Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “RESUSCITATION”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 505 records · Page 28Linked to original sources
PubMed1995

Responses of immunoreactive ACTH and bioactive ACTH to large hemorrhage and resuscitation in conscious dogs.

We studied the effect of fluid resuscitation on immunoreactive adrenocorticotropic hormone (irACTH) and bioactive ACTH (bioACTH) after hemorrhage in conscious dogs. Animals (n = 7) were bled 30% (approximately 25 ml/kg) over 3 min and 30 min later were either resuscitated [43.3 ml/kg 0.9% NaCl (1.8 times hemorrhage volume) over 10 min] or not. Blood was reinfused after 210 min. Animals had both treatments (> 4 days apart). irACTH, bioACTH, cortisol, angiotensin II, and aldosterone increased rapidly after hemorrhage. Resuscitation increased blood volume and cardiac output to resting values, but arterial hypotension persisted. bioACTH and irACTH decreased 40-90 min after hemorrhage in both groups, but each decreased more rapidly after resuscitation. The elimination half-life of bioACTH was shorter than that of irACTH, but neither was affected by resuscitation. The ratio of bioACTH to irACTH followed the same pattern with or without resuscitation. Angiotensin II and aldosterone remained increased without resuscitation but decreased promptly after resuscitation. In conclusion, 1) saline infusion at 1.8 x hemorrhage volume provides effective cardiovascular resuscitation, with resolution of hormonal responses to hemorrhage; 2) although ACTH responses resolved with or without resuscitation, resuscitation produced more rapid resolution without changing the parameters of ACTH elimination; 3) the dynamics of the resolution of the ACTH response to hemorrhage are similar whether induced by stimulus removal or feedback inhibition.

Adrenocorticotropic Hormone↗
PubMed1998

Delivery room resuscitation decisions for extremely premature infants.

BACKGROUND: Neonatologists are criticized for overtreating extremely premature infants who die despite invasive and costly care. Withholding resuscitation at delivery has been recommended as a way to minimize overtreatment. It is not known how decisions to forgo initiating aggressive care are made, or whether this strategy effectively decreases overtreatment. OBJECTIVE: To identify whether physicians' or parents' preferences primarily determine the amount of treatment provided at delivery, to examine factors associated with the provision of resuscitation, and to assess whether resuscitation at delivery significantly postpones death in nonsurvivors. METHODS: We evaluated delivery room resuscitation decisions and mortality for all infants born at 23 to 26 weeks gestation at the University of North Carolina Hospitals from November 1994 to October 1995. On the day of delivery, the attending neonatologist completed a questionnaire regarding discussion with the parents before delivery, the prognosis for survival estimated before delivery, the degree of certainty about the prognosis, parents' preference for the amount of treatment at delivery, and the degree of influence exerted by parents and physicians on the amount of delivery room treatment provided. Medical records were reviewed for demographics and hospital course. RESULTS: Thirty-one of 41 infants were resuscitated (intubation and/or cardiopulmonary resuscitation) at delivery. Resuscitation correlated with increasing gestational age, higher birth weight, estimated prognosis for survival greater than or equal to 10%, and uncertainty about prognostic accuracy. Physicians saw themselves as primarily responsible for delivery room resuscitation decisions when the parents' wishes about initiating care were unknown, and as equal partners with parents when they agreed on the level of care. When disagreement existed, doctors always thought parents preferred more aggressive resuscitation, and identified parents as responsible for the increased amount of treatment at delivery. Twenty-four infants died before hospital discharge. The median age at death was 2 days when physicians primarily determined the amount of treatment at delivery, 1 day when parents primarily determined the amount of treatment, and < 1 day when responsibility was shared equally. The median age at death was < 1 day when physicians and parents agreed about the preferred amount of treatment at delivery and 1.5 days when they disagreed. The median age at death was < 1 day when parents' preferences were known before delivery and 4 days when parents' preferences were unknown. CONCLUSIONS: Physicians resuscitated extremely premature infants at delivery when they were very uncertain about an infant's prognosis or when the parents' desires about treatment were unknown. When parents' preferences were known, parents usually determined the amount of treatment provided at delivery. Resuscitation at delivery usually postponed death by only a few days, decreasing prognostic uncertainty and honoring what physicians perceived were parents' wishes for care, without substantially contributing to overtreatment.

