year, and an additional 16% (n = 46) experienced another arrest. 73% of those patients who were still alive after 1 year returned to pre-arrest function.
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The effect of water temperature on the outcome of nearly drowned children was studied retrospectively. All patients under 16 years of age, who required admission to the paediatric intensive care unit (PICU) or who died despite life support measures between January 1, 1985 and December 31, 1994 in Southern Finland, were included in the study. The authors created a Near Drowning Severity Index (NDSI) and an age-adjusted NDSIage as tools to evaluate the effect of submersion duration and water temperature on the outcome of nearly drowned children. ⋯ The inclusion of age (NDSIage) in the formula did not increase predictive performance of the NDSI. With a cut-off value of 10 min, the duration of submersion alone had a sensitivity of 96.6% and specificity of 89.5% in predicting the outcome. In conclusion the effect of a potentially beneficial rapid development of hypothermia by cold water on the outcome of nearly drowned children could not be proved.