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 541 records · Page 30Linked to original sources
PubMed2003

Splanchnic perfusion during delayed, hypotensive, or aggressive fluid resuscitation from uncontrolled hemorrhage.

The purpose of this study was to determine the effect of three different fluid resuscitation strategies on splanchnic perfusion in a clinically relevant model of uncontrolled hemorrhage after liver trauma. Anesthetized swine were instrumented with a gastric near-infrared spectroscopy probe (GStO2), a jejunal tonometer (PrCO2), a portal vein catheter (SpvO2, lactate), and an ultrasonic blood flow probe on the superior mesenteric artery. The liver was lacerated to produce uncontrolled hemorrhage and a shock state characterized by a 40-60% decrease in cardiac output and a decrease in mean arterial pressure (MAP) to 42 +/- 1 mmHg. Animals were randomly assigned to either delayed resuscitation (n = 6); hypotensive resuscitation with lactated Ringer's infusion to MAP = 60 mmHg (n = 6); or aggressive resuscitation with LR to MAP >/= 75 mmHg (n = 6). For the remainder of the protocol, the treatment was identical. The data showed that blood loss (47 +/- 7 and 45 +/- 10 mL/kg) and total fluid requirements (118 +/- 73 and 171 +/- 85 mL/kg) were similar with either hypotensive or aggressive resuscitation. In contrast, with delayed resuscitation, both values were lower (27 +/- 2 mL/kg and 87 +/- 33 mL/kg, both P < 0.05). Despite aggressive resuscitation, SpvO2 and GstO2 were about 10% lower (both P < 0.05 within group) and PrCO2 was about 20 mmHg higher (P < 0.05 within group) than the corresponding values in the other two groups. Thus, delayed resuscitation minimized the blood loss but did not restore tissue oxygenation, whereas aggressive resuscitation was associated with maximal blood loss and splanchnic hypoperfusion. For this reason, it is reasonable to conclude that hypotensive resuscitation might be an effective strategy to maintain splanchnic perfusion after blunt abdominal trauma and uncontrolled hemorrhage.

Acid-Base Equilibrium↗
PubMed2004

Effect of initial fluid resuscitation on subsequent treatment in uncontrolled hemorrhagic shock in rats.

SUMMARY: Using a modified uncontrolled hemorrhage shock model with massive splenic and vascular injury, we evaluated outcome and tissue oxidation injury with different resuscitation interventions during prehospital and hospital phases. The aim of our study was to explore the effect of initial fluid resuscitation on subsequent treatment of uncontrolled hemorrhagic shock in rats. Uncontrolled hemorrhagic shock was produced in 114 Wistar rat by sharp transection both of the splenic parenchyma at one location between the major branches of the splenic artery into the spleen and of one of the major branches of the splenic artery. Experimental design consisted of three phases: a "prehospital phase" (resuscitation with balanced saline to a mean arterial pressure (MAP) of 40, 50, 60, 80, and 100 mmHg, respectively, when MAP reached 30 mmHg), followed by a "hospital phase" (120 min, including control of hemorrhage and resuscitation with balanced saline and whole blood (2:1) or balanced saline alone to a MAP >80 mmHg), and a 240-min observation phase. Blood loss, infused volume, hematocrit, and survival rate were recorded. At the end of the experiment, survivors were sacrificed, and the lung, kidney, and distal ileum were harvested for determination of malondialdehyde (MDA) content and total antioxidative capacity (T-AOC). All rats that were resuscitated to a MAP >80 mmHg in the prehospital phase and received balanced saline alone in the hospital phase died, whereas those that had been resuscitated to a MAP of 40 or 50 mmHg during the prehospital phase and then resuscitated with balanced saline and whole blood in the hospital phase survived throughout the experiment. The animals whose MAP was kept higher than 80 mmHg had significantly higher MDA content and lower T-AOC than those whose MAP was maintained 40, 50, or 60 mmHg during the prehospital phase. In the hospital phase, resuscitation with balanced saline and whole blood not only relieved tissue damage but also improved the survival, as indicated by 44.4% survival rate in the rats that resuscitated to a MAP of 80 or 100 mmHg in the prehospital phase. These results suggested that in our uncontrolled hemorrhagic shock model, limited resuscitation in the prehospital phase had benefit for subsequent treatment in the hospital phase in terms of alleviated tissue damage and improved survivorship.

