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At least 1,117 records · Page 62Linked to original sources
PubMed1986

Resuscitation outside hospital in Auckland.

All resuscitation attempts outside hospital attended by the Auckland life support unit ambulances during 1983 were reviewed. There were 405 attempted resuscitations during the 12 month period. Of the 344 patients who arrested before the life support unit arrived, 189 (55%) had cardiopulmonary resuscitation initiated by bystanders and 34 (10%) by conventional ambulance personnel. Sixty one patients suffered their arrest after the arrival of the life support unit. One hundred and ninety two patients (47% of the total 405 patients) died at the scene of collapse, 95 patients (24%) died in accident and emergency departments and 46 (11%) died in hospital. Eighteen of the 213 patients successfully resuscitated and transported to hospital had complications related to cardiopulmonary resuscitation. Of the 72 patients discharged, 65 (90%) were alive one year after discharge. Of all patients in whom resuscitation was attempted, 75% were males. This male predominance was present in all age groups and disease categories except subarachnoid haemorrhage and stroke. Myocardial infarction and other ischaemic heart disease accounted for the great majority of cases, followed by asthma and a variety of other conditions. Below 30 years of age the causes of collapse were predominantly noncardiac, and with age increasing above 30 years there was increasing likelihood of a cardiac cause for the collapse.

Adolescent↗
PubMed1987

Neonatal resuscitation in Canadian hospitals.

A survey of Canadian hospitals providing obstetric care was undertaken to assess preparation, protocols, training and staff availability for neonatal resuscitation. Of the 721 hospitals contacted 577 (80%) responded. The reported availability of written guidelines for resuscitation varied greatly, depending on hospital size and proximity to a tertiary care centre. Many hospitals, especially those with 300 births or fewer annually, reported that they depend on family physicians or nurses to start and to continue neonatal resuscitation. Approximately one third of the hospitals had written guidelines for summoning personnel for additional help, and one third used a list of maternal or fetal indications for the presence of a physician specifically for the care of the infant at birth. Of 200 hospitals 138 (69%) had to summon additional medical help from outside the institution, 60% at all times. A neonatal resuscitation team in which members' roles were defined was established in 22% of the hospitals. Few hospitals held rehearsals for resuscitation. Nurses were permitted to perform intubation in 21 hospitals (4%), 7 of them in Alberta. National professional bodies should develop guidelines for training and skill maintenance, and hospitals should develop protocols for maintaining equipment and for neonatal resuscitation team activities, including regular practice. Training should be improved in family practice and obstetrics programs, and consideration should be given to training senior obstetric nurses and respiratory therapists in intubation of neonates.

Canada↗
PubMed1979

[Resuscitation of the elderly brain].

The little poses the question of the usefulness of resuscitation of elderly individuals, victims of cerebral damage or aggression. The author reviews the difficulties inherent in the definition of the "elderly patient" and the "elderly brain". The results obtained in 195 patients aged 60 or over are reported. In a 12 month period, this accounted for 32.77 p. 100 of "resuscitated" patients in a department of neurosurgery. Resuscitation implied a state of coma with artificial ventilation for varying periods. It thus differed from simple surveillance, even specialised. Survival rates are analysed in terms of neurological state, aetiology, whether or not there was surgery under general anaesthesia, past history, complications and the gravity of the resuscitation methods employed. The overall rate of 32.31 p. 100 was already lower than that in the elderly in a general intensive care unit. The picture in geriatric neurological resuscitation worsens further if only good quality survivals are noted: approximately 21.03 p. 100. Nevertheless, all the indications are that these figures are likely to improve in this recent field of resuscitation.

Aged↗
PubMed1985

[Use of acupuncture in the resuscitation of animals].

In the present work fundamental experience is summed up regarding the acupuncture resuscitation of animals. The results are based on examination of 243 cases of 17 different species of domestic and exotic animals and birds. The apnoea condition, or only deep narcosis, has been induced with the use of different kinds of narcotics, above all Thiopental. A review of four most effective acupuncture points and the proper way of resuscitation are given. The acupuncture resuscitation has shown up to 100% results in clinically healthy dogs, whereas in animals affected with different diseases the success of intervention showed to be smaller (77.47%). In zoo animals in narcosis induced by medicines, the resuscitation effectiveness achieved 92.6%. The resuscitation effect is based not only on strictly determined points but also on diffusive irritation of respective point and its surroundings by acupressure. Discussion deals with the factors on which the acupuncture resuscitation and its success are dependent.

Acupuncture Therapy↗
PubMed1985

Successful cardiovascular resuscitation after massive intravenous bupivacaine overdosage in anesthetized dogs.

