Resuscitation
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This paper reports, consistent with Utstein Style definitions, 13 years experience observing out-of-hospital cardiac arrest survivors' prognosis, longevity and functional status. We report for all patients, available outcome information for out-of-hospital cardiac arrest survivors in Göteborg Sweden between 1980 and 1993. Patients were followed for at least 1 year and some for over 14 years. ⋯ Cerebral performance categories (CPC) scores were: At hospital discharge N = 324; Data available for 320-1 = 53% (n = 171), 2 = 21% (n = 66), 3 = 24% (n = 77), 4 = 2% (n = 6). One year post arrest N = 263; Data available for 212-1 = 73% (n = 156), 2 = 9% (n = 18), 3 = 17% (n = 36), 4 = 1% (n = 2). Overall, 21% (n = 61) of cardiac arrest survivors died during the first year, and an additional 16% (n = 46) experienced another arrest. 73% of those patients who were still alive after 1 year returned to pre-arrest function.
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The effect of water temperature on the outcome of nearly drowned children was studied retrospectively. All patients under 16 years of age, who required admission to the paediatric intensive care unit (PICU) or who died despite life support measures between January 1, 1985 and December 31, 1994 in Southern Finland, were included in the study. The authors created a Near Drowning Severity Index (NDSI) and an age-adjusted NDSIage as tools to evaluate the effect of submersion duration and water temperature on the outcome of nearly drowned children. ⋯ The inclusion of age (NDSIage) in the formula did not increase predictive performance of the NDSI. With a cut-off value of 10 min, the duration of submersion alone had a sensitivity of 96.6% and specificity of 89.5% in predicting the outcome. In conclusion the effect of a potentially beneficial rapid development of hypothermia by cold water on the outcome of nearly drowned children could not be proved.
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Because closed chest cardiopulmonary resuscitation (CCCPR) achieve restoration of spontaneous circulation (ROSC) in less than 50% of cases, and because of the apparent physiological superiority of open-chest cardiopulmonary resuscitation (OCCPR), we evaluated OCCPR in out-of hospital cardiac arrest in cases who did not respond to standard external cardiopulmonary resuscitation with advanced life support. Over a period of 12 years, OCCPR was performed in 33 patients with out-of-hospital cardiac arrest arising from different causes, after unsuccessful attempts to achieve ROSC with CCCPR efforts over 7-121 min (median 25 min). With OCCPR, ROSC was achieved in 13/33 patients. ⋯ Our data suggest that OCCPR is more effective than CCCPR in achieving ROSC outside hospital in patients with major cardiac disease and prolonged arrest. OCCPR is feasible in the out-of-hospital setting. Survival without neurological deficit cannot be expected when CCCPR with no-flow is continued beyond 25 min.
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Case Reports
Gastric rupture--an uncommon complication after successful cardiopulmonary resuscitation: report of two cases.
Gastric rupture is a poorly described complication following cardiopulmonary resuscitation. An incidence of 0.1% has been reported in the literature. Published reports describe traumatic gastric rupture after use of the CardioPump, after mouth-to-mouth ventilation, and in children after resuscitation performed by paramedics. ⋯ This patient died on the 6th postinterventional day. Gastric rupture rarely occurs after cardiopulmonary resuscitation. The causes of gastric rupture and the means to avoid this complication will be discussed.
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Undetected displacement of the endotracheal tube may lead to death of the patient. The present report illustrates the benefits of using a disposable carbon dioxide detector, designed for adults, also in a new-nate during resuscitation. ⋯ The trachea was intubated, but the tube was displaced soon after return of spontaneous circulation. The oesophageal position of the tube was, however, discovered before bradycardia had occurred, thanks to the use of the CO2 detector.