Critical Care↗
PubMed1999

An advisory statement from the Pediatric Working Group of the International Liaison Committee on Resuscitation.

The International Liaison Committee on Resuscitation (ILCOR), with representation from North America, Europe, Australia, New Zealand, Africa, and South America, was formed in 1992 to provide a forum for liaison between resuscitation organizations in the developed world. This consensus document on resuscitation extends previously published ILCOR advisory statements on resuscitation to address the unique and changing physiology of the newly born infant within the first few hours after birth and the techniques for providing advanced life support. After careful review of the international resuscitation literature and after discussion of key and controversial issues, consensus was reached on almost all aspects of neonatal resuscitation, and areas of controversy and high priority for additional research were delineated. Consensus on resuscitation for the newly born infant included the following principles: Common or controversial medications (epinephrine, volume expansion, naloxone, bicarbonate), special resuscitation circumstances affecting care of the newly born, continuing care of the newly born after resuscitation, and ethical considerations for initiation and discontinuation of resuscitation are discussed. There was agreement that insufficient data exist to recommend changes to current guidelines regarding the use of 21% versus 100% oxygen, neuroprotective interventions such as cerebral hypothermia, use of a laryngeal mask versus endotracheal tube, and use of high-dose epinephrine. Areas of controversy are identified, as is the need for additional research to improve the scientific justification of each component of current and future resuscitation guidelines.

Documentation↗
PubMed2006

[The effects of earlier resuscitation on following therapeutic response in sepsis with hypoperfusion].

OBJECTIVE: To evaluate the effects of early sufficient resuscitation on important organs function and their therapeutic response in sepsis with hypoperfusion. METHODS: From January 2004 to December 2005, 34 sepsis patients with hypoperfusion in surgical and respiratory intensive care units were resuscitated sufficiently for the management of severe sepsis and septic shock. According to the time of resuscitation end points, these patients were divided to early resuscitation group (E group, 15 patients) and later group (L group, 19 patients). The important organs function and their therapeutic response followed resuscitation were investigated and compared in the tow groups. RESULTS: After earlier sufficient resuscitation, the incidence of repeated resuscitation was 73.7% in L group and 20.0% in E group (P < 0.01); the incidence of steroids replacement, coagulation dysfunction and multiple organ dysfunction syndrome (MODS) were 63.2%, 73.7% and 68.4% respectively in L group and significantly higher than those in E group (P < 0.05). Seven days after resuscitation, the level of serum creatinine in E group was lower than that in L group (P < 0.05). In the day 1 and 7 after resuscitation, heart rate in E group was lower than that in L group (P < 0.05). Seven days post resuscitation, PaO(2) and PaO(2)/FiO(2) were higher in E group than in L group (P < 0.05). The mortality was 42.1% in L group and 13.3% in E group (P < 0.05). CONCLUSIONS: Early sufficient resuscitation in sepsis patients with hypoperfusion could significantly enhance the effects of following treatment, relieve inflammation and coagulation reaction and thereby reduce the mortality.

Aged↗
PubMed1994

Effect of do-not-resuscitate orders on the nursing care of critically ill patients.

BACKGROUND: The effect of a do-not-resuscitate order on the standard of care of critically ill patients is of concern to practitioners, patients, and their families. Because "do not resuscitate" may be misconstrued to include more than "no cardiopulmonary resuscitation," it may influence the aggressiveness with which some patients are managed. Nurses play a central role in determining standards of care. Hence, confusion on their part as to the meaning of this term can have a significant impact on patient care. OBJECTIVES: To compare nurses' attitudes about standards of care for critically ill patients with and without a do-not-resuscitate order. METHOD: A quasi-experimental design using simulation measurement was used for this study. RESULTS: Nurses reported that they would be significantly less likely to perform a variety of physiologic monitoring modalities and interventions for patients with a do-not-resuscitate order than for patients without such an order. Patients with a do-not-resuscitate order were more likely to receive psychosocial interventions including assessment of their spiritual needs and more flexible visiting practices. CONCLUSIONS: Our findings suggest that "do-not-resuscitate" may be misinterpreted to include more than "no cardiopulmonary resuscitation" even if the patient is receiving aggressive medical management. Misinterpretation of orders not to resuscitate may be related to a variety of factors including lack of understanding about hospital policy and ethical and moral values of the staff. We suggest replacing orders such as "Do not resuscitate" with clearly defined resuscitation plans that are jointly determined by the multidisciplinary team, patient, and family.

