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PubMed1992

Outcomes of cardiopulmonary resuscitation in dialysis patients.

Patients with renal failure are believed to have a poor survival rate after cardiopulmonary resuscitation, but there is little specific information about the outcomes of cardiopulmonary resuscitation in dialysis patients. To be better able to inform dialysis patients and assist them in decision making about cardiopulmonary resuscitation, the eight-year experience with cardiopulmonary resuscitation in dialysis patients at a university dialysis program was analyzed and outcomes were compared with those of a control group of nondialysis patients undergoing cardiopulmonary resuscitation during the same time period in the same hospital. Of 221 dialysis patients experiencing cardiopulmonary arrest, 74 (34%) had CPR compared with 247 (21%) of 1,201 control patients (P = 0.0002). Six of 74 (8%; 95% confidence interval, 2 to 14%) dialysis patients survived to hospital discharge compared with 30 of 247 (12%; 95% confidence interval, 8 to 16%) control patients (P = not significant). At 6 months after CPR, 2 (3%) of 74 dialysis patients were still alive compared with 23 (9%) of 247 controls (P = 0.044); this difference was not explained by age or comorbid conditions. Twenty-one (78%) of the 27 successfully resuscitated dialysis patients died a mean of 4.4 days later; 95% were on mechanical ventilation in an intensive care unit at the time of death. It was concluded that cardiopulmonary resuscitation is a procedure that rarely results in extended survival for dialysis patients. In discussions about cardiopulmonary resuscitation with dialysis patients, nephrologists should provide this information.

Adult↗
PubMed2004

Frequency and outcome of in-hospital resuscitation outside the ICU-setting.

BACKGROUND: Guidelines on performing cardiopulmonary resuscitation and its research have been published. Only few data concerning in-hospital resuscitation are available from Switzerland. The aim of our study was to evaluate the frequency and outcome of cardiopulmonary arrests in our hospital and to look for ways of improving our resuscitation management. METHODS: The prospective study was performed in the Kantonsspital Liestal, a primary care hospital with 360 beds, where about 24'300 in-patients were treated during the 2 year observation period. Only in-hospital resuscitations outside the ICU were included and recorded according to the Utstein criteria. RESULTS: Within a 24 months period, 61 emergency calls were registered. 25 patients needed cardiopulmonary resuscitation. Initial cardiac rhythms were available for all subjects: 8 patients had asystole, 7 ventricular fibrillation and 10 pulseless electrical activity. 12 of 25 resuscitated patients had a return of spontaneous circulation, 7 lived longer than 24 hours and 6 patients (24%) survived to hospital discharge, 4 of them in a very good or good neurological condition. After 12 months 3 patients (12%) were living independently at home, 2 patients had to be treated in a nursing home and 1 patient had died. CONCLUSIONS: Our data correspond to survival rates in larger studies from abroad but are limited by the number of patients investigated. Improvements are necessary in documentation of resuscitation efforts. Rapid defibrillation must be further stressed. The implementation of a multicentre study is suggested because quality control and further improvement of in-hospital resuscitation are needed in Switzerland.

Adult↗
PubMed1989

Evaluation of five adult disposable operator-powered resuscitators.

UNLABELLED: We evaluated the performance and safety of five adult disposable operator-powered resuscitators: BagEasy, Bag Mask Resuscitator, Pulmanex, 1st Response, and Stat Blue. METHOD: We tested the devices against the American Society for Testing and Materials (ASTM) Standard F-920-85. We tested each resuscitator by using it to ventilate a lung model, the Bio-Tek VT-1 Adult Ventilator Tester. RESULTS: All resuscitators met the requirements of VT 600 mL, f 20/min, and I:E less than 1:1. Standard F-920 specifies a fractional delivered O2 concentration (FDO2) greater than or equal to 0.85 with attachments and greater than or equal to 0.40 without attachments, at oxygen flows of 15 L/min and VE of 7.2 L (600 mL x 12). The Pulmanex with bag reservoir attached had a mean +/- SD FDO2 of 0.74 +/- 0.02, and the other four devices had an FDO2 of 0.93 +/- 0.02. Without attachments only the 1st Response and BagEasy had FDO2 greater than or equal to 0.40. All devices when disabled with simulated vomitus were restored to proper function within 20 s and were functional at O2 flow of 30 L/min. Only the Bag Mask Resuscitator did not pass the drop test. Only the Stat Blue did not pass the back-leak test. CONCLUSIONS: Although we do not have practical experience with these resuscitators, we conclude that only 1st Response and BagEasy meet the ASTM standard for operator-powered resuscitators and that, of the devices tested, only the 1st Response and BagEasy are acceptable replacements for permanent resuscitators.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2000

A 2-year prospective cohort study of cardiac resuscitation in a major Canadian hospital.

