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PubMed2002

Quality of life 6-months after cardiac arrest.

BACKGROUND: Evaluation of outcome after cardiac arrest focuses mainly on survival. Survivors of cardiac arrest end up in different states of health and survival alone may not be a sensitive measure for successful cardiopulmonary resuscitation (CPR). OBJECTIVES: To evaluate health-related quality of life (HR-QOL) of cardiac arrest survivors with EQ-5D, a generic instrument developed by the EuroQol group. PATIENTS AND METHODS: From April 1997 to December 2000, all cardiac arrest adult patients admitted to an eight-bed medical/surgical (ICU) of a tertiary care hospital were enrolled. At 6-months after ICU discharge survivors attended a follow-up interview and answered EQ-5D questionnaire. A match-control group was created choosing for each survivor of cardiac arrest two controls, with similar age range (+/-5 years) and similar Apache II (+/-3 Apache II units), that were randomly selected among other ICU patients. RESULTS: From a total of 1106 patients, 97 (9%) patients were admitted after cardiac arrest. Forty-seven patients (48%) were discharged from ICU. Of these, 11 patients died in the ward. Thirty-six (37%) patients were discharged from hospital. Twelve patients died after hospital discharge but before 6-month evaluation. Five patients were not evaluated, three because they were living in distant locations and two for unknown reasons. Nineteen patients attended the follow-up consultation. Eight of these patients were actively working and six of them had managed to return to their previous activity. Eleven patients were retired and seven of these managed to return to their previous level of activity while four patients presented with anoxic encephalopathy: one with mild and one with moderate neurological dysfunction, two with severe anoxic neurological dysfunction. Although a higher percentage of cardiac arrest survivors reported more extreme problems in some dimensions than other ICU patients, no significant differences were found on HR-QOL, when evaluated by EQ-5D. CONCLUSIONS: When evaluated with EQ-5D at 6-months after ICU discharge, survivors of cardiac arrest exhibit a HR-QOL similar to other ICU survivors. These results agree with previous reports stating that CPR is frequently unsuccessful but if survival is achieved a fairly good quality of life can be expected.

Adult↗
PubMed2004

Is this patient dead, vegetative, or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest.

CONTEXT: Most survivors of cardiac arrest are comatose after resuscitation, and meaningful neurological recovery occurs in a small proportion of cases. Treatment can be lengthy, expensive, and often difficult for families and caregivers. Physical examination is potentially useful in this clinical scenario, and the information obtained may help physicians and families make accurate decisions about treatment and/or withdrawal of care. OBJECTIVE: To determine the precision and accuracy of the clinical examination in predicting poor outcome in post-cardiac arrest coma. DATA SOURCES AND STUDY SELECTION: We searched MEDLINE for English-language articles (1966-2003) using the terms coma, cardiac arrest, prognosis, physical examination, sensitivity and specificity, and observer variation. Other sources came from bibliographies of retrieved articles and physical examination textbooks. Studies were included if they assessed the precision and accuracy of the clinical examination in prognosis of post-cardiac arrest coma in adults. Eleven studies, involving 1914 patients, met our inclusion criteria. DATA EXTRACTION: Two authors independently reviewed each study to determine eligibility, abstract data, and classify methodological quality using predetermined criteria. Disagreement was resolved by consensus. DATA SYNTHESIS: Summary likelihood ratios (LRs) were calculated from random effects models. Five clinical signs were found to strongly predict death or poor neurological outcome: absent corneal reflexes at 24 hours (LR, 12.9; 95% confidence interval [CI], 2.0-68.7), absent pupillary response at 24 hours (LR, 10.2; 95% CI, 1.8-48.6), absent withdrawal response to pain at 24 hours (LR, 4.7; 95% CI, 2.2-9.8), no motor response at 24 hours (LR, 4.9; 95% CI, 1.6-13.0), and no motor response at 72 hours (LR, 9.2; 95% CI, 2.1-49.4). The proportion of individuals' dying or having a poor neurological outcome was calculated by pooling the outcome data from the 11 studies (n = 1914) and used as an estimate of the pretest probability of poor outcome. The random effects estimate of poor outcome was 77% (95% CI, 72%-80%). The highest LR increases the pretest probability of 77% to a posttest probability of 97% (95% CI, 87%-100%). No clinical findings were found to have LRs that strongly predicted good neurological outcome. CONCLUSIONS: Simple physical examination maneuvers strongly predict death or poor outcome in comatose survivors of cardiac arrest. The most useful signs occur at 24 hours after cardiac arrest, and earlier prognosis should not be made by clinical examination alone. These data provide prognostic information, rather than treatment recommendations, which must be made on an individual basis incorporating many other variables.

