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PubMed2002

Scientific priorities and strategic planning for resuscitation research and life saving therapy following traumatic injury: report of the PULSE Trauma Work Group. Post Resuscitative and Initial Utility of Life Saving Efforts.

Traumatic injury and its sequelae remains a major, unrecognized, public health problem in North America. It is the principle cause of death in patients aged 1-44 and the overall leading cause of life years lost in the United States. Recognizing this the National Heart, Lung and Blood Institute (NHLBI), in conjunction with other federal agencies, organized a conference in June 2000 to discuss the basic and clinical research projects that could lead to improved outcomes following cardiopulmonary or post-injury resuscitation. The Post Resuscitative and Initial Utility of Life Saving Efforts (PULSE) Workshop resulted and eight workgroups were established to focus on various aspects including organ systems, pharmacology, epidemiology, and trauma. The Trauma Work group recommendations are presented in this manuscript. Despite the recognition of improved survival and outcome through advancements in trauma systems and trauma care, the National Institutes of Health (NIH) support ratio for trauma research is only 0.10 compared to 1.65 for cancer research and a remarkable support ratio of 3.51 for AIDS and HIV infection research. The successful federal HIV research program has significantly decreased the morbidity and mortality over the last ten years at a cost of 1.4 billion dollars per year. A coordinated trauma research program should aim to replicate the success achieved by such programs; however, a centralized federal "home" for trauma research does not exist. Consequently, the existing limited research support is derived from NIH institutes in addition to other federal and state agencies. This report serves to describe some of the obstacles and to outline various strategies and priorities for basic science, clinical and translational trauma resuscitation research.

Animals↗
PubMed2005

Improved resuscitation outcome in emergency medical systems with increased usage of sodium bicarbonate during cardiopulmonary resuscitation.

BACKGROUND: The use of sodium bicarbonate (SB) in cardiopulmonary resuscitation (CPR) is controversial. This study analyzes the effects of SB use on CPR outcome in the Brain Resuscitation Clinical Trial III (BRCT III), which was a multicenter randomized trial comparing high-dose to standard-dose epinephrine during CPR. Sodium bicarbonate use in BRCT III was optional. METHODS: The entire BRCT III database was reviewed. Analysis included only patients who arrested out of the hospital and whose time from collapse to initiation of ACLS was no longer than 30 min (total n = 2122 patients). Sodium bicarbonate use by the 16 participating study sites was analyzed. The study sites were divided according to their SB usage profile: 'low SB user' sites administered SB in less than 50% of CPRs and their first epinephrine to SB time exceeded 10 min; and 'high SB user' sites used SB in over 50% of CPRs and their first epinephrine to SB time was <10 min. RESULTS: Sites' SB usage rates ranged between 3.1% and 98.2% of CPRs. Sodium bicarbonate usage rates correlated inversely with the sites' intervals from collapse (r = - 0.579 P = 0.018) from initiation of ACLS (r = - 0.685 P = 0.003) and from first epinephrine (r = - 0.611 P = 0.012) to SB administration. Mean ROSC rate in the 'high SB user' sites was 33.5% (CI = 30.0-37.0) compared to 25.7% (CI = 23.1-28.4) in the 'low SB user' sites. In the 'high SB user' sites, hospital discharge rate was 5.3% (CI = 3.6-7.0) compared to 3% (CI = 2.0-4.0) in the 'low SB user' sites, and 5.3% (CI = 3.6-7.0) had a favorable neurological outcome compared to 2.1% (CI = 1.2-3.0) in the 'low SB user' sites. Collapse to ACLS interval was 8.5 min (CI = 8.1-9.0) in the 'high SB user' sites compared to 10.2 min (CI = 9.8-10.6) in the 'low SB user' sites, and their ACLS to first epinephrine interval was 7.0 min (CI = 6.5-7.5) compared to 9.7 min (CI = 9.3-10.2). Multivariate regression analysis found that belonging to 'high SB user' sites independently increased the chances for ROSC (OR 1.36, CI 1.08-1.7) and for achieving a good neurological outcome (OR 2.18, CI 1.23-3.86). CONCLUSIONS: Earlier and more frequent use of SB was associated with higher early resuscitability rates and with better long-term outcome. Sodium bicarbonate may be beneficial during CPR, and it should be subjected to a randomized clinical trial.