Adult↗
PubMed1996

Hypertonic saline improves brain resuscitation in a pediatric model of head injury and hemorrhagic shock.

INTRODUCTION: Brain injury accompanied by hypovolemic shock is a frequent cause of death in multiply injured children. Hypertonic saline (HTS) has been shown to return hemodynamics to normal in adult models, without increasing intracranial pressure (ICP) as seen with crystalloids. To assess fluid resuscitation, the authors evaluated HTS versus lactated Ringer's solution (LR) with respect to hemodynamics and cerebrovascular hemoglobin oxygen saturation (Sco2) in anesthetized, head-injured, 1-month-old piglets. METHODS: Group 1 (n = 6) was studied for 3.5 hours after a cryogenic brain injury and no shock. Groups 2 and 3 had cryogenic brain injury followed by hemorrhagic shock, in which mean arterial pressure (MAP) was reduced to 40 to 50 mm Hg and maintained for 30 minutes. Group 2 (n = 5) was then resuscitated with 1 mL of 7.5% HTS per 1 mL of blood loss. Group 3 (n = 6) was resuscitated with 3 mL of LR per 1 mL of blood loss. Sco2 was determined by near-infrared spectroscopy in the injured region of the brain. All data were analyzed using analysis of variance with repeated measures. RESULTS: MAP, ICP, temperature, serum sodium, and cardiac output (CO) were similar in all groups during baseline and between groups 2 and 3 during shock. After resuscitation, MAP, CO, and core temperature were similar in all three groups, and serum sodium was increased in the HTS group (by 29%). Sco2 increased transiently after cryogenic injury in all groups, then gradually decreased to below baseline. After shock, Sco2 decreased precipitously in group 2 and 3. After resuscitation, Sco2 was different in the two resuscitation groups, increasing in the HTS group, above baseline values, but remaining below baseline values in the LR group (P < .002). ICP was lowered by HTS resuscitation and increased by LR resuscitation (P < .002) CONCLUSION: In our model of head injury and shock, resuscitation with either HTS or LR restored MAP and CO to control levels. However, during shock, the injured brain was severely deoxygenated, and administration of HTS restored cerebral oxygenation whereas LR did not, reflecting improved cerebral resuscitation by HTS without elevating ICP. The data suggest that HTS is a better resuscitation fluid than LR in head-injured children with hemorrhagic shock.

Animals↗
PubMed2001

Resuscitation-induced pulmonary apoptosis and intracellular adhesion molecule-1 expression in rats are attenuated by the use of Ketone Ringer's solution.

