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Biomedical subjects

R Juchems

Publications and source records attributed to R Juchems.

At least 19 recordsLinked to original sources
PubMed1994

[Initial defibrillation by emergency physicians or by first aid assistants? A prospective, comparative multicenter study in outpatients with ventricular fibrillation].

In a controlled prospective randomized study, defibrillation by emergency medical technicians (EMTs) was compared with the current standard of care in Germany (basic life support by EMTs and defibrillation by emergency physicians only) in order to answer the following questions: 1. Does EMT defibrillation improve the survival rate and long-term prognosis of patients in ventricular fibrillation as compared to the current German standards in resuscitation (basic life support by EMTs and defibrillation by emergency physicians)? 2. Are the prerequisites for the use of semiautomatic defibrillators fulfilled in the emergency medical systems (EMS) of the participating centers? METHODS. The study phase includes randomization of 121 adult patients with witnessed cardiac arrest and ventricular fibrillation (VF) as first ECG rhythm. Prior to the onset of the study, all EMTs of the participating EMS systems were retrained in basic life support (BLS) measures. In each center, randomly assessed EMT-Ds (EMTs trained in Defibrillation) were trained to use semiautomatic defibrillators. With the help of one-line tape recording, the time intervals during resuscitation and treatment steps were evaluated. Successfully resuscitated patients were followed up with the help of the Glasgow Coma Scale and the Pittsburgh Cerebral and Overall Performance Categories. RESULTS. From 1 February 1991 until 28 June 1992, 159 patients with VF were randomized. In 121 cases, collapse was witnessed. 25% (14/57) of the patients receiving defibrillation by EMT-Ds (study group = S) were discharged from the hospital alive. In the control group, 52 patients were defibrillated by emergency physicians, following BLS by EMTs [control group 1 = C1; discharged: 29% (15/52)]. Fifty patients received BLS and advanced cardiac life support (ACLS) by the emergency physicians crews [control group 2 = C2; discharged: 18% (9/20)]. In the study group, the median time interval from collapse of the patient until initiation of BLS measures was 7.7 min, 7 min in C1 and 8 min in C2. ACLS measures were initiated significantly earlier (P < 0.05) in the control groups, as compared to the study group [S: 13 min, C1: 11 min; C2: 10.3 min]. Sixty-seven percent (30/45) of the study patients and 46% (36/76) of the control patients were defibrillated within 12 min. Study patients were defibrillated earlier (P < 0.05) (S: 9.9 min; C1: 12.2 min; C2: 12.75 min); return of spontaneous circulation (ROSC) was achieved earlier (P < 0.05) in the study group [S: 14 min; C1: 19 min; C2: 18.2 min] and the number of patients in the study group requiring no epinephrine during resuscitation was higher (P < 0.01) than in the control groups [S: 35.3% (12/34); C1: 10% (4/40); C2: 10.5% (4/38)]. Furthermore, the total amount of epinephrine [mean (+/- standard error)] administered in the study group [S: 2.35 (+/- 0.49) mg; C1: 6.71 (+/- 0.98) mg; C2: 7.71 (+/- 1.31) mg] was significantly lower (P < 0.05). No significant differences in neurological long-term prognosis were found for the groups investigated. CONCLUSION. Neither the initial survival rate the number of patients discharged alive, nor the neurological long-term prognosis was significantly different for any of the groups investigated. Because of apparent differences in indirect prognostic parameters (time interval until ROSC, number of patients requiring no epinephrine) and because of the fact that the time interval to the first defibrillation was reduced by EMT defibrillation, EMT-Ds may perform defibrillation if: (a) they reach the patient before the emergency physician and (b) if they are trained intensively and supervised continuously. In order to increase the efficiency of defibrillation by EMT-Ds, far-reaching changes in our EMS are mandatory: (a) a reduction in the time interval from collapse until initiation of BCLS measures by intensifying layperson CPR training; (b) an increase in the number of emergency units equipped with semiautomatic defibril

Electric Countershock↗
PubMed1994

Early defibrillation by emergency physicians or emergency medical technicians? A controlled, prospective multi-centre study.