Animals↗
PubMed1997

Ethical issues of cardiopulmonary resuscitation: current practice among emergency physicians.

OBJECTIVE: To determine current practice and attitudes among emergency physicians (EPs) regarding the initiation and termination of CPR. METHODS: An anonymous survey was mailed to randomly selected EPs. Main outcome measures included respondents' answers to questions regarding outcome of resuscitation, and current practice regarding initiation, continuation, and termination of resuscitation for victims of cardiopulmonary arrest. RESULTS: The 1,252 respondents were from all 50 states, a variety of practice settings, and varying board certification. Most (78%) respondents honor legal advance directives regarding resuscitation. Few (7%) follow unofficial documents, or verbal reports of advance directives (6%). Many (62%) make decisions regarding resuscitation because of fear of litigation or criticism. A majority (55%) have recently attempted numerous resuscitations despite expectations that such efforts would be futile. Most respondents indicated that ideally, legal concerns should not influence physician practice regarding resuscitation (78%), but that in the current environment, legal concerns do influence practice (94%). CONCLUSIONS: Most EPs attempt to resuscitate patients in cardiopulmonary arrest, regardless of futility, except in cases where a legal advance directive is available. Many EPs' decisions regarding resuscitation are based on concerns of litigation and criticism, rather than their professional judgment of medical benefit or futility. Compliance with patients' wishes regarding resuscitation is low unless a legal advance directive is present. Possible solutions to these problems may include standardized guidelines for the initiation and termination of CPR, tort reform, and additional public education regarding resuscitation and advance directives.

Advance Directive Adherence↗
PubMed1995

Success of cardiopulmonary resuscitation after heart attack in hospital and outside hospital.

OBJECTIVES: To determine factors associated with cardiopulmonary resuscitation being attempted after cardiac arrest from myocardial infarction, in or outside hospital, and estimate short term and long term survival rates. DESIGN: Descriptive cross sectional and cohort study. SETTING: Community based register of all suspected heart attacks and sudden cardiac deaths in Lower Hunter region of New South Wales, Australia. SUBJECTS: 4924 men and women aged 25-69. MAIN OUTCOME MEASURES: Rates of attempted cardiopulmonary resuscitation and survival after successful resuscitation. RESULTS: Cardiopulmonary resuscitation was attempted in 41% of cases of cardiac arrest after myocardial infarction outside hospital and 63% of cases in hospital. Survival rates at 28 days were 12% and 39% respectively. Among the survivors, although 41% had another myocardial infarction (or coronary death), 81% of both groups were still alive two years later. Younger and better educated people were more likely to receive cardiopulmonary resuscitation in either setting, and being married predicted cardiopulmonary resuscitation being attempted outside hospital. Younger age predicted better survival rates after attempted resuscitation in hospital. CONCLUSIONS: The reasons for better education to predict cardiopulmonary resuscitation being attempted need explanation. The higher survival rate after cardiopulmonary resuscitation in hospital compared with outside hospital and the good long term prognosis for survivors in both settings suggest that attempts to improve success of cardiopulmonary resuscitation outside hospital may be worth while.

Adult↗
PubMed1999

Resurrecting autonomy during resuscitation--the concept of professional substituted judgment.

The urgency of the resuscitation and the impaired ability of the patient to make a reasonable autonomous decision both conspire against adequate consideration of the principles of medical ethics. Informed consent is usually not possible for these reasons and this leads many to consider that consent is not required for resuscitation, because resuscitation brings benefit and prevents harm and because the patient is not in a position to give or withhold consent. However, consent for resuscitation is required and the common models employed for this purpose are presumed consent or consent from a patient proxy. However, if we are to honour the principles of respect for patient autonomy, as well as beneficence and non-maleficence, when starting and continuing resuscitation we must try and achieve the best balance between benefit and harm from the patient's perspective. The concept of professional substituted judgment involves the resuscitators gathering as much information about the patient as they possibly can, including any previously expressed attitudes towards such a situation, and combining this with their acquired professional knowledge of the likely benefits and harms of the resuscitation endeavour and then exercising their moral imagination, imagining themselves as the patient, and asking "would I want this treatment?" By employing professional substituted judgment resuscitators should recognise when the balance of benefit and harm becomes unfavourable from the patient's perspective and at this point they have a moral obligation to withdraw resuscitation as they can no longer presume the patient's consent. In this way the principles of beneficence, non-maleficence and respect for patient autonomy are more favourably balanced than under other resuscitation decision making processes.

