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PubMed2004

Long-term subjective memory function in ventricular fibrillation out-of-hospital cardiac arrest survivors resuscitated by early defibrillation.

BACKGROUND: Brain injury after a cardiac arrest remains a major cause of morbidity. Programs focusing on early defibrillation have yielded improved survival of patients after hospital discharge following ventricular fibrillation (VF) out-of-hospital cardiac arrest (OHCA). Early defibrillation that promptly restores a circulating rhythm should decrease the hypoxic period and subsequent organ injury. Therefore this study was designed to determine if long-term memory complaints persist in VF OHCA survivors resuscitated in an early defibrillation program when compared with a healthy control population not experiencing cardiac arrest. METHODS: All patients with an OHCA between November 1990 and January 2001 who received defibrillation by emergency medical services personnel in Olmsted County, MN, USA, were included. The memory function questionnaire (MFQ), a 64-item, 7-point Likert-scaled instrument to evaluate the perception of everyday memory functioning was sent to all survivors. The MFQ comprises four scales: general frequency of forgetting (rates general forgetting), retrospective functioning (compares current memory with past ability), seriousness of forgetting (rates how memory impairment impacts daily life), and mnemonics usage (measures adaptation). The MFQ is scaled so that high scores reflect less severe memory complaints. The comparison population comprised members of the Mayo Older Americans Normative Studies (MOANS) cohort. Quality of life was ascertained with a short form (SF)-36 survey. RESULTS: Seventy-nine of the 200 VF OHCA patients (40%) were discharged. Twenty-two patients have died since dismissal, with an overall average length of follow-up of 4.9+/-3.0 years. Thirty-eight (67%) of the survivors completed the MFQ. Compared with the normal, there was a significant decrease in the general frequency of forgetting score of 144.2+/-37.4 versus 168.1+/-27.3 ( P<0.001) and the seriousness of forgetting score of 84.8 +/-26.7 versus 95.2+/-19.7 (P=0.004). The retrospective function-scale scores were not significantly different ( 18.4+/-6.8 versus 18.7+/- 5.0 (P=0.74). Younger patients (lesser than 65 years of age) reported an increase in general forgetting and the seriousness of forgetting compared with older survivors. A comparison with SF-36 scores suggested an association between general forgetting and decreased vitality (P=0.03) and the seriousness of forgetting with a decreased general health (P=0.005), mental health (P=0.009), physical functioning ( P=0.02 ), and vitality ( P=0.05). CONCLUSION: In a cohort of VF OHCA patients, survivors report more memory complaints in comparison with a general healthy older population. There were more long-term-memory complaints in younger patients. Patients with higher long-term quality-of-life score have fewer memory complaints.

Adult↗
PubMed1998

Emergency department cardiopulmonary bypass in the treatment of human cardiac arrest.

OBJECTIVE: To study the use of emergency department (ED) femoro-femoral cardiopulmonary bypass (CPB) in the resuscitation of medical cardiac arrest patients. DESIGN: Prospective, uncontrolled trial. SETTING: Urban academic ED staffed with board-certified emergency physicians (EPs). PARTICIPANTS: Ten patients with medical cardiac arrest unresponsive to standard therapy. INTERVENTIONS: Femoro-femoral CPB instituted by EPs. RESULTS: The time of cardiac arrest prior to CPB (mean+/-SD) was 32.0+/-13.6 min. The cardiac output while on CPB was 4.09+/-1.03 L/min with an average of 229+/-111 min on bypass. All 10 patients had resumption of spontaneous cardiac activity while on CPB. Seven of these were weaned from CPB with intrinsic spontaneous circulation. Of these, six patients were transferred from the ED to the operating room for cannula removal and vessel repair while the other patient died in the ED soon after discontinuing CPB. Mean survival was 47.8+/-44.7 h in the six patients leaving the ED. Although these patients had successful hemodynamic resuscitation, there were no long-term survivors. CONCLUSION: CPB instituted by EPs is feasible and effective for the hemodynamic resuscitation of cardiac arrest patients unresponsive to advanced cardiac life support therapy. Future efforts need to focus on improving long-term outcome.