Acidosis↗
PubMed1990

Effect of New York State's do-not-resuscitate legislation on in-hospital cardiopulmonary resuscitation practice.

PURPOSE: On April 1, 1988, New York State enacted legislation governing the withholding of cardiopulmonary resuscitation (CPR). Suggestions that the mandated protocol for withholding CPR is too cumbersome and will result in an increase in CPR attempts led us to study the effect of the new law on in-hospital resuscitation practice. PATIENTS AND METHODS: We retrospectively reviewed the charts of 245 adult in-patients at a county teaching hospital who died during three-month periods before and after the law took effect. RESULTS: There was a statistically nonsignificant decline in the frequency of CPR attempts at the time of death, from 59 (50%) of 119 patients in 1987 to 57 (45%) of 126 patients in 1988. Use of explicit written "do-not-resuscitate" (DNR) orders increased significantly from 13 (22%) of 60 patients who died without CPR in 1987 to 64 (93%) of 69 patients in 1988. Patient and family involvement in decisions to withhold CPR was common before the law and did not change significantly. CONCLUSION: Although changing the way DNR decisions are documented, the legislation resulted in no significant change either in the frequency of CPR or in the degree to which patients are involved in these decisions.

Adult↗
PubMed1989

Serum electrolyte disturbances in the post-resuscitation period. The Cerebral Resuscitation Study Group.

In the context of the registration project of the Belgian Cerebral Resuscitation Study Group, the presence or absence of electrolyte disturbances (serum K+ less than 3.0 or greater than 5.5 mEq/l and/or serum Na+ less than 130 or greater than 150 mEq/l) was registered during the 24-h period following resuscitation after an out-of-hospital cardiac arrest. The analysis of 161 consecutive patients seen in the period 1983-1987 at the University Hospital of Gent indicates that patients with such electrolyte disturbances do not have a worse prognosis. Moreover, we also looked at the serum concentrations of potassium and magnesium in 100 and 90 patients respectively by means of a retrospective analysis of the files of 113 consecutive patients seen during 1985-1988 at the University Hospital of Gent and the Free University of Brussels. Hypokalemia (serum K+ less than 3.5 mEq/l) was observed in 30% of the patients and was not related to outcome. The hypokalemia could not be explained by alkalosis; no relationship was found with either the amount of adrenaline administered during resuscitation or the duration of CPR. An abnormal magnesium level (serum less than 1.8 or greater than 2.4 mg/dl) was found in 42% of the patients and our data suggest that the prognosis may be worse in this group. A prospective study on the clinical significance of disturbances in magnesemia would be of interest.

Dose-Response Relationship, Drug↗
PubMed2005

Hypertonic fluid resuscitation from subarachnoid hemorrhage in rats: a comparison between small volume resuscitation and mannitol.

