Critical care medicine
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Current resuscitation methods, although occasionally effective, rarely perform as well as initially anticipated. Some of the disappointment can be attributed to the difficulty of the task for many, including both professional and lay first responders. Significant attention has been paid recently to the need to simplify both the technique and the teaching of resuscitation. ⋯ Telephone dispatcher-guided BLS cardiopulmonary resuscitation (CPR) has likewise shown no survival disadvantage to chest compression-only CPR when compared with telephone-guided standard BLS CPR. Based on this reasoning, a new simplified BLS method has been proposed. "Staged" CPR consists of a strategy to initially teach laypersons a simplified approach to BLS, which requires only chest compressions and not mouth-to-mouth breathing. "Bronze" CPR, in which chest compression-only BLS is taught, was compared with the standard European Resuscitation Council BLS course for laypersons. Manikin "exit testing" at course completion has revealed significant advantages of the simplified approach compared with standard CPR courses for the lay public.
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Critical care medicine · Nov 2000
ReviewEffects of inspired gas content during respiratory arrest and cardiopulmonary resuscitation.
Mouth-to-mouth and bag-valve-mask ventilation have been an indispensable part of cardiopulmonary resuscitation (CPR). However, only recently have the effects of different tidal volumes on arterial oxygenation been reported for mouth-to-mouth and bag-valve-mask ventilation. Currently recommended tidal volumes (10-15 mL/kg) are associated with an increased risk of gastric inflation because they produce high peak inspiratory pressures. ⋯ Arterial and mixed-venous Po2 were significantly higher, and Pco2 was significantly lower in the air ventilation group. Investigations of the cardiovascular effects of mouth-to-mouth ventilation during CPR suggest that there are adverse effects during low blood flow states. However, mouth-to-mouth ventilation during respiratory arrest is lifesaving and should continue to be taught and emphasized in basic life support courses.
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Critical care medicine · Nov 2000
ReviewSuspended animation for delayed resuscitation from prolonged cardiac arrest that is unresuscitable by standard cardiopulmonary-cerebral resuscitation.
Standard cardiopulmonary-cerebral resuscitation fails to achieve restoration of spontaneous circulation in approximately 50% of normovolemic sudden cardiac arrests outside hospitals and in essentially all victims of penetrating truncal trauma who exsanguinate rapidly to cardiac arrest. Among cardiopulmonary-cerebral resuscitation innovations since the 1960s, automatic external defibrillation, mild hypothermia, emergency (portable) cardiopulmonary bypass, and suspended animation have potentials for clinical breakthrough effects. Suspended animation has been suggested for presently unresuscitable conditions and consists of the rapid induction of preservation (using hypothermia with or without drugs) of viability of the brain, heart, and organism (within 5 mins of normothermic cardiac arrest no-flow), which increases the time available for transport and resuscitative surgery, followed by delayed resuscitation. ⋯ In contrast, except for one antioxidant (Tempol), explorations of 14 different drugs added to the aortic flush at room temperature (24 degrees C) have thus far had disappointing outcome results. Profound hypothermia (10 degrees C) during 60-min cardiac arrest induced and reversed with cardiopulmonary bypass achieved survival without functional or histologic brain damage. Further plans for the systematic development of suspended animation include the following: a) aortic flush, combining hypothermia with mechanism-specific drugs and novel fluids; b) extension of suspended animation by ultraprofound hypothermic preservation (0 degrees to 5 degrees C) with cardiopulmonary bypass; c) development of the most effective suspended animation protocol for clinical trials in trauma patients with cardiac arrest; and d) modification of suspended animation protocols for possible use in normovolemic ventricular fibrillation cardiac arrest, in which attempts to achieve restoration of spontaneous circulation by standard external cardiopulmonary resuscitation-advanced life support have failed.
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Critical care medicine · Nov 2000
Randomized Controlled Trial Clinical TrialDispatcher-assisted "phone" cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation.
Based on both animal studies and field studies of the process and intermediate outcomes related to cardiopulmonary resuscitation (CPR), we initiated a randomized trial of dispatcher-assisted CPR, with the intervention arm receiving instructions for chest compression only and the control arm receiving standard instructions for airway maintenance ventilation, and chest compression. Of 241 patents randomized to chest compression instructions only, 35 survived (14.6%) compared with 29 of 279 (10.4%) patients in the control arm (p = .09). These results may have implications for future guidelines and teaching CPR.
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Critical care medicine · Nov 2000
ReviewVasopressin and endothelin during cardiopulmonary resuscitation.
Vital organ blood flow during cardiopulmonary resuscitation (CPR) and neurologic recovery after CPR were significantly better in pigs treated with vasopressin compared with epinephrine. Furthermore, two clinical studies evaluating both out-of-hospital and inhospital cardiac arrest patients found higher 24-hr survival rates in patients who were resuscitated with vasopressin compared with epinephrine. Scientists at the Leopold Franzens University in Innsbruck, Austria, are currently coordinating a multicenter, randomized clinical trial under the aegis of the European Resuscitation Council to study the effects of vasopressin vs. epinephrine in out-of-hospital cardiac arrest patients. ⋯ To date, this vasopressor has only been studied as an intervention in animal CPR models, although plasma levels have been investigated in cardiac arrest patients. Initial reports found improved coronary perfusion pressure when combined with epinephrine. However, the CPR research group of the University of Arizona Sarver Heart Center found excessive vasoconstriction and worse survival than with epinephrine alone.