Ethics, Medical↗
PubMed1997

Phased chest and abdominal compression-decompression. A new option for cardiopulmonary resuscitation.

BACKGROUND: We describe a new manual method of phased chest and abdominal compression-decompression with a Lifestick resuscitator for cardiopulmonary resuscitation (CPR). METHODS AND RESULTS: Ventricular fibrillation (VF) was induced in 20 domestic pigs. After either 5 or 7 minutes of untreated VF, either phased chest and abdominal compression-decompression (Lifestick resuscitator) or precordial compression was initiated. Defibrillation was attempted at 2 minutes after the start of CPR. For the animals in which VF was untreated for 7 minutes, epinephrine was administered in doses of 20 micrograms/kg at 2 minutes after start of CPR. The coronary perfusion pressure generated by the Lifestick resuscitator was more than twofold greater (P < .01) than that generated by conventional precordial compression. Of 5 control animals, none were resuscitated after 5 minutes of VF. However, each of 5 animals treated with the Lifestick resuscitator was resuscitated (P < .01) and survived after 48 hours (P < .01). When untreated VF was prolonged to 7 minutes and epinephrine was administered, only 2 of the 5 control animals were resuscitated, and none of them survived for more than 4 hours. However, each of the Lifestick-treated animals was resuscitated and survived for more than 48 hours (P < .01). CONCLUSIONS: Phased chest and abdominal compression-decompression substantially increased hemodynamic efficacy of CPR and outcome in terms of successful resuscitation, 48-hour survival, and cerebral recovery.

Abdomen↗
PubMed2004

Resuscitation with 100% O2 increases cerebral injury in hypoxemic piglets.

Perinatal asphyxia is a major cause of immediate and postponed brain injury in the newborn. We hypothesized that resuscitation with 100% O2 compared with ambient air is detrimental to the cerebral tissue. We assessed cerebral injury in newborn piglets that underwent global hypoxia and subsequent resuscitation with 21 or 100% O2 by extracellular glycerol, matrix metalloproteinase (MMP) expression levels, and oxidative stress. Extracellular glycerol was sampled by cerebral microdialysis. MMP levels were analyzed in cerebral tissue by gelatin zymography, broad matrix degrading capacity, and real-time PCR. Total endogenous antioxidant capacity was measured by the oxygen radical absorbance capacity assay. Extracellular glycerol increased 50% after resuscitation with 100% O2 compared with 21% O2. Total MMP activity was doubled in resuscitated animals at endpoint compared with baseline (p=0.018), and the MMP-2 activity was significantly increased in piglets that were resuscitated with 21% O(2) (p=0.003) and 100% O2 (p=0.001) compared with baseline. MMP-2 mRNA level was 100% increased in piglets that were resuscitated with 100% O2 as compared with 21% O2 (p < 0.05). Oxygen radical absorbance capacity values in piglets that were resuscitated with 100% O2 were considerably reduced compared with both baseline (p=0.001) and piglets that were resuscitated with 21% O2 (p=0.001). In conclusion, our data show increased MMP-2 activity at both gene and protein levels, accompanied with cerebral leakage of glycerol, presumably triggered by augmented oxidative stress. Our findings suggest that resuscitation of asphyxiated piglets with 100% O2 is detrimental to the piglet brain compared with resuscitation with 21% O2.

Acute Disease↗
PubMed2002

Cerebral intracellular calcium concentrations in asphyxiated rat fetuses resuscitated with oxygen.