Adolescent↗
PubMedDate not supplied

A preliminary study of the reliability of immediate vs. delayed interviews of cardiac arrest witnesses.

INTRODUCTION: Methods to characterize the interval between a collapse from cardiac arrest until a 911 call is made have not yet been developed. OBJECTIVE: To determine the concordance of cardiac arrest data obtained by two methods: an immediate nurse interview of out-of-hospital cardiac arrest (OHCA) witnesses, and a follow-up phone interview performed two weeks later. METHODS: This was a prospective study of OHCA witnesses dating from January 1997 to May 1998. Witnesses were briefly interviewed at the time of emergency department presentation, and two weeks later a more lengthy structured phone interview was performed. The authors identified key data elements: 1) was the arrest witnessed? (Wit); 2) was CPR administered prior to EMS arrival? (BCPR); 3) was the first call placed to 911? (c911); and 4) was the estimated collapse to call interval <4 minutes? (ECCI). The analysis utilized Cohen's kappa statistic and Spearman's correlation coefficient. RESULTS: A convenience sample of 42 matched pairs of OHCA cases was analyzed. Kappa statistics for agreement between methods were: 1) Wit(kappa = 0.750), 2) BCPR(kappa = 0.892), 3) c911 (kappa = 0.892), and 4) ECCI(kappa = 0.571, Spearman's 0.528). CONCLUSION: There is good to excellent agreement between immediate and phone interview data retrieval methods. Phone interviews appear to yield data comparable to that with the more difficult and expensive, direct interview method.

Aged↗
PubMed1998

Quantitative analysis of synaptophysin immunoreactivity in human neocortex after cardiac arrest: confocal laser scanning microscopy study.

Transient global ischaemia caused by cardiac arrest results in lesions that involve all brain structures. The aim of this study was to investigate the condition of synapses in patients surviving, but remaining in a persistent vegetative state, following resuscitation after cardiac arrest. We performed a quantitative analysis of the distribution and density of elements containing a synaptic vesicle protein--synaptophysin (p38)--in human neocortex in cases which survived for 1 week, 2 months, and 1 year after the cardiac arrest. Neurologically healthy cases that died following an accident served as control. Dual-channel confocal laser scanning microscopy (CLSM) was used to image p38-immunoreactivity (IR) and lipofuscin autofluorescence. In control cases no statistically significant differences were found for p38-IR between layers II-III and V-VII. However, the temporal cortex had a higher density of p38-immunoreactive structures than the motor cortex. In postischaemic cases a reduction in the density of p38-IR elements was apparent, mainly in the frontal and motor cortices and less pronounced in the temporal cortex. The least decrease compared with controls was observed in the visual cortex. In the 1 week survival case, a maximal decrease in p38-IR (35% below control) was found. In this case, the number of p38-IR elements per visual field was decreased, and big aggregates of p38-IR structures were observed. In general, the amounts of p38-IR structures were higher in all of the control cases compared with the postischaemic cases.

Autopsy↗
PubMed2004

Cardiac arrest in the early stage of cardiosurgical procedure.

Cardiosurgical operations remain one of the most demanding and complicated surgical procedures. Cardiac arrest before extra corporeal circulation (ECC) is one of severe intraoperative complications which can occur in any moment of operation. We have tried to evaluate possible risk factors of intraoperative, pre-ECC cardiac arrest in cardiac surgical patients and also have tried to estimate, if such an incident itself can be a risk factor for further post-operative complications. Pre-ECC intraoperative cardiac arrest (ICA) has occurred in 28 (aged 34-9) of 1,288 cardiac surgical patients operated on in our institution between July 1998 and December 2001. In 20 of these patients (71%) CABG was a planned procedure and in the remaining eight heart valve prostheses implantation were planned. In all 28 cases ventricular fibrillation was a cause of ICA and all patients required indirect and/or direct cardiac massage up to the moment of ECC start. In the subgroup with coronary artery disease (CAD) eight patients (35%) had left main stenosis, 13 (46.4%) had myocardial infarction in medical history. In the group of valve patients mitro-aortis valve disease was diagnosed in three cases and mitro-aorto-tricuspid valve disease with CAD or mitral valve disease or aortic valve disease in single patients. ICA was the most frequent during sternotomy (eight cases), pericardium opening (seven cases) and harvesting of left internal mammary artery (LIMA). In 16 cases prolonged reperfusion was necessary after declamping of the aorta, and in two of these cases ECC re-entry was needed. Eight patients (28.6%) have died, in 14 cases (50%) low output syndrome has been diagnosed, in five cases (18%) myocardial infarction has occurred and, in nine cases (32%) different neurological complications have been found postoperatively and five patients required resternotomy. All these complications were significantly more frequent in the investigated group than in the whole population of patients. We conclude that pre-ECC ICA contributes to noticeable post-operative complications rate increase. Sternotomy and opening of pericardium are the most frequent moments when pre-ECC ICA appears. We have not found any significant preoperative risk factors for pre-ECC ICA.