Brain Death↗
PubMed1995

Expression of Bcl-2 and Bax in the frontoparietal cortex of the rat following cardiac arrest.

Following 10-min cardiac arrest and resuscitation, male Sprague-Dawley rats developed posthypoxic myoclonus. This phenomenon peaked at 14 days and disappeared by 45 days after cardiac arrest. The mechanisms for the initial dysfunction and later restoration of motor function are not completely known. In the present study, involvement of Bcl-2 and Bax in these phenomena was investigated. In the frontoparietal cortex, both bcl-2 and bax mRNA levels were significantly increased 1, 3, 7, 14, and 28 days postresuscitation. bax mRNA levels continued to be high 45 days postcardiac arrest, whereas bcl-2 mRNA levels were returned to control levels. The apoptotic cells were found in layers IV to VI of the frontoparietal cortex of rats 3 days postcardiac arrest. These results indicate that after cardiac arrest, the initial rise of Bax levels may mediate apoptosis and neurodegeneration in the rat brain. At later time points, increased levels of Bcl-2 may contribute to recovery of motor function in posthypoxic rats.

Animals↗
PubMed2006

First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults.

CONTEXT: Cardiac arrests in adults are often due to ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), which are associated with better outcomes than asystole or pulseless electrical activity (PEA). Cardiac arrests in children are typically asystole or PEA. OBJECTIVE: To test the hypothesis that children have relatively fewer in-hospital cardiac arrests associated with VF or pulseless VT compared with adults and, therefore, worse survival outcomes. DESIGN, SETTING, AND PATIENTS: A prospective observational study from a multicenter registry (National Registry of Cardiopulmonary Resuscitation) of cardiac arrests in 253 US and Canadian hospitals between January 1, 2000, and March 30, 2004. A total of 36,902 adults (> or =18 years) and 880 children (<18 years) with pulseless cardiac arrests requiring chest compressions, defibrillation, or both were assessed. Cardiac arrests occurring in the delivery department, neonatal intensive care unit, and in the out-of-hospital setting were excluded. MAIN OUTCOME MEASURE: Survival to hospital discharge. RESULTS: The rate of survival to hospital discharge following pulseless cardiac arrest was higher in children than adults (27% [236/880] vs 18% [6485/36,902]; adjusted odds ratio [OR], 2.29; 95% confidence interval [CI], 1.95-2.68). Of these survivors, 65% (154/236) of children and 73% (4737/6485) of adults had good neurological outcome. The prevalence of VF or pulseless VT as the first documented pulseless rhythm was 14% (120/880) in children and 23% (8361/36,902) in adults (OR, 0.54; 95% CI, 0.44-0.65; P<.001). The prevalence of asystole was 40% (350) in children and 35% (13 024) in adults (OR, 1.20; 95% CI, 1.10-1.40; P = .006), whereas the prevalence of PEA was 24% (213) in children and 32% (11,963) in adults (OR, 0.67; 95% CI, 0.57-0.78; P<.001). After adjustment for differences in preexisting conditions, interventions in place at time of arrest, witnessed and/or monitored status, time to defibrillation of VF or pulseless VT, intensive care unit location of arrest, and duration of cardiopulmonary resuscitation, only first documented pulseless arrest rhythm remained significantly associated with differential survival to discharge (24% [135/563] in children vs 11% [2719/24,987] in adults with asystole and PEA; adjusted OR, 2.73; 95% CI, 2.23-3.32). CONCLUSIONS: In this multicenter registry of in-hospital cardiac arrest, the first documented pulseless arrest rhythm was typically asystole or PEA in both children and adults. Because of better survival after asystole and PEA, children had better outcomes than adults despite fewer cardiac arrests due to VF or pulseless VT.

Adolescent↗
PubMed1994

Emergency cardiopulmonary bypass in the cardiac surgical unit can be a lifesaving measure in postoperative cardiac arrest.

