Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “RESUSCITATION”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 991 records · Page 55Linked to original sources
PubMed2006

Hemorrhagic shock resuscitation with carbon monoxide saturated blood.

The response to exchange transfusion with red blood cells (RBCs) saturated with carbon monoxide (CO) in amelioration of microvascular function and providing tissue protection in hemorrhagic shock resuscitation was investigated in the hamster chamber window model. Shock was induced by the withdrawal of 50% of blood volume (BV). Blood volume was restored 1 h after hemorrhage with a single volume infusion (resuscitation) of 25% BV with fresh RBCs (saturated or unsaturated with CO) suspended in human serum albumin (HSA). Hemorrhage, shock and resuscitation were monitored continuously in terms of mean arterial pressure (MAP), microvascular blood flow, capillary perfusion and systemic gas parameters. Eight hours after resuscitation, Annexin V and propidium iodide (PI) were injected into the window chamber to study tissue viability, and labeled cells were observed by using intravital epifluorescence microscopy. TUNEL staining was performed on the tissue to confirm in vivo results. Systemic and microvascular restoration were not different with or without CO up to 90 min after resuscitation. CO concentration decreased over 90 min, increasing oxygen carrying capacity and gradually reoxygenating the tissue. CO saturated blood partially mitigated cell injury at 8 h after resuscitation. The precise cellular mechanisms involved require further elucidation. CO is a novel experimental strategy to improve tissue viability and requires the appropriated preclinical studies to confirm its efficacy.

Animals↗
PubMed1996

Effects of isotonic saline solution resuscitation on blood coagulation in uncontrolled hemorrhage.

BACKGROUND: It has been suggested that fluid resuscitation before surgical control of hemorrhage may lead to increased bleeding because of the elevated blood pressures and clotting factor dilution. This study was designed to assess the effects of isotonic saline solution resuscitation on blood coagulation during uncontrolled hemorrhage. METHODS: Twenty-four female Sprague-Dawley rats were randomized into four groups with different resuscitation regimens: group A, no resuscitation; group B, 40 ml/kg in 4 minutes; group C, 80 ml/kg in 4 minutes; and group D, 80 ml/kg in 1 minute. Baseline blood samples were collected just before a sharp resection of 75% of the tail to initiate the hemorrhage; 15 minutes later the resuscitation began. Additional blood samples were obtained at 60 minutes after resection. The blood was analyzed for platelets, fibrinogen, prothrombin time, and activated partial thromboplastin time. RESULTS: The largest differences between time 0 and 60 minutes were observed in group D with platelets decreasing 43.36% +/- 7.86%, fibrinogen decreasing 57.10% +/- 16.88%, and prothrombin time increasing from an average 16.5 to 19.2 seconds. These differences was statistiacally significant (p <0.05) with the Student's test. CONCLUSIONS: The results suggested that even though the volume of resuscitation fluid did not appear to affect clotting time when compared with that of nonresuscitated animals, the rate of extremely large volume infusions may play an important role in the cessation of bleeding and consequently in the management of uncontrolled hemorrhagic shock.

Animals↗
PubMed1976

Cardiopulmonary resuscitation by lay people.

The survival-rate in 75 of 631 patients with cardiac arrest in whom resuscitation was started outside hospital by lay people was 36%. Only 8% survived when attempts at resuscitation were delayed until the arrival of an ambulance team which included an anaesthetist and a specially trained nurse. These data show the importance of anoxia-time (time from cessation of circulation to initiation of resuscitation) to the chances of survival after resuscitation) to the chances of survival after resuscitation, and support the idea that lay people should be taught and encourage to perform cardiopulmonary resuscitation.

Blood Circulation↗
PubMed1992

Use of cardiopulmonary bypass, high-dose epinephrine, and standard-dose epinephrine in resuscitation from post-countershock electromechanical dissociation.

