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Biomedical subjects

L A Cobb

Publications and source records attributed to L A Cobb.

107 records · Page 6Linked to original sources
PubMed1975

Resuscitation from out-of-hospital ventricular fibrillation: 4 years follow-up.

In 51 months, 234 patients with out-of-hospital ventricular fibrillation (VF) were successfully resuscitated, hospitalized, and discharged home. Patients surviving an episode of primary ventricular fibrillation, that is, VF not associated with acute myocardial infarction, showed a 2-year mortality rate greater than three times that of survivors from VF associated with acute transmural infarction. Recurrent out-of-hospital VF was common, and a pattern of early recurrence was noted, with a median interval of 17 weeks in 34 documented cases. Ten patients were counted as long-term survivors from second episodes of out-of-hospital VF, one of whom survived a third episode. Coronary anatomy and ventricular function were studied in 29 survivors of primary VF. Of the 29 patients, 23 had coronary disease, considered "operable" in 17. Exercise testing and left ventricular function studies were normal or minimally abnormal in approximately half of these patients. There is an obvious need to develop effective measures to prevent primary VF, which commonly presents almost instantaneously, without prodromal symptoms.

Acute Disease↗
PubMed1974

Long term pulmonary artery pressure monitoring in the management of the critically ill.

Detailed experience during prolonged pulmonary artery pressure monitoring (up to 19 days) in 86 seriously ill patients is reviewed. Strict adherence to a protocol developed for insertion and maintenance of Swan-Ganz catheters resulted in successful catheterization of the pulmonary artery in nearly 100% of patients with minimal morbidity. Several technical problems associated with the use of this catheter-monitoring system are described, excessive balloon inflation with resultant misleading, spuriously high pressure measurement being one of the most serious. Most technical problems are avoidable. In the majority of critically ill patients both central venous and pulmonary artery diastolic pressures proved to be in-accurate estimates of pulmonary artery wedge pressure (PAW). PAW was a useful adjunct in the assessment of intravascular volume and hemodynamic alterations in these patients. The Swan-Ganz catheter serves for other functions including collection of mixed venous blood for cardiac output determination and injection of contrast material for small vessel angiography. Measurement of pulmonary artery wedge pressures should be routinely included in the sequential hemodynamic evaluation of most patients sufficiently ill to be hospitalized in an intensive care unit.

Adolescent↗
PubMedDate not supplied

Does age affect outcomes of out-of-hospital cardiopulmonary resuscitation?

We examined the relation between age and outcomes in patients treated for out-of-hospital cardiac arrest in Seattle, Wash. Considering all out-of-hospital cardiac arrests treated by paramedics over a recent 5-year period, 386 (27%) of 1405 consecutive patients aged 70 years or older were resuscitated and admitted to a hospital vs 474 (29%) of 1624 younger patients; 140 elderly patients (10%) were discharged alive vs 223 younger patients (14%). Of the 140 elderly patients, 112 went home and 28 went to a nursing home. Considering only patients whose initial rhythms were ventricular fibrillation, the percent of patients discharged alive was substantially higher: 120 (24%) of 493 for elderly patients and 194 (30%) of 639 for younger patients. Elderly patients can benefit from attempted resuscitation from out-of-hospital cardiac arrest.

Adult↗
PubMedDate not supplied

The revolution and evolution of prehospital cardiac care.

Prehospital cardiac care, first established in Belfast, Northern Ireland, in 1966, may be called revolutionary in that it was a radical break from existing practices. The Belfast program "moved" the coronary care unit into the community by treating the early complications of acute myocardial infarcation. The program staffed a mobile coronary care unit with a physician and nurse and demonstrated that patients with out-of-hospital sudden cardiac arrest could be resuscitated. The idea of prehospital cardiac care spread to other countries after publication of the Belfast experience in the Lancet. The first program in the United States, stationed at St Vincent's Hospital in New York, NY, began in 1968 and was modeled after the Belfast program. The physician-staffed model, however, was not widely imitated in the United States. Rather, beginning in 1969, programs using specially trained personnel, know as paramedics, began in Miami, Fla, Seattle, Wash, Columbus, Ohio, Los Angeles, Calif, Portland, Ore, and Nassau County, New York. Paramedic-staffed programs were designed not only to treat early complications of acute myocardial infarction, but also to attempt resuscitation for primary cardiac arrest. Most of the early paramedic programs were based in fire departments. Other programs used private ambulance or police personnel. Prehospital cardiac care has evolved significantly in the past 3 decades. Some notable developments include the tiered response system, training of the general public in cardiopulmonary resuscitation, low-energy defibrillators, automatic external defibrillators, and 12-lead electrocardiographic telemetry. The basic lesson of prehospital cardiac care is that the timely provision of cardiopulmonary resuscitation and defibrillation saves lives.

Ambulances↗