BACKGROUND: Postoperative cardiac arrest that is not responsive to conventional resuscitation is uniformly fatal. Sixteen patients who experienced postoperative ventricular fibrillation (VF) and arrest over a 6-year period and did not respond to open chest resuscitation were placed on an emergency basis on cardiopulmonary bypass (CPB) in the cardiac surgical intensive care unit (CSICU). METHODS AND RESULTS: Data were reviewed by retrospective analysis. Nine of the 16 patients (56.3%) survived, and they spent a mean of 9 +/- 2.8 days in the CSICU and a mean of 17 +/- 4.6 days in the hospital. They all are alive 1 month to 5 1/2 years later. The mean interval between VF/arrest and CPB in the CSICU was 50 +/- 6.7 minutes (range, 25 to 83 minutes) for survivors and 51 +/- 6.1 minutes (35 to 83 minutes) for nonsurvivors (P = .98). The duration of CPB in the CSICU was 111 +/- 16.0 minutes (range, 55 to 189 minutes) for survivors and 167 +/- 20.7 minutes (range, 80 to 232 minutes) for nonsurvivors (P = .05). There were no apparent differences between survivors and nonsurvivors in age, history of arrhythmias, use of antiarrhythmics, congestive heart failure, recent myocardial infarction, ejection fraction, preoperative intra-aortic balloon pump, urgency, or type of operation. Surgical variables and postoperative medications and electrolytes (after the primary procedure) were similar. The use of cardioplegic arrest during CPB in the CSICU was higher among survivors (3 of 9) compared with 0 of 7 for nonsurvivors (P = .21). There was no mediastinitis and only two minor soft tissue infections among survivors. CONCLUSIONS: The use of CPB in the CSICU can achieve significant survival in patients who have otherwise irreversible cardiac arrest and/or VF after surgery; the incidence of infection in patients undergoing CPB in the CSICU is very low; and the use of warm cardioplegic arrest may enhance the changes of survival in this type of patient.

Aged↗
PubMed2001

Emergency drug availability for the cardiac arrest team: a national audit.

Cardiac arrest teams are called upon to deal with many different acute medical emergencies, including cardiac arrest. However, the drugs that are supplied for them to perform their role differs vastly from hospital to hospital. We have confirmed this in an audit of adult cardiac arrest teams from all the acute hospitals within Wales. The rational use of defibrillation and drugs during cardiopulmonary resuscitation has been standardised according to International guidelines, and there is no reason why resuscitation kits could not also be standardised. Further considerations of drug availability is needed for acute management of other collapsed patients without cardiac arrest, most commonly vaso-vagal syncope, anaphylaxis, hypoglycaemia, fits and respiratory arrest. Based upon recent recommendations from the project team of the Resuscitation Council (UK), augmented by other commonly needed drugs for first aid in the collapsed patient, we propose a reduced and simplified emergency drug list, employing a two box system covering immediate and most secondary requirements. A standardised format of drug kits for use by adult cardiac arrest teams could speed effective delivery of emergency care.

Cardiopulmonary Resuscitation↗
PubMed2005

Hypothermia improves outcome from cardiac arrest.

Out-of-hospital cardiac arrest is common and patients who are initially resuscitated by ambulance officers and transported to hospital are usually admitted to the intensive care unit (ICU). In the past, the treatment in the ICU consisted of supportive care only, and most patients remained unconscious due to the severe anoxic neurological injury. It was this neurological injury rather than cardiac complications that caused the high rate of morbidity and mortality. However, in the early 1990's, a series of animal experiments demonstrated convincingly that mild hypothermia induced after return of spontaneous circulation and maintained for several hours dramatically reduced the severity of the anoxic neurological injury. In the mid-1990's, preliminary human studies suggested that mild hypothermia could be induced and maintained in post-cardiac arrest patients without an increase in the rate of cardiac or other complications. In the late 1990's, two prospective, randomised, controlled trials were conducted and the results confirmed the animal data that mild hypothermia induced after resuscitation and maintained for 12 - 24 hours dramatically improved neurological and overall outcomes. On the basis of these studies, mild hypothermia was endorsed in 2003 by the International Liaison Committee on Resuscitation as a recommended treatment for comatose patients with an initial cardiac rhythm of ventricular fibrillation. However, the application of this therapy into routine clinical critical care practice has been slow. The reasons for this are uncertain, but may relate to the relative complexity of the treatment, unfamiliarity with the pathophysiology of hypothermia, lack of clear protocols and/or uncertainty of benefit in particular patients. Therefore, recent research in this area has focused on the development of feasible, inexpensive techniques for the early, rapid induction of mild hypothermia after cardiac arrest. Currently, the most promising strategy is a rapid infusion of large-volume (40 mL/kg) ice cold intravenous fluid. Also, newer automated surface cooling/warming devices have been developed which allow tight control of body temperature in the ICU. On the other hand, a number of questions remain. The benefit of hypothermia in non-ventricular fibrillation cardiac arrest remains uncertain. Also, the best timing of induction and the duration of hypothermia after cardiac arrest are uncertain. Clinical trials are currently underway to assess these issues.

