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PubMed1985

Observations on colloid osmotic pressure, hematocrit, and plasma osmolality during cardiac arrest.

A porcine model of cardiac arrest with irreversible electromechanical dissociation was associated with highly significant decreases in colloid osmotic pressure in the absence of increases in hematocrit during the initial half hour of CPR. Pulmonary edema was typically observed. These observations are best explained by increases in capillary permeability to plasma proteins. The progression of acidemia was remarkably slow; arterial blood pH remained normal for more than 16 min. Even though there was significant lactic acidosis, concurrent respiratory alkalosis during CPR accounted for the greatly delayed onset of acidemia. There was also an as-yet unexplained increase in plasma osmolality.

Animals↗
PubMed2003

[In-hospital cardiac arrest resuscitation: medical and paramedical theory skill assessment in an university hospital].

OBJECTIVES: Theory knowledge and attitude assessment about in-hospital cardiac arrest (CA) basic life support by hospital staff. METHODS: We tested medical and paramedical working staff in a 450 beds university hospital with anonymous questionnaire based on training for basic life support. Questions were about presence of a formation before, clinical signs reached in front of unconscious patient, attitude in front of cardiac-arrest, practical experience with basic life support and ward emergency trolley. RESULTS: Five hundred and seventy one on 996 people answered to handed out questionnaires (57%): 158 from medical staff (Med group) and 413 from nurses "Pmed". Seventy one percent people from "Med" group and 64% from "Pmed" received one time at least training about cardiac-arrest. Front of unconscious patient, no spontaneous breath was reached explicitly by 55% people from Med group and 19% from "Pmed" group and central pulse was reached explicitly by 70% people from "Med" group and 18% from "Pmed" group. Front of CA, 50% people from "Med" group released airway, 75% began ventilation and 86%, External Heart Compression (EHC) and 42% called for rescue. There were respectively 29, 47, 64 and 60% people from "Pmed" group. Eighty-one percent people from "Med" group thought they knew to do ventilation and 82% did it one time at least. Eighty-eight thought they knew to do EHC and 85% did it one time at least. They were respectively 67, 76, 73 and 78% people from Pmed group. Sixty-four per cent of Med group people know that there is emergency trolley in there department versus 89% for "Pmed" group. CONCLUSION: This study showed that theoretical knowledge of hospital staff about cardiac arrest diagnostic and management are insufficient from the point of view of national and international guidelines. Analysis is difficult because of weak response number and knowledge people overestimation.

Allied Health Personnel↗
PubMed1998

[Influence of moderate hypothermia on the contents of 6-KETO-PGF1 alpha and TXB2 in brain tissues after cardiac arrest and resuscitation in dogs].

To investigate the effect of moderate hypothermia of whole brain (30 degrees C to 32 degrees C) on the levels of prostacyclin and thromboxane A2 in brain tissues after cardiac arrest and resuscitation. Twenty-one dogs were divided into four groups: Group A, nonischemic controls (n = 4); Group B, 15 minute cardiac arrest without reperfusion (n = 4); Group C, 15 minute cardiac arrest and standard resuscitation (n = 6); Group D, 15 minute cardiac arrest and moderate hypothermia (30 degrees C-32 degrees C). The results showed that as compared with those in Group A, the 6-Keto-PGF1 alpha levels remained substantially unchanged in Group C and D (P > 0.05), and the levels of TXB2 and TXB2/6-Keto-PGF1 alpha ratio increased significantly in Group C (P < 0.01), but both maintained basically stable in Group D (P > 0.05). In comparison with those in Group C, the levels of TXB2 and TXB2/6-Keto-PGF1 alpha ratio decreased dramatically (P < 0.01). It is concluded that the moderate hypothermia can depress the arachidonic acid metabolism and keep a certain balance between the activities of TXA2 and PGI2 during cerebral resuscitation.

6-Ketoprostaglandin F1 alpha↗
PubMed2003

[Emergency medicine -- new concepts and therapies improve outcome from cardiac arrest].