BACKGROUND: Resuscitation with Lactated Ringer's solution after hemorrhagic shock in rats has been shown to cause early cellular injury in the lung. We hypothesized that the use of energy substrates, such as ketone bodies, in the resuscitation fluids would protect against this injury. As markers of cellular injury we measured the induction of apoptotic cell death and the expression of Intracellular Adhesion Molecule-1 (ICAM-1). STUDY DESIGN: Male Sprague Dawley rats (n = 35) under inhaled isoflurane anesthesia had placement of femoral arterial and venous catheters. A three-stage hemorrhage model was used for this experiment. There was an initial hemorrhage of 27 mL/kg for 10 minutes. During the next 75 minutes another 8 mL/kg of blood was withdrawn at a steady rate. The resuscitation fluids were then infused for 45 minutes during which the third continuous hemorrhage of 8 mL/kg was performed. The animals were randomized to five groups: 1) sham hemorrhage (n = 6); 2) sham resuscitation (n = 7); 3) Lactated Ringer's resuscitation, three times the volume of shed blood (n = 8); 4) Ketone Ringer's (containing 28 mEq/L of beta-hydroxybutyrate) resuscitation, three times the volume of shed blood (n = 7); and 5) plasma resuscitation, volume equal to shed blood (n = 7). The animals were sacrificed 1 hour after resuscitation and lungs were harvested. Western blot technique was used for the determination of proapoptotic protein (bax), antiapoptotic protein (bcl-2), apoptotic fragments of poly ADP-ribose polymerase, and ICAM-1. Sections of lung were also subjected to immunostaining using antibodies to bax and ICAM-1 proteins (reported as number of positive cells/mm2). RESULTS: Lactated Ringer's resuscitation caused a significant increase in pulmonary apoptosis and ICAM-1 expression compared with the sham hemorrhage group. Animals resuscitated with Ketone Ringer's solution and plasma did not show this injury pattern. CONCLUSIONS: Substitution of lactate with ketone bodies in the resuscitation fluid attenuates the expression of cellular injury markers in the lung.

3-Hydroxybutyric Acid↗
PubMed1998

Cerebral excitatory amino acids and Na+,K+-ATPase activity during resuscitation of severely hypoxic newborn piglets.

We tested the hypothesis that early brain recovery in hypoxic newborn piglets is improved by resuscitating with an O2 supply close to the minimum level required by the newborn piglet brain. Severely hypoxic 2-5-d-old anaesthetized piglets were randomly divided into three resuscitation groups: hypoxaemic (n = 8), 21% O2 (n = 8), and 100% O2 groups (n = 8). The hypoxaemic group was mechanically ventilated with 12-18% O2 adjusted to achieve a cerebral venous O2 saturation of 17-23% (baseline; 45 +/- 1%, mean +/- SEM). During the 2h resuscitation period, extracellular aspartate and glutamate concentrations in the cerebral striatum were higher during hypoxaemic resuscitation (p = 0.044 and p = 0.055, respectively) than during resuscitation with 21% O2 or 100% O2, suggesting an unfavourable accumulation of potent excitotoxins during hypoxaemic resuscitation. The cell membrane Na+,K+-ATPase activity of cerebral cortical tissue after 2 h resuscitation was similar in the three groups (p = 0.30). In conclusion, hypoxaemic resuscitation did not normalize early cerebral metabolic recovery as efficiently as resuscitation with 21% O2 or 100% O2. Resuscitation with 21% O2 was as efficient as resuscitation with 100% O2 in this newborn piglet hypoxia model.

Analysis of Variance↗
PubMed1997

Fluid resuscitation.

Contention over fluid resuscitation is not new. The issues however have changed considerably. The crystalloid/colloid debate has largely reached a stalemate with little to define clear differences between the two especially early in traumatic shock when increased capillary permeability is a minor issue. Blood, despite its difficulties and its cost is now safer than ever before and we will have to wait a number of years before routine use of blood substitutes becomes possible. Hypertonic saline and hypertonic saline dextran solutions used as an early bolus of 4-6 ml/kg and in conjunction with isotonic crystalloids and blood appear to be the new resuscitation fluids of first choice for haemorrhagic shock and there will be a progressive swing towards these fluids over the next 5 years. Application of the principles of minimal volume or delayed resuscitation requires the reconsideration of many entrenched attitudes and expectations present in the traditional management of haemorrhagic shock. Currently there is hard evidence to support its use only in ruptured AAA and penetrating truncal trauma but the application of the principles should be much more widespread. Minimal volume resuscitation emphasizes the need for urgent investigation and definitive management of uncontrollable haemorrhage reserving the early use of fluid resuscitation to maintain life only, until the integrity of the vascular circuit has been verified or restored. Thus it is the timing rather than the quantity of fluid which is the underlying issue. The questions which these new models of haemorrhage raise and the reconsideration of the physiology of haemorrhagic shock must be our focus. It would be foolish to replace the long-held dogma of aggressive fluid resuscitation in all situations with the new dogma of minimal volume resuscitation in all situations. Instead we must walk the tightrope attempting to understand the likely physiological mechanisms of our patients at an individual level. Fluid resuscitation has necessarily become more complex as the potential to do harm has been more clearly demonstrated. The use of resuscitation fluids must now receive as much care and consideration as is currently given to the prescription of potent drugs, weighing the potential benefits of a course of action against its possible side effects. Much research is required to clarify and refine the data on fluid resuscitation but there is little doubt that the conceptual changes which underlie this work on haemorrhagic shock offer the most exciting advances in fluid resuscitation seen in the past 30 years.