Journal Article↗
PubMed2002

Common mechanisms and strategies for prevention and treatment of cardiac arrest during epidural anesthesia.

Cardiac arrests continue to occur during epidural anesthesia and frequently result in death or brain damage. Although unintentional "total spinal" anesthesia, respiratory depression, myocardial ischemia, and local anesthetic toxicity can also lead to cardiac arrest, often the arrests do not fit any of these four categories. Many of the unexplained arrests may be attributed to vagal predominance. The evidence for a vagal-linked circulatory mechanism for these arrests is reviewed, and the characteristics that are associated with an increased risk for cardiac arrest during epidural anesthesia are identified. Specific strategies to forestall vagal predominance are discussed. In case these strategies fail, multiple interventions are discussed that should increase the likelihood of a successful resuscitation in the setting of extensive sympathetic blockade.

Anesthesia, Epidural↗
PubMed2005

The effects of pulsatile versus non-pulsatile extracorporeal circulation on the pattern of coronary artery blood flow during cardiac arrest.

BACKGROUND: In sudden cardiac arrest, the effective maintenance of coronary artery blood flow is of paramount importance for myocardial preservation as well as cardiac recovery and patient survival. The purpose of this study was to directly compare the effects of pulsatile versus non-pulsatile circulation to coronary artery flow and myocardial preservation in a cardiac arrest condition. METHODS: A cardiopulmonary bypass circuit was constructed in a ventricular fibrillation model using fourteen Yorkshire swine weighing 25-35 kg each. The animals were randomly assigned to group I (n=7, non-pulsatile centrifugal pump) or group II (n=7, pulsatile T-PLS pump). Extracorporeal circulation was maintained for two hours at a pump flow of 2 L/min. The left anterior descending coronary artery flow was measured with an ultrasonic coronary artery flow measurement system at baseline (before bypass) and at every 20 minutes after bypass. Serologic parameters were collected simultaneously at baseline, 1 hour, and 2 hours after bypass in the systemic arterial and coronary sinus venous blood. The Mann-Whitney U test of STATISTICA 6.0 was used to determine intergroup significances using a p value of <0.05. RESULTS: The resistance index of the coronary artery was lower in group II and the difference was significant at 40 min, 80 min, 100 min and 120 min (p<0.05). The mean velocity of the coronary artery was higher in group II throughout the study, and the difference was significant from 20 min after starting the pump (p<0.05). The coronary artery blood flow was higher in group II throughout the study, and the difference was significant from 40 min to 120 min (p<0.05) except at 80 min. Serologic parameters showed no differences between the groups at 1 hour and 2 hours after bypass in the systemic and coronary sinus blood (p=NS). CONCLUSION: In the cardiac arrest condition, pulsatile extracorporeal circulation provides more blood flow, higher flow velocity and less resistance to coronary artery than non-pulsatile circulation.

Animals↗
PubMed2000

Minimally invasive direct cardiac massage versus closed-chest cardiopulmonary resuscitation in a porcine model of prolonged ventricular fibrillation cardiac arrest.

Open chest cardiac massage has been shown to be superior to closed-chest cardiopulmonary resuscitation for both hemodynamics produced during resuscitation and ultimate resuscitation success. The inexperience of many rescuers with emergency thoracotomy, along with the associated morbidity contributes to the continued reluctance in the use of invasive cardiopulmonary resuscitation techniques. A device has been developed for performing 'minimally invasive' direct cardiac massage. This technique was compared to standard closed-chest CPR for resuscitation results in 20 swine during prolonged ventricular fibrillation cardiac arrest. Minimally invasive direct cardiac massage was superior to closed-chest CPR for return of spontaneous circulation (7/10 vs. 2/10; P<0.02) and coronary perfusion pressure at 30 min of CPR (17+/-9 vs. 6+/-6 mmHg; P<0.05). No significant injuries altering outcome were found with the invasive device. Throughout most of the time course of the study no significant differences in end-tidal expired carbon dioxide levels were noted. Nor were there any differences in 24-h survival. Improvements in assuring proper placement of the device on the epicardium should make this technique a potent advanced cardiac life support adjunct.

