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PubMed1984

Cardiopulmonary resuscitation in a hospitalized population: prospective study of factors associated with outcome.

A prospective study of advanced cardiopulmonary resuscitation (CPR) was carried out on 226 patients in order to examine factors predicting successful resuscitation and 6 month survival. The mean age of all patients was 70 years and median age was 74. Cardiopulmonary resuscitation was successful in 40.5% (137) of all arrests and in 48.7% (110) of the first arrests. Thirty of 207 patients with one or more cardiac arrests were discharged alive (14%). Twenty-one of our patients were alive at 6 months (10.3%). Patients in ventricular fibrillation and/or ventricular tachycardia at the time of arrest were more likely to have successful outcomes. When the patient required Isuprel or bicarbonate, cardiopulmonary resuscitation was significantly less successful. We found no correlation of immediate outcome with the following variables: location of arrest; time of day; pre-existence of shock; coma; stroke; malignancy. Uremia and/or chronic obstructive pulmonary disease was not significantly associated with failed resuscitation. Most notable in our results of specific treatments was the evidence for the need to improve the initial pH, particularly when it was less than 7.2. Failure to do so by the time the second blood gas was drawn was associated with failure of cardiopulmonary resuscitation. Our results also suggest that the adequate treatment of metabolic acidosis, and improved ventilatory management with improved PO2 and optimization of PCO2, play a role in the better outcome of cardiopulmonary resuscitation.

Acid-Base Equilibrium↗
PubMed1989

The effect of cardiopulmonary bypass resuscitation on cardiac arrest induced lactic acidosis in dogs.

The adequacy of end organ blood flow following a cardiac arrest varies depending on the artificial reperfusion technique utilized and may critically affect patient outcome. Both oxygen consumption (VO2) and arterial lactate values have previously been used to assess tissue perfusion. Cardiopulmonary bypass resuscitation (CPB) is a reperfusion technique capable of providing near normal end organ blood flow. The purpose of this investigation was to study the effect of femoro-femoral veno-arterial CPB resuscitation compared to standard CPR on VO2 and arterial lactic acid values after a prolonged cardiac arrest. Ten mongrel dogs were electrically fibrillated and left in cardiopulmonary arrest without therapy for 12 min. Resuscitation was attempted according to a standardized protocol utilizing either CPB (n = 5) or standard external CPR (n = 5). Oxygen consumption values and arterial lactic acid samples were obtained at baseline, at timed intervals throughout resuscitation and after return of spontaneous circulation in successfully resuscitated dogs. Baseline hemodynamic and biochemical measurements were similar in both treatment groups (P greater than 0.05). Oxygen consumption (440 +/- 50 ml/min/M2) and mean arterial lactic acid values (7.44 +/- 2.25 mmol/l) were significantly higher at 1 min of resuscitation in CPB-treated dogs compared to dogs treated with CPR (60 +/- 10 ml/min/M2) (3.16 +/- 0.69 mmol/l) respectively (P less than 0.05). Mean arterial lactic acid values rose significantly at each sampling interval during CPR (P less than 0.05) but began to decrease after 5 min of resuscitation in the CPB animals and were not significantly different than baseline after 60 min of bypass (P greater than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Acidosis, Lactic↗
PubMed1995

Failure of ambulance crew to initiate cardiopulmonary resuscitation.

The Utstein style of reporting out-of-hospital cardiac arrests requires that all confirmed cardiac arrests considered for resuscitation are analysed and that a record is made of the number of cases where no resuscitation is attempted. We report a series of 942 confirmed cardiac arrests considered for resuscitation by South Glamorgan Emergency Medical Service (EMS). There were 370 (39.3%) cases where no resuscitation was attempted by the EMS. The ages, male/female ratio and EMS response times were similar in both the group that received ambulance resuscitation and those that did not. Those not receiving resuscitation were less likely to have had an arrest of cardiac aetiology (51.3% vs. 75%, P < 0.00001). Rigor mortis or decomposition of the body was present in 50.8% of cases and in 20% a doctor had already confirmed the patient dead. In the remainder the ambulance crew failed to start resuscitation for a variety of reasons.

Aged↗
PubMed1994

Cardiopulmonary-cerebral resuscitation with 100% oxygen exacerbates neurological dysfunction following nine minutes of normothermic cardiac arrest in dogs.