We investigated whether anesthetized dogs (n = 6) could be resuscitated from massive cardiovascular toxic intravenous bupivacaine overdoses. Five mg/kg of bupivacaine was given into the right atrium over 10 sec every minute until cardiac collapse occurred. At the same time the bupivacaine was given, the animals were made apneic for 90 sec (to mimic the clinical situation in which seizures often render patients apneic) and then ventilated with 100% oxygen. After bupivacaine administration, cardiovascular collapse occurred in the form of ventricular tachycardia, or more commonly, electromechanical dissociation. Resuscitation was performed using open-chest heart massage, bretylium for ventricular tachycardia, and epinephrine with atropine for electromechanical dissociation and bradycardia. After successful resuscitation, each animal was again given bupivacaine as above until cardiovascular collapse occurred and resuscitation was performed again. Each dog underwent three arrests and resuscitations. The total cumulative bupivacaine dose was 64.1 +/- 26.8 mg/kg. We conclude that anesthetized dogs receiving massive cardiovascular toxic doses of bupivacaine can be resuscitated easily and consistently with appropriate therapy.

Animals↗
PubMed1983

Crystalloid versus colloid for fluid resuscitation of hypovolemic patients.

The choice of the initial asanguinous fluid--either crystalloid or colloid--used for the resuscitation of the hypovolemic patient remains controversial. Colloid supporters argue for the careful preservation of the plasma colloid osmotic pressure (PCOP) to protect the lung from pulmonary edema. A careful analysis of the Starling microvascular forces operative at the pulmonary capillary makes such an effect unlikely. In fact, the lung is relatively immune to hemodilution and any decrease in PCOP is roughly one fourth as important as increases in hydrostatic pressure in causing increased fluid exchange. A critical review of the experimental and clinical studies comparing crystalloid versus colloid resuscitation essentially shows no physiologic difference in the two solutions. Using the thermal-green dye technique of extra-vascular lung water (EVLW) measurement in twenty crystalloid resuscitated trauma (n = 10) and burn (n = 10) patients, we have specifically evaluated the pulmonary effects of profound depression of PCOP and a negative PCOP - PAWP gradient (a shorthand form of the Starling equation argued to predict the presence of pulmonary edema if + 4 mm Hg or less). Average resuscitative fluid volumes during the first two hospital days were: 31.8 litres of crystalloid and no colloid for each burn patient; and 18.5 liters of crystalloid, 21 units of blood and 1 liter of colloid (as fresh frozen plasma) for each trauma patient. EVLW remained in the normal range of 7.0 +/- 1.0 ml/kg during the first five hospital days for all patients despite profound decrease in PCOP (less than 15 mm Hg) and a low or negative PCOP - PAWP gradient. Crystalloid resuscitation clearly is not harmful to the lung and it is equally as effective as colloid resuscitation. Crystalloid is markedly less expensive than colloid and, given the greater cost of colloid without evident benefit, one wonders how their further use can be justified.

Animals↗
PubMed1978

[Therapy of cardiac arrest: cardiopulmonary resuscitation (author's transl)].

Reports of successful attempts at resuscitation have been published for more than 200 years, but systematic analysis of an optimal technique has been undertaken for only the last 20 years. As a result of these experiments and of the many years of experience of resuscitation teams, extensive recommendations were formulated by a conference on cardiopulmonary resuscitation of the "American Heart Association" in May 1973. The superiority of mouth-to-mouth resuscitation in comparison to older methods and the importance of the triple-airway-maneuvre for the maintenance of a patent airway were pointed out. Despite the fact, that an exact numerical relationship of cardiac massage to artificial ventilation is not particularly important, an optimal procedure was established. However, the worldwide spread of cardiopulmonary resuscitation should not lead to this procedure being performed just somehow, since correct execution, if possible without interruptions, is essential for the effectiveness of the remaining circulation and the response to medications and defibrillation. The prognosis varies widely depending on the group of patients being examined. In 1976 34 resuscitations were performed on adult patients of the Cardiothoracic Intensive Care Unit of the German Heart Centre in Munich (5.5% of patients admitted). Seven patients survived primarily. Of these, four patients died within the subsequent twentyfour hours. One patient survived with permanent brain damage, two could eventually be discharged from the hospital without complications.

Coronary Care Units↗
PubMed1980

Response of the pulmonary microcirculation to fluid loading after hemorrhagic shock and resuscitation.