Animals↗
PubMed2006

Fluid resuscitation increases inflammatory gene transcription after traumatic injury.

BACKGROUND: The debate continues over type and quantity of fluid to administer for resuscitation after traumatic injury. This study aimed to examine effects of resuscitation with lactated Ringer's (LR) and Hextend (HEX) on the inflammatory response after uncontrolled hemorrhagic shock (UHS). METHODS: There were 38 swine randomized. Control swine were anesthetized and killed. Sham swine underwent laparotomy, splenectomy, and 2 hours of anesthesia. UHS swine received a grade V liver injury after laparotomy and splenectomy and were randomized to no fluid (NF) resuscitation or to blinded resuscitation 30 minutes after injury with LR or HEX. Fluids were infused as needed to maintain baseline blood pressure for 90 minutes. Lung tissue mRNA levels of interleukin-6 (IL-6), granulocyte colony stimulating factor (G-CSF), and tumor necrosis factor alpha (TNF-alpha) were determined. Lung sections were examined for neutrophils (PMNs) sequestered within alveolar walls. RESULTS: All UHS animals survived and initial blood loss was similar between groups. Mean arterial pressures (MAPs) were similar for all UHS animals until resuscitation was initiated. MAPs of resuscitated animals remained similar and were significantly higher than MAPs of the NF animals. Sequestered PMNs were equally elevated in all UHS animals. Cytokine analysis showed increased IL-6, G-CSF, and TNF-alpha gene transcription in resuscitated swine compared with NF swine. LR and HEX resuscitated swine tissue mRNA levels showed no differences. CONCLUSIONS: Fluid resuscitation after solid organ injury and uncontrolled hemorrhage results in greater proinflammatory gene transcription than no resuscitation. LR and HEX resuscitation have equivalent effects on indices of inflammation in the lungs.

Animals↗
PubMed1993

Do-not-resuscitate orders in a children's hospital.

OBJECTIVES: a) To quantify the use of do-not-resuscitate orders in a tertiary care children's hospital; and b) to characterize the circumstances in which such orders are written. DESIGN: Retrospective chart review. SETTING: University teaching hospital. PATIENTS: All inpatients who died in an urban children's hospital over a 1-yr period of time. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The hospital records of 54 of 69 patients who died were reviewed. Eighty-two percent of patient deaths occurred in the ICU; 13% of patient deaths occurred in the operating room, and 5% occurred in a medical ward. Other findings included the following: 25 (46%) of 54 patients died after attempted cardiopulmonary resuscitation; 13 (24%) patients were brain dead; and 16 (30%) died with a do-not-resuscitate order in effect. Age was associated with resuscitation status: do-not-resuscitate orders were written for five (21%) of 22 infants (< 1 yr of age); seven (50%) of 14 children (1 to 11 yrs of age); and four (80%) of five adolescents who died (p < .002). Fifteen of 16 do-not-resuscitate orders were written for patients who were in the ICU, where they remained until death. Findings in patients when the do-not-resuscitate orders were written were as follows: 15 ICU patients were receiving mechanical ventilation; 14 (95%) of 15 were receiving inotropic agents; 12 (80%) of 15 patients were receiving narcotic analgesics; and one (6%) patient was being dialyzed. At least one therapeutic modality was withdrawn in 7 (44%) of 16 patients. Do-not-resuscitate orders followed documented conferences with physicians and family members in 13 (81%) of 16 cases. These discussions were initiated by physicians in 12 (92%) of 13 cases. CONCLUSIONS: Do-not-resuscitate orders in pediatric patients are written more often in older than younger hospitalized children who die. Most do-not-resuscitate orders are written for patients who are receiving aggressive medical therapy in the ICU.