OBJECTIVE: Death and severe morbidity after subarachnoid hemorrhage (SAH) are mainly caused by global cerebral ischemia through increased intracranial pressure (ICP) and decreased cerebral blood flow (CBF). We have recently demonstrated neuroprotective effects of small volume resuscitation (7.5% saline in combination with 6% dextran 70) in an animal model of SAH, leading to normalization of increased ICP, reduced morphological damage and improved neurological recovery. In the present study, we compared the concept of small volume resuscitation represented by two clinically licenced hypertonic-hyperoncotic saline solutions with the routinely used hyperosmotic agent-mannitol-and investigated their effects on ICP, CBF, neurological recovery and morphological damage after SAH in rats. METHODS: 60 dextran-resistant Wistar rats were subjected to SAH by an endovascular filament. ICP, MABP (mean arterial blood pressure) and bilateral local CBF were continuously recorded. All animals were randomly assigned to four groups: (I) NaCl 0.9% (4 ml/kg bw), (II) 7.5% NaCl+6% dextran 70 (4 ml/kg bw), (III) 7.2% NaCl+HES 200,000 (4 ml/kg bw) and (IV) 20% mannitol (9.33 ml/kg bw) given 30 min after SAH. Neurological deficits were assessed on days 1, 3 and 7 after SAH. The morphological damage was evaluated on day 7 after SAH. RESULTS: The induction of SAH resulted in an immediate ICP increase to 46.6+/-3.2 mm Hg (mean+/-S.E.M.) and 29.6+/-1.3 (mean+/-S.E.M.) mm Hg 90 min post-SAH. While a treatment with both hypertonic saline solutions (II, III) decreased ICP as well as the 20% mannitol solution, only the group treated with hypertonic saline and dextran 70 (II) showed an increase of ipsilateral CBF for 20 min after the infusion and significantly more surviving neurons in the motorcortex and caudoputamen. Mortality was reduced from 60% (I) and 73% (III and IV), respectively, to 40% in group II. CONCLUSION: Of all hypertonic solutions investigated, small volume resuscitation with NaCl 7.5% in combination with 6% dextran 70 evolved to be most effective in terms of reducing the initial harmful sequelae of SAH, leading to lowered ICP and less morphological damage after SAH in the rat.

Animals↗
PubMed2004

Direct peritoneal resuscitation as adjunct to conventional resuscitation from hemorrhagic shock: a better outcome.

BACKGROUND: Conventional resuscitation (CR) from hemorrhagic shock often culminates in multisystem organ failure and death, commonly attributed to a progressive splanchnic vasoconstriction and hypoperfusion, a gut-derived systemic inflammatory response (SIR), and fluid sequestration. Direct peritoneal resuscitation (DPR) produces a sustained state of tissue hyperperfusion in splanchnic and distant organs. In this study we evaluated the therapeutic potential of DPR on the SIR and fluid sequestration as parameters of treatment outcome. METHODS: Anesthetized nonheparinized rats continuously monitored for hemodynamics were bled to 40% of mean arterial pressure for 60 minutes. Animals were randomized for CR or CR plus DPR under aseptic conditions. Sham nonhemorrhaged rats served as control. Qualitatively, animals were blindly observed for body weight, illness score, or death for 72 hours. Tissues were harvested from survivors, and SIR was measured by interleukin (IL)-6, IL-10, tumor necrosis factor-alpha, and enzyme-linked immunosorbent assay, and fluid sequestration was measured by dry weight/wet weight ratio (DW/WW). RESULTS: Adjunct DPR caused a marked increase (P >.01 by analysis of variance) in the immunoregulator IL-10 in the liver (10,990 +/- 1,470 pg/g) and gut (1815 +/- 640 pg/g), compared to CR rats (6450 +/- 1000 pg/g and 1555 +/- 590, respectively), which is associated with down-regulation of IL-6 and tumor necrosis factor-alpha in liver and gut, from 57 +/- 4 and 20 +/- 3 pg/g, respectively, to 42 +/- 4 and 9 +/- 2 pg/g in DPR-treated animals. CR animals had a lower DW/WW ratio in liver (-36%), spleen (-22%), and lung (-24%) compared to DPR (P <.05), where the DW/WW ratio did not differ from control animals. This fluid sequestration is consistent with a 12% and 5% gain in prehemorrhage body weight at 24 and 72 hours after treatment in the CR animals. Thirty percent of CR animals died within 24 hours, and survivors were squeaking, cold, and pale in eyes and ears and oliguric despite features of fluid overload. In comparison, DPR animals exhibited normal appearance by 24 hours and demonstrated a 100% survival at 72 hours. CONCLUSIONS: This study demonstrates that DPR as adjunct to CR has beneficial effects on the pathophysiology of resuscitated hemorrhagic shock. In addition to restoration of tissue perfusion, DPR has immunomodulation and anti-fluid sequestration effects. These modulations result in improved outcome.

Animals↗
PubMed1993

Pediatric resuscitation pharmacology. Members of the Medications in Pediatric Resuscitation Panel.