We compared the response of the pulmonary microcirculation to fluid overload before and 24 hours after hemorrhagic shock, resuscitated with either blood or crystalloid, to determine whether vascular permeability was altered, making the lung more susceptable to fluid overload after shock and whether this response differed depending on the type of resuscitation fluid. Fourteen unanesthetized sheep with chronic lung lymph fistula were given a fluid challenge (one half of blood volume) before and 24 hours after hemorrhagic shock. Seven sheep were resuscitated after whock with shed blood and seven sheep were resuscitated with Ringer's lactate alone equal to 2.5 times the amount of shed blood. Pulmonary vascular pressures and lung lymph flow Ql were at baseline in both groups 24 hours after resuscitation except for the decreased plasma oncotic pressure pi p in the crystalloid group. Interstitial oncotic pressure, pi i was also lowered in this group such that the gradient (pi p-pi i) remained at baseline. In the blood group, pulmonary vascular pressures and QL increased transiently after fluid loading before and after shock with the mean time for QL to return to baseline being 5.5 and 5.9 hours for the preshock and postshock periods, respectively. In the crystalloid group, fluid loading after shock produced an increase in pulmonary vascular pressures resulting in a significant increase in QL over the preshock fluid response with the mean time for QL to return to baseline being 10.1 hours. However, changes in the value of (pi p-pi i) were identical to those seen before shock. Therefore we noted that 24 hours after shock, lung permeability was not significantly altered but crystalloid resuscitation did make the lung more susceptible to volume overload.

Animals↗
PubMed1980

Lung fluid and protein dynamics during hemorrhagic shock, resuscitation, and recovery.

Fluid and protein flow across the pulmonary microcirculation was measured during hemorrhagic shock resuscitation and recovery using either blood or crystalloid as the resuscitation fluid. Fluid filtration rate (Qf) and protein permeability were measured using, as reliable indicators, lung lymph flow and lymph protein content in the unanesthetized sheep with chronic lung lymph fistula. During shock, Qf was maintained, probably because of an increase in pulmonary venous resistance. During resuscitation Qf was significantly increased, but no increase in protein permeability was noted. This increase in Qf was not affected by the type of resuscitation fluid, as the decrease in plasma oncotic pressure with crystalloid was compensated for by a decrease in plasma oncotic pressure with crystalloid was compensated for by a decrease in the interstitial oncotic pressure. Crystalloid resuscitation did, however, increase the Qf response to a fluid challenge in the recovery period, whereas blood resuscitation did not.

Animals↗
PubMed1993

Do not resuscitate orders in an Irish teaching hospital.

A chart review was performed to determine the resuscitation status of all in-patients in this hospital on a single day. A decision not to resuscitate had been made for 11 (3.7%) of 293 patients. Seven of these patients had a severe stroke, two had dementia and one had a malignancy. We identified a further 22 patients who would be unlikely to benefit from resuscitative efforts but who had not been excluded from resuscitation: four patients with major impairment following a stroke, five patients with severe dementia and 13 patients with incurable malignancy. A policy of routinely discussing and documenting the resuscitation status of patients might reduce the unnecessary performance of cardiopulmonary resuscitation.

Adolescent↗
PubMed1996

Self-efficacy in pediatric resuscitation: implications for education and performance.

OBJECTIVE: This article examines the relevance of self-efficacy--a cognitive process indicating people's confidence in their ability to effect a given behavior--to training and performance of pediatric resuscitation. The case is made that self-efficacy is likely to influence the development of and real-time access to cognitive, affective, psychomotor, and social aspects of resuscitation proficiency. METHODS: Comprehensive literature reviews were conducted on relevant topic areas, including self-efficacy theory and empirical investigations of self-efficacy in clinical practice. Three case studies are used to illustrate the influence of self-efficacy on resuscitation practice. RESULTS: The limited empirical evidence on the role of self-efficacy in clinical practice is consistent with self-efficacy theory: clinicians are less likely to initiate and sustain behaviors for which they lack confidence. This performance-based confidence can be distinguished from both knowledge and skills necessary to perform the behavior. CONCLUSIONS: Even clinicians who are knowledgeable and skilled in resuscitation techniques may fail to apply them successfully unless they have an adequately strong belief in their capability. General guidelines for promoting self-efficacy are presented, and specific recommendations are made for enhancing resuscitation self-efficacy during resuscitation training and postresuscitation procedures.

Attitude of Health Personnel↗
PubMed1996

Factors associated with cognitive recovery after cardiopulmonary resuscitation.