This study investigated the effects of normoxic (FIO2 = 0.21), hyperoxic (FIO2 = 1.0), and hyperoxic (FIO2 = 1.0) plus antioxidant pretreatment (tirilazad mesylate) [corrected] resuscitation on neurologic outcome following 9 min of normothermic (39 +/- 1.0 degrees C) cardiac arrest. Physiologic variables including arterial blood gases and neurologic outcome, which was assessed using a standardized scoring system, were followed over a 24-h period following resuscitation from cardiac arrest. Hyperoxically resuscitated dogs sustained significantly worse neurological deficit at 12 and 24 h (mean scores: 39 +/- 3 and 49 +/- 8, respectively) than did antioxidant pretreated hyperoxically resuscitated dogs (mean scores: 22 +/- 1, P = 0.0007 and 22 +/- 1, P = 0.004, respectively) and normoxically resuscitated dogs (mean scores: 28 +/- 4, P = 0.025 and 33 +/- 8, P = 0.041 respectively). These data suggest that oxidant injury has a major role in central nervous system dysfunction following successful resuscitation from 9 min of cardiac arrest. Also, resuscitation from cardiac arrest with hyperoxic FIO2's may contribute to and further exacerbate neurologic dysfunction.

Animals↗
PubMed1994

Clinical and laboratory investigations of active compression-decompression cardiopulmonary resuscitation.

Based upon an anecdotal report of successful resuscitation using a toilet plunger, Cohen and co-workers have developed and investigated a hand-held suction cup as an adjunct to standard manual CPR. This new method, called active compression-decompression cardiopulmonary resuscitation, utilizes a device which is placed over the mid-sternum, approximately 1-2 inches above the lower rib cage border. Active compression-decompression cardiopulmonary resuscitation is then performed in accordance with American Heart Association guidelines at a rate equal to 80-100/min using a 50% duty cycle and compression depth of 1.5-2.0 inches. Initial studies using the ACD device in both models and human subjects late after cardiac arrest have demonstrated improved cardiopulmonary hemodynamics when compared to standard manual CPR. Transophageal echocardiographic studies in human subjects have shown increased left ventricular filling during active decompression suggesting that active chest decompression improves venous return to the heart thus increasing left ventricular volume and stroke volume. Improved resuscitation success has also been documented in human subjects after in-hospital and pre-hospital cardiac arrest. Active compression-decompression cardiopulmonary resuscitation is a simple method which utilizes a hand held suction cup as an interface between rescuer and victim during closed chest circulatory support. This method allows for standard manual cardiopulmonary resuscitation with the addition of active chest wall decompression and appears to be a beneficial adjunct to standard manual cardiopulmonary resuscitation.

Blood Flow Velocity↗
PubMed1994

Long-term survival after successful out-of-hospital resuscitation.

Between 1983 and 1989, 962 patients in Rotterdam were resuscitated outside hospital, of whom 240 (25%) could be discharged alive. A follow-up study was performed to determine prognosis in these patients. Of the 240 survivors of out-of-hospital resuscitation 80% survived after 1 year and 61% after 5 years. During the first year, 9% suffered from myocardial (re)infarction and 13% underwent coronary bypass surgery or angioplasty. Within the first 3 years after resuscitation 60% of the patients were readmitted to hospital. Permanent or temporary neurological deficits were observed in 30 patients (14%). Patients with a primary arrhythmia without myocardial infarction had a worse prognosis than patients with a cardiac arrest in the context of an infarct. Survival was better in patients in whom resuscitation was initiated by physicians or ambulance-nurses, than in patients resuscitated by lay-people. Multivariate analysis revealed that this difference could be explained by a larger proportion of patients with a primary arrhythmia in the latter group. Since long-term prognosis after out-of-hospital resuscitation is satisfactory, programmes for resuscitation courses should be stimulated. Such programmes should aim predominantly at relatives of patients with known heart disease, police officers and children.

Emergency Medical Services↗
PubMed1996

Volume expansion during cardiopulmonary resuscitation reduces cerebral no-reflow.