OBJECTIVE: To investigate the effects of resuscitation with three different oxygen concentrations on cerebral intra- and extra-cellular calcium, sodium and potassium changes in asphyxiated rat fetuses. METHODS: Fifty-six fetal rats of gestational age of 20 days were randomly assigned into five study groups: sham operation group (control, n = 11), room-air resuscitation group (n = 10), and 3 oxygen-resuscitated groups (n = 14, 11, and 10 respectively). Different inhaled oxygen concentrations and different timings of oxygen delivery were assigned. Except for control all fetal rats were rendered ischemic and hypoxic in utero by interrupting the placental circulation. After re-circulation, intra- and extra-cellular concentrations of calcium, sodium, and potassium in the brains were measured for each individual group. RESULTS: The mean intracellular free calcium concentration of fetal rat brains was similar for the room-air resuscitation group (552.1 +/- 93.5 nmol/L) and the group resuscitated with 92.8% oxygen (520.6 +/- 79.1 nmol/L) and both were significantly higher than in the control (315.3 +/- 86.9 nmol/L) (P < 0.001). After resuscitation with 65% oxygen, be it instituted before or immediately after hypoxia, their mean intracellular free calcium concentrations in the brain cells (441.5 +/- 47.9 and 452.9 +/- 36.4 nmol/L respectively) were significantly lower than those in the room-air resuscitation (P < 0.01) and 92.8% oxygen group (P < 0.05), though still higher than in the control (P > 0.05). There was no difference in the total concentrations of calcium, sodium, or potassium among all groups. CONCLUSIONS: Resuscitation with 92.8% oxygen or room air exerted a similar effect on the parameters measured, indicating that resuscitation of asphyxiated neonates using 100% oxygen might not be superior to using room air. Resuscitation with 65% oxygen resulted in lower cerebral intracellular calcium concentrations and might produce a better outcome than using 100% oxygen or room air.

Animals↗
PubMed1998

Resuscitation of asphyxiated newborn infants with room air or oxygen: an international controlled trial: the Resair 2 study.

OBJECTIVE: Birth asphyxia represents a serious problem worldwide, resulting in approximately 1 million deaths and an equal number of serious sequelae annually. It is therefore important to develop new and better ways to treat asphyxia. Resuscitation after birth asphyxia traditionally has been carried out with 100% oxygen, and most guidelines and textbooks recommend this; however, the scientific background for this has never been established. On the contrary, theoretic considerations indicate that resuscitation with high oxygen concentrations could have detrimental effects. We have performed a series of animal studies as well as one pilot study indicating that resuscitation can be performed with room air just as efficiently as with 100% oxygen. To test this more thoroughly, we organized a multicenter study and hypothesized that room air is superior to 100% oxygen when asphyxiated newborn infants are resuscitated. METHODOLOGY: In a prospective, international, controlled multicenter study including 11 centers from six countries, asphyxiated newborn infants with birth weight >999 g were allocated to resuscitation with either room air or 100% oxygen. The study was not blinded, and the patients were allocated to one of the two treatment groups according to date of birth. Those born on even dates were resuscitated with room air and those born on odd dates with 100% oxygen. Informed consent was not obtained until after the initial resuscitation, an arrangement in agreement with the new proposal of the US Food and Drug Administration's rules governing investigational drugs and medical devices to permit clinical research on emergency care without the consent of subjects. The protocol was approved by the ethical committees at each participating center. Entry criterion was apnea or gasping with heart rate <80 beats per minute at birth necessitating resuscitation. Exclusion criteria were birth weight <1000 g, lethal anomalies, hydrops, cyanotic congenital heart defects, and stillbirths. Primary outcome measures were death within 1 week and/or presence of hypoxic-ischemic encephalopathy, grade II or III, according to a modification of Sarnat and Sarnat. Secondary outcome measures were Apgar score at 5 minutes, heart rate at 90 seconds, time to first breath, time to first cry, duration of resuscitation, arterial blood gases and acid base status at 10 and 30 minutes of age, and abnormal neurologic examination at 4 weeks. The existing routines for resuscitation in each participating unit were followed, and the ventilation techniques described by the American Heart Association were used as guidelines aiming at a frequency of manual ventilation of 40 to 60 breaths per minute. RESULTS: Forms for 703 enrolled infants from 11 centers were received by the steering committee. All 94 patients from one of the centers were excluded because of violation of the inclusion criteria in 86 of these. Therefore, the final number of infants enrolled in the study was 609 (from 10 centers), with 288 in the room air group and 321 in the oxygen group. Median (5 to 95 percentile) gestational ages were 38 (32.0 to 42.0) and 38 (31.1 to 41.5) weeks (NS), and birth weights were 2600 (1320 to 4078) g and 2560 (1303 to 3900) g (NS) in the room air and oxygen groups, respectively. There were 46% girls in the room air and 41% in the oxygen group (NS). Mortality in the first 7 days of life was 12.2% and 15.0% in the room air and oxygen groups, respectively; adjusted odds ratio (OR) = 0.82 with 95% confidence intervals (CI) = 0.50-1.35. Neonatal mortality was 13.9% and 19.0%; adjusted OR = 0. 72 with 95% CI = 0.45-1.15. Death within 7 days of life and/or moderate or severe hypoxic-ischemic encephalopathy (primary outcome measure) was seen in 21.2% in the room air group and in 23.7% in the oxygen group; OR = 0.94 with 95% CI = 0.63-1.40. (ABSTRACT TRUNCATED)