According to scientific articles focusing on emergency medicine published in international journals in the past few months, early defibrillation by lay persons, thrombolysis during cardiopulmonary resuscitation (CPR) and treatment with mild therapeutic hypothermia have been identified as relevant, new and clinically important treatment options to improve outcome following cardiac arrest. Early defibrillation using automated external defibrillators by lay persons reduces the time interval between collapse and first attempts at defibrillation and thus improves outcome after prehospital cardiac arrest. Thrombolysis during CPR -- for which the results regarding safety and efficacy are available from nonrandomized trials -- can also be safely performed in case of pulseless electrical activity. Thrombolysis during cardiopulmonary resuscitation has, however, no significant effect in this subgroup of patients with pulseless electrical activity in whom outcome is poor if the drug is administered at the end of conventional CPR procedures. Mild therapeutic hypothermia, i. e., cooling of cardiac arrest victims to 32-34 degrees C central body temperature for 12-24 h following out-of-hospital cardiac arrest, markedly improves survival rate and neurological outcome. Since this has now been clearly documented in two randomized clinical trials, it can be assumed that this kind of intervention will be recommended and translated into clinical practice soon. In conclusion, new and clinically relevant methods to improve outcome following cardiac arrest are available and can now be widely used clinically.

Cardiopulmonary Resuscitation↗
PubMedDate not supplied

Thrombin-antithrombin appearance in out-of-hospital cardiac arrest.

OBJECTIVE: Intravascular thrombosis induced during out-of-hospital cardiac arrest (OOHCA) may contribute to the pathophysiology of cardiac arrest and complicate resuscitation. We characterized the prevalence of thrombogenesis during OOHCA by measuring plasma levels of thrombin-antithrombin complexes (TAT). METHODS: An observational cohort study of medical OOHCA patients in an urban emergency medical services (EMS) system. Subjects were patients>or=18 years suffering medical OOHCA. Citrated blood samples were drawn in the prehospital setting either directly from venous blood or during the placement of a central venous catheter and frozen (-70 degrees C). The EMS physician documented age, gender, time intervals, return of spontaneous circulation (ROSC), therapies administered and time of blood draw. TAT assays were performed by commercial ELISA. RESULTS: Eighty-eight patients (58% male) aged 63.4+/-15.9 years were enrolled in the study. Median [interquartile range IQR] TAT values in 80 samples (8 samples were grossly clotted and excluded) were 159.2 [38, 2, 522, 8] and ranged from 0.79 to 1,343.9. Patients transported to the hospital had lower TAT levels than those pronounced in the field (p=0.014). Of four EMS-witnessed arrests, three had return of pulses with TAT values of 0.79, 6.8, and 17.9. The fourth had a TAT over 525 after a long unsuccessful resuscitation. For subjects with TAT below 50 (n=23), all but three were witnessed arrests or received bystander CPR. CONCLUSIONS: Except for a single case witnessed by EMS and immediately defibrillated into a perfusing rhythm, all cases of OOHCA exhibited increased thrombotic state. Intravascular thrombosis may represent a global barrier to resuscitation and ultimately, end-organ perfusion.

Aged↗
PubMed1998

[Heat of polymerization of bone cement can induce cardiac arrest].

Total hip arthroplasty is associated with cardiopulmonary complications including cardiac arrest. We present one of four cases of cardiac arrest, two of the cases were fatal. The pathogenesis suggested to explain these complications is venous air embolism, generated by the methylmethacrylate bone cement polymerization causing thermal blood damage. To prevent this happening cortical bone allotransplantation around the prosthesis and bone cement with a low temperature of polymerization may be used.

Aged↗
PubMed2002

[Recurrent cardiac arrest after splenectomy in a patient with ITP and diabetes mellitus].