Resuscitation of the brain after cardiac arrest requires homogeneous blood recirculation which, however, may be impaired by low reperfusion pressure, intravascular coagulation, increased blood viscosity and endothelial cell swelling. Intravascular volume expansion induced by intravenous infusion of a small volume of hypertonic solution has previously been shown to improve nutritional flow to the brain after severe hemorrhage shock. We therefore investigated whether this therapy also improves cerebral reperfusion after cardiopulmonary resuscitation. Fourteen adult normothermic cats were resuscitated after 15 min of ventricular fibrillation by closed-chest cardiac massage in combination with epinephrine, bicarbonate and DC-defibrillations. Eight animals were submitted to the standard resuscitation protocol. Six cats received additionally 2 ml/kg/10 min 7.5% NaCl/6% hydroxyethyl starch solution for post-ischemic volume expansion. EEG, ECG, CBF, and the aortic, left ventricular, central venous and intracranial pressures were monitored. Reperfusion of the brain was visualized 30 min after cardiac resuscitation by labelling the circulating blood with fluorescein isothiocyanate albumin. Areas of impaired brain reperfusion (no-reflow)-defined by the absence of microvascular filling-were identified by fluorescence microscopy at eight standard coronal levels of the forebrain, and expressed as percent of total sectional area. All animals were successfully resuscitated although volume expansion decreased myocardial and cerebral reperfusion pressure during cardiopulmonary resuscitation. Treatment with hypertonic solution increased serum osmolality transiently and prevented hemoconcentration throughout the experiment. Cerebral no-reflow was significantly reduced from 28 +/- 13% to 15 +/- 6% of total forebrain sectional area. Volume expansion by small volume hypertonic solutions may, therefore, improve recovery of brain function following cardiac arrest.

Animals↗
PubMed1991

Influences of different resuscitation regimens on acute early weight gain in extensively burned patients.

Dissatisfaction with the massive weight gain that commonly followed crystalloid resuscitation of extensively burned patients dictated the need for a study to determine if acute weight gain could be minimized with an alternative form of resuscitation. Three groups of ten patients each with statistically similar age and burn size (mean BSA 46 per cent) were resuscitated with lactated Ringer's solution (LR), hypertonic saline solution (HPT), or fresh frozen plasma (FFP). The volume of infused fluid and the patient weight gain were measured over the first 48 h of treatment. The mean urine output of the three groups was comparable (P greater than 0.05). The volume of infused resuscitation fluid to maintain urine output was a mean of 4.8 ml/kg/per cent BSA in the LR group, 3.16 in the HPT group and 2.68 in the FFP group. The difference in infusion rate between the FFP group and the LR group was statistically significant (P less than 0.01). All patients gained weight with resuscitation. The median percentage weight gain at the end of the first day of treatment was 10.69 per cent in the LR group, 7.88 per cent in the HPT group and 2.38 per cent in the FFP group. Weight gain at the end of the second day of treatment was 13.9 per cent in the LR group, 11.99 per cent in the HPT group, and 4.37 per cent in the FFP group. The differences between FFP, HPT and LR groups were statistically significant (P less than 0.01). In our study the use of fresh frozen plasma for resuscitation of extensively burned patients has been associated with minimal weight gain and minimal oedema. We believe that fresh frozen plasma resuscitation is an attractive alternative to crystalloid infusion and that further comparative studies should be performed.

Acute Disease↗
PubMed1993

Out-of-hospital resuscitation preferences of emergency health care workers.

The objective of this study was to assess the personal preferences of emergency physicians, nurses, and medical technicians regarding their own potential out-of-hospital resuscitation. An anonymous multiitem survey instrument was used at a statewide emergency medicine educational conference. Emergency personnel who regularly treat out-of-hospital cardiac arrest patients were enlisted to participate. Subjects picked the last intervention that they would wish for themselves in an optimally managed advanced cardiac life support (ACLS)-based resuscitation for ventricular fibrillation. One hundred millimeter visual analog scales were used to measure individual preferences for severe neurological disability or death. Hypothesis testing was by analysis of variance with Newman-Keuls, multiple regression with stepwise variable selection, and the chi 2 and binomial distributions. Of 185 survey instruments, 105 were returned completed by eligible subjects. There was little difference among the three occupational groups (P > .5), although older respondents favored shorter resuscitations (r = -.38; P = .002). Ten subjects did not want cardiopulmonary resuscitation started, and 65% wanted resuscitation stopped before the second dose of epinephrine. Only three subjects chose to undergo the entire ACLS sequence. Eighty-two percent of respondents preferred death to severe neurological disability. Emergency health care professionals have a unique personal awareness of issues surrounding out-of-hospital resuscitation. That a large majority would prefer death to severe disability and few would willingly undergo full resuscitation as currently practiced suggests that prevailing guidelines should be reevaluated.

Adult↗
PubMed1993

Discrepancy in resuscitation beliefs among physicians at various levels of training.