Acid-Base Equilibrium↗
PubMed2001

Who's teaching neonatal resuscitation to housestaff? Results of a national survey.

OBJECTIVE: This study was designed to investigate current patterns of training in neonatal resuscitation in US residency programs in general pediatrics. METHODS: A questionnaire was mailed to the chief residents and directors of all US residency programs in general pediatrics to determine who provides supervision and teaching of neonatal resuscitation in the delivery room and neonatal intensive care unit. This questionnaire also inquired as to the use within these residency programs of standardized resuscitation training courses such as Pediatric Advanced Life Support and Neonatal Resuscitation Program. RESULTS: Residents in their third and second years of training are most often cited as responsible for supervision and teaching of neonatal resuscitation in the delivery room, whereas attending neonatologists are cited most frequently as being responsible for these tasks in the neonatal intensive care unit. Pediatric Advanced Life Support is required by virtually all US residency programs, followed in frequency by Neonatal Resuscitation Program and Advanced Cardiac Life Support. CONCLUSIONS: Because those in training collectively provide much of the supervision and teaching of neonatal resuscitation, vigilance is required so that appropriate resuscitation skills are developed and maintained. Objective performance markers may be useful in assessing competency in caring for sick newborns.neonatal resuscitation, delivery room, Neonatal Resuscitation Program, Pediatric Advanced Life Support, Advanced Cardiac Life Support.

Data Collection↗
PubMed2003

Witnessed resuscitation--exploring the attitudes and practices of the emergency staff working in level I emergency departments in the province of KwaZulu-Natal.

AIM: The aim of this study was to explore the attitudes and practices of witnessed resuscitation by the staff working in Level I Emergency Departments in the province of KwaZulu-Natal. Witnessed resuscitation involves the 'medical' resuscitation of the patient with their relatives or loved ones present in the resuscitation room (Boyd, 2000:171). METHODOLOGY: A qualitative approach was used to explore the participants' attitudes and practices of witnessed resuscitation using individual semi--structured interviews. The principle of theoretical saturation was applied and a total of six participants from two Level I Emergency Departments (one provincial and one private institution) were included in this study. FINDINGS: The emergency staff disliked the idea of witnessed resuscitation. They believed it to be a harmful experience for the witnesses, a threat to the resuscitation process and the emergency staff, and impossible to implement in their Emergency Departments. There were however, subtle references made during the interviews that revealed some aspects of witnessed resuscitation that the staff favoured once they had considered the practice. There were no written policies to dictate how the relatives were handled, but all the staff agreed that the relatives were asked to wait outside the resuscitation area, were kept informed and then brought in when the patient was stable or had died. A number of recommendations are suggested in an attempt to introduce witnessed resuscitation as an option in KwaZulu-Natal's Emergency Departments.

Attitude of Health Personnel↗
PubMed2006

Withholding resuscitation: a new approach to prehospital end-of-life decisions.

