Resuscitation
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This study examined plasma epinephrine (E) and norepinephrine (NE) concentrations, pH, and mean arterial blood pressure (MAP) in a cardiac arrest model. Twenty-three domestic swine (15-26 kg) were anesthetized with ketamine 20 mg/kg, i.m. and alpha-chloralose 25 mg/kg, i.v. and ventilated with a respirator. Catheters were placed in the right ventricle, left ventricle and femoral arteries for MAP recordings and blood pH sampling every 2 min. ⋯ An analysis of variance revealed that the CE and I routes were significantly different (P less than 0.05) from the P group and that all three groups were different (P less than 0.05) from the C. Plasma E and NE concentrations at 0, 6, 10, 12, 20 and 30 min post arrest in the C group were, respectively: 3 and 10, 94 and 327, 119 and 329, 92 and 234, 33 and 135, and 127 and 62 ng/ml, respectively. All 3 groups receiving NaHCO3 demonstrated similar patterns and were not significantly different from C when compared with a 2-way analysis of variance.(ABSTRACT TRUNCATED AT 400 WORDS)
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Neostigmine was first used 50 years ago to treat sinus tachycardia and paroxysmal auricular tachycardia. Then there were reports of successful treatment by neostigmine of other forms of supraventricular tachycardias. However, reports of sudden death using neostigmine for reversal of neuromuscular blockade at the end of an operation, which were not properly treated with atropine abandoned the use of neostigmine as an antiarrhythmic drug. ⋯ It gave an immediate bradycardic effect in all three patients. The use of a low-dose neostigmine intravenously for an immediate treatment of supraventricular tachycardia is a novel suggestion. It has to be further evaluated and compared to the conventional drugs used like digoxin, verapamil, propranolol or esmolol.
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During a 10-year period, 5631 cardiac arrests were treated in our paramedic system. In all, 4216 resuscitations were attempted, of which 533 (12.6%) resulted in saves, defined as hospital discharges. Patients presenting with an initial rhythm of coarse ventricular fibrillation or ventricular tachycardia were found to have significantly increased save rates in comparison to those presenting with an initial arrest rhythm of asystole/fine ventricular fibrillation or electromechanical dissociation (P less than or equal to 0.01). ⋯ Advanced life support response times in saved patients with witnessed cardiac arrests were analyzed. Ninety-five percent of all saves had a response time of less than 10 min. We conclude that, when evaluating the effectiveness of CPR, the variables of witnessing of arrest, presenting arrest rhythm, and respective response times must be controlled or analyzed.
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At the end of a study program, evaluating the feasibility and the effectiveness of a unique training session on a school population, the majority of the students were asking for additional training opportunities. We therefore set up the present study with the purpose of evaluating skills, knowledge and attitude concerning CPR, after respectively one and two training sessions. 265 students from 4 different school levels were trained. 6 months later 134 answered a questionnaire and were again trained in CPR, 129 students answered the same questionnaire and were tested for their skills in CPR. Ten months later 75 students who had two training sessions answered again the questionnaire and 65 among them were tested for their skills. ⋯ The influence on attitude shows that fear to apply CPR increased significantly after one training session and does not significantly lower after the second training. This attitude seems to be rather person-linked, for no correlation was found with age, theoretical knowledge or practical skill scoring. We have no way of knowing whether the statement concerning fear to apply CPR will correspond with such an attitude when confronted with a concrete emergency situation.
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Comparative Study
The effect of cardiopulmonary bypass resuscitation on cardiac arrest induced lactic acidosis in dogs.
The adequacy of end organ blood flow following a cardiac arrest varies depending on the artificial reperfusion technique utilized and may critically affect patient outcome. Both oxygen consumption (VO2) and arterial lactate values have previously been used to assess tissue perfusion. Cardiopulmonary bypass resuscitation (CPB) is a reperfusion technique capable of providing near normal end organ blood flow. ⋯ Baseline hemodynamic and biochemical measurements were similar in both treatment groups (P greater than 0.05). Oxygen consumption (440 +/- 50 ml/min/M2) and mean arterial lactic acid values (7.44 +/- 2.25 mmol/l) were significantly higher at 1 min of resuscitation in CPB-treated dogs compared to dogs treated with CPR (60 +/- 10 ml/min/M2) (3.16 +/- 0.69 mmol/l) respectively (P less than 0.05). Mean arterial lactic acid values rose significantly at each sampling interval during CPR (P less than 0.05) but began to decrease after 5 min of resuscitation in the CPB animals and were not significantly different than baseline after 60 min of bypass (P greater than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)