UNLABELLED: In a controlled, prospective multi-centre study, defibrillation by emergency medical technicians (EMTs) was compared with the current standard of care in Germany--defibrillation by emergency physicians (EPs)-in order to answer the following questions: can EMTs in a two-tiered emergency medical services (EMS) system with physicians in the field defibrillate earlier than, and as safely as EPs? Does defibrillation by EMTs (study group) affect survival rate and long-term prognosis of patients in ventricular fibrillation (VF), as compared with the current national standards in resuscitation (basic cardiopulmonary resuscitation (CPR) by EMTs, and defibrillation by physicians: control group? METHODS: Prior to the onset of the study, all EMTs completed retraining in basic life support (BLS). Randomly assessed EMTs were then trained to use semi-automatic defibrillators. With the help of on-line tape recordings, the complete resuscitation sequence was evaluated. Follow-up of the patients was carried out with the help of the Glasgow Coma Scale as well as Pittsburgh Cerebral and Overall Performance Categories. RESULTS: A total of 159 patients with VF were included in the study. In 121 cases, collapse was witnessed. Of the patients receiving defibrillation by EMTs 25% were discharged from hospital alive, compared to 24% of the patients defibrillated by EPs. Of the study patients 67% were defibrillated within 12 min, while the percentage of control patients was 46%. Study patients were defibrillated earlier (P < 0.01), the return of spontaneous circulation (ROSC) was achieved earlier (P < 0.05), and the rate of patients requiring no adrenalin during resuscitation was higher in the study group (P < 0.05). The total amount of adrenalin administered in the study group was lower (P < 0.05). No statistically significant differences were found concerning the neurologic long-term prognosis. CONCLUSIONS: In our study, EMT defibrillation was equally effective as defibrillation by EPs, but failed to improve survival rates or long-term outcome of patients in VF significantly, compared to EP defibrillation. Due to a reduction in the time intervals from collapse to defibrillation and to ROSC, as well as in adrenalin doses, by EMT-defibrillation, EMTs in Germany should defibrillate if they reach a patient prior to an EP, provided they have received continuous medical training and supervision.

Cardiopulmonary Resuscitation↗
PubMed1993

Influence of age on the survival rate of out-of-hospital and in-hospital resuscitation.

During a 9-year period 1472 cardiopulmonary resuscitations were analysed. Five-hundred seventy-two were in-hospital and 898 out-of-hospital resuscitations. Of the out-of-hospital resuscitations 495 (55.1%) patients were less than 70 years and 403 (44.9%) older than 70 years. Survival in the former group was 71 (14.3%) in the elderly group 44 (10.9%) (P < 0.1). In the in-hospital population 245 (43%) were below 70 years and 327 patients above 70 years (57%). Seventy patients (28.2%) in the former group and 46 (14.1%) in the latter group survived (P < 0.01). The statistical analysis of the out-of-hospital resuscitations indicates no significant difference in the survival rate of patients younger than 70 years compared to those above 70 years. The survival rate however for patients above 70 years in the in-hospital group was significantly worse, probably attributed to multimorbidity of the older in-hospital patients. The results in our study indicate that old age is not a determinant of prognosis or outcome after CPR.

Age Factors↗
PubMed1991

[Opening and closing movements of the heart valves in cardiopulmonary resuscitation. Confirmation of the cardiac pump theory ].

Cardiorespiratory arrest occurred in a 64-year-old man with severe triple-vessel coronary artery disease (status after two myocardial infarctions) and heart failure (ejection fraction of 20%). After intubation and starting resuscitation measures, transoesophageal echocardiography (TE) was performed to exclude electromechanical dissociation with ventricular tamponade. During the thoracic compression of closed-chest cardiac massage the aortic valve opened, while the mitral and tricuspid valves closed. During the relaxation phase the mitral and tricuspid valves rapidly opened, the aortic valve closed. When the cardiac massage was stopped (wide, fixed pupils) echo density increased spontaneously in all four cardiac chambers due to the cessation of blood flow. On resuming thoracic compression after about 30 sec the echo density decreased, first in the right ventricle, then right atrium, followed by left atrium and finally left ventricle. This is the first time that the wash-out of spontaneous echo-contrast has been reported in these circumstances. It makes it possible, together with the movements of the cardiac valves during thoracic compression, to state precisely the localization and direction of blood flow during closed-chest cardiac massage in man. The observations confirm the correctness of the cardiac pump theory rather than the thoracic pump one.