STUDY OBJECTIVE: To determine the effects of cardiopulmonary bypass with standard-dose epinephrine, high-dose epinephrine, and standard-dose epinephrine on perfusion pressures, myocardial blood flow, and resuscitation from post-countershock electromechanical dissociation. DESIGN: Prospective, controlled laboratory investigation using a canine cardiac arrest model randomized to receive one of three resuscitation therapies. INTERVENTIONS: After the production of post-countershock electromechanical dissociation, 25 animals received ten minutes of basic CPR and were randomized to receive cardiopulmonary bypass with standard-dose epinephrine, high-dose epinephrine, or standard-dose epinephrine. MEASUREMENTS AND MAIN RESULTS: Myocardial blood flow was measured using a colored microsphere technique at baseline, during basic CPR, and after intervention. Immediate and two-hour resuscitation rates were determined for each group. Return of spontaneous circulation was achieved in eight of eight cardiopulmonary bypass with standard-dose epinephrine compared with four of eight high-dose epinephrine and three of eight standard-dose epinephrine animals (P less than .04). One animal was resuscitated with CPR alone and was excluded. Survival to two hours was achieved in five of eight cardiopulmonary bypass with standard-dose epinephrine, four of eight high-dose epinephrine, and three of eight standard-dose epinephrine animals (NS). Coronary perfusion pressure increased significantly in the cardiopulmonary bypass with standard-dose epinephrine group when compared with the other groups (cardiopulmonary bypass with standard-dose epinephrine, 76 +/- 45 mm Hg; high-dose epinephrine, 24 +/- 12 mm Hg; standard-dose epinephrine, 3 +/- 14 mm Hg; P less than .005). Myocardial blood flow was higher in cardiopulmonary bypass with standard-dose epinephrine and high-dose epinephrine animals compared with standard-dose epinephrine animals but did not reach statistical significance. Cardiac output increased during cardiopulmonary bypass with standard-dose epinephrine (P = .001) and standard-dose epinephrine (NS) compared with basic CPR but decreased after epinephrine administration in the high-dose epinephrine group (NS). CONCLUSION: Resuscitation from electromechanical dissociation was improved with cardiopulmonary bypass and epinephrine compared with high-dose epinephrine or standard-dose epinephrine alone. However, there was no difference in survival between groups. Cardiopulmonary bypass with standard-dose epinephrine resulted in higher cardiac output, coronary perfusion pressure, and a trend toward higher myocardial blood flow. A short period of cardiopulmonary bypass with epinephrine after prolonged post-countershock electromechanical dissociation cardiac arrest can re-establish sufficient circulation to effect successful early resuscitation.

Animals↗
PubMed1984

Improved resuscitation from cardiac arrest with open-chest massage.

A study was done to assess the effect of open-chest massage on resuscitation from cardiac arrest. Ten mongrel dogs weighing 20.3 +/- 3.2 kg were fibrillated electrically. Cardiopulmonary resuscitation (CPR) was initiated and continued for 15 minutes. Half the dogs with coronary perfusion pressures less than 30 mm Hg underwent thoracotomy and internal cardiac massage for three minutes. Closed-chest massage was continued with the other dogs. All dogs were defibrillated at 19 minutes, and resuscitation was determined at 20 minutes after defibrillation. None of the dogs in the closed-chest massage group was resuscitated successfully. Four of the five dogs that underwent open cardiac massage were resuscitated. Significant differences in aortic pressures and coronary perfusion pressures were noted for the first two minutes of open-chest massage (P less than .05). The results of this study indicate that resuscitation may be improved using open-chest massage when closed-chest massage fails to produce an adequate coronary perfusion pressure.

Animals↗
PubMed1994

The efficacy of an ACLS training program for resuscitation from cardiac arrest in a rural community.

