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PubMed2004

Knowledge and attitudes towards cardiopulmonary resuscitation in the community.

AIMS: This study examined basic aspects of knowledge and attitudes towards resuscitation in a New Zealand urban community. METHODS: Using a telephone survey, we questioned 400 subjects aged (over 17 years of age), on their prior training, knowledge, and attitudes towards resuscitation. RESULTS: Seventy-four percent of subjects had previously been taught cardiopulmonary resuscitation (CPR). Of these, 12% had been taught during the previous year, and 63% over 5 years previously. Older subjects were less likely to have learnt CPR than younger subjects. Seventy-three percent of those surveyed desired to know more about resuscitation (than they currently did) and 70% thought that resuscitation should be a compulsory component of the New Zealand Driver's Licence test. Sixty-three percent said they would be willing to perform mouth-to-mouth ventilation on a stranger. CPR knowledge was poor, however, with only 4% knowing an acceptable rate at which to perform chest compressions, and only 9% knowing the correct compression-to-ventilations ratio for adult CPR. Overall knowledge was highest for those taught in the previous year, and for those persons aged between 26 and 45 years. CONCLUSIONS: Although attitudes of the community toward CPR are positive, theoretical knowledge relating to basic CPR is poor. This suggests that present community CPR educational strategies have limited efficacy.

Adult↗
PubMed2004

Permissive hypotensive resuscitation--an evolving concept in trauma.

Trauma fluid resuscitation continues to be a hotly debated issue. There is overwhelming experimental evidence to suggest that administration of resuscitation fluids is not entirely innocuous. Aggressive intravenous crystalloid administration in the presence of uncontrolled hemorrhage promotes continued bleeding and increases mortality. However this is countered by concerns that avoidance of fluids in the resuscitative phase may lead to tissue hypoperfusion, organ failure and death prior to control of bleeding. It may also have a deleterious effect on neurologic outcome in patients with TBI as well as increase the number of unnecessary operations. Currently there is no clear cut universal consensus pertaining to the optimal resuscitation strategy in trauma patients. However most prudent trauma surgeons propose, that a policy of judicious fluid administration to maintain the MAP in the 60-80 mmHg range is advisable and appropriate. Fluid resuscitation in trauma should be considered a double edged sword (too much too early or too little too late!). It should not be considered definitive therapy; as in a number of trauma patients it is only a temporizing measure, until surgical control of bleeding can be achieved.

Brain Injuries↗
PubMed2004

[Thrombolysis during cardiopulmonary resuscitation].

It has been estimated that 50-70% of cardiac arrests are caused by acute myocardial infarction or fulminant pulmonary embolism. Thrombolysis could be the treatment of choice during cardiopulmonary resuscitation given its ability to treat the underlying cause of the condition. Traditionally thrombolysis during cardiopulmonary resuscitation has been contraindicated because of risk of life-threatening bleeding complications. Early clinical experience and results of several trials suggest that the risk of bleeding is lower and the overall clinical benefit is greater than previously thought. Imbalance between coagulation and fibrinolysis develops during cardiopulmonary resuscitation, followed by disseminated clotting in small vessels. This condition causes inadequate reperfusion of the brain. Experimental studies demonstrate that besides dissolving coronary thrombus or pulmonary emboli, thrombolytic therapy improves microcirculatory flow resulting in better reperfusion of the brain which translates into better neurological outcome after resuscitation. Should the currently ongoing "Thrombolysis In Cardiac Arrest - TROICA Study" confirm the results of the earlier trials, thrombolytic therapy may soon become part of the resuscitation guidelines.

Animals↗
PubMed2004

[Clinical study on the changes in plasma sodium level and blood erythrocyte after resuscitation with different fluid regimes at early postburn stage].

