Search PubMed⌕ Search

Biomedical subjects

D Bregman

Publications and source records attributed to D Bregman.

At least 19 recordsLinked to original sources
PubMed1992

Survival from in-hospital cardiac arrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation.

OBJECTIVE: --To determine whether interposed abdominal counterpulsation (IAC) during standard cardiopulmonary resuscitation (CPR) improves outcome in patients experiencing in-hospital cardiac arrest. DESIGN AND SETTING: --Randomized controlled trial in a university-affiliated hospital. PATIENTS: --Patients experiencing in-hospital cardiac arrest during a 6-month period. INTERVENTIONS: --Patients were randomized to receive either IAC during CPR or standard CPR in the event of cardiac arrest. Abdominal compressions were performed during the relaxation phase of chest compression, corresponding to CPR diastole, at a rate of 80/min to 100/min. MAIN OUTCOME MEASURES: --The three end points studied were (1) return of spontaneous circulation, (2) survival 24 hours after resuscitation, and (3) survival to hospital discharge. In addition, we examined neurological outcome in those patients surviving to hospital discharge. RESULTS: --During the study period there were 135 resuscitation attempts in 103 patients. Return of spontaneous circulation was significantly greater in the group receiving IAC during CPR than in the group receiving standard CPR (51% vs 27%, P = .007). At hospital discharge, a significantly greater proportion of patients was alive in the IAC group than in the control group (25% vs 7%, P = .02). Eight (17%) of 48 patients who received IAC during CPR survived to hospital discharge neurologically intact, compared with only three (6%) of 55 patients from the standard CPR group (not significant). CONCLUSIONS: --We conclude that the addition of IAC to standard CPR may improve meaningful survival following in-hospital cardiac arrest. The optimal use of this technique awaits further clinical trials.

Adult↗
PubMed1979

Left ventricular mechanics of counterpulsation and left heart bypass, individually and in combination.

Counterpulsation and left heart bypass devices have been successfully used to salvage patients with severe left ventricular power failure following cardiopulmonary bypass. Each of these techniques is believed to reduce or minimize myocardial work, yet the effects of these devices on the force of myocardial contraction have not been defined. In the present investigation the effects of counterpulsation produced by intravascular (intra-aortic balloon pumping) and extravascular (pulsatile assist device) balloon devices, partial left atrial-aortic bypass, and total bypass on left ventricular mechanics were examined. The devices were studied individually and in combination in 10 anesthetized open-chest dogs. Left ventricular wall stress, external work, and contractility indices were calculated by computer using a changing volume spherical model of the left ventricle. Results indicate that although all currently available circulatory assist devices reduced peak left ventricular wall stress, a spectrum of relative effectiveness progressed from intra-aortic balloon pumping or pulsatile assist device alone through the combination intra-aortic balloon pumping plus the pulsatile assist device. Partial left heart bypass was more effective than intra-aortic balloon pumping plus the pulsatile assist device in reducing peak wall stress, but the difference was small. Total left heart bypass was vastly superior to any of the other modalities tested in its effects on peak wall stress as well as external work. The addition of counterpulsation to partial or total left heart bypass produced minimal changes in left ventricular systolic mechanics.

Animals↗
PubMed1978

Renovascular hypertension following surgical repair of dissecting aneurysm of the thoracic aorta.

A critically ill patient with refractory renovascular hypertension following successful intrathoracic repair of a type I aortic dissection was treated successfully with gelfoam embolization of the left kidney. Renal artery stenosis secondary to aortic dissection can exacerbate pre-existent hypertension in the preoperative or postoperative periods and can be diagnosed angiographically. Unilateral renal artery embolization may provide a safe alternative to nephrectomy for renovascular hypertension in cases where surgery is not feasible.

Aortic Dissection↗
PubMed1978

[Counterpulsation by means of a new device with a pulsatile blood flow in open heart operations (author's transl)].

A new counterpulsation method in operations on an open heart is described. Clinical experience in the use of the new device in 124 patients, which also makes it possible to produce a pulsatile flow of blood in the system of extracorporeal circulation, testifies to its effectiveness. The authors claim that the positive changes in cardiac output, diastolic and systolic pressure, and coronary circulation are among the factors which cause an improvement in the final result of the operation in patients with severe valvular diseases and ischemic heart disease.

Adult↗
PubMed1978

Mechanical circulatory support: evolving perspectives.

Mechanical circulatory support of the failing circulation is an emerging discipline. Prototype circulatory support services have been established in a few institutions but are spreading15. Intra-aortic balloon pumping, developmental only a decade ago, is now widespread. Pneumatically-actuated intra and extracorporeal left ventricular assist devices, federally-approved for clinical trials only 2 yrs ago, show encouraging early results. Efforts in West Germany, Austria, Switzerland, Russia and Japan are underway and a spirit of cooperation exists. There is a need to clarify and quantitate indications and timing for deployment, prior to the onset of multiple organ failure. Electrically and nuclear-activated LVAD's16--18 are being developed. Clarification of projected patient populations are needed and the role of the right heart in left ventricular assist device function requires further investigation. There is a need to define a reasonable clinical role for the much discussed and rather elusive total artificial heart. Many problems remain with actuation, energy conversion, percutaneous leads, compliance devices and biomaterials. The challenges are many and welcomed.

Assisted Circulation↗