Having previously described some of the attitudes of health care providers toward resuscitation for themselves, based on an individual's beliefs about the likelihood of success of cardiopulmonary resuscitation (CPR), the differences among attitudes of physicians at different levels of training have now been assessed. A multi-question survey was sent to medical students, house officers, and attending physicians at two university medical centers. Sociodemographic information, questions regarding beliefs about outcome after CPR, and personal desires were included. Respondents were asked to identify the clinical condition carrying the worst prognosis during cardiac arrest from among: metastatic cancer (MC), end-stage renal disease (ESRD), acquired immunodeficiency syndrome (AIDS), sepsis, and myocardial infarction (MI), and to specify their resuscitation desires should they be affected by these conditions. The preferences of each group regarding resuscitation given their least favored diagnosis were assessed using chi 2 analysis of trends for binomial proportions. Approximately 186 questionnaires were evaluated and consisted of 90 by medical students (MS), 67 by house officers (HOs), and 29 by attending physicians (APs). Resuscitation desires for each diagnosis were MC, 7 of 40; ESRD, 8 of 34; AIDS, 10 of 74; sepsis, 10 of 15; and MI, 20 of 23. chi 2 test for trend of desire to be resuscitated from the self-selected worst prognostic category by level of training demonstrated no significant decrease in desire to be resuscitated with increasing level of training. Physician's beliefs about CPR may be influenced by their experiences with particular patients and events.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗
PubMed2003

A novel method of peritoneal resuscitation improves organ perfusion after hemorrhagic shock.

BACKGROUND: After resuscitation from hemorrhagic shock, intestinal microvessels constrict leading to impairment of blood flow. This occurs despite restoration and maintenance of central hemodynamics. Our recent studies have demonstrated that topical and continuous exposure of the gut microvasculature to a clinical solution (Delflex; Fresenius Medical Care), as a technique of direct peritoneal resuscitation (DPR), reverses the postresuscitation vasoconstriction and hypoperfusion to a sustained dilation and hyperperfusion. We hypothesize that initiation of DPR simultaneously with resuscitation from hemorrhagic shock enhance organ blood flow to all tissues surrounding the peritoneal cavity as well as distant organs. METHODS: Male Sprague-Dawley rats were anesthetized, intubated and cannulated for monitoring of hemodynamics and for withdrawal of blood. Rats were hemorrhaged to 50% of mean blood pressure for 60 minutes prior to resuscitation with shed blood plus 2 volumes of saline. Animals were randomized for intraperitoneal therapy with 30 mL saline (group 1, n = 9), or Delflex (group 2, n = 9). Whole organ blood flow was measured by colorimetric microsphere technique with phantom organ at baseline, after completion of resuscitation, and at 120 minutes postresuscitation. Replenishment of the dwelling intraperitoneal saline or Delflex was performed in (group 3, n = 8), and (group 4, n = 8), respectively at 90 minutes postresuscitation, and a single whole organ blood flow was performed at 120 minutes postresuscitation. RESULTS: Direct peritoneal resuscitation caused a significant increase in blood flow to the jejunum (35%), ileum (33%), spleen (48%), and pancreas (57%), whereas a marked increase in blood flow was detected in the lung (111%), psoas major muscle (115%), and diaphragm (132%), as compared with the saline treated animals in group 1. At 120 minutes postresuscitation, organ blood flow returned to the prehemorrhagic shock baseline level in all organs irrespective of peritoneal therapy. Replenishment of the intraperitoneal solution in group 3 and 4, enhanced blood flow to the liver, kidneys, and diaphragm. CONCLUSIONS: Direct peritoneal resuscitation enhanced blood flow to organs incited in the pathogenesis of multiple organ failure that follows hemorrhagic shock.

Animals↗
PubMed2006

Non-initiation and discontinuation of resuscitation.

Whereas certain aspects of neonatal resuscitation may benefit from evidence evaluation using standard evaluation techniques, the ethical aspects of non-initiation and discontinuation of resuscitative efforts are more subjective and might certainly be influenced by the biases of the reviewers. The outcome data are relatively straightforward, although survival and morbidity data differ significantly by region and even among hospitals classified at similar levels in the same region. However, the interpretation of that data is necessarily somewhat subjective. Whereas certain aspects of neonatal resuscitation may benefit from evidence evaluation using standard evaluation techniques, the ethical aspects of non-initiation and discontinuation of resuscitative efforts are more subjective and might certainly be influenced by the biases of the reviewers. The outcome data are relatively straightforward, although survival and morbidity data differ significantly by region and even among hospitals classified at similar levels in the same region. However, the interpretation of that data is necessarily somewhat subjective. Does a survival rate of 1% of patients at a certain weight or gestational age warrant full resuscitative efforts? What about 20% or 49%? Similar questions could be posed regarding significant morbidity. However, as the science of neonatal resuscitation advances, it is important to review objective evidence-based outcome data in certain situations in which non-initiation or discontinuation of resuscitative efforts may be appropriate to determine if certain common themes can be elicited.