BACKGROUND: Emergency medical services (EMS) personnel often are not permitted to honor requests to withhold resuscitation at the end of life, particularly if there is no written do-not-resuscitate (DNR) order. OBJECTIVE: To determine whether EMS personnel from agencies implementing new guidelines would be more likely to withhold resuscitation from persons having out-of-hospital cardiac arrests than would personnel from agencies that did not implement the guidelines. DESIGN: Observational study in which 16 of 35 local EMS agencies volunteered to implement new guidelines for withholding resuscitation. SETTING: King County, Washington. PATIENTS: 2770 patients with EMS-attended cardiac arrest. INTERVENTION: New guidelines adopted by participating agencies permitted EMS personnel to withhold resuscitation if the patient had a terminal condition and if the patient, family, or caregivers indicated, in writing or verbally, that no resuscitation was desired. MEASUREMENTS: Proportion of resuscitations withheld in agencies that implemented new guidelines compared with those that did not. RESULTS: Emergency medical services personnel from agencies implementing new guidelines withheld resuscitation in 11.8% of patients (99 of 841 patients) having cardiac arrests, compared with an average of 5.3% (range, 4.2% to 5.9%) of patients (103 of 1929 patients) in 3 historical and contemporary control groups. Honoring verbal requests alone accounted for 53% of withheld resuscitations in the intervention group (52 of 99 patients) compared with an average of 8% (range, 7% to 9%) in the control groups (8 of 103 patients). LIMITATIONS: The study was not a randomized, controlled trial; individual agencies chose whether to implement the guidelines. CONCLUSIONS: Implementation of new guidelines was associated with an increase in the number of resuscitations withheld by EMS personnel. This increase was primarily due to honoring verbal requests.

Aged↗
PubMed1991

Evaluation of ten manual resuscitators across an operational temperature range of -18 degrees C to 50 degrees C.

UNLABELLED: Because of the temperature extremes encountered during emergency resuscitation and transport in the field, we sought to evaluate the performance and safety of 10 adult resuscitators (5 permanent units: Hope 4, Laerdal, Lifesaver, Mark 3, and PMR; and 5 disposable units: BagEasy, Code Blue, CPR Bag, DMR, and SPUR) across an operational temperature range of -18 degrees C to 50 degrees C. METHOD: We tested the devices against the American Society for Testing and Materials (ASTM) Standard F-920 and the International Organization for Standardization (ISO) Standard 8382. We tested each resuscitator by using a lung model, the Bio-Tek VT-1 Ventilator Tester. RESULTS: All of the resuscitators met the ventilation requirements for VT and F (600 mL X 20) and I:E less than 1:1 except the SPUR at -18 degrees C. Standards ASTM F-920 and ISO 8382 specify a fractional delivered oxygen concentration (FDO2) of greater than or equal to 0.85 with attachments and greater than or equal to 0.40 without attachments at oxygen flow of 15 L/min and VE of 7.2 L/min (600 mL X 12). Nine resuscitators met Standards ASTM F-920 and ISO 8382 for FDO2 with attachments at 21 degrees C and 50 degrees C, but only 3 units (Code Blue, DMR, and PMR) passed at -18 degrees C. At 21 degrees C, the Hope 4 had an FDO2 of 0.77 +/- 0.03, which was significantly lower (p less than 0.001) than that of the other 9 resuscitators, all of which were greater than or equal to 0.93. Nine resuscitators met the FDO2 standard without attachments. All 10 resuscitators passed the tests for valve function after contamination with simulated vomitus (at an oxygen flow of 30 L/min) and for backward leakage. At the ventilation pattern recommended by the American Heart Association (AHA) (800 mL X 12) the PMR's mean FDO2 dropped to 0.86 +/- 0.03 because of air leaking into the bag where it attaches to the patient-valve assembly. All 10 resuscitators passed the test for mechanical shock at 21 degrees C and 50 degrees C, but 3 units failed at -18 degrees C. CONCLUSION: We conclude that only the Code Blue and DMR meet the ASTM and ISO standards for operator-powered adult resuscitators across the operational temperature range of -18 degrees C to 50 degrees C.

Disposable Equipment↗
PubMedDate not supplied

Pediatric resuscitation guidelines in the new millennium.

