Resuscitation
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Comparative Study
Thiopental and phenytoin by aortic arch flush for cerebral preservation during exsanguination cardiac arrest of 20 minutes in dogs. An exploratory study.
We are systematically exploring in our exsanguination cardiac arrest (CA) outcome model in dogs suspended animation (SA), i.e. immediate preservation of brain and heart for resuscitative surgery during CA, with delayed resuscitation. We have shown in dogs that inducing moderate cerebral hypothermia with an aortic arch flush of 500 ml normal saline solution of 4 degrees C, at start of CA 20 min no-flow, leads to normal functional outcome. We hypothesized that, using the same model, adding thiopental (or even better thiopental plus phenytoin) to the flush at ambient temperature (24 degrees C), which would be more readily available in the field, will also achieve normal functional outcome. ⋯ Thiopental in large doses caused side effects. We conclude that neither thiopental alone nor thiopental plus phenytoin by flush, with or without additional intravenous infusion, can consistently provide 'clinically significant' cerebral preservation for 20 min no-flow. Other drugs and drug-combinations should be tested with this model in search for a breakthrough effect.
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Comparative Study
Differences in the pharmacodynamics of epinephrine and vasopressin during and after experimental cardiopulmonary resuscitation.
Vasopressin has been investigated as a possible alternative to epinephrine during cardiopulmonary resuscitation (CPR). We tested the hypothesis that vasopressin, in comparison with epinephrine, would improve cerebral blood flow and metabolism during CPR as well as after restoration of spontaneous circulation (ROSC). A total of 22 anaesthetised piglets were subjected to 5 min of ventricular fibrillation followed by 8 min of closed-chest CPR. ⋯ During the initial 5 min following ROSC, cerebral cortical blood flow was greater in the vasopressin group. In conclusion, there is a difference between epinephrine and vasopressin in the time from injection to maximal clinical response and the duration of their effect, but their overall effects on blood pressures and cerebral perfusion do not differ significantly during CPR. In contrast, vasopressin results in a greater cerebral cortical blood flow during a transient period after ROSC.
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Six adult cadavers had 40 N cricoid pressure applied using a cricoid 'yoke' whilst maintaining manual in-line stabilisation of the cervical spine. No other spinal supports were used. Lateral radiographs were taken before and after applying pressure to the cricoid cartilage and the degree of cervical spine movement accurately determined. ⋯ There was no disruption to the lines formed by the anterior or posterior borders of the cervical bodies. We have been unable to demonstrate that single-handed cricoid pressure causes clinically significant displacement of the cervical spine in a cadaver model. This conflicts with previous studies.
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Comparative Study Retracted Publication
Usefulness of two-dimensional echocardiography and myocardial perfusion imaging for immediate evaluation of chest pain in the emergency department.
Accurate identification of patients in the emergency department at high risk of acute coronary syndrome with possible myocardial ischaemia and a nonischaemic electrocardiogram is problematic. Both two-dimensional echocardiography and myocardial perfusion imaging with technetium-99m-sestamibi can identify patients at low and high risk, however comparative studies are lacking. ⋯ Agreement between the two imaging techniques is high when used in patients with possible myocardial ischaemia. Both techniques identified patients at high risk who required admission and those who could be safely discharged directly from the ED.
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Comparative Study
Is there a difference between women and men in characteristics and outcome after in hospital cardiac arrest?
To describe the characteristics and outcome among patients suffering from an in-hospital cardiac arrest in women and men. ⋯ Thirty nine percent of patients suffering in-hospital cardiac arrest for whom the CPR-team was alerted, were women. Women were less frequently found in VF/VT than men. After correcting for dissimilarities at baseline, female gender was associated with a small improvement in survival.