STUDY OBJECTIVE: To determine whether an advanced cardiac life support (ACLS) course in a rural hospital will improve resuscitation success from cardiac arrest. DESIGN: A retrospective case review of all patients in cardiac arrest during a 13-month period before and after the institution of an ACLS training program. SETTING: Emergency department of a 42-bed rural, community hospital in a community with no prehospital advanced life support or early defibrillation. PARTICIPANTS: All patients in cardiac arrest were entered into the data base. Twenty-nine patients were included in the pre-ACLS period and 35 in the post-ACLS period. There were no significant differences in age, gender, initial rhythm, comorbid diseases, witnessed versus unwitnessed arrest, or total arrest time in the patients in the pre-ACLS period compared with those in the post-ACLS period. INTERVENTION: ACLS provider training. MAIN RESULTS: Patients in cardiac arrest who had ventricular fibrillation/tachycardia as their initial rhythm had significant improvement in resuscitation success compared with patients in ventricular fibrillation/tachycardia in the pre-ACLS period (six of 15 versus none of nine, P < .05). Out-of-hospital cardiac arrest resuscitation was more successful in the post-ACLS period than in the pre-ACLS period (five of 30 versus none of 25, P < .05). Overall, seven of 35 patients (20%) were resuscitated successfully in the post-ACLS period, with two patients surviving to hospital discharge. This was not significantly different than the two of 29 patients (7%) resuscitated in the pre-ACLS period, with one patient surviving to discharge. CONCLUSION: The institution of an ACLS-provider course in a rural community hospital was associated with improvement in initial resuscitation for patients with ventricular fibrillation/tachycardia and out-of-hospital arrest.

Cardiopulmonary Resuscitation↗
PubMed1996

Field termination of unsuccessful out-of-hospital cardiac arrest resuscitation: acceptance by family members.

STUDY OBJECTIVE: To determine whether family members accept field termination of unsuccessful out-of-hospital cardiac arrest resuscitation. METHODS: We carried out a prospective cohort study, using a structured interview, in an urban, municipal, advanced life support emergency medical services (EMS) system. The interview subjects were family members present at the scene in a consecutive series of unsuccessful out-of-hospital resuscitation attempts. RESULTS: During the 4-month study period, 140 out-of-hospital cardiac arrests occurred. Follow-up with a family member was performed in 42 of the 53 cardiac arrests that met the inclusion criteria (79%). When resuscitation was terminated in the field (n = 25), 24 family members (96%) reported satisfaction with the decision. When resuscitation was terminated in the emergency department (n = 17), 14 family members (82%) reported satisfaction with the decision to transport the victim to the hospital. However, responses indicated that 13 of the family members (76%) might have accepted termination of resuscitation in the home. In all cases, relatives reported satisfaction with the paramedics' care and with the manner in which they were informed of the victims' deaths. CONCLUSION: Family members accept termination of unsuccessful out-of-hospital cardiac arrest resuscitation in the field.

Aged↗
PubMed2001

The Utstein template and the effect of in-hospital decisions: the impact of do-not-attempt resuscitation status on survival to discharge statistics.

BACKGROUND: Variables for reporting outcome of pre-hospital cardiac arrest have been delineated in the Utstein style template. The primary outcome statistic is survival to hospital discharge (SHD). The template allows comparisons of pre-hospital care systems and has been used to determine the benefit of pre-hospital interventions. Post-resuscitation care has not been standardized and in-hospital events that affect SHD are not considered in the template. STUDY PURPOSE: To determine the frequency and timing with which do-not-attempt resuscitation (DNAR) status is conferred following resuscitation from pre-hospital cardiac arrest and to assess the impact of this action on SHD. METHODS: A 4-year retrospective, observational cohort study of all adult patients successfully resuscitated from nontraumatic pre-hospital cardiac arrest and admitted to a single municipal teaching hospital. Study variables included age, witnessed arrest, bystander cardiopulmonary resuscitation (CPR), initial rhythm documented by paramedics, hospital admission rate, frequency and time at which DNAR status was conferred, and SHD. RESULTS: Four hundred and eighteen adult patients experienced pre-hospital arrest and received standard advanced cardiac life support interventions during the study period. Seventy-nine patients (19%; 95% confidence interval (CI), 15-23%) survived to be admitted to the hospital. Fifty-four of these patients (68%; 96% CI, 57-78%) were subsequently placed in DNAR status. Only one of these patients had a living will or advanced directive prior to cardiopulmonary arrest. In 37 DNAR patients (68%; 95% CI, 54-81%), DNAR status was conferred within 24 h of hospital admission. For patients made DNAR within 24 h of admission, 38% had a witnessed arrest, 22% had ventricular fibrillation as the first documented arrest rhythm, and 29% received bystander CPR. When patients made DNAR are included in the calculation of SHD rate, the SHD rate for the study period was 5.3% (95% CI, 3.3-7.8%). If DNAR patients are excluded, the SHD was 6.1% (95% CI, 3.8-9.0%), representing a 15% increase in SHD rate. CONCLUSION: In-hospital care and medical decision making are not considered in the Utstein template and can have a significant effect on reported survival statistics. When assessing the benefit of pre-hospital interventions, it may be preferable to consider survival to hospital admission as the primary outcome statistic until such time as post-resuscitation care after hospital admission is rigidly standardized.