The goal of resuscitation pharmacology is to restart the heart as quickly as possible while preserving vital organ function during chest compression. Unfortunately, the application of advanced life support to pediatric cardiac arrest patients is often unsuccessful. The goal of this paper is to review the scientific rationale and educational considerations used to derive the guidelines for medication use in the pediatric patient during CPR. The first step in drug delivery during CPR is to achieve vascular access. The endotracheal route and intraosseous route may be used, although the former is not reliable. To maximize endotracheal drug effect, a larger dose should be instilled into the airway as deeply as possible. Any vascular access, including intraosseous, is preferable to endotracheal drug administration. Although other alpha-adrenergic agents are theoretically superior, epinephrine remains the drug of choice in pediatric resuscitation. The previously recommended dose, however, may be inadequate; a dose 10 to 20 times larger (100-200 micrograms/kg) should be considered, particularly if the standard dose is ineffective. Lacking convincing data, the indications and dose for calcium are unchanged. Similarly, there are no data advocating a change in the indications or dose for lidocaine, bretylium, or atropine. The treatment of arrest-induced acidosis remains controversial. The mainstay of therapy consists of efforts to maximize oxygenation and tissue perfusion. Bicarbonate is not a first-line drug; its use should be considered when the patient fails to respond to advanced life support efforts, including the administration of high-dose epinephrine. Bicarbonate may be helpful in the postresuscitation setting, but its use should not supplant efforts to maximize tissue perfusion. Adenosine is an effective and generally safe medication for the treatment of supraventricular tachycardia in infants and children. Therefore, its indications, dose, and toxicities should be included in the new guidelines. Finally, a summary of research initiatives are included, including a call for the development of a multi-institutional pediatric clinical resuscitation research group. Large numbers of patients must be enrolled in a standardized manner to better evaluate the benefits and adverse effects of various therapies. This includes the use of high-dose epinephrine, calcium, bicarbonate, and other buffer agents such as Carbicarb and THAM. Animal models simulating the etiology and pathophysiology of pediatric arrest also are needed. In both clinical and animal studies, neurologic outcome and long-term survival should be assessed rather than simply the rate of restoration of spontaneous circulation.

Acidosis↗
PubMed2001

European Resuscitation Council Guidelines 2000 for Adult Advanced Life Support. A statement from the Advanced Life Support Working Group(1) and approved by the Executive Committee of the European Resuscitation Council.

The European Resuscitation Council (ERC) last issued guidelines for Basic Life Support (BLS) in 1998 [1]. These were based on the 1997 International Liaison Committee on Resuscitation (ILCOR) Advisory Statements [2]. In 1999 and 2000 representatives of ILCOR, at the invitation of the American Heart Association, met on a number of occasions in Dallas to agree a Consensus on Science upon which future guidelines would be based. Representatives from the ERC played a prominent role in the deliberations, which culminated in the publication of "Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care--A Consensus on Science" in August 2000 [3]. The consensus was evidence-based wherever possible. The ERC ALS Working Group has considered this document and has recommended some changes in the guidelines that will be suitable for European practice. These changes, together with a summary of the Sequence of Actions in ALS, are presented in this paper.

Adult↗
PubMed1999

Maximisation of cerebral blood flow during experimental cardiopulmonary resuscitation does not ameliorate post-resuscitation hypoperfusion.