BACKGROUND: A range of neuro-cognitive sequelae, from mild intellectual impairments to brain death, have been reported in survivors of aborted sudden cardiac death. PURPOSE: To determine to what extent, if any, factors associated with cardiopulmonary resuscitation, left ventricular function, and mood state are related to outcomes in five cognitive areas, namely orientation, attention, memory, reasoning, and motor performance. METHODS: Repeated measures were used to assess cognitive outcomes in 45 sudden cardiac arrest survivors over the 6 months following cardiopulmonary resuscitation. A battery of neuro-psychological tests was used to assess cognitive outcomes and psychological status over time. The relationship of the cardiopulmonary resuscitation, left ventricular function, and psychological variables to cognitive outcomes were assessed at each data point. The independent variables included time to cardiopulmonary resuscitation, time to defibrillation, duration of cardiopulmonary resuscitation, time to awakening, ejection fraction, New York Heart Association Class I to IV, tension, anger, and depression. RESULTS: During hospitalization 38 of the 45 survivors (84%) had mild to severe deficits in one or more cognitive areas; 19 of 38 survivors (50%) continued to be impaired in one or more cognitive areas at 6 months. Of these, all had mild to severe deficits in at least one aspect of memory, with delayed recall the most frequent impairment. Time to awakening accounted for a unique portion of the variance in orientation and memory outcomes over time. The left ventricular function variables accounted for a significant portion of the variance in motor speed. CONCLUSIONS: Our results suggest that half of the long-term survivors of aborted sudden cardiac death are cognitively intact 6 months after resuscitation but that 25% have moderate to severe impairment in memory, which could hamper and/or preclude the resumption of prearrest roles.

Analysis of Variance↗
PubMed1996

[Indications for and termination of resuscitation].

In the opinion of the American Heart Association [AHA] all patients suffering respiratory or cardiac arrest should be resuscitated unless 1. there are obvious signs of clinical death, 2. resuscitating the patient would place the rescuer/rescuers at significant risk of physical injury or 3. there is a documentation or another reliable person confirming that resuscitation is not wanted or in the patient's best interest. Once begun resuscitation should continue until one of the following occurs: 1. Return of spontaneous circulation and ventilation. 2. Care is transferred to another team of trained rescuers [physician, ECC team, etc.]. 3. Reliable criteria for the determination of death is recognized. 4. The rescuer/rescuers ar too exhausted to continue resuscitation or environmental hazards endanger the rescuers. 5. Valid no-CPR documentation is represented to the rescuers, either before the resuscitation has begun or during the effort. The psychological aspects of critical incident debriefing are described as are recommendations for conveying news of a sudden death to family members. In addition, the ethical points of organ transplants and practicing intubation on newly deceased persons are described.

Adult↗
PubMed1997

High touch in high tech: the presence of relatives and friends during resuscitative efforts.

Hospital emergency departments traditionally have policies that require relatives and friends to wait out the resuscitative attempt of their loved ones in a counseling room. In recent years, this widespread practice has been questioned. In some hospitals, family members and friends are given the option to attend the resuscitative effort. Based on in depth interviews, three different resuscitation perspectives to which health care providers subscribe have been identified. According to the advocates of the survival framework, the only goal that a resuscitation should achieve is to save a human life. In the bifurcated perspectives, a resuscitation has two separate goals: saving lives and taking care of family members. Health care providers who subscribe to the holistic framework are still concerned with survival of the patient, but significant others become participants in the resuscitation process.

Attitude of Health Personnel↗
PubMed1989

Traumatic shock and head injury: effects of fluid resuscitation on the brain.

UNLABELLED: The effects of resuscitation of traumatic-hemorrhagic shock on the brain are unknown. Traumatic shock in sheep (fracture/crush injury, 2-hr hemorrhage to 40 mm Hg) was followed by resuscitation to baseline mean arterial pressure. Two groups without brain injury were resuscitated with lactated Ringer's (LR1, n = 7) or albumin (ALB1, n = 6). Focal brain injury was added in two further groups (LR2, n = 6; ALB2, n = 6). Hemodynamics, intracranial pressure (ICP), EEG, and colloid osmotic pressure (COP) were followed. Brain water (BW) and cerebral blood volume (CBV) were compared to those of controls (C, n = 7). RESULTS: ICP rose in all groups. Animals without brain injury did not have increased brain water. Below are results for brain-injured animals after resuscitation (mean +/- SEM). (table; see text) Maintaining COP during initial resuscitation does not minimize cerebral edema: the effects of LR and ALB were similar in this setting. Focal brain injury causes edema but does not cause large increases in ICP with initial resuscitation.

Albumins↗
PubMed1991

ATP-MgCl2 restores the depressed hepatocellular function and hepatic blood flow following hemorrhage and resuscitation.