Adult↗
PubMed2001

Do health care professionals report sudden cardiac arrest better than laymen?

OBJECTIVE: To compare the emergency calls made by health care providers and by laymen reporting a non-traumatic cardiac arrest, and to evaluate the handling of these calls by dispatchers. METHODS: The study was conducted prospectively over a 1-year period in 1996. The callers (N=328) where divided in to three groups based on profession: I, doctors and nurses (N=33); II, other health care providers (N=19); and III, laymen (N=276). Main outcome measures where the information given by the caller, use of the dispatching protocol, recognition of the cardiac arrest, and survival to hospital. RESULTS: Doctors and nurses told the dispatcher spontaneously what had happened in 67% of the calls when total strangers to the patient told it in 72%. Group I gave no information about the vital signs in 24% of the calls, group II in 0% and group III in 6%. Of the 52 phone calls made by groups I and II, in six cases the patient was not in cardiac arrest, in four the patient had already irreversible signs of death and in four only transportation to another hospital was requested for a patient in cardiac arrest. Of the professionals calling, 49 (94%) were on duty at the time of the call. The cardiac arrest was recognized by the dispatcher in group I in 70%, in group II in 74% and in group III in 73%. There where no statistical differences between the groups. CONCLUSIONS: Our data do suggest that health care professionals, excluding those in emergency medicine, are not better than laymen in evaluating an emergency situation correctly, and when the caller is a doctor or a nurse the dispatcher seems to trust the evaluation of the situation to be correct and rarely asks any clarifying questions about vital signs of the patient.

Emergencies↗
PubMed1994

Survival after cardiac arrest outside hospital over a 12-year period in Gothenburg.

BACKGROUND: A two-tiered ambulance system with a mobile coronary care unit and standard ambulance has operated in Gothenburg (population 434,000) since 1980. Mass education in cardiopulmonary resuscitation (CPR) commenced in 1985 and in 1988 semiautomatic defibrillators were introduced. AIM: To describe early and late survival after cardiac arrest outside hospital over a 12-year period. TARGET POPULATION: All patients with prehospital cardiac arrest in Gothenburg reached by mobile coronary care unit or standard ambulance between 1980 and 1992. RESULTS: The number of patients with cardiac arrest remained fairly steady over time. Among patients with witnessed ventricular fibrillation, the time to defibrillation decreased over time. The proportion of patients in whom bystander initiated CPR was increased only moderately over time. The proportion of patients given medication such as lignocaine and adrenaline successively increased. The number of patients with cardiac arrest who were discharged from hospital per year remained steady between 1981 and 1990 (20 per year), but increased during 1991 and 1992 to 41 and 31 respectively. CONCLUSIONS: Improvements in the emergency medical service in Gothenburg over a 12-year period have lead to: (1) a shortened delay time between cardiac arrest and first defibrillation and (2) an improved survival of patients with cardiac arrest outside hospital probably explained by this shortened delay time.

Adult↗
PubMed1996

Serum neuron-specific enolase as a prognostic marker for irreversible brain damage in comatose cardiac arrest survivors.