OBJECTIVE: To study the changes in plasma sodium level and blood erythrocyte after resuscitation with different fluid regimes at early postburn stage. METHODS: One hundred and fifty burn patients admitted to our burn ward were randomly divided into three groups based on the different regimes of fluid resuscitation, i.e. A (n = 50, resuscitation with balanced salt solution for to the patients with middle and small burn area, Na(+) = 130 mmol/L); B (n = 50, with the same regime as in group A for those with large burn area), and C (n = 50, with hypertonic saline resuscitation for those with large burn area, Na(+) = 174 mmol/L) groups. The fluid supplementation, and changes in plasma sodium level and blood erythrocyte count, and the mean corpuscular volume (MCV) were observed during 1st to 3rd post burn day (PBD). RESULTS: The average volume of fluid supplementation in C group was lower than that in A and B groups (P < 0.01), though the average sodium supplementation in C group was higher than that in B group within 3 PBDs (P < 0.01). The average plasma level of sodium in B group was obviously lower than that in C group within 3 PBDs (P < 0.05). Negative correlation between the plasma sodium level and burn index (BI) was observed in A and B group on 1 PBD (r = -0.84, P < 0.01). The plasma sodium level was in the lower margin of normal range (137.4 +/- 3.9) mmol/L in B group, while that in C group was in the higher margin of normal range with obvious difference compared with B and C groups (P < 0.05 or 0.01). The MCV in group was lower than that in B group on the 1st and 2nd PBD, i.e. (92.1 +/- 4.5) fl vs (95.5 +/- 5.5) fl on the 1st PBD, and (90.9 +/- 5.4) fl vs (93.2 +/- 6.4) fl on the 2nd PBD, P > 0.05). CONCLUSION: The plasma sodium level was stable with milder degree of swelling of the erythrocytes when hypertonic saline resuscitation was given to patients with large burn area during early postburn stage.

Adult↗
PubMed2005

Therapeutic effect of cisapride on gastric injury following hemorrhagic shock resuscitation in rats.

OBJECTIVE: To investigate the therapeutic effect of cisapride on gastric injury following hemorrhagic shock resuscitation. METHODS: 108 Wistar rats weighing (200 g+/-30 g) were randomly divided into a sham shock (SS) group (n=36), a hemorrhagic shock resuscitation (HS) group (n=36) and a hemorrhagic shock cisapride treated (HSC) group (n=36). Sampling at 1, 2 and 4 hours after resuscitation was done and 6 samples for each observation item were taken. The gastric blood flow volume was measured by isotope label biological microglobulin. Gastric pHi, gastric emptying, MDA and Na+-K+-ATPase of gastric mucosa were measured. RESULTS: In the HSC group, the relative residual rate of gastric pigment decreased significantly, the gastric blood flow volume elevated; gastric pHi increased significantly at 2 hours; the level of mucosal MDA decreased at 4 hours, the activity of Na+-K+-ATPase increased and the lactic acid level in the portal vein decreased significantly compared to the HS group. CONCLUSIONS: After hemorrhagic shock resuscitation, cisapride contained the following functions, 1) promoting gastric emptying, 2) increasing the blood flow of gastric blood flow volume and gastric pHi, 3) depressing the lactic acid concentration of the portal vein and improving MDA volume and Na+-K+-ATPase activity of gastric mucosa. It suggests that after complementing effective circulating blood volume for hemorrhagic shock resuscitation, early use of cisapride for gastric motility is helpful for an improvement of lasting ischemia and hypoxia in stomach.

Animals↗
PubMed2005

Administration of recombinant interleukin-11 improves the hemodynamic functions and decreases third space fluid loss in a porcine model of hemorrhagic shock and resuscitation.