Age Factors↗
PubMed1998

Gut and liver: the organs responsible for increased nitric oxide production after trauma-hemorrhage and resuscitation.

OBJECTIVE: To determine which organs produce the increased levels of nitric oxide (NO) seen after hemorrhage and resuscitation. ANIMALS AND INTERVENTIONS: Adult male rats underwent laparotomy (ie, trauma induced) and were bled to and maintained at a mean arterial pressure of 40 mm Hg until 40% of the maximum bleedout volume was returned in the form of Ringer lactate. The rats were then resuscitated with Ringer lactate, 4 times the maximum bleedout volume for 1 hour. Sham-operated animals underwent only the surgical procedure. MAIN OUTCOME MEASURES: Plasma levels of nitrate/nitrite (NO3-/NO2-, stable products of NO) were measured by colorimetric assay at the maximum bleedout volume; at the end of hemorrhage; at the end of resuscitation; and 1.5, 4, 8, and 24 hours after resuscitation. In additional rats, the heart, liver, small intestine, kidneys, and spleen were harvested 4 hours after resuscitation for the measurement of NO3-/NO2- levels. Moreover, tissue perfusion was determined in the above-mentioned organs by radioactive microspheres 4 hours after resuscitation in other groups of animals. RESULTS: Plasma levels of NO3-/NO2- were similar to those of sham-operated animals during hemorrhage and at the end of resuscitation. One and a half hours after the end of resuscitation, however, NO production increased significantly. The peak levels of plasma NO3-/NO2- occurred at 4 hours, and the levels remained elevated even 24 hours after resuscitation. Tissue NO3-/NO2- levels were significantly increased in the liver, small intestine, and spleen 4 hours after resuscitation. In contrast, the levels of NO3-/NO2- were similar to those of sham-operated animals in the heart and kidneys at all times. Blood flow in the heart was maintained after hemorrhage, whereas hepatic, intestinal, splenic, and renal perfusion decreased significantly. CONCLUSIONS: The gut and liver seem to be the sites responsible for the increased NO production seen after trauma and hemorrhage. The overproduction of NO is most likely caused by up-regulation of inducible NO synthase. Thus, attempts to reduce NO production using specific inhibitors for inducible NO synthase might be helpful for improving hepatic and intestinal functions after trauma and hemorrhagic shock.

Animals↗
PubMed1994

Audit of emergency preoperative resuscitation.

A total of 148 patients of mean age 61 years with acute gastrointestinal disease who were assessed as requiring preoperative resuscitation were studied. Overall, the mortality rate was 14.2 per cent and the morbidity rate 50.7 per cent. Resuscitation was associated with a mean(s.e.m.) improvement in predicted mortality rate of 4.2(0.8) per cent and in morbidity rate of 4.3(0.7) per cent. However, there was a group of patients in whom resuscitation was unsuccessful, despite there being no apparent difference in duration or methods of resuscitation from those of the rest of the population studied. A poor response to resuscitation was found in 28 patients; this was commoner in the elderly (P < 0.001) and in women (P < 0.05). Complications were more frequent in patients failing to improve with resuscitation (P < 0.001). In the group deteriorating despite resuscitative (P < 0.001). In the a greater proportion of patients with a perforated viscus (P < 0.001), whereas intestinal obstruction was less common (P < 0.05). This study demonstrates that resuscitation can be audited and quantified. Preoperative resuscitation appears to be beneficial, but there is a group that may benefit from synchronous surgery and resuscitation.

Acute Disease↗
PubMed2000

E- and P-selectin expression depends on the resuscitation fluid used in hemorrhaged rats.