Adult↗
PubMed2002

Simultaneous sterno-thoracic cardiopulmonary resuscitation improves short-term survival rate in canine cardiac arrests.

We have reported previously that simultaneous sterno-thoracic cardiopulmonary resuscitation (SST-CPR) using a device that compresses the sternum and constricts the thorax circumferentially during a compression systole that can be achieved using standard cardiopulmonary resuscitation (STD-CPR). This study was designed to assess whether SST-CPR improves the survival rate of dogs with cardiac arrest compared with STD-CPR. Twenty-nine mongrel dogs (19-31 kg) were enrolled in this study. After 4 min of ventricular fibrillation induced by an AC current, animals were randomized to be resuscitated by either STD-CPR (n=15) or SST-CPR (n=14). Defibrillation was attempted 10 min after the induction of cardiac arrest. Standard advanced cardiac life support was started if defibrillation was unsuccessful. Aortic blood pressure, coronary perfusion pressure, and end tidal CO(2) tension were measured during CPR and the post-resuscitation period. Survival was determined 12 h after the induction of cardiac arrest. SST-CPR resulted in a significantly (P<0.001) higher systolic arterial pressure (91+/-47 vs 47+/-24 mmHg), diastolic pressure (43+/-24 vs 17+/-10 mmHg), coronary perfusion pressure (35+/-25 vs 13+/-9 mmHg), and end tidal CO(2) tension (9+/-4 vs 3+/-2 mmHg). Two of 15 animals (13%) resuscitated by STD-CPR and seven of 14 animals (50%) resuscitated by SST-CPR survived for 12 h after cardiac arrest (P<0.05). In conclusion, SST-CPR improves the short-term survival rate in canine cardiac arrest compared with STD-CPR.

Animals↗
PubMed2003

A comparison of alpha-methylnorepinephrine, vasopressin and epinephrine for cardiac resuscitation.

The objective of this research was to compare the effects of an alpha- and beta-adrenergic agonist, epinephrine, a selective alpha(2)-adrenergic agonist, alpha-methylnorepinephrine (alpha-MNE), and a non-adrenergic vasopressin on post-resuscitation myocardial function and duration of survival. Epinephrine continues to be the primary adrenergic agent for advanced cardiac life support. However, its major inotropic actions and especially its beta-adrenergic and, to a lesser extent, its alpha(1)-actions increase the severity of global ischemia during cardiac arrest and adversely affect post-resuscitation myocardial function and survival. We had previously observed significantly better outcomes with a selective alpha(2)-adrenergic agonist when compared with epinephrine. Non-adrenergic vasopressin also has promise of more favorable actions. The present study was, therefore, undertaken to compare a selective alpha(2)-adrenergic vasopressor drug with vasopressin, epinephrine, and saline placebo. Ventricular fibrillation (VF) was induced in 20 Sprague-Dawley rats. Mechanical ventilation and precordial compression were initiated after 8 min of untreated VF. About 2 min later, alpha-MNE in a dose of 100 microgram/kg, vasopressin in a dose of 0.4 U/kg, epinephrine in a dose of 30 microgram/kg, or saline control was administered. Defibrillation was attempted after 6 min of CPR. Left ventricular pressure, dP/dt(40), -dP/dt, and cardiac index were measured for an interval of 240 min after resuscitation. Except for saline controls, comparable increases in coronary perfusion pressure (CPP) were observed after each drug intervention. All animals were successfully resuscitated. Post-resuscitation myocardial function and survival were significantly better in animals treated with alpha-MNE. Both post-resuscitation myocardial function and survival were most improved after administration of the selective alpha(2)-adrenergic agonist, intermediate after vasopressin and least after epinephrine and saline placebo.

Analysis of Variance↗
PubMed1999

Neonatal resuscitation--a practical assessment.