We report a case of 58-year-old man who had repeated cardiac arrests on the first post-operative day. The patient underwent splenectomy due to ITP (idiopathic thrombocytopenic purpura). He also had diabetes mellitus and nephrotic syndrome. There was no abnormal finding at the preoperative examination, except bleeding time of 6 minutes. The operation was finished without complications under general anesthesia. Midnight on the day of surgery, the first cardiac arrest occurred, and lasted for about 10 seconds. He recovered soon from the incident, but at 6 o'clock next morning, he developed severe bradycardia and cardiac arrest. He recovered again, but around 10 o'clock, he developed bradycardia and arrest again, and fell into a fit of convulsions and lost his consciousness. Again he recovered soon and no bradycardia and cardiac arrest occurred after this episode. Two years later, he was scheduled for vitrectomy due to diabetic retinosis. There were a few PACs and PVCs in his Holter-ECG, but no typical bradycardia and ST changes. During the operation, we injected atropine sulfate, dopamine hydrochloride and bucladesine sodium to increase his heart rate above 60 per minute. The operation was finished smoothly and there was no trouble perioperatively. A year later, he also underwent bilateral cataract extraction under local anesthesia without any troubles.

Diabetes Complications↗
PubMed2000

Survey of effects of anesthesia protocols on hemodynamic variables in porcine cardiopulmonary resuscitation laboratory models before induction of cardiac arrest.

OBJECTIVE: An advantage of animal models in cardiopulmonary resuscitation (CPR) research is the possibility to control confounding variables that may be impossible to standardize in clinical trials. A neglected effect of the anesthesia protocol in porcine CPR studies may be its impact on hemodynamic variables before induction of cardiac arrest. Accordingly, the purpose of the study reported here was to evaluate published CPR reports with regard to their anesthesia protocol. METHODS: Of 100 articles that reported on laboratory models simulating cardiac arrest between 1987 and 1997 in peer-reviewed journals, 25 met inclusion criteria and were analyzed for values of coronary perfusion pressure, mean arterial pressure, heart rate, temperature, and cardiac index before induction of cardiac arrest. Subsequently, mean values for all animals in a given report were calculated and corrected for group size; statistical analysis was not performed since this was a survey only. RESULTS: Different anesthesia protocols resulted in a widely distributed pattern of hemodynamic variables prior to induction of cardiac arrest. Ranges compared with reference values were: heart rate, 100 to 122 beats/min versus 105+/-11 beats/min; mean arterial pressure, 68 to 130 mm Hg versus 102+/-9 mm Hg; coronary perfusion pressure, 55 to 114 mm Hg (no reference value); cardiac index, 69 to 152 ml/kg/min versus 147+/-22 ml/kg/min; body temperature, 37 to 38.5 degrees C versus 38.5+/-0.7 degrees C. CONCLUSION: The anesthesia protocol may have an impact on hemodynamic variables before induction of cardiac arrest in CPR studies.

Anesthesia↗
PubMed1994

Out-of-hospital cardiac arrest in an Oriental metropolitan city.

To investigate the epidemiology of out-of-hospital cardiac arrest in Taipei City, Taiwan, a prospective chart review and follow-up study was conducted by collecting the prehospital cardiac arrest record from 10 designated responsible emergency departments (EDs) from August 1, 1992 through May 31, 1993. Cases with the restoration of spontaneous circulation (ROSC) were followed up until discharged from hospital. The information gathered included age, sex, bystander cardiopulmonary resuscitation, response time (time elapsed from receiving the call to arrival on the scene), advanced cardiac life support (ACLS) time (time elapsed from receiving the call to arrival at the ED), initial cardiac rhythm in the ED, ROSC, survival to discharge from the hospital, underlying disease, past history, personal history, and neurological outcome at discharge. Of 638 out-of-hospital cardiac arrests, 554 (86.7%) were nontraumatic. Response time, ACLS time, ROSC rates, and survival rates were 7.4 minutes, 21.6 minutes, 15.8%, and 1.4%, respectively. In comparing the trauma and nontrauma group, there were significant differences in age, sex, response time, and ACLS time. Between cases of patients who had ROSC and those who died, the data were statistically significant, P = .0143, showing that ACLS time was shorter in the ROSC group (19.5 v 21.9 minutes). In analysis of underlying disease, definite and probable cardiac-origin sudden deaths were found in only 120 patients, which may extend the annual sudden cardiac death rates to be 0.0053%. In conclusion, the low resuscitation and survival rates in this country were because of delayed initiation of both basic life support and ACLS.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2004

[Efficacy of transesophageal echocardiography in patients with cardiac arrest or shock].