Analysis of Variance↗
PubMedDate not supplied

Sensitivity and specificity of the medical priority dispatch system in detecting cardiac arrest emergency calls in Melbourne.

INTRODUCTION: In Australia, cardiac arrest kills 142 out of every 100,000 people each year; with only 3-4% of out-of-hospital patients with cardiac arrest in Melbourne surviving to hospital discharge. Prompt initiation of cardiopulmonary resuscitation (CPR), defibrillation, and advanced cardiac care greatly improves the chances of survival from cardiac arrest. A critical step in survival is identifying by the emergency ambulance dispatcher potential of the probability that the person is in cardiac arrest. The Melbourne Metropolitan Ambulance Service (MAS) uses the computerized call-taking system, Medical Priority Dispatch System (MPDS), to triage incoming, emergency, requests for ambulance responses. The MPDS is used in many emergency medical systems around the world, however, there is little published evidence of the system's efficacy. OBJECTIVE: This study attempts to undertake a sensitivity/specificity analysis to determine the ability of MPDS to detect cardiac arrest. METHODS: Emergency ambulance dispatch records of all cases identified as suspected cardiac arrest by MPDS were matched with ambulance, patient-care records and records from the Victorian Ambulance Cardiac Arrest Registry to determine the number of correctly identified cardiac arrests. Additionally, cases that had cardiac arrests, but were not identified correctly at the point of call-taking, were examined. All data were collected retrospectively for a three-month period (01 January through 31 March 2003). RESULTS: The sensitivity of MPDS in detecting cardiac arrest was 76.7% (95% confidence interval (CI): 73.6%-79.8%) and specificity was 99.2% (95% CI: 99.1-99.3%). These results indicate that cardiac arrests are correctly identified in 76.7% of cases. CONCLUSION: Although the system correctly identified 76.7% of cardiac arrest cases, the number of false negatives suggests that there is room for improvement in recognition by MPDS to maximize chances for survival in out-of-hospital cardiac arrest. This study provides an objective and comprehensive measurement of the accuracy of MPDS cardiac-arrest detection in Melbourne, as well as providing a baseline for comparison with subsequent changes to the MPDS.

Efficiency, Organizational↗
PubMed1988

Rate of decrease of myocardial O2 consumption due to cardiac arrest in anesthetized goats.

The rate of change of myocardial O2 consumption, MVO2, has been measured during the transition from beating to cardiac arrest. Cardiac arrest was achieved by destruction of the bundle of His by injection of formalin and induced by 25 s interruption of pacing. The left main coronary artery was perfused under constant pressure and the great cardiac vein was drained under controlled pressure. The arterio-venous O2 content difference, [O2](a-v), and coronary arterial and venous flows, CAF resp CVF, were continuously measured. The MVO2 transient was calculated using the following equation based on a 3 compartment model: MVO2 = CAF . [O2](a-v) - (Vc + Vv) . d[O2]v/dt - (Vc . Vv/CVF) . d2[O2]v/dt2 where Vc and Vv are the capillary and the venous blood volume as function of time and [O2]v is the venous oxygen content. A 7th order polynoma was fit to the [O2]v-data and the fitted equation was differentiated analytically to obtain the first and second order derivatives. The MVO2 decreased from 94 +/- 5 microliters O2/s/100 g (mean +/- SE) before cardiac arrest to 15.4 +/- 5 microliters O2/s/100 g after 15 s of cardiac arrest. The change in MVO2 (50% in 3.8 +/- 0.3 s) preceded the change in venous oxygen content (50% in 12.7 +/- 0.5 s) and the change in coronary resistance (50% in 14.9 +/- 0.9). These results are in accordance with the hypothesis that interstitial O2 concentration is a major determinant of coronary resistance.

Animals↗
PubMed1986

Brain iron delocalization and lipid peroxidation following cardiac arrest.