OBJECTIVE: To assess the use of serum neuron-specific enolase (S-NSE) level as a noninvasive predictor of CNS injury irreversibility in comatose cardiac arrest survivors. METHODS: An observational, prospective clinical study was performed in a community hospital ED and intensive care unit. All cardiac arrest survivors (n = 52) with impaired neurologic status admitted between February 1994 and May 1995 were followed until return of consciousness (1) or death due to CNS failure (0). Serum samples for S-NSE determination (ng/mL) using the radioimmunoassay technique were obtained 24 hours after cardiac arrest. Data were analyzed using stepwise logistic regression with dichotomized predictors to validate the correlation between S-NSE (X) and outcome (Y), where X = 0 if < or = median and 1 if > median S-NSE level. Adjustment was made for the following variables: glucose level on admission, total epinephrine dose used before return of spontaneous circulation, and best Glasgow Coma Scale score on admission. These data were all available in 34 cases. In 16 cases, CSF enzymes at 48 hours postarrest were obtained and compared with S-NSE. RESULTS: The logistic equation determining the influence of S-NSE (X) on outcome (Y) was: Y = 0.606-1.785X (odds ratio = 6; p = 0.020). There was no confounding effect of the other variables related to survival. The mean S-NSE value for all the patients was 34 (7.9-188). All the patients recovering consciousness (n = 15) had an S-NSE mean +/- SEM value of 17.5 +/- 2.4, with a maximum of 47. CONCLUSION: These data support the conclusion that measurement of S-NSE at 24 hours post-cardiac arrest may supplement clinical assessment of hypoxic-ischemic encephalopathy after cardiac arrest.

Adolescent↗
PubMed2001

Near-death experience in survivors of cardiac arrest: a prospective study in the Netherlands.

BACKGROUND: Some people report a near-death experience (NDE) after a life-threatening crisis. We aimed to establish the cause of this experience and assess factors that affected its frequency, depth, and content. METHODS: In a prospective study, we included 344 consecutive cardiac patients who were successfully resuscitated after cardiac arrest in ten Dutch hospitals. We compared demographic, medical, pharmacological, and psychological data between patients who reported NDE and patients who did not (controls) after resuscitation. In a longitudinal study of life changes after NDE, we compared the groups 2 and 8 years later. FINDINGS: 62 patients (18%) reported NDE, of whom 41 (12%) described a core experience. Occurrence of the experience was not associated with duration of cardiac arrest or unconsciousness, medication, or fear of death before cardiac arrest. Frequency of NDE was affected by how we defined NDE, the prospective nature of the research in older cardiac patients, age, surviving cardiac arrest in first myocardial infarction, more than one cardiopulmonary resuscitation (CPR) during stay in hospital, previous NDE, and memory problems after prolonged CPR. Depth of the experience was affected by sex, surviving CPR outside hospital, and fear before cardiac arrest. Significantly more patients who had an NDE, especially a deep experience, died within 30 days of CPR (p<0.0001). The process of transformation after NDE took several years, and differed from those of patients who survived cardiac arrest without NDE. INTERPRETATION: We do not know why so few cardiac patients report NDE after CPR, although age plays a part. With a purely physiological explanation such as cerebral anoxia for the experience, most patients who have been clinically dead should report one.

Adult↗
PubMed2004

The incidence and risk factors for cardiac arrest during emergency tracheal intubation: a justification for incorporating the ASA Guidelines in the remote location.

STUDY OBJECTIVE: To determine the incidence and etiology of cardiopulmonary arrest during emergency intubation in the remote location by comparing two periods (1990-1995 vs. 1995-2002) at the same institution to assess whether immediate access to advanced airway devices and endotracheal tube-verifying devices altered the incidence of hypoxemia-driven cardiac arrest. DESIGN: Retrospective review of a quality improvement (QI) database for emergency intubation outside the operating room (OR). SETTING: 765-bed tertiary care, level 1 trauma center. PATIENTS: 3035 critically ill patients suffering from cardiopulmonary, traumatic, septic, metabolic, or neurological-based deterioration and requiring emergency airway management. MEASUREMENTS: Rate of cardiac arrest, as defined as asystole, bradycardia, or ventricular dysrhythmia with non-measurable blood pressure during or within 5 minutes of intubation, requiring cardiopulmonary resuscitation (CPR), were measured. MAIN RESULTS: 60 cardiac arrests were documented (2%, or one per 50 cases), 83% of which were associated with profound hypoxemia (oxygen saturation <70%) during the airway procedure. Esophageal intubation was a frequent complication (n = 38; 63%), often leading to hypoxemia (97%) and regurgitation (67%). The overall rate of cardiac arrest was reduced 50% between the two time periods (2.8%: 1990-1995 period and 1.4%: 1995-2002 period). The relative risk estimate for complications in a match cohort contributing to the etiology of cardiac arrest included hypoxemia (4X), regurgitation (28X), aspiration (22X), bradycardia (23X) (all P < 0.003), and esophageal intubation (7X), P < 0.04). A total of 34% patients survived less than 24 hours and 31% survived to be discharged. CONCLUSION: Cardiac arrest during emergency tracheal intubation outside the OR is relatively common compared with the OR environment. Airway-related complications played a prominent role, either singly or in combination with the patient's underlying physiological state. Immediate access to advanced airway devices and endotracheal tube-verifying devices appear to have a significant impact on the incidence of hypoxemia-driven cardiac arrest.