OBJECTIVES: Only a few examinations are available to critically ill patients. We assessed the efficacy of transesophageal echocardiography (TEE) in the management of patients with cardiac arrest or shock. METHODS: Among a total of 2,021 patients who underwent TEE over the past 13 years at our institution, we reviewed 18 patients who underwent TEE during cardiac arrest or shock. RESULTS: TEE was performed in four patients with cardiac arrest and in 14 patients with shock. In 12 (67%) of 18 patients, TEE identified the following abnormalities: aortic dissection in four, ruptured thoracic aortic aneurysm in two, papillary muscle rupture in two, left ventricular free wall rupture in two, postoperative cardiac tamponade in one and ruptured chordae tendineae in one. TEE excluded suspected cardiac abnormality in two other patients. Transthoracic echocardiography could not be performed in 8 of 18 patients, and showed poor quality of images in the remaining 10 patients. Of the 12 patients with a diagnosis based on TEE, three patients died during cardiopulmonary resuscitation, whereas nine patients were treated with emergent surgery and six of these survived to hospital discharge. CONCLUSIONS: TEE is feasible even in patients with cardiac arrest or shock, and can play an important role in establishing the diagnosis and determining the treatment of such patients.

Aged↗
PubMedDate not supplied

The effect of cardiac arrest on the blood-testis barrier to albumin, tumor necrosis factor-alpha, pituitary adenylate cyclase activating polypeptide, sucrose, and verapamil in the mouse.

Impotence commonly occurs after events such as acute myocardial infarction, coronary bypass, head trauma, and cerebral bleeding, including subarachnoid hemorrhage. We hypothesize that the hypoxia accompanying these events could damage the blood-testis barrier (BTB) and so cause testicular dysfunction, a possible cause of impotence. We examined the effect of cardiac arrest in mice on testis weight and various aspects of BTB function. Testis weight was decreased by about 24% 12 hours after cardiac arrest but had recovered fully by day 7. The testis/serum ratio for albumin was increased 12 hours after arrest, showing a disruption in the vascular BTB with recovery by 24 hours. The testis/serum ratio for sucrose was not consistently elevated, showing that the Sertoli cell BTB remained intact. The testis/serum ratio for verapamil was increased on day 3 of cardiac arrest, suggesting impaired function of the BTB's p-glycoprotein efflux transporter. Transporters for pituitary adenylate cyclase activating polypeptide and tumor necrosis factor-alpha were not affected by cardiac arrest. These results show that cardiac arrest affects testis weight and some aspects of BTB function. Such changes might have long-term effects on testicular function.

Albumins↗
PubMed2003

Is vasopressin superior to adrenaline or placebo in the management of cardiac arrest? A meta-analysis.

Vasopressin is currently recommended in the management of patients with cardiac arrest, but its efficacy is still incompletely established. We systematically reviewed randomized trials comparing vasopressin to control treatment in the management of cardiac arrest in humans and animals. Two human and 33 animal studies were retrieved. At pooled analysis vasopressin appeared equivalent to adrenaline (epinephrine) in the management of human cardiac arrest (N=240), with, respectively 63 (78/124) vs 59% (68/116) ROSC (P=0.43), and 16 (20/124) vs 14% (16/116) survival to hospital discharge (P=0.52). In animal trials (N=669) vasopressin appeared instead significantly superior to both placebo (ROSC, respectively 93 [98/105] vs 19% [14/72], P<0.001) or adrenaline (ROSC, respectively 84 [225/268] vs 52% [117/224], P<0.001). In conclusion, vasopressin is superior to both placebo or adrenaline in animal models of cardiopulmonary resuscitation. Evidence in humans is still limited and confidence intervals estimates too wide to reliably confirm or disprove results obtained in experimental animal settings.