Anencephaly↗
PubMed2005

Witnessed resuscitation: a concept analysis.

The science and practice of resuscitation is recognised and endorsed on an international level, yet for more than a decade it has appeared in the literature alongside words such as witnessing or witnessed to signify the practice of family presence during a resuscitation attempt. This paper explores the meaning of witnessed resuscitation using the process for concept analysis proposed by Rodgers. The term resuscitation is explored, followed by identification of relevant uses of the concept of witnessed resuscitation. The reader is introduced to conceptual variations that challenge the way in which the concept has become associated with family or relatives presence in the resuscitation room of an accident and emergency department. Conceptual clarity is further enhanced through the identification of references, antecedents and consequences of witnessed resuscitation and by providing a model case of the concept that includes its defining attributes.

Attitude of Health Personnel↗
PubMed2005

Communication during trauma resuscitation: do we know what is happening?

OBJECTIVE: Verbal communication is essential for teamwork and leadership in high-intensity performances like trauma resuscitation. We evaluated communication during multidisciplinary trauma resuscitation. METHODS: The main trauma room of a level one trauma centre was equipped with a digital video recording system. Resuscitations were consecutively and prospectively enrolled. Patients with revised trauma score (RTS)=12 were resuscitated by a 'minor trauma team' and patients with RTS<12 by a 'major trauma team'. Information transferral from physicians to other team members was evaluated separately for all ABCDE's, according to initiation, audibility and response. The observer was trained and the first 30 video's were excluded. RESULTS: From May 1st to September 1st 2003, 205 resuscitations were included, 12 were lost for evaluation. The 'major trauma team' resuscitated 74 patients (ISS:21.4). Communication was audible in 56% and understandable in 44% during the primary survey. The 'minor trauma team' assessed 119 patients (ISS:7.4). Communication was audible in 43% and understandable in 33%. CONCLUSIONS: Communication during trauma resuscitation was found to be sub optimal. This is potentially harmful for trauma victims. Professionals and institutions should be aware that communication is not self-evident. Introduction of an aviation-like communication feedback system could help to optimise trauma care.

Adult↗
PubMed2005

Differential expression of extracellular matrix remodeling genes in rat model of hemorrhagic shock and resuscitation.

BACKGROUND: Matrix metalloproteinases (MMPs) and their specific physiological inhibitors, tissue inhibitors of metalloproteinases (TIMPs), are thought to play an essential role in tissue repair, cell death and morphogenesis. We have previously discovered unexpected up-regulation of genes coding for multiple MMP/TIMP family members in a rat model of hemorrhagic shock and resuscitation. However, the effect of different resuscitation protocols at the level of protein expression and function remains unknown. MATERIALS AND METHODS: Male Sprague-Dawley rats (n = 50; 10/group) were subjected to a three-stage volume controlled hemorrhage and resuscitated as follows: 1) lactated Ringer's solution (LR), 3:1 volume of lost blood; 2) 7.5% hypertonic saline (HTS), 9.7 ml/kg; 3) plasma, 1:1 volume. Sham hemorrhage and sham resuscitation groups were used as controls. Expression of lung and spleen MMPs (-2, -7, -9, -10, -14, and -16), and TIMPs (-1, -2, and -3) was analyzed at transcriptional, functional and protein expression level using RT-PCR, ELISA, Western blotting, and gelatin zymography techniques. RESULTS: Spleen was affected more than lung by the resuscitation strategy and the largest number of changes was caused by HTS resuscitation. RT-PCR confirmed an increased levels of MMP-2, MMP-9, MMP-7, MMP-14, MMP-16, and TIMP-1, TIMP-2 in the spleen of HTS group compared to sham groups, whereas in lungs transcriptional levels of only TIMP-3 and TIMP-1 were significantly changed. CONCLUSION: Expression of MMP and TIMP in lung and spleen following hemorrhage is modulated by the resuscitation strategy.

Animals↗
PubMed2004

Combination of therapeutic mild hypothermia and delayed fluid resuscitation improved survival after uncontrolled haemorrhagic shock in mechanically ventilated rats.