OBJECTIVES: To determine the outcome of cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest and to identify risk factors associated with survival to the time of hospital discharge. DESIGN: A 2-year prospective cohort study. SETTING: Foothills Medical Centre, a 700-bed tertiary, academic and regional referral centre for Calgary and southern Alberta. PATIENTS: Adult inpatients, excluding those who had cardiac arrest in the Emergency Department or operating room. INTERVENTION: Cardiac resuscitation. MAIN OUTCOME MEASURES: Spontaneous return of the pulse with a minimum systolic blood pressure of 80 mm Hg and survival defined as survival to the time of hospital discharge. RESULTS: In 334 patients there were 390 cardiac arrests, of which 200 were primary cardiac arrests and 39 cardiac arrests that occurred while the resuscitation team was in attendance. Of 239 resuscitated patients, 51 (21.3%) survived. Fifteen variables were identified as being associated with survival. This association could be explained, through multivariate analysis, by the effect of the following 3 variables (odds ratio [OR], 95% confidence interval [CI]): initial observed rhythm other than pulseless electrical activity or asystole (OR 17.34, 95% CI 8.2 to 36.8); a patient who was ambulatory and able to provide self-care (OR 3.8, 95% CI 1.9 to 7.5); and a spontaneous return of circulation with resuscitation in less than 20 minutes (OR 12.9, 95% CI 4.8 to 20.7). CONCLUSIONS: Survival to hospital discharge after cardiac arrest remains static. Initial cardiac rhythm and duration of resuscitation before spontaneous return of circulation were the most important risk factors for survival. These factors and the patient's functional status are relevant when discussing cardiac resuscitation with patients or when considering whether to discontinue resuscitation efforts.

Canada↗
PubMed2003

Neonatal resuscitation.

Ten million or more newborns worldwide each year need some type of resuscitation assistance. More than 1 million babies die annually from complications of birth asphyxia. Over the past 3 decades, neonatal resuscitation has evolved from disparate, word-of-mouth teaching methods to organized programs. The most widely-used curriculum is the Neonatal Resuscitation Program, which is supported by the American Academy of Pediatrics and the American Heart Association. To date more than 1.5 million individuals have been trained in the Neonatal Resuscitation Program. Resuscitation efforts are geared toward avoiding or mitigating the adverse sequelae of asphyxia neonatorum. Certain characteristics distinguish the preterm infant, including propensity to become hypothermic and higher potential for adverse neurologic and pulmonary complications from resuscitation efforts. In this era of evidence-based medicine the most recent Neonatal Resuscitation Program guidelines were developed to provide recommendations based on the best currently-available science. A number of major proposals received considerable scrutiny during the evaluation process. Many areas of neonatal resuscitation still need to be studied.

Asphyxia Neonatorum↗
PubMed2003

[Clinical study of plasma substitute (Gelofusion) on fluid resuscitation in patients with burned shock].

OBJECTIVE: To investigate the effects of plasma substitute(Gelofusion) on fluid resuscitation in patients with burned shock. METHODS: Twenty burn shock patients with total body surface area (TBSA) more than 40% were enrolled for clinical study on the effect of resuscitation with plasma substitute (Gelofusion). The patients were randomly divided into two groups: Gelofusion resuscitation group (n=11) and plasma resuscitation group (n=9). The cardiac output (CO),oxygen delivery (DO2), packed cell volume (PCV), blood and plasma viscosity, lactate(LA) and base deficit (BD) levels were detected at shock stage (postburn from 1 to 48 hours). RESULTS: Two hours after rapid fluid replacement, the levels of CO and DO2 were gradually increased, while the levels of PCV, blood and plasma viscosity, LA and BD were markedly decreased (P<0.05 or P<0.01). After resuscitation, plasma viscosity in Gelofusion resuscitation group were obviously lower than that in plasma resuscitation group within 24 hours postburn (all P<0.05).With an exception of plasma viscosity, there were no significant differences in other parameters between two groups at various intervals (all P>0.05). CONCLUSION: In the resuscitation of burn shock, the clinical effect of Gelofusion treatment is similar to that of plasma treatment. Gelofusion appears to be a fairly good plasma substitute for extensive application on the management of burn shock during the early stage.