Continuous intra-aortic balloon occlusion has been reported to improve cerebral blood flow during cardiopulmonary resuscitation (CPR) but not to ameliorate the impaired blood recirculation occurring after restoration of spontaneous circulation (ROSC). Volume expansion with hypertonic solutions may improve recovery of brain function by enhancing post-resuscitation cerebral blood flow. We hypothesised that the combination of these treatments with open-chest CPR would improve cerebral blood flow during CPR, and attenuate post-resuscitation flow disturbances. In 32 anaesthetised piglets, catheters were placed for haemodynamic and blood gas monitoring. Open-chest CPR was initiated after 9 min of ventricular fibrillation. The piglets were treated either with 3 ml kg(-1) hypertonic saline and dextran (HSD) (n = 10), HSD and balloon occlusion (n = 10) or with normal saline (n = 12). After 7 min of CPR, internal defibrillatory shocks were administered to restore spontaneous circulation. Haemodynamic variables, continuous cerebral cortical blood flow, cerebral tissue pH and pCO2 and blood gas parameters were measured during CPR and up to 210 min after ROSC. Higher cerebral perfusion pressure was found in the balloon-HSD group during CPR. This group exhibited less arterial hypertension immediately after ROSC compared with the other groups. Thereafter, a fairly rapid decrease of the perfusion pressures was observed in all groups reaching a minimum level approximately 30 min after ROSC. Cerebral cortical blood flow was significantly higher and cerebral oxygen extraction ratio significantly lower in the balloon-HSD group during CPR, but not after ROSC. In conclusion, a combination of intra-aortic balloon occlusion and HSD administration improves cerebral blood flow and brain oxygen supply during experimental open-chest CPR. In contrast, cerebral blood flow after ROSC was not shown to be influenced by this treatment.

Animals↗
PubMed2000

Bovine hemoglobin-based oxygen carrier (HBOC-201) for resuscitation of uncontrolled, exsanguinating liver injury in swine. Carolina Resuscitation Research Group.

In the setting of rapidly exsanguinating hemorrhage, resuscitation with intravenous (i.v.) crystalloid solution may not sustain survival before availability of allogenic blood transfusion and surgery. This study tested the hypothesis that bovine hemoglobin-based oxygen carrier, HBOC-201, would improve resuscitation and extend early survival from exsanguinating hemorrhage. This study simulated the prehospital scenario of rapidly exsanguinating hemorrhage with prolonged prehospital time and lack of blood availability. Severe hemorrhagic shock was induced in swine by using multiple liver lacerations. At 9 min after the onset of bleeding, swine were randomized to receive approximately 10 mL/kg/min of i.v. lactated Ringer's solution (n = 10) or HBOC-201 (n = 7) to achieve a mean aortic pressure (MAP) of 60 mmHg. Thereafter, infusion rate was adjusted to maintain MAP at 60 mmHg for up to 2 h. All animals were initially successfully resuscitated. The results showed 2-h survival was 1 of 10 with lactated Ringer's and 7 of 7 with HBOC-201 (P = 0.0004). Nine lactated Ringer's swine had cardiovascular collapse at 36 +/- 10 min. Lactate at 30 min was 18 +/- 3 mmol/L with lactated Ringer's and 12 +/- 2 mmol/L with HBOC-201 (P < 0.05). Hematocrit was <1% in 9 of 10 lactated Ringer's and 6 of 7 HBOC-201 animals. These data indicate that HBOC-201 improved early survival and stabilized hemodynamic and metabolic parameters vs. lactated Ringer's in this swine model of liver injury with uncontrolled, lethal hemorrhage that simulates the prehospital care environment where allogenic blood is unavailable.

Animals↗
PubMedDate not supplied

The effect of resuscitation technique and pre-arrest state of oxygenation on blood-gas values during cardiopulmonary resuscitation in dogs.

Large mongrel dogs were anesthetized, instrumented, and subjected to electrically induced ventricular fibrillation after breathing either 100% oxygen (O2) or 10% O2 and 90% nitrogen for 10 minutes before arrest. Four minutes after arrest, open chest cardiopulmonary resuscitation (CPR) or intermittent abdominal compression closed chest CPR was initiated and continued for 20 minutes, at which time defibrillation was attempted. Central arterial and mixed venous blood samples were collected serially for the measurement of pH, carbon dioxide partial pressure (PCO2), and O2 partial pressure (PO2), and calculation of bicarbonate concentration and base excess. Mixed venous blood was collected serially for the measurement of lactate concentration. Hemodynamically variable resuscitation techniques and pre-arrest hypoxia or hyperoxia did not significantly influence blood-gas values during CPR. Mixed venous lactate concentrations after 20 minutes of CPR were significantly higher when hypoxia preceded the arrest and when intermittent abdominal compression closed chest CPR was used for resuscitation. Mixed venous PCO2 was significantly higher than arterial PCO2 in all dogs during CPR but was not significantly different before arrest.