In year 2000, American Heart Association published the new guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. The new guidelines are the consensus of American Heart Association & International Liaison Committee on Resuscitation. There are a number of new changes concerning the knowledge and skills for the performance of basic and advanced cardiopulmonary resuscitation in adults, pediatric and neonatal patients based on evidence-based medicine principle. The new guidelines re-emphasize the importance of sequential ABCD approach during cardiopulmonary resuscitation and include many new changes resulting from the growing knowledge and skills concerning pediatric and neonatal cardiopulmonary resuscitation in recent years. As with previous editions of Pediatric Advanced Life Support & Neonatal Resuscitation Program textbooks, the pediatric and neonatal parts of the new guidelines were the collaborative efforts of subcommittees with members from American Heart Association, American Academy of pediatrics and the International Liaison Committee on Resuscitation. For each step, the new advances in the past few years were considered and discussed and were included in the new guidelines if scientific merit existed. The new changes are discussed and summarized within the text of the article, and in the end there is a table briefly listing all the major changes of cardiopulmonary resuscitation in the pediatric and neonatal aspects. The readers may find the latest editions of Pediatric Advanced Life Support & Neonatal Resuscitation Program textbook and correlate the specific steps mentioned in this article with the original previous edition of textbook so a full scale of the new way to conduct cardiopulmonary resuscitation in pediatric patients may be undertaken.

Child↗
PubMed2003

Family presence during cardiopulmonary resuscitation and invasive procedures: practices of critical care and emergency nurses.

BACKGROUND: Increasingly, patients' families are remaining with them during cardiopulmonary resuscitation and invasive procedures, but this practice remains controversial and little is known about the practices of critical care and emergency nurses related to family presence. OBJECTIVE: To identify the policies, preferences, and practices of critical care and emergency nurses for having patients' families present during resuscitation and invasive procedures. METHODS: A 30-item survey was mailed to a random sample of 1500 members of the American Association of Critical-Care Nurses and 1500 members of the Emergency Nurses Association. RESULTS: Among the 984 respondents, 5% worked on units with written policies allowing family presence during both resuscitation and invasive procedures and 45% and 51%, respectively, worked on units that allowed it without written policies during resuscitation or during invasive procedures. Some respondents preferred written policies allowing family presence (37% for resuscitation, 35% for invasive procedures), whereas others preferred unwritten policies allowing it (39% for resuscitation, 41% for invasive procedures), Many respondents had taken family members to the bedside (36% for resuscitation, 44% for invasive procedure) or would do so in the future (21% for resuscitation, 18% for invasive procedures), and family members often asked to be present (31% for resuscitation, 61% for invasive procedures). CONCLUSIONS: Nearly all respondents have no written policies for family presence yet most have done (or would do) it, prefer it be allowed, and are confronted with requests from family members to be present. Written policies or guidelines for family presence during resuscitation and invasive procedures are recommended.

Adult↗
PubMed2005

[Comparison of resuscitation with Parkland formula and with improved protocol on hemodynamics in projectile-burn combined wound in dogs with seawater immersion].

OBJECTIVE: To compare hemodynamic effects of resuscitation with Parkland formula or with the improved protocol on projectile-burn combined wound in dogs with seawater immersion. METHODS: A model of projectile-burn combined wound in dogs with seawater immersion was reproduced, and 20 dogs were randomized into three groups: projectile-burn combined wound with seawater immersion (immersion group, n=8), Parkland formula resuscitation (lactated Ringer's solution 4 ml/kg per 1%total body surface area for 24 hours, standard resuscitation group, n=6), and improved protocol groups (lactated Ringer's solution 2.5 ml/kg per 1% total body surface area colloid solution 6% hetastarch 0.5 ml/kg per 1% total body surface area for 24 hours, improved group, n=6). Changes of hemodynamics and central temperature (CT) before injury, and 4, 7, 10, 20 and 28 hours after injury were observed. The mortality was observed. RESULTS: After resuscitation with Parkland formula, CT as well as hemodynamic indexes and amount of urine were improved, but central venous pressure (CVP) and the amount of urine were higher in early period of resuscitation. CVP was (14.7+/-3.1)cm H2O and the amount of urine was (2.38+/-0.18)ml.h(-1).kg(-1) at 7 hours after injury. Hemodynamics was not stable during later period of experiment. After resuscitation with the improved protocol, the hemodynamics ameliorated better than resuscitation with Parkland formula. No animals died in improved group, but 4 and 1 died respectively in immersion group and standard resuscitation group. CONCLUSION: Fluid resuscitation according to the improved protocol is more suitable for projectile-burn combined wound in dogs with seawater immersion than resuscitation with Parkland formula.