Adolescent↗
PubMed1992

[Neonatal resuscitation in the delivery room. What role does the anesthetist play?].

Neonatal resuscitation in the delivery room of small obstetric units is problematic because of the lack of on-site personnel with adequate training and experience. In large university hospitals this task is usually fulfilled by neonatologists who are present 24 h/day. However, in medium-sized and small obstetric units neonatal resuscitation is performed by a variety of professionals: paediatricians, obstetricians, anaesthetists, midwives, nurses, and nurse anaesthetists. The degree of responsibility and involvement of the anaesthesia specialist in the resuscitation of the newborn in Switzerland is unknown, and therefore an investigation was conducted. METHOD. After a telephone inquiry at all the hospitals in Switzerland, a total of 175 obstetric units were identified. A questionnaire with items regarding organisation, responsibilities, and the extent of involvement of the anaesthesia department of the particular hospital was sent to each of the appropriate anaesthetists. RESULTS. Of the 175 questionnaires, 163 (93%) were returned; 14 could not be analysed (5 were sent to hospitals where there was in fact no obstetric unit and 9 were sent to anaesthetists who shared responsibilities for one unit). In 1988, 76,505 babies were born in Switzerland; two-thirds of these were delivered in hospitals with an annual birth rate of less than 600 births per year. Of the 149 questionnaires that were eligible for further analysis, 118 (79%) documented participation of the anaesthetic team in the resuscitation of the newborn. However, only 22% of these departments had an official contract with the hospital administration. Ninety-nine per cent of all responders agreed that every anaesthetist should have the knowledge--both theoretical and practical--to resuscitate a newborn infant. However, reservations were expressed on how to acquire and how to maintain this competence. The initial evaluation of the newborn was done by an anaesthetist in 3% (2250/76,505) of all deliveries in Switzerland in 1988; 1.2% (882/76,505) of these babies needed bag-and-mask ventilation and in 0.4% (308/76,505) endotracheal intubation was performed by the anaesthetist. Proceeding on the assumption that 5% of all newborns need some sort of resuscitation immediately after birth, it is estimated that in 1988 approximately one-third of resuscitations were performed by anaesthetists. It is therefore concluded that anaesthetists play an important role in the resuscitation of newborns in Switzerland.

Anesthesiology↗
PubMed2004

Lived experience of critically ill patients' family members during cardiopulmonary resuscitation.

BACKGROUND: During resuscitative efforts, patients' family members are often barred from the patients' rooms and may never have the opportunity to see their loved ones alive again. Recently, the need to ask family members to leave the room is being questioned. Little is known about families' perceptions of cardiopulmonary resuscitation. OBJECTIVE: To describe the experiences, thoughts, and perceptions of family members of critically ill patients during cardiopulmonary resuscitation in the intensive care unit. METHOD: Six family members whose loved ones underwent cardiopulmonary resuscitation and survived consented to an audiotaped interview. During the interview, family members were asked to describe their experiences during the resuscitation. Interviews were transcribed and were analyzed for relevant themes by using Van Manen thematic analysis. RESULTS: One major theme emerged. Should we go or should we stay? Additionally, 2 subthemes emerged: What is going on? and You do your job. A model, the family's experience with cardiopulmonary resuscitation, was developed to reflect the research findings. CONCLUSIONS: During the period of resuscitation, healthcare professionals neglect to recognize that patients' family members are experiencing crisis along with the patients and that coping mechanisms are impaired. Moreover, the family members' informational and proximity needs are often ignored during this time of crisis. Addressing these needs through appropriate nursing interventions will become increasingly important as patients' family members begin to remain with their loved ones during cardiopulmonary resuscitation.

Cardiopulmonary Resuscitation↗
PubMed2004

[Out-of-hospital resuscitation in Israel 2000].