Current European neonatal resuscitation guidelines (Zideman et al. Resuscitation 1998;37:103-110) advocate cardiopulmonary resuscitation (CPR) at 120 compressions per minute in a ratio of 3:1. This is commonly interpreted as a net rate, thus requiring delivery of 40 breaths per minute, which is the upper end of the range of 30-40 breaths per minute suggested in the guidelines. At least one other interpretation is available, but the correct one is not specified. No studies have evaluated whether the rates inferred by the guidelines can be achieved. This study assesses the ability of trained hospital providers to fulfil these criteria in a simulated arrest scenario. A group of anaesthetists, paediatricians, midwives and neonatal nurses was asked to perform CPR either as single rescuers or in pairs, for 5 min, following European Resuscitation Council guidelines. Breaths and compressions delivered were measured by inductance plethysmography. The number of breaths delivered in the first and fifth minute of the scenario were measured, as well as the quality of delivered breaths. Of 33 single resuscitators, none were able to deliver 40 breaths per minute in either the first minute (range 11-34; median 20; interquartile range 14-26) or the fifth (13-35; 19; 15.25-26.5). Of 18 pairs of rescuers, four achieved 40 breaths per minute in the first minute (24-45; 33.5; 29.75-38.25) but only three of 17 were able to sustain this to the fifth minute (21-48; 35; 30.5 39). One pair did not complete 5 min of resuscitation. Single rescuers were unable to achieve the rate of CPR suggested by current guidelines. Only 22% of paired rescuers were able to achieve this standard in the first minute, falling to less than 20% by the fifth minute. We recommend modifying the guidelines to make them unambiguous and practicable, with the emphasis shifted onto the quality of compressions and ventilations, rather than quantity.

Cardiopulmonary Resuscitation↗
PubMed2000

Simply add oxygen: why isn't oxygen administration taught in all resuscitation training?

Resuscitation training is all about procedures, yet the overwhelming need is to get sufficient oxygen to hypoxic and endangered tissues. Neither the Australian Resuscitation Council nor the American Heart Association make mention in any basic courses of the need to add oxygen as soon as possible. The Australian Resuscitation Council has a separate policy on oxygen, and the American Heart Association mentions the need, but not until page 2274 of the 1992 'Guidelines'. Major first aid training organisations do not mention the use of oxygen resuscitation in basic courses. There seems to be a belief in first aid training that oxygen administration is potentially dangerous and is an 'Advanced' skill. Oxygen should be used as soon as possible, in as near 100% as possible in all resuscitation situations, and for the early management of injury and illness. Its use will never disadvantage a patient under these circumstances. This skill should be added into all resuscitation training. In these days of high technology for all, we can easily add the simple skill of administration of oxygen, as soon as available, to basic life support and first aid. An oxygen supply should be as easily available as a fire extinguisher, and as simply used.

Animals↗
PubMed1998

Effect of cutaneous burn injury and resuscitation on the cerebral circulation in an ovine model.

The aim of our study was to evaluate the effects of a large cutaneous burn injury on the cerebral circulation. Anesthetized sheep (n = 8) were prepared with vascular catheters, a urinary catheter and a Richmond bolt for intracranial pressure monitoring. A scald injury was inflicted on 70 percent of total body surface area with hot water. Resuscitation was started 30 min after scald with Ringer's lactate to restore and maintain baseline oxygen delivery. Resuscitation maintained blood pressure, cardiac output and urine output at normal levels. Brain blood flow was measured with colored microspheres. During resuscitation intracranial pressure rose slowly from 10.6 +/- 1.5 to 17.0 +/- 4.0 mmHg (P < 0.05) and cerebral perfusion pressure was reduced from 86.4 +/- 6.8 to 64.1 +/- 2.8 mmHg (P < 0.05). During early resuscitation cerebrovascular resistance declined to maintain brain blood flow and oxygen delivery at baseline or better. After 6 h, mean cerebrovascular resistance was inappropriately increased during a period of reduced cerebral perfusion pressure which resulted in brain blood flow reductions of half the baseline levels. These data suggest that autoregulation maintains brain blood flow immediately after burn shock and early resuscitation, but the autoregulation may be less effective as burn resuscitation proceeds.

