Resuscitation
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Of 954 attempted resuscitations outside hospital performed by ambulance personnel, 48 patients (5%) had primary respiratory arrest. Comparing this group with those manifesting cardiorespiratory arrest, patients with primary respiratory arrest were significantly more likely to be female (25 of 48 vs 269 of 906-P < 0.005), were more likely to have a non-cardiac cause (67% vs. 22%-P < 0.00001) and more likely to have witnessed arrest. Of all arrests witnessed by ambulance crew, 35% were respiratory arrests. ⋯ Outcome was significantly better, with 19 patients (40%) being discharged compared to only 49 patients (5.1%) discharged in cases of cardiorespiratory arrest (p < 0.00001). Considering that many respiratory arrests were witnessed by ambulance crew, the type of crew (EMT or paramedic) made no difference to outcome. Our findings suggest that patients manifesting respiratory arrest outside hospital are a heterogeneous group who have a relatively good prognosis regardless of the type of ambulance crew that attends.
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During uncontrolled hemorrhagic shock (UHS) in acute animals models, attempts to achieve normotension with i.v. fluid resuscitation (FR) caused further bleeding and higher acute mortality. In the absence of a published clinically realistic long-term animal outcome study of UHS, we developed such a model in rats. In the preliminary study, phase I of the model involved 60 min of simulated 'pre-hospital' UHS by tail amputation and different FR regimens. ⋯ In group 1, without FR in phases I and II, all 10 rats died by 12 h. In group 2, without FR in phase I and hemostasis plus all-out FR with lactated Ringer's solution and blood to hematocrit (Hct) 30% in phase II, 5 of 10 rats died at the end of phase I and 9 of 10 died at the end of phase III. This final volume-initiated UHS model may be suitable for comparing different pre-hospital treatment modalities in terms of outcome.
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Randomized Controlled Trial Clinical Trial
Standard doses versus repeated high doses of epinephrine in cardiac arrest outside the hospital.
Among all of the cathecolamines used for cardiac arrest treatment, epinephrine injection during cardio-pulmonary resuscitation is currently the most powerful means of enhancing effectiveness; however, deliberations about the optimal dosage have recently become intense. In the SAMU of Lyon (F), we conducted a double blind prospective randomized study over an 18-month period, comparing repeated standard-dose epinephrine (1 mg) and repeated high-dose epinephrine (5 mg) in the management of cardiac arrest outside the hospital. Five-hundred thirty-six patients were enrolled with 265 in the standard-dose group and 271 in the high-dose group; both groups are globally similar. ⋯ We never noticed cardiac or neurologic adverse effects with the high doses. The results of this study are not statistically significant, but we observed a marginal trend towards repeated 5 mg epinephrine doses. A large French multicentre study is now necessary.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of exertion required to perform standard and active compression-decompression cardiopulmonary resuscitation.
Active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) utilizes a hand-held suction device with a pressure gauge that enables the operator to compress as well as actively decompress the chest. This new CPR method improves hemodynamic and ventilatory parameters when compared with standard CPR. ACD-CPR is easy to perform but may be more labor intensive. The purpose of this study was to quantify and compare the work required to perform ACD and standard CPR. ⋯ Approximately 25% more work is required to perform ACD-CPR compared with standard CPR. Both methods require subanaerobic energy expenditure and can therefore be sustained for a sufficient length of time by most individuals to optimize resuscitation efforts. Due to the slightly higher work requirement, ACD-CPR may be more difficult to perform compared with standard CPR for long periods of time, particularly by individuals unaccustomed to the workload requirement of CPR, in general.
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Randomized Controlled Trial Clinical Trial
The technique of endobronchial lidocaine administration does not influence plasma concentration profiles and pharmacokinetic parameters in humans.
This study investigated plasma concentration profiles, pharmacokinetic characteristics and side-effects of lidocaine following 3 different administration techniques. Sixty ASA I/II patients undergoing elective ENT-operations were randomised into 4 groups. Lidocaine 1% (1 mg/kg) was administered 50 min before the end of the operation, via a regular endotracheal tube (group 1), a suction-catheter deep endobronchially (group 2), or an EDGAR-(Endobronchial-Drug and Gas Application during Resuscitation)-tube characterized by a separate injection channel ending at the orifice of the tube (group 3). ⋯ Patients from group 3 were ventilated continuously because of a separate injection channel integrated in the EDGAR-tube. Sore throat was significantly increased in group 2 as compared with groups 1, 3 and 4. Asorption of lidocaine in groups 1-3 resulted in maximal mean plasma concentrations ranging from 0.78 to 0.85 micrograms/ml after 16.9 to 22.4 min.(ABSTRACT TRUNCATED AT 250 WORDS)