Adolescent↗
PubMed2001

Interns' perceptions of performance and confidence in participating in and managing simulated and real cardiac arrest situations.

This study attempts to describe the effects of a computerized patient simulator education program on interns' perceptions of their own performance and confidence in managing and/or participating in a cardiac arrest incident during simulated and real events. The study design was qualitative using thematic analysis of debriefing sessions and individual interviews. The setting for the research was an education program for interns working at Southern Health, Victoria, Australia utilising a high-fidelity patient simulator. The participants were junior doctors (n = 30) in the first three-month rotation of their first postgraduate year (interns). The results describe the interns' self-reported experiences and perceptions relating to: (1) cardiac arrest experiences prior to the simulation scenario; (2) a simulated cardiac arrest scenario; (3) real-life cardiac arrest experiences after the simulation scenario. The interns expressed perceptions of improved self-confidence in: managing this particular critical situation; their own decision making during a critical incident; their ability to prioritize tasks. They also reported improved awareness and understanding with regards to: the need for leadership and effective teamwork; and the need for effective communication with senior staff during a critical incident. The interns considered that they had improved their ability to effectively handle a cardiac arrest situation as a result of the simulator program. The interns interviewed expressed decreased levels of anxiety and improved confidence in their decision making and their ability to prioritize tasks during a similar real-world situation as a result of the simulator program.

Journal Article↗
PubMedDate not supplied

Prehospital management of cardiac arrest: how useful are vasopressor and antiarrhythmic drugs?

Out-of-hospital resuscitation protocols for patients suffering cardiac arrest have historically included cardiopulmonary resuscitation, defibrillation, and rapid transport to a hospital. For many years, use of drugs to improve myocardial perfusion or to correct arrhythmias that occur during cardiac arrest has been part of prehospital efforts to revive patients in ventricular tachycardia or ventricular fibrillation. Use of some of these drugs, however, may be based more on tradition than on well-documented evidence of efficacy. The authors reviewed pertinent data on the vasopressors epinephrine and vasopressin and the antiarrhythmics amiodarone and lidocaine to evaluate the usefulness of these drugs in cardiac arrest. They found little clinical data supporting the prehospital use of lidocaine in cardiac arrest, and despite a great deal of laboratory and clinical data addressing the efficacy of epinephrine, there is no large, randomized, controlled clinical trial supporting its use. Data on amiodarone and vasopressin support the use of these drugs in out-of-hospital resuscitation efforts.

Amiodarone↗
PubMed2000

[Multi-recurrent cardiac arrest: when to discontinue cardiopulmonary resuscitation?].

A 52-year-old man developed an out-of-hospital cardiac arrest complicating a myocardial infarction. After prolonged cardiopulmonary resuscitation, he was admitted to an intensive care unit, where 25 episodes of cardiac arrests occurred within a few hours. Finally the outcome was favourable. This case raises the question of the duration a cardiopulmonary resuscitation in case of out-of-hospital and in-hospital cardiac arrest. The question is to determine how long resuscitation efforts must be prolonged after recurrent cardiac arrests.

Anti-Arrhythmia Agents↗
PubMed1998

Normoxic ventilation after cardiac arrest reduces oxidation of brain lipids and improves neurological outcome.