Brain injury after cardiac arrest and resuscitation may occur, in part, by oxygen radical mechanisms. The availability of a transition metal, such as iron, is essential for in vitro initiation of this type of reaction. The brain has significant stores of iron bound in large proteins. We conducted this study to determine whether iron availability is enhanced in the canine brain following resuscitation from 15 minutes of cardiac arrest, and whether this iron is associated with the appearance of products of radical-mediated lipid peroxidation (LP) after two hours of reperfusion. Examination of the data by the method of multivariate analysis revealed significant increases in the low molecular weight species (LMWS) iron (300% of nonischemic controls, P less than .01), malondialdehyde (MDA), a lipid peroxidation degradation product (145% of nonischemic controls, P less than .01), and conjugated dienes (CD) (204% of nonischemic controls, P = .07). Therapy with deferoxamine (50 mg/kg IV immediately post resuscitation) produced a reduction in MDA and CD to levels statistically indistinguishable from nonischemic controls. We conclude that brain tissue iron is delocalized from normal storage forms to a LMWS pool after two hours of reperfusion following resuscitation from a 15-minute cardiac arrest, and that this is associated with increased products of LP. The increase in LP products is blocked by treatment with deferoxamine.

Analysis of Variance↗
PubMed1986

Automatic detection of cardiac arrest rhythms prior to automatic external cardiac defibrillation.

The detection and correction of ventricular fibrillation at the earliest time after its onset is essential to ensure long-term survival. During successive cardiac arrests the rhythms occurring were sensed by using disposable pre-gelled ECG defibrillator pads placed in the anterior-anterior position. Simultaneously with the treatment, the arrest rhythms were analyzed continually every 8 to 18 seconds by a microprocessor system. This system sampled digitally the electrocardiogram, and the algorithm looked for absence of the isoelectric segment, irregular energy density spectrum, and irregular wave shape. The analysis was displayed visually as ventricular fibrillation (VF) or non-VF, and simultaneously the ECG and system's analysis were recorded on tape. Later, the system's interpretation of the rhythm was compared with the ECG record. There were 46 males and 32 females. Their ages ranged from 14 to 85 years, with a mean of 63 years. Twenty-nine patients had sustained an acute myocardial infarction. In the remaining 49 patients, there were a variety of causes for cardiac arrest, including heart failure, vasovagal syncope, cardiomyopathy, and postoperative cases. We report in detail the process and results.

Journal Article↗
PubMed1994

Accuracy of determining cardiac arrest by emergency medical dispatchers.

STUDY OBJECTIVE: To identify and determine the rates of delivery and performance of telephone CPR in noncardiac arrest incidents. DESIGN: We studied prospectively all out-of-hospital cardiac arrest and potential cardiac arrest incidents from July 1 through October 31, 1992. SETTING: King County, Washington, excluding the city of Seattle. PARTICIPANTS: Persons with cardiac arrest or an initial complaint resembling cardiac arrest who received emergency medical services. INTERVENTIONS: Dispatcher-assisted telephone CPR. MEASUREMENTS AND MAIN RESULTS: Three hundred fifty-eight incidents of cardiac arrest, respiratory arrest, and potential cardiac arrest were reviewed. Telephone CPR was offered appropriately in 61 of 87 cases (70%) and inappropriately in eight of 154 potential cardiac arrests (5.2%) (95% confidence interval, 1.7%, 8.7%). Ventilation instructions were performed appropriately in 52 of 87 cases (60%) and inappropriately in three of 154 potential cardiac arrests (1.9%) (95% confidence interval, 0%, 4.1%). Chest compressions were performed appropriately in 26 of 68 cardiac arrests (38.2%) and inappropriately in two of 173 potential cardiac arrests (1.2%) (95% confidence interval, 0%, 2.8%). CONCLUSION: We found a low rate of performance of telephone CPR in King County for incidents resembling cardiac arrest. This finding suggests that the protocols designed for dispatcher-assisted telephone CPR effectively screen out those incidents that may initially resemble cardiac arrest.

Adult↗
PubMed2002

Perioperative cardiac arrest at Siriraj Hospital between 1999-2001.