The aim of the study was to evaluate the impact of pre-hospital cardio-pulmonary resuscitation, performed by mobile intensive cardiac care units of Magen David Adom (MDA) teams in the framework of a national survey conducted in the period February and March 2000. During the survey, MDA performed 539 resuscitations, 485 of which were performed by mobile intensive care units of MDA, and they constitute the study population of the present analysis. The average age of the patients was 70.5 years, and 68% were men. The mean response time of the mobile intensive care units was 10.3 minutes. In 14% of the cases, a bystander initiated basic cardiac life support before the arrival of the MDA team. Upon arrival of the resuscitation team, 242 patients (50%) had asystole, 19% ventricular tachycardia (VT)/ventricular fibrillation (VF), 13% pulseless electrical activity (PEA), and 18% had other severe arrhythmias. One hundred and ninety-nine patients (41%) were transferred alive to the hospital after successful resuscitation. Hospital summaries were obtained for 148 of these patients. The cause of cardiac arrest was cardiac in 64% of the cases and 48% of the patients who reached the hospital had a previous history of heart disease. Fifty-three patients (11%) were discharged alive from the hospital. Patients discharged alive were younger, more promptly resuscitated, 78% had a cardiac cause of death and 38% of them were in ventricular tachycardia/fibrillation when first seen by the resuscitation team. The rate of successful resuscitation to discharge in the sub-group with VT/VF was 21%, and only 4% for patients in asystole, which is in line with other studies. However, the rate of initiation of resuscitation by bystanders is low in Israel. These data may help the medical staff and the health policy providers in Israel.

Aged↗
PubMed2005

Hemorrhage- and resuscitation-related alterations in gastrointestinal circulation: effect of a low dose of L-NMMA.

The gastrointestinal tract, including its mucosal barrier, is most sensitive to ischemic insults. The present study was conducted to evaluate hemorrhage- and resuscitation-related regional alterations in gastrointestinal circulation in presence or absence of a low dose of N(G)-monomethyl-L-arginine (L-NMMA), a nonspecific nitric oxide synthase inhibitor. Organ-specific circulation was studied using the colored microsphere technique in rats subjected to prolonged hemorrhagic shock (180 min) followed by resuscitation with or without L-NMMA (2 mg/kg body weight) treatment at the end of resuscitation. We found an initial distal gradient in the intestinal blood flow with the highest rate in duodenum followed by jejunum, ileum, and colon. Hemorrhage resulted in the highest decrease in gastric blood flow. Resuscitation restored circulation in the intestinal tract to baseline levels except for gastric blood flow. L-NMMA treatment after completion of resuscitation did not deteriorate gastrointestinal blood flow. Our data show (a) a distal gradient in the intestinal blood flow from duodenum to colon, (b) that hemorrhage and resuscitation cause different degrees of alteration in gastric and intestinal blood flow, (c) that gastric perfusion does not recover after resuscitation, predisposing to further organ damage, and (d) that a low dose of L-NMMA does not deteriorate intestinal circulation in rats subjected to hemorrhage and resuscitation.

Animals↗
PubMed2005

The neonatal resuscitation training project in rural South Africa.

A paediatrician trainer from Australia (JT) spent 3 months in South Africa to assist with the development of neonatal resuscitation training in rural areas, particularly in district hospitals. The project was initiated by the Rural Health Unit at the University of the Witwatersrand and coordinated through the Family Medicine Education Consortium (FaMEC). The Rural Workforce Agency of Victoria together with General Practice and Primary Health Care Northern Territory covered the salary and international travel costs of the trainer, while local costs were funded by provincial departments of health, participants and a Belgian funded FaMEC project. The trainer developed an appropriate one-day skills training course in neonatal resuscitation (NNR), using the South African Paediatric Association Manual of Resuscitation of the Newborn as pre-reading, and a course to train trainers in neonatal resuscitation. From July to October 2004 he moved around the country running the neonatal resuscitation course, and, more importantly, training and accrediting trainers to run their own courses on an ongoing basis. The neonatal resuscitation course involved pre- and post-course multiple-choice question tests to assess knowledge and application, and, later, pre- and post-course skills tests to assess competence. A total of 415 people, including 215 nurses and 192 doctors, attended the neonatal resuscitation courses in 28 different sites in eight provinces. In addition, 97 trainers were trained, in nine sites. The participants rated the course highly. Pre- and post-course tests showed a high level of learning and improved confidence. The logistical arrangements, through the departments of family medicine, worked well, but the programme was very demanding of the trainer. Lessons and experiences were not shared between provinces, leading to repetition of some problems. A clear issue around the country was a lack of adequate equipment in hospitals for neonatal resuscitation, which needs to be addressed by health authorities. A process of ongoing training has been established, with provincial coordinators taking responsibility for standards and the roll-out of training. A formal evaluation of the project is planned. The project serves as a model for skills training in rural areas in South Africa, and for collaboration between organisations. A number of specific recommendations are made for the future of this NNR training project, which offer lessons for similar programmes.