BACKGROUND AND PURPOSE: Increasing evidence that oxidative stress contributes to delayed neuronal death after global cerebral ischemia has led to reconsideration of the prolonged use of 100% ventilatory O2 following resuscitation from cardiac arrest. This study determined the temporal course of oxidation of brain fatty acyl groups in a clinically relevant canine model of cardiac arrest and resuscitation and tested the hypothesis that postischemic ventilation with 21% inspired O2, rather than 100% O2, results in reduced levels of oxidized brain lipids and decreased neurological impairment. METHODS: Neurological deficit scoring and high performance liquid chromatography measurement of fatty acyl lipid oxidation were used in an established canine model using 10 minutes of cardiac arrest followed by resuscitation with different ventilatory oxygenation protocols and restoration of spontaneous circulation for 30 minutes to 24 hours. RESULTS: Significant increases in frontal cortex lipid oxidation occurred after 10 minutes of cardiac arrest alone with no reperfusion and after reperfusion for 30 minutes, 2 hours, and 24 hours (relative total 235-nm absorbing peak areas=7.1+/-0.7 SE, 17.3+/-2.7, 14.2+/-3.2, 16.1+/-1.0, and 14.0+/-0.8, respectively; n=4, P<0.05). The predominant oxidized lipids were identified by gas chromatography/mass spectrometry as 13- and 9-hydroxyoctadecadienoic acids (13- and 9-HODE). Animals ventilated on 21% to 30% O2 versus 100% O2 for the first hour after resuscitation exhibited significantly lower levels of total and specific oxidized lipids in the frontal cortex (1.7+/-0.1 versus 3.12+/-0.78 microg 13-HODE/g wet wt cortex., n=4 to 6, P<0.05) and lower neurological deficit scores (45.1+/-3.6 versus 58.3+/-3.8, n=9, P<0.05). CONCLUSIONS: With a clinically relevant canine model of 10 minutes of cardiac arrest, resuscitation with 21% versus 100% inspired O2 resulted in lower levels of oxidized brain lipids and improved neurological outcome measured after 24 hours of reperfusion. This study casts further doubt on the appropriateness of present guidelines that recommend the indiscriminate use of 100% ventilatory O2 for undefined periods during and after resuscitation from cardiac arrest.

Animals↗
PubMed2005

Delayed hypothermia preferentially increases expression of brain-derived neurotrophic factor exon III in rat hippocampus after asphyxial cardiac arrest.

Brain-derived neurotrophic factor (BDNF) protein levels increase in rats treated with a regimen of delayed, mild hypothermia that improve neurological recovery after asphyxial cardiac arrest. BDNF transcription in rat brain involves at least five different BDNF exons (exons I-V) that produce four different varieties of mRNA, each containing exon V paired with one of exons I-IV. This study examined whether these different BDNF transcripts are differentially affected by cardiac arrest and by therapeutic hypothermia in rat hippocampus using a reverse transcription and PCR-based method. At 24 h after asphyxial cardiac arrest, transcripts containing exons I and III increased. In rats treated with hypothermia after cardiac arrest, transcripts containing exon III were further increased. No significant alterations in transcripts from exons II or IV were observed, though there was a trend for hypothermia to decrease message from these exons. These data suggest that hypothermia after cardiac arrest produces exon-specific changes in BDNF transcription.

Analysis of Variance↗
PubMed2005

Out-of-hospital pediatric cardiac arrest: an epidemiologic review and assessment of current knowledge.

