Critical care medicine
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Critical care medicine · Nov 1985
Comparative StudyManual versus mechanical cardiopulmonary resuscitation in an experimental canine model.
Manual and mechanical chest compressions during CPR were compared in the canine model. Endpoints were hemodynamics produced during CPR, resuscitation success at 30 min, 24-h survival, neurologic function of survivors, and CPR-produced trauma. Ten animals in each group underwent 20 min of ventricular fibrillation, during which CPR was performed for 17 min. ⋯ Neurologic function of survivors was excellent and similar in each group. There was no significant difference in trauma between the two types of chest compression. The similar results for manual and mechanical chest compression in this canine model suggest that different experimental CPR studies can be compared regardless or whether manual or mechanical chest compressions were performed.
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Critical care medicine · Nov 1985
Case ReportsAdult respiratory distress syndrome: successful support with continuous negative extrathoracic pressure.
We describe the use of continuous negative extrathoracic pressure to treat successfully the adult respiratory distress syndrome in a 19-yr-old woman who resisted the application of positive airway pressure. Arterial hypoxemia was reversed with -26 cm H2O of extrathoracic pressure, produced by a modified Emerson iron lung. ⋯ The patient required continuous negative extrathoracic pressure for 9 days; 12 days after admission, she was discharged. This case indicates that negative extrathoracic pressure therapy can be an effective and safe alternative to positive airway pressure for the management of selected patients with adult respiratory distress syndrome.
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Previous studies demonstrated selective increases in mixed venous carbon dioxide tension (PvCO2) during CPR in a porcine model of cardiac arrest. This was associated with a decrease in end-tidal carbon dioxide concentration (ETCO2), possibly due to a critical reduction in cardiac output and therefore pulmonary blood flow during CPR. ⋯ Observations in 19 minipigs confirmed a high linear correlation between ETco2 and cardiac output. We conclude that the increase in Pvco2 and the concurrent decrease in ETco2 reflect a critical reduction in cardiac output, which reduces alveolar blood flow to the extent that carbon dioxide clearance by the lung fails to keep pace with systemic CO2 production.
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Critical care medicine · Nov 1985
End-tidal CO2 as a guide to successful cardiopulmonary resuscitation: a preliminary report.
Utilizing a well-established porcine model of cardiac arrest, we found that end-tidal CO2 concentration (ETCO2) strikingly decreased to approximately 24% of control levels, immediately after cardiac arrest and before precordial compression. During precordial compression, ETCO2 progressively increased to 46% of control values in successfully resuscitated animals but only to 26% in animals which failed to respond to resuscitation efforts. After successful resuscitation, ETCO2 rapidly returned to baseline values. These data indicate that ETCO2 may be a useful monitor for assessing the adequacy of CPR.