Allied Health Personnel↗
PubMed2006

[Effect of fluid resuscitation on adhesion molecule and hemodynamics in patients with severe sepsis].

OBJECTIVE: To explore the effects of fluid resuscitation on adhesion molecule and hemodynamics in patients with severe sepsis. METHODS: Thirty-eight patients with severe sepsis were randomly divided into 2 groups: rapid fluid resuscitation group and general treatment group. Before and after fluid resuscitation, heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), lactic acid content, plasma P-selection and intercellular adhesion molecule-1 (ICAM-1) contents were determined. RESULTS: There were no statistically significant differences in sex, age, resuscitation time and acute physiology and chronic health evaluation II (APACHE II) score between the two groups. Compared with general treatment group, more liquid volume but less aramine dosage were used (both P<0.05), MAP and CVP were increased after fluid resuscitation in rapid fluid resuscitation group (all P<0.05). The expression of P-selection, HR, contents of ICAM-1 and lactic acid were decreased (all P<0.05), and all of those were better than those of before fluid resuscitation. CONCLUSION: Early rapid fluid resuscitation can improve hemodynamics and decrease the expression of adhesion molecule to retard the development of sepsis.

Adult↗
PubMed1990

Rat maze performance after resuscitation with cross-linked hemoglobin solution.

Unmodified stroma-free hemoglobin has been found to produce neurotoxicity and behavioral impairment in rats. In contrast, a recent assessment of a modified (diaspirin alpha-alpha cross-linked) hemoglobin (HbXL) solution found normal memory, learning, and brain histology after infusion of a clinically relevant dose of a 14% HbXL solution. The current study examined this potential resuscitation fluid for evidence of neurobehavioral toxicity under clinical conditions. Rats were trained to complete a water alley maze, had 50% of their total blood volume (30 ml/kg) withdrawn, were resuscitated with 14% HbXL solution (45 ml/kg), Ringer's lactate (60 ml/kg), or autologous shed blood, and were subsequently retested in the water maze. Rats resuscitated with HbXL or autologous shed blood survived resuscitation, while 20% of those resuscitated with Ringer's lactate died during treatment. No significant performance degradation was observed in the HbXL rats following resuscitation, and no brain pathology was observed at necropsy 10 days after treatment. Ischemic brain lesions were observed in three (25%) of the surviving rats resuscitated with Ringer's lactate solution. Renal tubule regeneration indicative of an earlier insult was observed in animals from all three groups. A significant correlation between the total pathology in the five organs examined and maze errors was observed (p less than 0.001). The survival, maze performance, and histology results suggest that resuscitation with 14% HbXL solution does not cause neurotoxicity, as assessed in this lethal hemorrhage model.

Animals↗
PubMed1987

[Resuscitation in the field of intensive care medicine: comparison of two periods of anesthesiologic intensive care separated by 10 years].

Acute failure of vital functions is more likely to occur in patients in intensive care units (ICU) than in peripheral wards. In this retrospective study, which analyzes the cases over two distinct 1-year periods separated by a 10-year interval, we have attempted to reflect the results obtained in our own ICU and to compare them with data reported in the literature. One hundred thirty-three patients requiring cardiopulmonary resuscitation were entered in the study. Over the 10-year interval, the survival rate increased. The number of patients that could be successfully resuscitated increased from 75.7% to 89.6%, and the rate of survivors discharged from hospital increased from 22.5% to 42.8%. During the first study period 17.8% of resuscitated ICU patients could be discharged with a good prognosis; 10 years later the rate was 32.7%. Possible explanations for the improved outcome could be the more restrictive resuscitation policy and the decreased mean age of resuscitated patients. Earlier detection of threatening complications and improvements in resuscitative measures could also be responsible for the more favorable outcome. During the first study period, 64.3% of patients died if resuscitation had to be started on peripheral wards, whereas in the second study period 63.2% survived. These results indicate the importance of improved resuscitation training programs for the entire hospital staff. Furthermore, over the 10-year interval the reason for admission has changed from traumatized patients to individuals suffering from acute respiratory failure. A comparison of our results with data reported by others could be hampered by the use of different criteria as well as by the differences in patient populations treated. For this reason, widely accepted common criteria should be established for further epidemiological studies.

