European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Since the end of the nineteenth century adrenaline has been used for the treatment of cardiac arrest. Since the 1960s a standard 1 mg dose administered intravenously every 5 min is common practice in cardiopulmonary resuscitation. ⋯ Several case reports of successfully resuscitated patients who had been given high dose adrenaline were published, but large, prospective, randomized, controlled clinical trials in humans found no statistically significant improvement in survival rates between high dose and standard dose resuscitated patients. It seems that 1 mg adrenaline given intravenously every 3-5 min during resuscitation for cardiac arrest remains the standard.
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Experience with the use of midazolam in the resuscitation of severely injured patients is described. All 33 patients included in the study were given midazolam to allow endotracheal intubation and/or positive pressure ventilation in the resuscitation room, prior to transfer to the operating theatre or intensive care unit. ⋯ Cardiorespiratory side effects were not seen. Midazolam was found to be a safe and viable alternative to muscle relaxants, allowing endotracheal intubation and ventilation, in addition to other invasive procedures, to be carried out with minimal distress to the patient.
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Comparative Study
Immediate management of the airway during cardiopulmonary resuscitation in a hospital without a resident anaesthesiologist.
The effect of withdrawing the resident anaesthesiologist from the cardiopulmonary resuscitation (CPR) team was audited over a 1-year period in a 407-bed hospital in which nurses had been trained in the use of the laryngeal mask airway (LMA) as a first response airway in CPR. The data were compared to those of the previous year, which are shown in parentheses. ⋯ There were no instances of failure to maintain the immediate airway during the audit period. Initial results suggest that an anaesthesiologist may not be essential for the provision of an immediate airway in patients requiring CPR.
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Comparative Study
Utstein style cardiopulmonary-cerebral resuscitation registry for out-of-hospital cardiac arrests between 1991 and 1993. The Belgian CPCR Study Group.
A global overview of the latest results (1991-1993) from the Belgian Cardio-Pulmonary-Cerebral-Resuscitation Study Group is presented in accordance with the Utstein style recommendations and compared with similar reports. Simple clinical research data requested in a standardized document generate better quality assurance because of the additional attention that accompanies scientific investigations. We hope that our results will stimulate more institutions to scrutinize their cardiopulmonary resuscitation efforts using similar endpoints and denominators. Summaries of these data enable clinicians to challenge conventional but untested therapeutic wisdom, and help to formulate rewarding hypotheses and algorithms with regard to fate and to process factors surrounding the incidence and treatment of cardiac arrests.