Resuscitation
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Comparative Study
Permeability studies in a hypovolemic traumatic shock model: comparison of Ringer's lactate and albumin as volume replacement fluids.
In order to shed light on the controversy surrounding the choice of resuscitative fluids in shock, we used a canine model which we feel to be a superior mimic of human traumatic shock, combining hemorrhage (to a mean arterial pressure of 50 mmHg), fracture of both femora, and soft tissue crush. After 90 min, animals were resuscitated by reinfusion of shed blood, supplemented by 5% albumin (n = 8) or lactated Ringer's solution (n = 8). Plasma colloid osmotic pressure (COP), transcapillary escape rate for albumin (TER), total lung water and extravascular lung water (EVLW) were measured. ⋯ TER rose 30% per hour, without difference between groups. Quality of resuscitation (achieved blood pressure and cardiac output) was somewhat better in the albumin group. We conclude that this model allows study of the early microvascular leakage seen in shock; within the time-frame studied (maximum 4.5 h following shock), colloid and crystalloid resuscitation were approximately equivalent.
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Apneic asphyxia to cardiac arrest (CA) in rats of 10 min was reversed by cardiopulmonary resuscitation (CPR), and after controlled ventilation and controlled normotension for 20 min, was followed by decapitation and brain freezing, and determination of brain concentrations of cytosolic and lysosomal enzymes. Normal values came from a control group of 10 rats without CA. In 20 rats with CA brain cytosolic enzymes CK, LD, and ASAT decreased post-arrest, while lysosomal enzyme changes were variable (Table I). ⋯ The lysosomal enzymes acid phosphatase, mannosidase, beta-glucuronidase and hexosaminidase showed variable concentration changes post-CA in the four groups, with a trend toward a lesser increase of some after MP or after post-treatment. Brain enzyme changes in our asphyxial CA rat model can serve as markers of brain damage. MP post-CA might enhance cardiovascular and EEG recovery, but does not seem to influence brain enzyme levels at 20 min post-CA.
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The prevalence of different CPR techniques and the use of adjuncts during the resuscitation attempt by the members of the emergency medical service (EMS) system [bystander, emergency medical technician (EMT), ward nurse, tiered nurse or paramedic, mobile intensive care unit (MICU) has been registrated prospectively during a 5-year period by 7 major Belgian EMS systems. A total of 4548 cardiac arrests have been registered, 3083 happened outside and 1465 inside the hospital. Evaluation of the methods used for assessment of quality of the CPR techniques revealed that this approach was biased both by the status of the health care provider and by the outcome of the patient. ⋯ EMT and ward nurses apply mainly the bag-valve-mask technique. The bag-valve-tube technique is more frequently used by nurses of a tiered system. The MICU-team applies usually the bag-valve-mask prior to intubation.
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Outcome of cardiac arrest (CA) is very much influenced by pre-CPR conditions. To assess the importance of these pre-CPR factors, an analysis of the Belgian CPCR registry was made according to some pre-CPR conditions. In this registry, several variables related to pre-arrest, arrest, CPR and post CPR period have been recorded in 4548 patients. ⋯ In the out-of-hospital setting the type of CA was 25% VF (LTS, 77%), 65% asystole (LTS, 4%) and 10% EMD (LTS, 3%). Outcome of the subgroup out-of-hospital, witnessed, VF is comparable to other reports. This sub-group seems to us the most appropriate for clinical trials.
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The hospital of Brugge relies on selection of the emergency calls and sends a Mobile Intensive Care Unit (MICU) whenever cardiac arrest (CA) is suspected. The University Hospital of Leuven does no selection of calls and responds to every emergency call by sending an ambulance with an advanced life support (ALS) trained nurse. The MICU is called when the ambulance crew recognizes the emergency to be a CA. ⋯ On the contrary, low versus high bicarbonate dosage has hardly any influence on immediate success (restoration of spontaneous circulatory activity) but low bicarbonate dosage favours long-term success (survival accompanied by recuperation of brain function). Our data support a negative effect on long-term survival with recuperation of consciousness from infusion of more than 1 mEq/kg body weight of sodium-bicarbonate during CPR. No final conclusions can be drawn so far as to the mechanisms of this negative effect at the level of the brain.