We challenged the current management of uncontrolled haemorrhagic shock (UHS) and put forward a hypothesis that therapeutic mild hypothermia combined with delayed fluid resuscitation will improve the survival rate. After an initial blood withdrawal of 3 ml/100g for 15 min, the rat's tail was amputated up to 75% to induce UHS phase I. The mean arterial blood pressure (MAP) was maintained at 40 mmHg or 80 mmHg, according to the assigned study group. This was followed by homeostasis of the tail wound and increase of the MAP up to 100 mmHg during resuscitation phase II. Finally, phase III was an observation of phase up to 72 h. Rats were anaesthetised and randomised into four groups. Group 1 received immediate fluid resuscitation and normothermia. Group 2 received immediate fluid resuscitation and therapeutic mild hypothermia. Group 3 received limited fluid solutions to maintain MAP at 40 mmHg and normothermia. Group 4 also received limited fluid solution, but the rats were subjected to therapeutic mild hypothermia. In groups 2 and 4, the body temperature was kept at 34 degrees C throughout the UHS phase I and resuscitation phase II. At the end of the observation phase III, the brains of the animals were fixed and analysed histologically. The blood loss from the tail during the UHS phase I was significantly higher in groups 1 and 2. The survival rate was 33.3, 83.3, 58.3 and 91.7%, respectively in groups 1-4. In all surviving rats, no histological brain damage was observed. These results indicate that therapeutic mild hypothermia or delayed fluid resuscitation increase the survival rate in this model. However, when mild hypothermia and limited fluid resuscitation were combined, the survival rate was the highest.

Analysis of Variance↗
PubMed2004

The varying ethical attitudes towards resuscitation in Europe.

OBJECTIVE: This study was conducted to assess the varying attitudes in Europe towards ethical aspects of resuscitation in Europe. METHOD: The ethics of resuscitation is a key discussion topic in the European Resuscitation Council Advanced Life Support (ALS) course. A questionnaire was sent to all leading ALS course directors in 20 European countries. All completed the questionnaire. The results were compiled in March 2004. Views were sought on the following ethical aspects:When not to attempt resuscitation Active euthanasia When to abandon resuscitation efforts The diagnosis of death by non physicians Permission for relatives to be with the patient during resuscitation if they wish Teaching on the recently dead Breaking bad news Results: The results reveal a considerable variation in the interpretation of ethical dilemmas within European countries. It is interesting to note that the results do not necessarily conform to traditional beliefs in the characteristic differences between Northern and Southern Europe. The Mediterranean countries do not all have the same attitudes, any more than the Nordic or Central European countries share the same views. CONCLUSIONS: There remains a widespread divergence of views on ethical aspects of resuscitation with the countries of Europe that are largely unpredictable according to commonly perceived national characteristics. The trend over the past 6 years is towards a more permissive attitude. For many ethical questions there can be no clear and correct didactic answers.

Attitude of Health Personnel↗
PubMed2006

Resuscitation by primary care doctors.

BACKGROUND: Sudden cardiac arrest is a common mechanism of premature death in the community. Resuscitation is often possible, but no large study of resuscitation by doctors who practice there has been published. METHODS: General practitioners (GPs) equipped with defibrillators reported 555 patients with cardiac arrest in whom they attempted resuscitation. FINDINGS: Average age was 65.4, 75% male. Most arrests (49%) occurred at the patient's home but some (18%) occurred at or near the doctors' surgeries. Heart disease was responsible for 88% of the arrests: in these cases resuscitation to leave hospital alive was frequently successful (148 of 436 attempts, 34%). Success was rare (one of 59, <2%) when the arrest was due to non-cardiac disease. Resuscitation was most common when the first monitored rhythm was shockable (VF/VT) and defibrillated promptly: 144 out of 351 (41%) patients surviving. VF/VT was most common with early rhythm monitoring, particularly when the doctor was present (63% survival), or nearby (54%). When VF/VT complicated AMI, 72% of those defibrillated within 1min of onset survived. With delayed attendance, the frequency of VF/VT fell and asystole or Pulseless Electrical Activity (PEA) became more common. Survival after resuscitation was rare for patients presenting with these rhythms: five of 202 (2.5%). No such patient survived unless the rhythm could be converted to VF/VT with drugs or basic life support and subsequently shocked. CONCLUSION: Primary care doctors equipped with defibrillators attend patients with cardiac arrest under circumstances in which resuscitation is frequently successful. This presents a unique opportunity to reduce mortality from sudden cardiac arrest.

Aged↗