Animals↗
PubMed2000

Resuscitative effects of polynitroxylated alphaalpha-cross-linked hemoglobin following severe hemorrhage in the rat.

alphaalpha-Cross-linked hemoglobin (alphaalphaHb) is an example of a hemoglobin-based oxygen carrier (HBOC) with significant cardiovascular activity. This may compromise the safety and efficacy of this HBOC by causing systemic hypertension and reducing blood flow to some organs. The present work is based on the hypothesis that incorporating antioxidant activity into an HBOC in the form of a covalently attached nitroxide may prevent these effects. We have tested this hypothesis by adding antioxidant activity to alphaalphaHb with 2,2,6,6-tetramethyl-piperidinyl-1-oxyl (Tempo) to create polynitroxylated alphaalphaHb (PN-alphaalphaHb). The new compound PN-alphaalphaHb acts as an antioxidant in our in vitro and in vivo assays. In this study urethane-anesthetized rats were hemorrhaged to a mean arterial pressure (MAP) of 35-40 mmHg and maintained for 30 min. Animals were resuscitated with solutions of (1) 10% PN-alphaalphaHb (43 mmHg), (2) 10% alphaalphaHb (43 mmHg), (3) 7.5% albumin (43 mmHg), (4) 300% Ringers lactate (RL), and (5) 0. 9% normal saline equal to the shed blood volume (SBV). Hemodynamics and regional blood circulation was measured at baseline, following hemorrhage, and at 30 and 60 min postresuscitation using a radioactive microsphere technique. Base deficit (BD) was measured at baseline, following hemorrhage, and at 60 min following resuscitative fluid infusion. Finally survival was determined as the time following resuscitation until secession of heart rhythm. Saline and 300% RL resuscitation did not improve BD, systemic hemodynamics, or regional blood circulation. PN-alphaalphaHb, alphaalphaHb, and albumin significantly improved these parameters, however, only PN-alphaalphaHb and alphaalphaHb improved survival. PN-alphaalphaHb was found to be less hypertensive than alphaalphaHb due to blunted increases in both cardiac output and systemic vascular resistance. This study demonstrates that, by using alphaalphaHb as a scaffold for polynitroxylation, improvement in vasoactivity and resuscitative efficacy may be possible. In conclusion, the addition of antioxidant activity in the form of polynitroxylation of a low molecular weight Hb (alphaalphaHb) may create a safe and efficacious resuscitative fluid.

Animals↗
PubMed1997

Should relatives be invited to witness a resuscitation attempt? A review of the literature.

This review of the literature focuses upon the somewhat controversial question of whether relatives should be invited to witness the resuscitation of a family member. The pioneering study undertaken at the Foote Hospital, Michigan is explored, as is much of the anecdotal case study material available. The review focuses around three main areas: Allowing the relatives into the resuscitation room. Success of the encounter. The effects upon the relatives who witness the event. It is clear from this review that opinion about the presence of relatives in the resuscitation room remains inconclusive, with an apparently equal balance of both positive and negative family responses during the resuscitation attempt. However, whilst there is some evidence regarding short term effects on relatives who actually choose to witness a resuscitation attempt, there is little evidence to suggest what the long-term effects are likely to be. This is an aspect of resuscitation that certainly merits further exploration.

Cardiopulmonary Resuscitation↗
PubMed2003

Major bleeding complications after cardiopulmonary resuscitation: impact of thrombolytic treatment.

