Resuscitation
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Clinical Trial
Quality assessment of defribrillation and advanced life support using data from the medical control module of the defibrillator.
What actually occurred during the two last links in the 'chain of survival': defibrillation and advanced life support (ALS), was studied in 156 patients with cardiac arrest of cardiac aetiology using the computer recording of the defibrillator and the Utstein-style data record. Ten patients (6%) survived. The ECG artefacts caused by chest compressions enabled a detailed analysis of compression rates (median 108 min(-1)) and duration of important compression free periods. ⋯ An isoelectric period followed 38% of the shocks, and in 27% this lasted more than 20 s, with five patients obtaining electrical activity with a pulse after more than 30 s of isoelectric ECG. Thoracic impedance did not affect the shock efficacy. The method of analysing resuscitation we describe may be useful for quality improvement.
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We have demonstrated recently that therapeutic moderate hypothermia of 32-33 degrees C, induced by surface cooling under the administration of narcotics, sedatives and muscle relaxant, suppresses cytokine production after traumatic brain injury. We present here the first documented case report of augmented cytokine production in two accidental hypothermia patients, unconscious 84- (acute immersion) and 87- (non-immersion) year-old women, whose rectal temperatures were below 28 degrees C. The victims were artificially ventilated after sedation with midazolam and buprenorphine in accordance with our protocol. ⋯ Since the mechanisms for developing accidental hypothermia were different, simple comparisons between the two cases should be limited. But, these findings may suggest a need for testing a hypothesis whether cytokine modulation could be a therapeutic approach worthy of consideration. The results presented here also suggest that in hypothermia, changes in cytokine release may vary depending on procedures such as the anesthetic drugs used, the duration of the therapy, or the rate of rewarming from hypothermia.
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Comparative Study
Comparison of esophageal Doppler monitor generated minute distance and cardiac output in a porcine model of ventricular fibrillation.
The primary goal of cardiopulmonary resuscitation (CPR) is to increase cardiac output (CO), providing adequate tissue perfusion and oxygenation to maintain normal organ function. A non-invasive, easy to use, commercially available esophageal doppler monitor (EDM, Deltex) has been found to provide minute distance (MD), which is the distance moved by a column of blood through the aorta in 1 min. The goal of our study was to determine if CO measurements correlate with the EDM MD, before and during cardiac arrest, in a porcine model of ventricular fibrillation. ⋯ MD measurement using EDM, and CO measurement using florescent microsphere injections were compared before and during CPR. MD correlated well with CO (r2 = 0.96) before and during CPR. Based on the excellent correlation between MD as determined by EDM and CO by florescent microsphere technique, it appears that the non-invasive use of the EDM may play a valuable role in determination of CO during CPR.