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Biomedical subjects

R O Cummins

Publications and source records attributed to R O Cummins.

At least 19 recordsLinked to original sources
PubMed1992

A comparison of standard-dose and high-dose epinephrine in cardiac arrest outside the hospital. The Multicenter High-Dose Epinephrine Study Group.

BACKGROUND: Experimental and uncontrolled clinical evidence suggests that intravenous epinephrine in doses higher than currently recommended may improve outcome after cardiac arrest. We conducted a prospective, multicenter study comparing standard-dose epinephrine with high-dose epinephrine in the management of cardiac arrest outside the hospital. METHODS: Adult patients were enrolled in the study if they remained in ventricular fibrillation, or if they had asystole or electromechanical dissociation, at the time the first drug was to be administered to treat the cardiac arrest. Patients were randomly assigned to receive either 0.02 mg of epinephrine per kilogram of body weight (standard-dose group, 632 patients) or 0.2 mg per kilogram (high-dose group, 648 patients), both given intravenously. RESULTS: In the standard-dose group 190 patients (30 percent) had a return of spontaneous circulation, as compared with 217 patients (33 percent) in the high-dose group; 136 patients (22 percent) in the standard-dose group and 145 patients (22 percent) in the high-dose group survived to be admitted to the hospital. Twenty-six patients (4 percent) in the standard-dose group and 31 (5 percent) in the high-dose group survived to discharge from the hospital. Ninety-two percent of the patients discharged in the standard-dose group and 94 percent in the high-dose group were conscious at the time of hospital discharge. None of the differences in outcome between the groups were statistically significant. CONCLUSIONS: In this study, we were unable to demonstrate any difference in the overall rate of return of spontaneous circulation, survival to hospital admission, survival to hospital discharge, or neurologic outcome between patients treated with a standard dose of epinephrine and those treated with a high dose.

Aged↗
PubMed1992

Transcutaneous cardiac pacing in the treatment of out-of-hospital pediatric cardiac arrests.

STUDY OBJECTIVE: To evaluate the effectiveness of transcutaneous cardiac pacing in out-of-hospital treatment of cardiac arrests in pediatric patients. DESIGN: We describe the outcome of patients treated during a prospective trial of transcutaneous cardiac pacing in the field. We compare their outcome with that of out-of-hospital arrests in submersion patients who were not paced. We identified patients from Seattle and King County Emergency Medical Services reports, hospitals, and medical examiner's registries. MEASUREMENTS AND MAIN RESULTS: Nine patients in cardiac arrest caused by drowning (six) and sudden infant death syndrome (three) were paced in the field. All were less than 6 years old. The one survivor was severely neurologically impaired and died six months later. Transcutaneous cardiac pacing produced electrical capture in two patients but no detectable pulse or blood pressure. Ten submersion patients less than 6 years old in cardiac arrest were not paced. One survived, with mild neurologic impairment at hospital discharge. CONCLUSION: Transcutaneous cardiac pacing was not effective and was not associated with improved survival.

Cardiac Pacing, Artificial↗
PubMed1991

Numerators, denominators, and survival rates: reporting survival from out-of-hospital cardiac arrest.

This study demonstrates the effect of different denominators on the survival rate from out-of-hospital cardiac arrest. We retrospectively analyzed data from a cardiac arrest surveillance system in King County, Washington during the years 1976 to 1988, and calculated survival rates using eight different definitions of denominators. The eight survival rates ranged from 16% to 49% discharge from hospital. The denominator for the lowest survival rate included all cases of cardiac arrest for whom emergency medical services personnel started cardiopulmonary resuscitation. The denominator for the highest survival rate included: all cases of presumed cardiac etiology; first recorded rhythm was ventricular fibrillation; collapse witnessed; cardiopulmonary resuscitation started by bystanders within 4 minutes; and definitive care provided within 8 minutes. The definition of cases included in the denominator can dramatically effect the resultant survival rate. There must be national and international agreement about definitions of denominators for valid cross community comparisons.

Emergencies↗
PubMed1990

Cardiac arrest and resuscitation: a tale of 29 cities.

Published reports of out-of-hospital cardiac arrest give widely varying results. The variation in survival rates within each type of system is due, in part, to variation in definitions. To determine other reasons for differences in survival rates, we reviewed published studies conducted from 1967 to 1988 on 39 emergency medical services programs from 29 different locations. These programs could be grouped into five types of prehospital systems based on the personnel who deliver CPR, defibrillation, medications, and endotracheal intubation; the five systems were three types of single-response systems (basic emergency medical technician [EMT], EMT-defibrillation [EMT-D], and paramedic) and two double-response systems (EMT/paramedic and EMT-D/paramedic). Reported discharge rates ranged from 2% to 25% for all cardiac rhythms and from 3% to 33% for ventricular fibrillation. The lowest survival rates occurred in single-response systems and the highest rates in double-response systems, although there was considerable variation within each type of system. Hypothetical survival curves suggest that the ability to resuscitate is a function of time, type, and sequence of therapy. Survival appears to be highest in double-response systems because CPR is started early. We speculate that early CPR permits definitive procedures, including defibrillation, medications, and intubation, to be more effective.

Emergency Medical Services↗
PubMed1990

Near-fatal yew berry intoxication treated with external cardiac pacing and digoxin-specific FAB antibody fragments.