Animals↗
PubMed2005

Ringer's ethyl pyruvate in hemorrhagic shock and resuscitation does not improve early hemodynamics or tissue energetics.

Reactive oxygen species (ROS) have been implicated in the pathogenesis of hemorrhagic shock. Ethyl pyruvate, a derivative of pyruvate and a proposed oxygen radical scavenger, is attractive as a possible resuscitation fluid. We investigated whether resuscitation with lactated Ringer's (LR) containing ethyl pyruvate (REP) had any hemodynamic or tissue energetic benefits compared with LR alone for hemorrhagic shock. Hemorrhagic shock was induced in splenectomized pigs via inferior vena cava cannula. After 90 min of shock, animals were resuscitated in a stepwise fashion with LR or REP (30 mg/kg/dose, given as 1.5 mg/mL in LR) at 20 cc/kg/step for four steps. Data collected during this experiment included physiologic and hemodynamic parameters, near-infrared reflectance spectroscopy measurements of tissue hemoglobin oxygen (StO(2)) of the stomach, liver, and hind limb, and nuclear magnetic resonance phosphorus spectra of the liver and hind limb at each time point. In both resuscitative groups, heart rate, and lactate and pyruvate values increased during shock and began to drop toward baseline values during resuscitation. Mean arterial pressure, oxygen delivery, and oxygen consumption decreased during shock and increased toward baseline levels during the resuscitative process. There were no significant changes in physiologic parameters between the LR- and REP-resuscitated animals. There was a significantly lower stomach StO(2) and hind limb cellular cytoplasmic pH during later resuscitative endpoints in REP-resuscitated animals. The clinical significance of these findings are unclear. There is no short-term hemodynamic or tissue energetic advantage to using REP as a resuscitation fluid when compared with LR. Long-term outcome studies are needed to further evaluate any potential benefits of use of REP in hemorrhagic shock.

Adenosine Triphosphate↗
PubMed1987

Resuscitation fluid composition and myocardial performance during burn shock.

The present study examines the effects of resuscitation fluid composition on myocardial function, myocardial high-energy phosphate content, and survival following third-degree anesthetic burn to 35-40% body surface area in the guinea pig. Treatment regimens used were 1) no resuscitation, 2) isotonic saline, 3) Ringer's lactate and 4) Ringer's acetate. Fluids were administered at the rate of 0.334 ml/kg/hr/% burn for 4 hr following injury, at which time myocardial function was assessed. Nonburned animals served as controls. In isolated working hearts, significant depression of myocardial function was observed in nonresuscitated and saline-resuscitated animals as evidenced by decreased cardiac output, dP/dt, -dP/dt, and stroke work. Lactate resuscitation produced some improvement in these parameters but did not restore them to those of nonburned control animals. In contrast, Ringer's acetate resuscitation resulted in normal cardiac output and contractility. Myocardial ATP content of hearts obtained from the various resuscitation groups did not differ from that of nonburned control hearts, except for hearts from Ringer's lactate group, which were significantly lower in myocardial ATP than those of the other groups. No differences were found in creatine phosphate content. Resuscitation with the different fluid regimens for 48 hr produced significant differences in survival. Fluids were given at the rate of 4 ml/kg/% burn for 24 hr. Half of the fluid was given in the first 8 hr and the rest during the remaining 16 hr. Nonresuscitated and saline-resuscitated animals showed significant mortality by 24 hr, whereas lactate- and acetate-treated animals had survival rates of 100% and 87.5%, respectively. However, by 48 hr, only acetate-treated animals survived. These data indicate that important differences exist in the effectiveness of different resuscitation fluids and that Ringer's lactate, the fluid most often utilized clinically, may not provide optimum benefit. In light of these results, serious consideration should be given to the substitution of acetate for lactate during the resuscitation of burn shock patients.

Animals↗