Resuscitation
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Blood flow during conventional cardiopulmonary resuscitation (CPR) is usually less than adequate to sustain vital organ perfusion. A new chest compression device (LifeBelt) which compresses both the sternum and the lateral thoraces (compression and thoracic constraint) has been developed. The device is light weight, portable, manually powered and mechanically advantaged to minimize user fatigue. The purpose of this study was to evaluate the mechanism of blood flow with the device, determine the optimal compression force and compare the device to standard manual CPR in a swine arrest model. ⋯ Blood flow with the LifeBelt device is primarily the result of cardiac compression. At a sternal force of 100-130 lb (45-59 kg), the device produces greater CPP than well-performed manual CPR during resuscitation from prolonged VF.
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Clinical and experimental studies have shown that marked activation of blood coagulation occurs in cardiac arrest (CA) and cardiopulmonary resuscitation (CPR). Extracorporeal lung and heart assist (ECLHA) is applied in CA patients who cannot be rescued using conventional therapies. We hypothesized that the dose of heparin administered during the pre-arrest period would influence the outcome in a canine model of CA induced by 15 min of normothermia followed by ECLHA, which consists of heparin coating membrane lung and tubing. We therefore investigated the effects of two dose regimes of the pre-arrest heparin for this model. ⋯ The use of ECLHA to resuscitate animals in prolonged CA may require a large dose of systemic heparin during the pre-arrest period even if ECLHA circuit was coated with heparin.
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Randomized Controlled Trial Multicenter Study
Survival from prehospital cardiac arrest is critically dependent upon response time.
This study correlated the delay in initiation of bystander cardiopulmonary resuscitation (ByCPR), basic (BLS) or advanced cardiac (ACLS) life support, and transport time (TT) to survival from prehospital cardiac arrest. This was a secondary endpoint in a study primarily evaluating the effect of bicarbonate on survival. ⋯ Delay to the initiation of BLS and ACLS intervention influenced outcome from prehospital cardiac arrest negatively. There were no survivors after prolonged delay in initiation of ACLS of 30 min or greater or total resuscitation and transport time of 90 min. This result was not influenced by giving bicarbonate, the primary study intervention, except at longer arrest times.
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Randomized Controlled Trial
The quality of chest compressions by trained personnel: the effect of feedback, via the CPREzy, in a randomized controlled trial using a manikin model.
Even after training, the ability to perform effective cardiac compressions has been found to be poor and to decrease rapidly. We assessed this ability with and without a non-invasive feedback device, the CPREzy, during a 270s CPR session in an unannounced, single-blinded manikin study using 224 hospital employees and staff chosen at random and using a non-cross over design. The two groups self-assessed their knowledge and skills as adequate. ⋯ If compressions were effective initially, the time until >50% of compressions were less than 4 cm deep was 75+/-81s in the control group versus 194+/-87 s in the CPREzy group (P=0.0001 [-180 to -57.5]). After a few seconds of training in its use, our candidates used the CPREzy effectively. Against the background knowledge that estimation of compression depth by the rescuer or other team members is difficult, and that performing effective compressions is the cornerstone of any resuscitation attempt, our data suggests that a feedback device such as the CPREzy should be used consistently during resuscitation.
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We sought to evaluate the knowledge of probable outcome by medical personnel for in-hospital and out-of-hospital cardiac arrests, and self-reported history of CPR training referrals for family members of cardiac patients. ⋯ This study demonstrates that medical experience is not associated with accurate estimates of cardiac arrest survival. Overwhelmingly, medical personnel believe family members should be trained to perform CPR, however, few refer family members for CPR training.