STUDY OBJECTIVE: We systematically summarize pediatric out-of-hospital cardiac arrest epidemiology and assess knowledge of effects of specific out-of-hospital interventions. METHODS: We conducted a comprehensive review of published articles from 1966 to 2004, available through MEDLINE, Cumulative Index to Nursing and Allied Health Literature, EmBase, and the Cochrane Registry, describing outcomes of children younger than 18 years with an out-of-hospital cardiac arrest. Patient characteristics, process of care, and outcomes were compared using pediatric Utstein outcome report guidelines. Effects of out-of-hospital care processes on survival outcomes were summarized. RESULTS: Forty-one studies met inclusion criteria; 8 complied with Utstein reporting guidelines. Included in the review were 5,363 patients: 12.1% survived to hospital discharge, and 4% survived neurologically intact. Trauma patients (n=2,299) had greater overall survival (21.9%, 6.8% intact); a separate examination of studies with more rigorous cardiac arrest definition showed poorer survival (1.1% overall, 0.3% neurologically intact). Submersion injury-associated arrests (n=442) had greater overall survival (22.7%, 6% intact). Pooled data analysis of bystander cardiopulmonary resuscitation and witnessed arrest status showed increased likelihood of survival (relative risk 1.99, 95% confidence interval 1.54 to 2.57) for witnessed arrests. The effect of bystander cardiopulmonary resuscitation is difficult to determine because of study heterogeneity. CONCLUSION: Outcomes from out-of-hospital pediatric cardiac arrest are generally poor. Variability may exist in survival by patient subgroups, but differences are hard to accurately characterize. Conformity with Utstein guidelines for reporting and research design is incomplete. Witnessed arrest status remains associated with improved survival. The need for prospective controlled trials remains a high priority.

Adolescent↗
PubMed2005

Agreement between an arterial blood gas analyser and a venous blood analyser in the measurement of potassium in patients in cardiac arrest.

BACKGROUND AND OBJECTIVE: Rapid measurement of potassium is crucial in the resuscitation of patients in cardiac arrest. This is often done on an arterial blood gas sample taken during resuscitation and analysed in an emergency department based blood gas analyser. No-one has assessed how accurate or reliable this is when compared with the traditional method of sending a venous sample to the laboratory for standard analysis. This study looked at the agreement between potassium measurements in arterial blood gas samples and venous blood samples in patients in cardiac arrest. METHOD: Arterial and venous blood samples were taken at the same time and analysed in the usual way from 50 patients in cardiac arrest. It was found that the mean difference between each pair of arterial and venous potassium measurements was low at 0.106 mmol/l. However, the standard deviation of these differences and subsequently the 95% limits of agreement were wide (-1.182 mmol/l to 1.394 mmol/l)-that is, 95% of differences will lie between these limits. It is felt that these limits are too wide for safe use in clinical practice. CONCLUSION: Based on these results, it is advised that arterial blood gas analysers should be used with caution to measure potassium in patients in cardiac arrest.

Arteries↗
PubMed2005

Cold simple intravenous infusions preceding special endovascular cooling for faster induction of mild hypothermia after cardiac arrest--a feasibility study.

OBJECTIVE: Mild therapeutic hypothermia has shown to improve neurological outcome after cardiac arrest. Our study investigated the efficacy and safety of cold simple intravenous infusions for induction of hypothermia after cardiac arrest preceding further cooling and maintenance of hypothermia by specialised endovascular cooling. METHODS: All patients admitted after cardiac arrest of presumed cardiac aetiology were screened. Patients enrolled received 2000 ml of ice-cold (4 degrees C) fluids via peripheral venous catheters. As soon as possible endovascular cooling was applied even if the cold infusions were not completed. The target temperature was defined as 33 +/- 1 degrees C. All temperatures recorded were measured via bladder-temperature probes. The primary endpoint was the time from return of spontaneous circulation to reaching the target temperature. Secondary endpoints were changes in haemodynamic variables, oxygenation, haemoglobin, clotting variables and neurological outcome. RESULTS: Out of 167 screened patients 26 (15%) were included. With a total amount of 24 +/- 7 ml/kg cold fluid at 4 degrees C the temperature could be lowered from 35.6 +/- 1.3 degrees C on admission to 33.8 +/- 1.1 degrees C. The target temperature was reached 185 +/- 119 min after return of spontaneous circulation, 135 +/- 112 min after start of infusion, and 83 +/- 85 min after start of endovascular cooling. Except for two patients showing radiographic signs of mild pulmonary edema no complications attributable to the infusions could be observed. Thirteen patients (50%) survived with favourable neurological outcome. CONCLUSION: Our results indicate that induction of mild hypothermia with infusion of cold fluids preceding endovascular cooling is safe and effective.

Advanced Cardiac Life Support↗