Resuscitation
-
Comparative Study
Prediction of neurological outcome after cardiopulmonary resuscitation.
In 231 patients with circulatory arrest of primary cardiovascular or pulmonary aetiology guidelines were established for predicting neurological outcome within the first year after cardiopulmonary resuscitation. Outcome measures were brain death, persistent unconsciousness, persistent disability after awakening and complete recovery. A total of 116 patients remained unconscious while 115 regained consciousness. ⋯ The time for recovery of individual neurological functions seemed to be the key to prognostication. Testing the caloric vestibular reflex or stereotypic reactivity thus differentiated patients regaining consciousness from those remaining unconscious, with positive predictive values of 0.79 and 0.77 at 1 h and negative values of 1.0 and 0.97 at 24 h as compared with 50/50 prior odds. The presence of speech at 24 h or the ability to cope with personal necessities at 72 h predicted complete recovery with positive predictive values of 0.91 and 0.92 as compared with prior odds of 0.17, whereas, the negative predictive values never exceeded prior odds of 0.83.
-
To determine if the appointment of a Resuscitation Training Officer improves survival to discharge from in-hospital ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest. ⋯ Appointment of a Resuscitation Training Officer is associated with improved survival to discharge in ventricular fibrillation and ventricular tachycardia in-hospital cardiac arrest.
-
Methods of rewarming patients with severe accidental hypothermia remain controversial. This paper reports our experience with the use of forced air rewarming in patients with severe accidental hypothermia and a body core temperature below 30 degrees C. Fifteen hypothermic patients (body core temperature 24-30 degrees C) were successfully treated with forced air rewarming to a body core temperature above 35 degrees C (mean rewarming rate 1.7 degrees C/h, range from 0.7 to 3.4 degrees C/h). ⋯ Group 2 patients needed catecholamine support during rewarming more frequently (83 versus 22%) and had higher lactate levels and lower pH values at all points of observation. In conclusion our preliminary data indicate that forced air rewarming is an efficient and safe method of managing patients with severe accidental hypothermia. The poor outcome of patients with a history of prehospital cardiopulmonary resuscitation is probably due to irreversible ischaemic brain damage in primarily asphyxiated avalanche and near-drowning victims, rather than the consequence of the rewarming method used.
-
To describe cardiac arrest data from five emergency medical services (EMS) systems in Europe with regard to survival from an out-of-hospital cardiac arrest. ⋯ Many EMS systems in Europe show extremely good results in terms of survival after an out-of-hospital cardiac arrest. Some of the results should be interpreted with caution since they were based on relatively small sample sizes. Furthermore, the results from one of the regions (Stavanger) was unit based and not community based.
-
Immersion in cold water is compatible with long-term survival, even when the period of immersion is relatively long. Guidelines for resuscitation after immersion stress the importance of prolonged resuscitation using advanced life support techniques. ⋯ Members of the emergency services, are failing to both initiate prehospital resuscitation and to continue this to hospital for victims of near drowning. There appears to be potential to reduce the drowning death rate by improving resuscitation. The emergency services and the public should be educated about the need to resuscitate those found in water.