Although ATP-MgCl2 produces a myriad of beneficial effects following organ ischemia and simple hemorrhagic shock in animal models which involved heparinization and/or blood resuscitation, it is not known whether ATP-MgCl2 has any salutary effect on the depressed active hepatocellular function (AHF) and hepatic microvascular blood flow (HMBF) in a nonheparinized model of trauma and severe hemorrhage in the absence of blood resuscitation. To determine this, rats underwent a midline laparotomy (i.e., trauma induced) and were bled to and maintained at a mean arterial pressure of 40 mm Hg until 40% of the maximum shed blood volume was returned in the form of Ringer's lactate (RL). The animals were then resuscitated with four times the volume of shed blood with RL. ATP-MgCl2, 50 mumoles/kg body weight (BW) each or an equivalent volume of normal saline, was infused intravenously for 95 min during and following crystalloid resuscitation. At 1.5 and 4 hr after resuscitation, AHF (Vmax, maximal velocity of indocyanine green clearance; Km, efficiency of the active transport process) was determined without blood sampling by using an in vivo indocyanine green clearance technique. HMBF was measured with laser Doppler flowmetry. Results indicate that Vmax, Km, and HMBF decreased significantly at 1.5-4 hr after hemorrhage and resuscitation. ATP-MgCl2 infusion restored the depressed Vmax, Km, and HMBF and prevented the occurrence of hepatic edema. The restoration of AHF with ATP-MgCl2 treatment may be due to its direct salutary effect on the active indocyanine green transport process and/or due to improvement in hepatic microcirculation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Triphosphate↗
PubMed2006

Histophysiological effects of fluid resuscitation on heart, lung and brain tissues in rats with hypovolemia.

The efficacy of using colloids and crystalloids in the treatment of hypovolemia still remains controversial. An important aspect in treating hypovolemia is to re-establish normal tissue hemodynamics after fluid resuscitation. Production of nitric oxide (NO) or growth factors such as transforming growth factor beta (TGF-beta) has been identified as a key mechanism in physiological and pathological processes in the different systems. This study was designed to investigate the histophysiological effects of resuscitation with different plasma substitutes on the heart, lung and brain tissues following acute blood loss in male Sprague-Dawley rats weighing 250-280g (n=30). After anesthesia with sodium pentobarbital, the left femoral vein and artery were cannulated for the administration of volume expanders and for direct measurement of arterial pressure and heart rate. Twenty rats were bled (5ml/10min) and infused (5ml/10min) with one of four randomly selected solutions, (a) human albumin, (b) gelatin (Gelofusine), (c) dextran-70 (Macrodex); or (d) physiological saline (0.9% isotonic saline). Five control rats were bled without infusion. Tissue samples were taken and fixed in 10% formalin solution, then processed for embedding in paraffin wax. Sections were cut and stained with hematoxylin and eosin. Indirect immunohistochemical labelling was performed to reveal binding of primary antibodies against endothelial nitric oxide synthase (eNOS), inducible nitric oxide synthase (iNOS) and TGF-beta. Mild immunoreactivity of eNOS was observed in endothelial cells of vessels in brain, heart and lung tissues. Increased immunoreactivities of eNOS, iNOS and TGF-beta were observed in the non-fluid resuscitated group in these organs; mild, moderate, moderate and strong immunoreactivities were seen in the albumin, gelatin, physiological saline and dextran-70 treated groups, respectively. Immunoreactivities of iNOS and TGF-beta in the non-fluid resuscitated group were increased significantly, in comparison to the other groups, apart from the dextran-70 treated group. The results of this study show that gelatin solution and physiological saline may be of use after acute blood loss, and dextran-70 is not the preferred resuscitation fluid in the early stages of acute blood loss. It was concluded that albumin solution is the preferred fluid for resuscitation.

Animals↗
PubMed2005

Controversies in fluid resuscitation for burn management: literature review and our experience.

The purpose of this review is to summarise the commonly used formulae for fluid resuscitation in major burns and to discuss the controversy surrounding the use of protein-based colloids as a component of these types of formulae. Fluid resuscitation in major burns is one of the most critical steps in managing this type of injury. In practice, a wide variety of formulae for fluid resuscitation has been suggested. Some propose only the use of crystalloids, while others combine the colloids together with crystalloids. A review was performed of the literature addressing fluid resuscitation formulae and our experience using our formula is presented. At the authors' burn centre a unique formula is in use, which combines plasma and crystalloids. Our experience using this specific formula extends over a period of 15 years and 356 patients with major burns have been resuscitated using this protocol. At our centre, 27 deaths were recorded, 19 of which had third degree burns of more than 80% total body surface area (TBSA). The protein-based colloids are included in most of the formulae and the beneficial effect is considered to be higher than the potential side effects. We are in favour of administering colloids during the resuscitation period for major burns, starting in the early period after injury.

Adult↗