Animals↗
PubMedDate not supplied

Time to intubation and survival in prehospital cardiac arrest.

OBJECTIVE: To examine the correlation between time to paramedic intubation and survival after prehospital cardiac arrest. METHODS: This was a retrospective cohort study of 693 patients who had paramedic endotracheal intubation for prehospital cardiac arrest in King County, Washington (excluding Seattle), between January 1991 and May 2003. Based on the time from patient collapse until intubation, cases were divided into quartiles. Survival in the slower three quartiles (defined as "slow intubation") was compared with survival in the fastest quartile (defined as "quick intubation"). RESULTS: In the quick intubation group (intubation time < or = 12 minutes), 46% of the patients survived; in the slow intubation group (intubation time > or = 13 minutes), 23% of the patients survived. Logistic regression was used to adjust for possible confounders that affect survival: age, gender, location, bystander cardiopulmonary resuscitation, cardiac rhythm, emergency medical technician response time, and paramedic response time. The fully adjusted odds ratio of survival for the slow intubation group compared with the quick intubation group was 0.42 (95% confidence interval 0.26, 0.69). CONCLUSIONS: This study is the first of its kind to compare survival with the time interval until an aspect of advanced life support is performed. These findings suggest that faster intubation times may increase odds of survival in prehospital cardiac arrest. Future prospective studies are merited to further understand this association.

Aged↗
PubMed1999

Active compression-decompression cardiopulmonary resuscitation: a population-based, prospective randomised clinical trial in out-of-hospital cardiac arrest.

Different mechanical devices have been developed to improve cardiopulmonary resuscitation (CPR). The aim of this study was to evaluate active compression-decompression (ACD) CPR applied by Emergency Medical Service (EMS) in a defined population. The Trondheim region EMS (population 154,000) employs simultaneous paramedic and physician response. Upon decision to treat, patients with cardiac arrest of presumed cardiac origin were allocated to ACD CPR (CardioPump) or standard CPR by drawing a random number tag. Outcome in each patient was determined on a 5 point ordinal scale (no clinical improvement = 1, survival to discharge = 5). In 4 years, CPR was attempted in a total of 431 cardiac arrests, 54 patients (13%) survived to discharge; 302 patients with similar baseline characteristics were randomised. The prevalence of bystander CPR was 57% and the median call-arrival interval 9 min. By intention to treat, the mean score in the standard CPR group was 2.51 and 17/145 patients (12%) survived. The mean score in the ACD CPR group was 2.53 (P = 0.9) and 20/157 patients (13%) survived. Cerebral outcome was similar in the two groups. Among the 145 ACD patients, the technique was successfully applied in 110, found inapplicable in 35 and in seven patients chest compressions were unnecessary. This is the largest, single-centre, randomised, population based study of ACD CPR in out-of-hospital cardiac arrest to date. Even when considering a wider outcome spectrum than crude survival, we found no evidence of clinical benefit. In a quarter of cases ACD CPR was inapplicable, further limiting its potential usefulness.

Aged↗
PubMed1989

Effect of excitatory amino acid receptor blocker MK-801 on overall, neurologic, and morphologic outcome after prolonged cardiac arrest in dogs.