Aortic Valve↗
PubMed1991

Evidence for the 'cardiac pump theory' in cardiopulmonary resuscitation in man by transesophageal echocardiography.

There are two theories to explain the mechanism of blood flow during cardiopulmonary resuscitation: The 'Cardiac Pump Theory' and the 'Thoracic Pump Theory'. We have performed transesophageal echocardiography during the resuscitation of a patient with cardiopulmonary arrest. By this method we could study the motion of the aortic, mitral and tricuspid valves and the changes in ventricular size during cardiopulmonary resuscitation in man. We demonstrated an opening of the aortic valve during thoracic compression with simultaneous closure of the mitral and tricuspid valves. During relaxation of the chest, a rapid opening of the atrioventricular valves and closure of the aortic valve was noted. Short interruption of cardiopulmonary resuscitation to test for spontaneous heart action lead to echocontrast in all four heart chambers through stasis of blood, which resolved on continuation of cardiopulmonary resuscitation. This 'washing out' phenomenon enables visualization of blood flow through the aortic valve during compression, and through the mitral valve during relaxation. These observations favour the Cardiac Pump Theory as the predominant hemodynamic principle of blood flow during cardiopulmonary resuscitation in man.

Aged↗
PubMed1983

[Myocarditis caused by Salmonella typhimurium].

A 53-year-old man died on the eight day of an acute enteritis caused by Salmonella typhimurium. Clinical signs of shock were pronounced; the electrocardiogram, initially not pathological, showed a peripheral low voltage with decreased R-amplitudes and distinct disturbances in repolarization. Laboratory findings demonstrating Salmonella typhimurium in blood cultures and stools and 45% band forms in the differential count were remarkable. The autopsy showed deep, fibrin-covered ulcera in the colon area and a dense submucous lympho-histiocyte cell infiltration. Histologically, a granulomatous myocarditis of the left ventricle with lymphocyte and histiocyte infiltration and a focal myolysis was observed. In the right ventricle, however, only a minimal interstitial edema was found.

Cardiomegaly↗
PubMed1977

[Therapy of the bronchitic syndrome in the elderly].

The prophylactic means and general modes in the treatment of the bronchitic syndrome in geriatric patients are outlined. The therapy is discussed with respect to the use of broncholytics, secretolytics and steroids on the basics of a detailed lung function test. The altered health condition of the geriatric patient needs an intensive and detailed therapy program and must include limitations caused by the old age.

Aged↗
PubMed1977

[Diagnosis of the bronchitic syndrome in the aged].

The cumulation of exogenic factors on the basis of an endogenic disposition and the addition of physiologic aging processes cause an increase of the "bronchitic syndrome" in old age. Heart insufficiency, tuberculosis, lung embolism and bronchial carcinoma are the important differential diagnostic aspects in these patients. The structural and functional changes of the lung in old people and the polypathy, resp. multimorbidity of the whole organism cause the complications and disadvantageous interferences. The prognostic important disturbances of the ventilation mechanics are early recognizable with new diagnostic tools, particularly with the whole body plethysmography.

Aged↗
PubMed1976

[The definition of heart failure with the product of minimal transit time and heart frequency (author's transl)].

The product of minimal transit time (MTT) and heart frequency (HF) defines the number of heart beats which are necessary to transport the blood in a determined region of the circulatory system. According to own studies in physiological (stress) and pharmacological conditions this product is constant, independent from body size, length, age etc. In proportion to the degree of heart failure the MTT X HF increases. Measuring appropriate regions of the circulatory system, right and left heart failure can easily be determined. The method has the advantage of a noninvasive procedure and gives exact quantitive accessment of the pump performance of the heart. In view of the increasing use of radio-nuclides this procedure can be recommended because of its good reliability causing little or no discomfort to the patient, and making it applicable, even under extreme conditions, for instance in a CCU.

Dye Dilution Technique↗