Anesthesia↗
PubMed1986

Comparison of resuscitation of sheep and dogs after bupivacaine-induced cardiovascular collapse.

This study evaluated interspecies sensitivity and ability to resuscitate pentobarbital anesthetized sheep and dogs after cardiovascular toxic doses of bupivacaine. Every minute, 3 mg/kg of bupivacaine was injected into the right atrium over the course of 10 sec until cardiovascular collapse occurred. While the bupivacaine was given, the animals were made apneic for 90 sec and then ventilated with 100% oxygen. After the bupivacaine administration, cardiovascular collapse occurred in the form of electromechanical dissociation progressing to asystole in dogs, whereas in sheep the predominant rhythm was ventricular fibrillation leading to asystole. Resuscitation was performed using open chest heart massage, bretylium for treatment of ventricular tachycardia and fibrillation, and epinephrine with atropine for treatment of electromechanical dissociation or asystole. The initial dose of bupivacaine used to cause cardiovascular collapse was 3.5 +/- 1.2 mg/kg in sheep and 24.6 +/- 8.5 mg/kg in dogs (P less than 0.01). All sheep and dogs were resuscitated from the first cardiovascular collapse. The resuscitation time was 2.1 +/- 1.0 min in dogs and 36.9 +/- 15.4 min in sheep (P less than 0.01). All dogs could be resuscitated after two additional cardiovascular collapses induced by bupivacaine, but no sheep could be resuscitated after a second cardiovascular collapse. Concentrations of bupivacaine in cardiac tissue and serum levels of bupivacaine after the last resuscitation attempt were significantly greater in the dogs than in the sheep. We conclude that sheep are more sensitive to bupivacaine than dogs, but that even sheep can be resuscitated after cardiovascular collapse produced by bupivacaine.

Animals↗
PubMed1994

Neurologic outcome and heart resuscitability with closed-chest cardiopulmonary bypass after prolonged cardiac arrest times in rabbits.

OBJECTIVES: To observe the influence of prolonged cardiac arrest times on neurologic outcome and heart resuscitability, using a resuscitation model with cardiopulmonary bypass in the rabbit, and to determine whether the changes in the plasma concentrations of lactate and lipoperoxide correlate with the severity of global brain ischemia. DESIGN: Randomized, prospective, controlled animal trial. SETTING: University research laboratory. SUBJECTS: Forty-three New Zealand white rabbits. INTERVENTIONS: Rabbits were randomly assigned to one of five groups: control, and four groups with cardiac arrest times of 8, 10, 12, and 15 mins. A bolus of 4 to 6 mL of 0.5-M potassium chloride was injected into the right atrium to induce cardiac arrest within 5 secs. Resuscitation was performed using closed-chest cardiopulmonary bypass, and mechanical ventilation with pure oxygen. When necessary, a DC shock of 10 joules/kg was used to terminate ventricular fibrillation. MEASUREMENTS AND MAIN RESULTS: Hemodynamics, electroencephalogram, electrocardiogram, and return times of various cranial reflexes were observed throughout the experiment. Plasma concentrations of lactate and lipoperoxide were determined before cardiac arrest and 5, 30, 90, and 150 mins after resuscitation. The neurologic outcome, measured by Neurologic Deficit Score, was determined at 150 mins postresuscitation. Values for the Neurologic Deficit Score were: 8 +/- 8 in the control group; 31 +/- 13; 37 +/- 19; 69 +/- 22; and 62 +/- 26 in the cardiac arrest groups of 8, 10, 12, and 15 mins, respectively. No significant differences in cardiac resuscitability were found among the four cardiac arrest groups. The plasma concentrations of lactate and lipoperoxide were significantly higher than the prearrest levels; however, there were no significant differences among the four cardiac arrest groups. CONCLUSIONS: Cardiopulmonary bypass can be used to establish a resuscitation model in rabbits. Neurologic outcome worsens progressively in proportion to the prolonged cardiac times, especially when it exceeds 10 mins. Cardiac resuscitability is still possible, even when arrest time exceeds 15 mins. Changes in plasma concentrations of lactate and lipoperoxide do not correlate with the neurologic outcome and heart resuscitability following cardiac arrest.