OBJECTIVE: The risk of bleeding complications caused by thrombolysis in patients with cardiac arrest and prolonged cardiopulmonary resuscitation is unclear. We evaluate the complication rate of systemic thrombolysis in patients with out-of-hospital cardiac arrest caused by acute myocardial infarction, especially in relation to duration of cardiopulmonary resuscitation. DESIGN: The study was designed as retrospective cohort study, the risk factor being systemic thrombolysis and the end-point major haemorrhage, defined as life-threatening and/or need for transfusion. Over 10.5 years, emergency cardiac care data, therapy, major haemorrhage and outcome of 265 patients with acute myocardial infarction admitted to an emergency department after successful cardiopulmonary resuscitation were registered. RESULTS: We observed major haemorrhage in 13 of 132 patients who received thrombolysis (10%, 95% confidence interval 5-15%), five of these survived to discharge, none died because of this complication. Major haemorrhage occurred in seven of 133 patients in whom no thrombolytic treatment had been given (5%, 95% confidence interval 1-9%), two of these survived to discharge. Taking into account baseline imbalances between the groups, the risk of bleeding was slightly increased if thrombolytics were used (odds ratio 2.5, 95% confidence interval 0.9-7.4) but this was not significant (P = 0.09). There was no clear association between duration of resuscitation and bleeding complications (z for trend = 1.52, P = 0.12). Survival was not significantly better in patients receiving thrombolysis (odds ratio 1.6, 0.9-3.0, P = 0.12). CONCLUSIONS: Bleeding complications after cardiopulmonary resuscitation are frequent, particularly in patients with thrombolytic treatment, but do not appear to be related to the duration of resuscitation. In the light of possible benefits on outcome, thrombolytic treatment should not be withheld in carefully selected patients.

Adult↗
PubMed2000

Medical history of hypercholesterolaemia adversely affects the outcome of out-of-hospital cardiopulmonary resuscitation; the 'Shahal' experience in Israel.

AIMS: To evaluate the impact selected risk factors for cardiac death may have on the success rate in a large cohort of subscribers to 'SHAHAL' who were resuscitated from out-of-hospital cardiac arrest. METHODS AND RESULTS: In this medical facility currently serving 50 000 subscribers, data were prospectively gathered from between 1987-1998. The information retrieved from the patients' medical records included a medical history of hypertension, diabetes, hypercholesterolaemia (>220.mg. dl(-1)) smoking, angina, previous myocardial infarction, and congestive heart failure. A total of 998 patients aged 74+/-12 years (mean+/-1 SD) were included. Death was announced at the scene for 659 (66%) victims, while 339 (34%) patients were taken to hospital. Of these 140 (14% of the total cohort) survived and were discharged from the hospital. A comparison of various selected parameters between survivors and non-survivors of resuscitation revealed that survivors were younger, had a higher rate of pulseless ventricular tachycardia/ventricular fibrillation, more were among the arrests witnessed by the 'SHAHAL' team, and that more had a shorter time lag to initiation of cardiopulmonary resuscitation than non-survivors. None of the studied risk factors predicted the outcome of cardiopulmonary resuscitation, with the exception of hypercholesterolaemia, which carried a significantly worse prognosis for cardiopulmonary resuscitation (P=0.009). CONCLUSIONS: A medical history of hypercholesterolaemia appears to be an important risk factor which adversely affects the outcome of cardiopulmonary resuscitation.

Aged↗
PubMed2004

[Neonatal-emergencies: basics in cardiopulmonary resuscitation].

The international guidelines for neonatal resuscitation were recently updated by the American Academy of Pediatrics (AAP), the American Heart Association (AHA) and the International Liaison Committee on Resuscitation (ILCOR). The most important steps in resuscitation of the newly born infant are oxygenation and ventilation, including endotracheal intubation. These fundamental techniques will be emphasized and discussed in a problem-oriented approach. The clinical assessment of the newly born infant is based on a triad of respiration, heart rate and color. If indicated, resuscitation has to be initiated approximately 30 s after birth, i. e. prior to determination of the 1 min. Apgar score and umbilical artery pH. The key to successful neonatal resuscitation is establishment of adequate ventilation; it should commence - after oropharyngeal suctioning and ineffective tactile stimulation - when the heart rate drops < 100 bpm. Clinical evidence supporting the hypothesis that ventilation with room air versus 50 or 100 % oxygen is preferable in terms of neurological outcome is still preliminary and requires further investigation. Chest compressions should be administered if the heart rate remains < 60 bpm (or heart rate 60 to 80 bpm and not rising) despite adequate assisted ventilation. There should be a 3 : 1 ratio of compressions to ventilations to achieve approximately 120 events per minute. Moreover, the international guidelines recommend crystalloid volume expanders (normal saline or Ringer's lactate), red blood cells, sodium bicarbonate and naloxone for cardiopulmonary resuscitation of the newly born infant.

Cardiopulmonary Resuscitation↗