Excitatory amino acids accumulating in the brain during ischemia may cause selective neuronal damage postischemia. This hypothesis was tested in a series of studies using MK-801, an N-methyl-D-aspartate (NMDA) receptor blocker, in a reproducible outcome model of prolonged cardiac arrest in dogs. After normothermic ventricular fibrillation cardiac arrest, the dogs were resuscitated with closed-chest femoral veno-arterial cardiopulmonary bypass. At 4 h they were separated from bypass, ventilation was controlled for 20 h, and intensive care was continued to 96 h. In Study I, ventricular fibrilation cardiac arrest (no-flow) was 17 min; starting immediately with reperfusion, MK-801 1200 mg/kg (n = 5) or an equal volume of placebo (n = 5) was infused over 12 h in blinded, randomized fashion. In Study II, the duration of the no-flow period was reduced to 15 min, and MK-801 2400 mg.kg-1 (n = 4) or placebo (n = 4) was infused. In Study III, no-flow lasted for 15 min, and MK-801 2400 mg/kg was started 30 min before ventricular fibrillation (n = 4); comparison was with Study II controls. In all three studies, MK-801 plasma concentrations peaked at greater than 50 ng/ml and were 15-30 ng/ml over 12 h. All 22 dogs of experiments within protocol survived with severe brain damage. MK-801 delayed return of pupillary reactivity, EEG activity, consciousness, and respiration, necessitating longer periods of controlled ventilation. Neurologic deficit scores, overall performance categories, and brain and heart morphologic damage scores at 96 h did not differ between placebo and MK-801 pretreatment or post-treatment groups. These negative outcome results after prolonged cardiac arrest do not negate the hyperexcitability hypothesis of selective vulnerability, but suggest the existance of additional mechanisms of secondary brain damage.

Animals↗
PubMed1983

Epidemiology of cardiac arrest and resuscitation in children.

A surveillance system identified all out-of-hospital cardiac patients under the age of 18 who received emergency care in suburban King County, Washington. The etiology, cardiac rhythm, and outcome were identified for each case. During a 6 1/2-year period, 119 cardiac arrests occurred (annual incidence, 12.7/100,000 among individuals less than 18). Sudden infant death was the most common etiology (32%), and drowning was the second most common (22%). The most common rhythm was asystole, accounting for 66% of all rhythms. Six percent of patients treated with basic EMT care were discharged, compared with 7% of patients treated with EMT and paramedic care. In contrast to resuscitation from cardiac arrest in adults, the likelihood of successful resuscitation in children is very poor. This is due to different etiologies and the higher proportion of asystole seen in pediatric cardiac arrest as compared with adults.

Adolescent↗
PubMed1981

Cardiac arrest from gas embolism in scuba diving.

The case of a scuba diver who suffered a cardiac arrest is presented. The history of a short, lucid interval after surfacing followed by cardiac arrest, the finding of hemoptysis, and the characteristic response to recompression therapy are consistent with the diagnosis of gas embolism. The clinical presentation and pathophysiology of gas embolism are discussed, and an approach to emergency stabilization and definitive management of gas embolism is reviewed, with emphasis on cardiac arrest.

Barotrauma↗
PubMed2005

Circumstances of out of hospital cardiac arrest in patients with ischaemic heart disease.

OBJECTIVES: To discover the circumstances of out of hospital cardiac death irrespective of resuscitation attempts. DESIGN: Prospective community study over the two years 1994 and 1995. SETTING: The health districts of Brighton, South Glamorgan, and York, UK. SUBJECTS: 1290 victims of sudden death or cardiac arrest caused by coronary heart disease who were under 76 years of age. INTERVENTIONS: Basic and advanced life support for witnessed cardiac arrests. MAIN OUTCOME MEASURES: Survival to reach hospital and for 30 days after the arrest. RESULTS: 35 (35%) of 101 patients (mean age 64) whose arrest was witnessed by a doctor or paramedic survived for 30 days compared with 9 of 464 (2%) whose arrest was witnessed by a relative or bystander at home (mean age 66) and 15 of 200 (8%) whose arrest was witnessed in a public place (mean age 61). None of the 525 victims of an unwitnessed arrest survived but the majority of those whose arrest was witnessed had complained of new symptoms before the arrest. Victims who were given basic life support by relatives or bystanders had better survival (14 of 183 (8%)) than those who were not (10 of 481 (2%), p < 0.001). Of the 20% of arrests that occurred in public places, few were in places where public access defibrillators would now be available. CONCLUSIONS: The burden of out of hospital cardiac arrest is mainly in the home but most victims have premonitory symptoms. Public education to seek help urgently for new or prolonged chest pain seems the most promising method to address the problem.

Age Distribution↗