Resuscitation
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Open-chest cardiac massage (OC-CM) provides higher blood pressure and flow than closed-chest compression and may improve the probability of successful resuscitation from cardiac arrest. Its clinical use has been limited by its requirement for a major thoracotomy. The present pilot study tested the technical feasibility of performing effective direct cardiac massage without a major thoracic incision, by using a simple, manually-powered plunger-like device, inserted through a small thoracic incision, to cyclically compress the cardiac ventricles. The method was termed minimally-invasive direct cardiac massage (MID-CM). Systemic blood flow using MID-CM was compared to that with OC-CM, by both direct systemic hemodynamic measurements, cumulative metabolic indicators of the ratio of whole body oxygen delivery and oxygen consumption, and a metabolic index of pulmonary blood flow. ⋯ Systemic Blood Pressure: Aortic systolic and diastolic blood pressures were reduced from baseline levels with both OC-CM and MID-CM. No difference in pressure was noted between OC-CM and MID-CM groups. Pulmonary Artery Pressure: Pulmonary artery systolic pressure was elevated from baseline during OC-CM and MID-CM. Pulmonary artery diastolic pressures remained constant throughout the resuscitation period in both groups. No differences in pulmonary systolic or diastolic pressure were noted between OC-CM and MID-CM groups. A trend towards higher pulmonary systolic pressures appeared with MID-CM. Thermodilution Blood Flow: Cardiac index fell from baseline levels with OC-CM and MID-CM. No difference in cardiac index was noted between OC-CM and MID-CM groups. Metabolic Indices: Mixed venous O2 saturation decreased from baseline levels during resuscitation in both experimental groups, with a further decrease at 30 min compared to 10- and 20-min levels. No difference was noted between OC-CM and MID-CM groups at any point. Arterial pH was reduced from baseline levels at 30 min in both groups compared to baseline but no difference was noted between groups.(ABSTRACT TRUNCATED AT 400 WORDS)
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Randomized Controlled Trial Clinical Trial
Buffer therapy during out-of-hospital cardiopulmonary resuscitation.
The effects of infusing a buffer solution on resuscitability and outcome was tested in patients during out-of-hospital cardiac arrest. A number (502) of adults with asystole or ventricular fibrillation with failure of first defibrillation attempt were entered into a prospective, randomized, double-blind, controlled trial. Of these, 245 patients received 250 ml of sodium bicarbonate-trometamol- phosphate mixture with buffering capacity 500 mmol/l and 257 patients received 250 ml 0.9% saline. ⋯ Mean base excess at hospital admission was -9 after Tribonat vs. -11 after saline (P = 0.04, CI for difference 0.2-3.8). Only 16 of the 502 patients had arterial alkalosis on arrival in the hospital and no patient had a positive base excess. Patients resuscitated after out-of-hospital cardiac arrest had metabolic acidosis, but buffer therapy did not improve the outcome.
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Survival among patients with out-of-hospital cardiac arrest found in electromechanical dissociation.
Many patients who suffer an out-of-hospital cardiac arrest are found in electromechanical dissociation at the time the Emergency Medical Service (EMS) arrives. Since they have a poor prognosis, less attention has been paid to them. ⋯ Of all the patients with out-of hospital cardiac arrest in whom CPR was attempted by our EMS, 22% were found in electromechanical dissociation. Of these, 13% were hospitalized alive and 2% could be discharged from the hospital. No independent predictor of an increased chance of survival was found.
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The aim of our prospective study was to evaluate the effects of a standardized mega-code and arrhythmia training upon process elements of quality of pre-hospital advanced cardiac life support provided by a physician-staffed mobile intensive care unit. In 145 cases of adult cardiac arrest due to cardiac aetiology, time intervals from arrival of the mobile intensive care unit at the patient's side until first ECG diagnosis, first defibrillation, endotracheal intubation, and first epinephrine administration were measured with on-line tape recording, prior to, and following a standardized 8-h arrhythmia and mega-code training. ⋯ Neither admission nor discharge rates differed significantly before and after the training. Thus, practical training including rhythm analysis and mega-code session improved the performance of our mobile intensive care unit in cases of asystole and pulseless electrical activity, and, hence, process elements of quality.
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Comparative Study
A peer-training model for instruction of basic cardiac life support.
This study evaluates a peer-training model for cardiopulmonary resuscitation (CPR) instruction for laypersons. Forty-one Norwegian factory employees were trained in CPR and given instructor training. These first trainees then trained 311 co-workers. ⋯ The performance of the Norwegians trained at home by peers did not differ from that of the ARC: Adult CPR trainees in six skills of the initial sequence of CPR. The home trainees outperformed the ARC: Adult CPR trainees in the proportion of compressions delivered correctly (P = 0.032) and ventilations delivered correctly (P = 0.015). Peer training may provide CPR instruction comparable to training in CPR classes at lower cost and with potential to reach new population segments.