BACKGROUND: E- and P-selectins are adhesion molecules that effect neutrophil-mediated reperfusion injury. Our hypothesis was that the expression of E- and P-selectins is dependent on the type of fluid used for resuscitation and that lactated Ringer's (LR) solution would result in an early upregulation of these molecules. METHODS: Male Sprague-Dawley rats (n = 36) were subjected to a 27 ml/kg hemorrhage over 5 min followed by a 1-h shock period and 1-h of resuscitation. The animals were randomized into the following resuscitation groups: (1) sham; (2) hemorrhage, no resuscitation; (3) whole blood (27 ml/kg); (4) 3:1 lactated Ringer's (81 ml/kg); (5) sham hemorrhage, infusion of lactated Ringer's (81 ml/kg); (6) 7. 5% hypertonic saline (9.7 ml/kg). Immediately after resuscitation, the spleen and lung were harvested for measurement of E- and P-selectin mRNA expression with reverse transcriptase- polymerase chain reaction (RT-PCR), and protein expression with immunostaining. RESULTS: LR resuscitation and LR infusion without prior hemorrhage significantly increased the E- and P-selectin mRNA in the lung and spleen. Immunostaining demonstrated that the adhesion molecule expression was mainly located in perivascular/peribronchial areas in the lung, and the marginal and trabecular areas in the spleen. Pulmonary edema and inflammatory cell infiltration were observed only in the animals that were hemorrhaged and resuscitated with LR. No resuscitation and resuscitation with whole blood caused no significant increase in selectin expression. CONCLUSION: LR resuscitation and LR infusion without hemorrhage are associated with early increased expression of E- and P-selectin molecules in the lung and spleen.

Animals↗
PubMed2006

Hypotensive resuscitation in patients with ruptured abdominal aortic aneurysm.

BACKGROUND: The technique of hypotensive resuscitation in haemorrhagic shock involves resuscitation to below normotensive blood pressures achieving the minimum perfusion pressure that will adequately perfuse vital organs until definitive arrest of haemorrhage. AIM: To summarise the evidence for the use of hypotensive resuscitation in patients with uncontrolled haemorrhagic shock and ruptured abdominal aortic aneurysm (AAA). METHODS: A MEDLINE (1966-2004) and Cochrane library search for articles relating to hypotensive resuscitation was undertaken; see text for further details. RESULTS: Several animal studies exist using an abdominal aortotomy model of ruptured AAA. These have demonstrated improved tissue perfusion, decreased blood loss and improved survival associated with hypotensive resuscitation compared with aggressive resuscitation. There are several human studies advocating delayed rather than immediate resuscitation in trauma patients but careful review of the literature reveals no prospective studies of hypotensive resuscitation in patients with ruptured AAA. CONCLUSIONS: Animal studies demonstrate superiority of hypotensive resuscitation over aggressive resuscitation but further research is required to assess its efficacy in patients with ruptured AAA.

Aneurysm, Ruptured↗
PubMed1987

Family participation during resuscitation: an option.

We began to question the fairness of a policy to exclude close family members from the treatment room during attempted resuscitation of cardiac arrest victims in 1982 after 13 of 18 surviving relatives (72%) who were surveyed about their experiences during the attempted resuscitation of a family member responded that they would have liked to have been present during the resuscitation. We report the results of a program instituted at that time that allowed selected family members to be present during resuscitation efforts. Family members were asked by a chaplain or nurse if they wished to be present in the resuscitation room, and those accepting were accompanied by a supporting emergency staff member who explained the milieu of the code room. None of the participants interfered with resuscitation efforts. Seventy persons who participated were later contacted by one of the chaplains and asked to complete a survey form. Forty-four of 47 respondents (94%) who had been present during resuscitation believed that they would participate again. Thirty-six (76%) thought that adjustment to the death or grieving was facilitated by their witnessing the resuscitation; 30 (64%) felt that their presence was beneficial to the dying family member. We conclude that lay person may wish to be with family members who may be dying even though resuscitation efforts are being made, and that it is reasonable to inquire about this wish. This experience has assisted the grieving process for many and has not interrupted or adversely affected medical efforts at resuscitation.

Adaptation, Psychological↗
PubMed2002

Factors influencing the outcomes after in-hospital resuscitation in Taiwan.

