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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Prevalence of bystander CPR and effect on outcome has been evaluated on 3053 out-of-hospital cardiac arrest (CA) events. Bystander CPR was performed in 33% of recorded cases (n = 998) by lay people in 406 cases (family members 178, other lay people 228) and by bystanding health care workers in 592 cases (nurses 86, doctors 506). Family members and lay people mainly applied CPR in younger CA victims at public places, roadside or at the working place. ⋯ In non-witnessed arrests of cardiac origin early and late survival are significantly higher in patients receiving bystander CPR. In CA events where response time of ALS exceeds 8 min, the beneficial effect of bystander CPR is most significant. Furthermore no deleterious effect of bad technique or inefficient bystander CPR can be demonstrated.
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CPR should be initiated in any patient who has a cardiac arrest. This might improve overall outcome but implies that CPR is started in patients without any virtual chance for long-term survival (LTS). The aim of this study is, by analysing retrospectively 2713 out-of-hospital cardiac arrests (CA), to identify indices which might be of help in the decision making to continue or to discontinue CPR. ⋯ Other patients in EMD or asystole without pupil reaction to light during CPR (1373/2713) but with efficient ECC should be resuscitated for more than 30 min, especially if the patient is gasping during CPR (LTS 27/1373). Patients in EMD or asystole on arrival of the MICU with pupil reaction to light during CPR (236/2713) should have an ALS-time of at least 45 min (LTS 42/236). Cardiac arrests in ventricular fibrillation (VF) (699/2713) should be resuscitated for at least 45 min, especially when gasping during CPR (LTS 119/699).
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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.