Animals↗
PubMed2026

Severe Fetal Cardiomyopathy: Considerations for Extracorporeal Cardiopulmonary Resuscitation During Neonatal Resuscitation.

Primary cardiomyopathies are associated with poor neonatal outcomes, including high mortality rates. Neonatal care of infants with significant prenatal cardiac diagnoses may warrant additional management considerations beyond standard Neonatal Resuscitation Program guidelines. Many of these management considerations are described in the Neonatal Resuscitation, 9th Edition, which details several congenital cardiac lesions and their delivery room management; still, a prenatal primary cardiomyopathy diagnosis warrants additional, unique predelivery care planning, especially in more severe cases. This case report describes our multidisciplinary team's approach to predelivery planning and neonatal resuscitation and stabilization of an infant with prenatal diagnosis of severe cardiomyopathy. The&#xa0;case underscores that with continued refinement in patient selection, timing, and technology, a similar approach undertaken in a future case might yield a favorable outcome.

Adult↗
PubMed1986

A randomized clinical study of cardiopulmonary-cerebral resuscitation: design, methods, and patient characteristics. Brain Resuscitation Clinical Trial I Study Group.

The Brain Resuscitation Clinical Trial (BRCT) was established as a multi-institutional, clinical study of brain resuscitation. The BRCT was designed to test the hypothesis that the addition of thiopental loading to the protocol of standard therapy for cardiac arrest survivors, comatose at 10-50 minutes after restoration of spontaneous circulation, would significantly increase the number of patients recovering good cerebral function. Twelve hospitals in nine countries collaborated in this randomized, controlled clinical trial. The study was designed to take into account numerous problems including the reliability of information on complex events surrounding cardiac arrest, the difficulty of maintaining uniform treatment protocols, and the difficulty of obtaining informed consent within the constraints of the time the therapy was hypothesized to be effective. The major outcome measurements of the study were neurological status at the end of various time intervals following resuscitation and the best neurological performance ever attained during follow-up. Mortality and other untoward events were closely monitored to establish treatment safety. Of the 262 patients entered into the study between 1979 and 1982, 45% were over 65 years of age, and 75% were men. The majority of the arrests (74%) occurred out of hospital, and major pathology underlying arrest was cardiac. Arrest time was greater than 5 minutes in 36% of the patients. As a result of randomization, patient characteristics at entry as well as the characteristics associated with the brain insult in the standard group were similar to those in the thiopental group.

Aged↗
PubMedDate not supplied

Efficacy of audio-prompted rate guidance in improving resuscitator performance of cardiopulmonary resuscitation on children.

OBJECTIVE: To evaluate the effect of audio-prompted rate guidance during chest compressions on the performance of cardiopulmonary resuscitation (CPR) on children. METHODS: This 24-month prospective study occurred in the pediatric intensive care units of a university hospital and a children's hospital. Intubated children with nontraumatic cardiac arrest were eligible. After placement of an infrared capnometer between the endotracheal tube and resuscitation bag, an audiotape instructed the resuscitator to perform chest compressions at 100 per minute or 140 per minute for one minute, followed by another minute at the other rate. End-tidal carbon dioxide partial pressure (PETCO2) was recorded prior to audiotape instruction and after one minute of CPR at each rate. RESULTS: Six patients, two boys and four girls, with a mean age of 15 +/- 13 months (range 2-36 months) were studied. All had asystole or pulseless electrical activity. CPR was provided for 14 +/- 9 minutes prior to institution of the study protocol. PETCO2 at 140/min was higher than at baseline (12 +/- 7 torr verus 4 +/- 3 torr, p < 0.05). There was a trend towards higher PETCO2s at 100/min compared with baseline (11 +/- 12 torr versus 4 +/- 3 torr, p = 0.08). PETCO2s did not differ at 100/min compared with 140/min. CONCLUSIONS: In support of prior adult and animal investigations suggesting that basic CPRR is often performed poorly and at inappropriately slow rates, audio- prompted rate guidance during CPR in children resulted in higher PETCO2, suggesting improved CPR performance.

