Resuscitation
-
No data have been published on the relationship between advanced cardiac life support (ACLS) training of the individual who initiates resuscitation efforts and survival to discharge. ⋯ Arrest discovery by nurses trained in ACLS is significantly and dramatically associated with higher survival-to-discharge rates.
-
The importance of bystander cardiopulmonary resuscitation (CPR) prior to arrival of the emergency medical service is well documented. In Sweden, CPR is initiated prior to emergency medical services (EMS) arrival in about 30% of cardiac arrests out-of-hospital, a figure which should be improved urgently. To do so, it is of interest to know more about the bystanders' perceptions of their intervention. ⋯ Interviews described how humanity and concern for another human being were the foundation of their intervention. CPR training offers the possibility to give appropriate help in this emergency. If the aim of CPR training was extended beyond teaching the skill of CPR to include preparation of the rescuer for the intervention and his/her reactions, this might increase the number of people able to take action in the cardiac arrest situation.
-
Vasopressin (VP) shows promise as a pressor agent in animals and adult human cardiac arrest and resuscitation, but has not been studied for pressor effect in critically ill or arrested children. VP infusion is routine treatment for diabetes insipidus during brain death evaluation and organ recovery. We hypothesized that low dose VP infusion during organ recovery in critically ill children exerts a pressor effect, without major organ toxicity. ⋯ Low dose vasopressin infusion exerts a pressor effect in critically ill children treated for diabetes insipidus during brain death and organ recovery. VP treated patients were 7.3 times more likely to wean from alpha agonists than comparably managed age matched controls, without adverse affect on transplant organ function. We speculate that further prospective assessment of VP safety and efficacy as a pressor adjunct for resuscitation of critically ill children is warranted.
-
As a result of out-of-hospital defibrillation initiatives, many cities have an increasing population of out-of-hospital cardiac arrest survivors. We previously identified that one third of these patients suffer memory problems in the months after resuscitation. The pattern of memory impairment (impaired recall memory and intact recognition memory) is suggestive of hippocampal damage. ⋯ Both recall and recognition memory were poor in the cardiac arrest group. We conclude that the memory deficits that we previously observed in cardiac arrest victims are persistent. Both recall and recognition memory are affected, implying that non-selective brain injury may be the mechanism.