Cardiac arrest during the perioperative period is a good indicator of the quality of anesthetic management. The incidence of perioperative cardiac arrest in Siriraj Hospital hasn't been reported before. Our objectives were to determine the incidence of perioperative anesthesia-related cardiac arrest and the results of cardiopulmonary resuscitation in these cases in order to find out how to improve our anesthetic care. This prospective study was undertaken between 1999-2001 by sending a questionnaire to those witnessing a cardiac arrest. The incidence of perioperative cardiac arrest was 8.2:10,000 instances of anesthesia with a mortality of 5.6:10,000 within 48 hours of the arrest. The incidence of perioperative cardiac arrest that was related to anesthesia was 0.7:10,000 instances of anesthesia and the anesthesia related mortality was 0.19: 10,000 within 48 hours of arrest. Failed cardiopulmonary resuscitation occurred in of occasions 41.7 per cent. There was no difference between intraoperative and postoperative cardiopulmonary resuscitation. Twenty-one per cent of patients experiencing a cardiac arrest were discharged from hospital. Seventy-three per cent of events occurred in patients with an ASA rating 3-5 and most often the cause of arrest was massive or uncontrolled bleeding. In those patients with an ASA rating 1-2 there were no outstanding cause of arrest.

Adolescent↗
PubMed1994

Cerebral and systemic arteriovenous oxygen monitoring after cardiac arrest. Inadequate cerebral oxygen delivery.

BACKGROUND: After prolonged cardiac arrest, under controlled normotension, cardiac output and cerebral blood flow are reduced for several hours. This dog study documents for the first time the postarrest reduction in oxygen (O2) delivery in relation to O2 uptake for brain and entire organism. METHODS: In eight dogs we used our model of ventricular fibrillation (VF) cardiac arrest of 12.5 min, reperfusion with brief cardiopulmonary bypass, and controlled normotension, normoxemia, and mild hypocapnia to 24 h. RESULTS: Between 4 and 24 h after cardiac arrest, cardiac output decreased by about 25% and the systemic arteriovenous O2 content difference doubled, while the calculated systemic O2 utilization coefficient (O2 UC) increased and the systemic venous PO2 decreased, both not to critical levels. The cerebral arteriovenous O2 content difference however, which was 5.6 +/- 1.7 ml/dl before arrest, increased between 1 and 18 h, to 10.8 +/- 3.2 ml/dl at 4 h. The cerebral O2 UC increased and the cerebral venous PO2 decreased, both to critical levels. CONCLUSIONS: After prolonged cardiac arrest in dogs with previously fit hearts, the reduction of O2 transport to the brain is worse than its reduction to the whole organism. Monitoring these values might help in titrating life-support therapies.

Animals↗
PubMed2006

The effects of pre-arrest heparin administration dose for cardiac arrest model using extracorporeal lung and a heart assist (ECLHA) in dogs.

BACKGROUND AND PURPOSE: Clinical and experimental studies have shown that marked activation of blood coagulation occurs in cardiac arrest (CA) and cardiopulmonary resuscitation (CPR). Extracorporeal lung and heart assist (ECLHA) is applied in CA patients who cannot be rescued using conventional therapies. We hypothesized that the dose of heparin administered during the pre-arrest period would influence the outcome in a canine model of CA induced by 15 min of normothermia followed by ECLHA, which consists of heparin coating membrane lung and tubing. We therefore investigated the effects of two dose regimes of the pre-arrest heparin for this model. METHODS: Twelve mongrel female dogs were divided into two groups: a group given 200 U/kg heparin (H200, n=6) and a group given 700 U/kg heparin (H700, n=6), group during pre-arrest period. Normothermic ventricular fibrillation (VF) was induced in all dogs for 15 min, followed by 24h of ECLHA with rapidly induced mild hypothermia (33 degrees C) and 120 h of intensive care. Outcome evaluations included: (1) activated coagulation time (ACT); (2) catecholamine dose; (3) hematocrit (Hct) and platelet count; (4) survival rate; (5) neurological deficit scores (NDS); (6) postmortal macroscopic examination with the exception of the brain. RESULTS: In the H200 group, four dogs died of cardiogenic shock within 28 h. The autopsy revealed extensive patchy hemorrhages in the heart and intestine. In the H700 group, the amount of dopamine was significantly lower (6+/-10mg versus 75+/-41 mg, p<0.05) and the survival rate was significantly higher (100% versus 17%, p<0.05) than in the H200 group. The NDS at 120 h in the H700 group was 18+/-8% and the autopsy revealed an almost normal external appearance of the vital organs. There were no significant differences between groups in either the Hct and platelet count during the 24h of resuscitation, and no bleeding complications were observed. CONCLUSION: The use of ECLHA to resuscitate animals in prolonged CA may require a large dose of systemic heparin during the pre-arrest period even if ECLHA circuit was coated with heparin.

Animals↗