Resuscitation
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A retrospective 6-month audit of out-of-hospital cardiac arrests in Hong Kong following the introduction of automatic external defibrillators is presented. During the 6-month period from 1 July 1995 to 31 December 1995, resuscitation was attempted on 754 patients. Of the 744 patients with cardiac arrest whose records were available, 53.6% had a witnessed arrest. ⋯ The survival rate of 1.6% is low by world standards. To improve the survival rates of people with out-of-hospital cardiac arrest, the arrest-to-call interval must be reduced and the frequency of bystander CPR assistance increased. Once these changes are in place, a beneficial effect from the use of pre-hospital defibrillation might be seen.
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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.
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Comparative Study
Vasopressin versus epinephrine during cardiopulmonary resuscitation: a randomized swine outcome study.
In animal models, vasopressin improves short-term outcome after cardiopulmonary resuscitation (CPR) for ventricular fibrillation compared to placebo, and improves myocardial and cerebral hemodynamics during CPR compared to epinephrine. This study was designed to test the hypothesis that vasopressin would improve 24-h neurologically intact survival compared to epinephrine. After a 2-min untreated ventricular fibrillation interval followed by 6 min of simulated bystander CPR, 35 domestic swine (weight, 25+/-1 kg) were randomly provided with a single dose of vasopressin (20 U or approximately 0.8 U kg(-1) intravenously) or with epinephrine (0.02 mg kg(-1) intravenously every 5 min). ⋯ Return of spontaneous circulation (ROSC) was attained in 12/18 (67%) vasopressin-treated pigs versus 8/17 (47%) epinephrine-treated pigs, P = 0.24. Twenty-four hour neurologically normal survival occurred in 11/18 (61%) versus 7/17 (41%), respectively, P = 0.24. In conclusion, vasopressin administration during CPR improved coronary perfusion pressure, but did not result in statistically significant outcome improvement.
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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.
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Comparative Study
Electrocardiographic evaluation of defibrillation shocks delivered to out-of-hospital sudden cardiac arrest patients.
Following out-of-hospital defibrillation attempts, electrocardiographic instability challenges accurate assessment of defibrillation efficacy and post-shock rhythm. Presently, there is no precise definition of defibrillation efficacy in the out-of-hospital setting that is consistently used. The objective of this study was to characterize out-of-hospital cardiac arrest rhythms following low-energy biphasic and high-energy monophasic shocks in order to precisely define defibrillation efficacy and establish uniform criteria for the evaluation of shock performance. ⋯ Defibrillation should uniformly be defined as termination of VF for a minimum of 5-s after shock delivery. Rhythms should be reported at 5-s after shock delivery to assess early effects of the defibrillation shock and at 60-s after shock delivery to assess the interaction of the defibrillation therapy and factors such as post-shock myocardial dysfunction and the patient's underlying cardiac disease.