BACKGROUND: The effects on prognosis of some advanced interventions established before cardiopulmonary resuscitation are not clear. The outcomes and patterns of various factors of in-hospital resuscitation are also influenced by different disease patterns in different areas. We studied the factors related to outcomes in an oriental country. MATERIALS AND METHODS: We studied the in-hospital resuscitation events in a tertiary medical center in Taipei city, Taiwan. All events and variables were recorded using the Utstein style for in-hospital resuscitation. We measured the influence of patients and event variables on the outcomes of return of spontaneous circulation (ROSC) and survival to discharge. RESULTS: The rate of establishing a ROSC was 67% and the rate of survival to discharge was 17% in the studied population. The 1-year survival rate was 3.9%. Only 17% of the patients resuscitated had coronary artery disease. VT/VF was the initial rhythm in only 13.6% patients. Nearly half (49%) of the resuscitation attempts took place in emergency department (ED). Patients who were already intubated or had received mechanical ventilation before resuscitation had reduced chances of achieving ROSC. (P<0.05). Favorable prognostic factors of survival to discharge were shorter time intervals from patient collapse to arrival of the resuscitation team (69 vs. 154 s, P<0.05) and to confirmation of arrest (93 vs. 217 s, P<0.05). CONCLUSION: Intubation and mechanical ventilation already established before arrest implies an underlying critical illness and reduce the chances of ROSC. Shorter intervals from collapse to resuscitation improve the chance of survival to discharge. The high proportion of resuscitation events occurring in the ED, reflecting ED overcrowding, and low frequency of pre-existing coronary artery disease are unique to our country.

Aged↗
PubMedDate not supplied

Resuscitation for patients with out-of-hospital cardiac arrest: Singapore.

AIM: To evaluate characteristics and outcome of out-of-hospital cardiac arrest (OHCA) patients presenting to the Emergency Department (ED), and to examine factors that could be used to determine to prolong or abort resuscitation for these patients. METHOD: All OHCA patients presenting to the ED were studied over a three-month period from November 2001 through January 2002. Patient with traumatic cardiac arrest were excluded. Data were collected from the ambulance case records, ED resuscitation charts, and the ED Very High Frequency (VHF) radio case-log sheet. Information collected included the patient's demographic characteristics, timings (time from call to ambulance arrival on scene, time from arrival at scene to departure from scene, time from scene to arrival in the ED) recorded in the pre-hospital setting, the outcome of the resuscitation, and the final outcome for patients who survived ED resuscitation. RESULTS: Ninety-three non-traumatic patients with an OHCA were studied during the three-month period. Of the 93 patients, 15 (16.1%) survived ED resuscitation, and one survived to hospital discharge. There were no statistically significant differences for age, race, or gender with regards to the outcome of the resuscitation. The initial cardiac rhythms were asystole (65), pulseless electrical activity (21), and ventricular fibrillation (7). Fourteen (15%) received bystander cardiopulmonary resuscitation (CPR). All seven patients with return of spontaneous circulation (ROSC) on arrival in the ED survived ED resuscitation. The ambulance took an average of 11.80 +/- 3.36 minutes for the survivors and 11.8 +/- 4.22 minutes for the non-survivors from the time of call to get to these patients. The average of the scene times was 12.5 +/- 4.61 minutes for the survivors and 12.0 +/- 4.02 minutes for the non-survivors. Transport time from the scene to the ED took an average of 39.1 +/- 8.32 minutes for the survivors and 37.2 +/- 9.00 minutes for the non-survivors. CONCLUSION: The survival rate for patients with OHCA after ED resuscitation is similar to the results from other studies. There is a need to increase the awareness and delivery of basic life support by public education. Automatic External Defibrillators (AED) should be available widely to ensure that the chance of early defibrillation is increased. Prolonged resuscitation efforts appear to be futile for OHCA patients if the time from cardiac arrest until arrival in the ED is > or = 30 minutes coupled with no ROSC, and if continuous asystole has been documented for > 10 minutes.

Aged↗