Carbon Dioxide↗
PubMed1995

Emergency brain resuscitation. A Working Group on Emergency Brain Resuscitation.

Past efforts to reverse or limit the effects of acute stroke have been largely unsuccessful, in part because of the inability to evaluate and treat most patients soon after stroke onset. One important factor in the delay of treatment has been the nihilistic attitude of medical personnel, including physicians, toward the need to rapidly evaluate and treat patients with stroke. This is important for non-neurologists because most patients with stroke are cared for by internists, family physicians, and emergency physicians. We present the concept of emergency brain resuscitation as one method of galvanizing and motivating health professionals to take a more proactive and aggressive approach to treating the patient with acute stroke. Laboratory and clinical data support the potential efficacy of emergency brain resuscitation teams, which will use standard and experimental techniques to treat patients with stroke. A cost-benefit analysis suggests that emergency brain resuscitation may lower the costs associated with stroke by reducing length of hospital stay, disability, and lost wages. The formation of pilot programs is a logical first step toward evaluating and refining this concept.

Animals↗
PubMed2005

Resuscitation of the viable but non-culturable state of Salmonella enterica serovar Oranienburg by recombinant resuscitation-promoting factor derived from Salmonella Typhimurium strain LT2.

A gene encoding the resuscitation-promoting factor (Rpf) from Salmonella Typhimurium LT2 was cloned and characterized. The amino acid sequence encoded by S. Typhimurium LT2 rpf gene shares 24.2% homology with Micrococcus luteus Rpf, which is secreted by growing cells, and required to resuscitate from viable but non-culturable (VNC) state. The S. Typhimurium LT2 rpf gene is 696 bp long, and shared a conserved segment with Salmonella enterica serovar Oranienburg (99.4%). Recombinant Rpf (rRpf) proteins of S. Typhimurium LT2 after expression in E. coli BL21 harboring the pET15-b plasmid was approximately 25 kDa. Since S. Oranienburg cells are relatively quick to enter the VNC state just after incubating in the presence of 7% NaCl at 37 degrees C for 3 days, we evaluated the biological effect of rRpf by using S. Oranienburg VNC cells. The rRpf not only promoted proliferation but also induced resuscitation of VNC cells to the culturable state in a dose-dependent manner. Therefore, rRpf may be useful for detection of bacterial contaminants present in the VNC form in food samples and the environment.

Amino Acid Sequence↗
PubMed1994

Outcome of cardiopulmonary resuscitation and predictors of resuscitation status in an urban community teaching hospital.

Medical records of all expired patients as well as all patients designated on billing logs as having received cardiopulmonary resuscitation (CPR) during a 6-month period were reviewed. Patients were considered to have been 'coded' if they were found unresponsive and if the advanced cardiac life support (ACLS) protocol of the American Heart Association (AHA) was subsequently initiated. Of 105 patients who received CPR, 98 died during their hospital stay. Of the seven remaining patients, four had undergone coronary by-pass graft surgery, one was discharged in a persistent vegetative state, one died during an admission 2 months later, and one patient was transferred to another institution where he died. Various factors were studied in an effort to determine how patients on whom resuscitation was attempted differed from those who died without ever having received CPR. Patients who underwent CPR at least once during their hospitalization were more likely to have had cardiac diagnoses on admission (P < 0.001), to have been postoperative (P = 0.02), to have been admitted to a monitored bed on admission (P < 0.001) to have received more days of intensive care (P < 0.001) and to have received more specialist consultations (P = 0.004). Patients not receiving CPR were more likely to have had a primary diagnosis of neoplastic disease (P < 0.001), stroke or intracranial hemorrhage (P = 0.02) or dementia (P < 0.001). Age, race, or gender did not differ significantly between the two groups.

Aged↗