Analysis of Variance↗
PubMed1994

Ventricular fibrillation voltage as a monitor of the effectiveness of cardiopulmonary resuscitation.

Ventricular fibrillation (VF) voltage was previously identified as a predictor of the success of cardiopulmonary resuscitation. In the present study we investigated the mechanism by which VF voltage predicts the success of cardiac resuscitation in a well-established rodent model of cardiac arrest. After 4 minutes of untreated VF, precordial compression was initiated and maintained for 6 minutes. Increases in coronary perfusion pressure during precordial compression were associated with concomitant increases in VF voltage (r = 0.61, p = 0.013). Significantly greater coronary perfusion pressure (24 vs 17 mm Hg) and VF voltage (0.17 vs 0.12 mV) were observed in resuscitated animals. To obviate electrical artifacts produced by precordial compression, boluses of oxygenated blood were injected into the ascending aorta in another 5 animals as an alternative method of cardiac resuscitation. This restored myocardial perfusion before defibrillation. Increases in VF voltage from 0.04 mV to 0.47 mV during aortic infusions were again correlated with coronary perfusion pressure (r = 0.62, p < 0.01) and predicted the success of cardiac resuscitation. Greater VF voltages after initiation of cardiac resuscitation were associated with increases in myocardial creatine phosphate, from 0.23 to 0.70 mmol/kg wet weight, and significant decreases in lactate content, from 22.8 to 13.9 mmol/kg wet weight. Increases in creatine phosphate were highly correlated with increases in VF voltage (r = 0.99, p < 0.01). Accordingly, increases in VF voltage during cardiac resuscitation reflect increases in myocardial perfusion and favorable changes in myocardial energy metabolism. As such, VF voltage, like coronary perfusion pressure, serves as a quantitative predictor of the success of cardiopulmonary resuscitation.

Action Potentials↗
PubMed1993

Transplantation of hearts after arrest and resuscitation. Early and long-term results.

Transplant surgeons are reluctant to use hearts that have undergone cardiopulmonary resuscitation for cardiac arrest because of the fear of poor early and late cardiac function. A policy of minimizing contraindications to use of donor hearts has led to the unique opportunity of assessing the effects of donor arrest and successful cardiopulmonary resuscitation on early and late cardiac function in pediatric heart transplantation. A number of 140 infants and children undergoing transplantation from birth to 17 years of age were studied retrospectively and divided into two groups on the basis of cardiopulmonary resuscitation status. Group 1 (72 patients) received donor hearts that were not subjected to cardiopulmonary resuscitation; group 2 (68 patients) received donor hearts that had cardiopulmonary resuscitation for a mean of 18.8 +/- 14.6 minutes, the longest period of time being 60 minutes. Mean ischemic times were almost identical in the two groups: 4.43 +/- 2.0 hours (cardiopulmonary resuscitation) versus 4.5 +/- 2.1 hours (no cardiopulmonary resuscitation). Early cardiac function was assessed on the basis of the number of days the recipient was supported by the ventilator, days receiving dopamine, days receiving isoproterenol, and the amount of inotropic agents required after the operation. The groups did not differ. Parameters of systolic function included fractional shortening, posterior wall thickening, and maximum velocity of change in left ventricular posterior wall dimension during systole. Diastolic function was measured on the basis of left ventricular end-diastolic volume, left ventricular mass, and maximum velocity of change in left ventricular posterior wall dimension during diastole. Both systolic and diastolic function were measured and analyzed from M-mode echocardiography at 1 week, 1 month, 6 months, 1 year, and 2 years after the operation. There were no statistically significant differences in graft function between the two groups in any of the echocardiographic parameters studied, even at 2 years. No group differed from ranges of normal. Our results suggest that hearts undergoing cardiopulmonary resuscitation for periods of up to 60 minutes can be used safely without evidence of deterioration of early or late cardiac function.

Adolescent↗