The case of a 5-year-old girl who survived a near-fatal ingestion of yew plant leaves after treatment with CPR, transcutaneous pacing, and digoxin-specific FAB antibody fragments is presented. Multiple rhythm disturbances, including profound bradycardia, occurred. She required endotracheal intubation, external chest compressions, and application of a transcutaneous pacemaker. Paced cardiac contractions produced a dramatic improvement in her blood pressure and clinical condition. Two empiric injections of digoxin-specific FAB antibody fragments were administered, after which cardiac function and rhythm gradually improved. She was discharged in her normal state of health three days later. Yew leaves and berries contain several alkaloids that can produce fatal conduction disturbances. Transcutaneous cardiac pacemakers may be lifesaving for patients with transient cardiac toxicity from drug or toxin ingestions. In addition, cross-reactivity between digoxin-specific FAB antibodies and the alkaloids in the yew plant may exist and may have therapeutic importance, although this mechanism was unlikely to have helped our patient.

Bradycardia↗
PubMed1990

Survival rates from out-of-hospital cardiac arrest: recommendations for uniform definitions and data to report.

Survival rates for out-of-hospital cardiac arrest vary widely among locations. We surveyed the definitions used in published studies of out-of-hospital cardiac arrest. Data from 74 studies involving 36 communities showed survival rates ranging from 2% to 44%. There were five different case definitions and 11 different definitions of survivors. The absence of uniform definitions prevents meaningful intersystem comparisons, prohibits explorations of hypotheses about effective interventions, and interferes with the efforts of quality assurance. The most satisfactory numerator for a survival rate appears to be survival to hospital discharge; the most appropriate denominator appears to be witnessed adult cardiac arrest of presumed heart disease etiology, with ventricular fibrillation as the initial identified rhythm. Proposed definitions for the data emergency medical services systems should report as they examine their cardiac arrest survival rates are presented.

Emergency Medical Services↗
PubMed1989

Frequency and types of medical emergencies among commercial air travelers.

We performed a one-year prospective survey of emergency medical responses to travelers at an international airport to observe the frequency and type of emergencies experienced in flight and before and after travel. Emergency personnel evaluated a total of 1107 people; 754 (68%) were travelers, 232 (21%) were employees of the airport or airlines, and 118 (11%) were area residents. Of the 754 travelers, 190 (25%) experienced their problem during flight; the aircraft made an unscheduled landing for seven of these travelers. The frequency of in-flight emergencies was 1 per 753 inbound flights, or 1 per 39,600 inbound passengers. The most common emergency problems among all travelers were abdominal pain, chest pain, shortness of breath, syncope, and seizures; 25% of the emergencies were caused by minor trauma. The majority of emergencies among air travelers (75% [564/754]) happened on the ground within the air terminal. Most problems (84% [633/754]) were effectively handled by personnel trained as emergency medical technicians. The types of problems encountered suggest that the "doctors only" medical kit now required aboard US air carriers contains clinically useful items and should continue to be required on board.

Aircraft↗
PubMed1989

Use of the automatic external defibrillator in homes of survivors of out-of-hospital ventricular fibrillation.

This 57-month study evaluated the use of automatic external defibrillators (AEDs) in the homes of high risk cardiac patients (survivors of out-of-hospital ventricular fibrillation [VF]). The goal was to determine the utility of these devices by trained lay persons in actual cardiac arrest episodes. Ninety-seven survivors of out-of-hospital VF were enrolled in the study; 59 patients received AEDs, and 38 patients served as a control group. During the study period, 7 deaths occurred in the hospital without preceding out-of-hospital cardiac arrest or from noncardiac causes. There were 14 out-of-hospital cardiac arrests, 10 in the AED group and 4 in the control group. There was 1 long-term survivor in the control group. In the AED group, among the 10 cardiac arrests for which the device was available, it was used in 6. Only 2 patients were in VF; 1 was resuscitated with residual neurologic deficits and survived several months. This study observed a small potential for AEDs to save high risk patients.

Aged↗
PubMed1989

Training lay persons to use automatic external defibrillators: success of initial training and one-year retention of skills.

This study was conducted to determine the feasibility of recruitment of lay persons to use automatic external defibrillators (AEDs), the effectiveness of their initial training, and the need for and frequency of retraining over time. Volunteers (n = 146), recruited from a variety of settings, included security personnel and administrative staff from large corporate centers, supervisors from senior care and exercise facilities, and employees in high-rise office buildings. Seven sites for 14 AEDs were recruited. In a single, two-hour class, participants learned to identify and respond to cardiac arrest, to notify emergency personnel, to retrieve and attach the semiautomatic (shock advisory) AED, and to respond to instructions presented on the display screen of the device. A skills check list was used to grade each student on performance of cardiopulmonary resuscitation, operation of the device, and time required to deliver an electric countershock. Retesting was performed one or more times after initial training to assess skill retention. The study lasted 1 year. All age groups, both sexes, and each responder type easily learned to operate the AED, with a trend for lower performance scores in people aged greater than 60 years. Performance time and skills declined significantly after initial training, but returned to satisfactory levels after one retraining session and were even higher after two retraining sessions. With retesting, errors that would have prevented delivery of countershocks to patients in ventricular fibrillation were rare (six of 146 tests, 4%). During the year of this study only three cardiac arrests occurred in the study sites.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