We have previously demonstrated that the administration of recombinant human interleukin-11 (rhIL-11) during resuscitation improves the blood pressure in a rodent model of hemorrhagic shock. The purpose of this study was to determine whether the effects of rhIL-11 could be reproduced in a large animal model and to elucidate the impact of rhIL-11 administration on the intravascular volume status and the degree of third space fluid loss after resuscitation. A 40% blood volume hemorrhage was induced in swine (n = 45, weight of 25-35 kg) followed by a 1-h shock period and resuscitation with 0.9% sodium chloride (three times the shed blood volume). The animals were randomized to receive sham hemorrhage (group I, sham); sham hemorrhage and 50 microg/kg rhIL-11 (group II, sham + IL-11); no drug (group III, saline); or 50 microg/kg rhIL-11 (group IV, IL-11). Blood and urine samples were obtained and analyzed at baseline, at the end of hemorrhaging, and thereafter once every hour. The pleural and peritoneal effusions were precisely quantified by using clinically accepted criteria. The mean arterial pressure (MAP) was higher postresuscitation (PR) in groups I, II, and IV (71.4 +/- 7.5 mmHg, 71.0 +/- 8.9 mmHg, and 72.9 +/- 12.3 mmHg, respectively) than in group III (59.9 +/- 10.9 mmHg), and the cardiac output of PR was higher in group IV (3.46 +/- 0.56 L/min) than in group III (2.99 +/- 0.62 L/min; P < 0.01). The difference in MAP between groups I and II became statistically significant at 40 min after rhIL-11 injection and such a difference persisted for 90 min. After resuscitation, the urine output was higher, and the urine specific gravity and third space fluid loss were lower in group IV (1434 +/- 325 mL and 1.0035, 82 +/- 21 mL) than in group III (958 +/- 390 mL and 1.0053, 125 +/- 32 mL; P < 0.05). In a porcine model of hemorrhagic shock, the administration of rhIL-11 at the start of resuscitation significantly improved the cardiac output and blood pressure. This strategy also significantly reduced the extent of third space fluid losses while also having a favorable impact on the intravascular volume status as evidenced by the improved urine output.

Animals↗
PubMed2005

Increase plasma viscosity sustains microcirculation after resuscitation from hemorrhagic shock and continuous bleeding.

Resuscitation from hemorrhagic shock (50% of blood volume, BV) followed by continuous bleeding (20% of BV per hour, over the entire observation time, 90 min) was studied in the unanesthetized hamster chamber window model. Blood losses equaled 100% of total BV. A single volume infusion (resuscitation) was performed 60 min after hemorrhage using 25% of the BV with 10% hydroxyethyl starch (HES 200, group HES4), or a mixture of HES 200 with 0.3% or 0.6% (w/v) alginate (groups HES7 and HES10, respectively) leading to solutions with a uniform colloidal oncotic pressure (84-87 mmHg) and viscosities ranging from 3.8 to 9.8 cp. Results showed all solutions to be similar immediately after resuscitation (10-15 min) and diverged after this initial period. The viscosity-enhanced solutions showed improved and longer-lasting effects (90 min) relative to the conventional low viscosity, in terms of sustained arterial blood pressure, microvascular flow, capillary perfusion, and laboratory parameters. All microvascular parameters 90 min after resuscitation with low viscosity fell back to the shock level. Improved recovery obtained with a hyperviscous plasma expander was related to microcirculation shear stress preservation, leading to improve blood flow by lowering peripheral vascular resistance when compared with low viscosity resuscitation. These findings suggest the possibility of using hyperviscous plasma expanders to prolong the period for initial treatment of blood losses and definitive institution therapy.

Alginates↗
PubMed2005

[French-Bulgarian program "Resuscitation of the newborn in a delivery room"--results and perspectives].

Since the year 2000 in Republic Bulgaria was started the French Bulgarian Program "Resuscitation of the Newborn in Delivery Room" (DR). The main goal was to reduce the neonatal mortality rate due to perinatal and intrapartal asphyxia and their consequences. This was achieved by providing the Delivery rooms in the City hospitals with resuscitation equipment and improving the qualification of the personal. The French foundation Medecines du Monde has ensured the materials--Baby balloons for ventilation, laryngoscopes and Magiles for each DR and a handbook with the guidelines of the neonatal resuscitation for each of the participants. In the period 2000-2003 French and Bulgarian neonatologists from the university obstetric hospitals visited all the DR in the country and two training seminars for resuscitation of the newborn were carried out in each of them. The first positive results of this program are: reduced neonatal mortality rate from 7.8% in 2001 to 6.8% in 2003 (P < 0.05). Asphyxia as a mean cause for death in the neonatal period was 9% in 2001 and dropped to 8% in 2003. To keep on improving this results is necessary to continue improving the qualification of personal working in DR--neonatologists, obstetricians and midwifes and be sure that resuscitation equipment is always ready for action.

Bulgaria↗
PubMed2005

[Effects of different means of fluid resuscitation on apoptosis of visceral organs in rats with hemorrhagic shock].

OBJECTIVE: To observe the effects of different means of fluid resuscitation on apoptosis of visceral organs in rats with hemorrhagic shock. METHODS: The tails of 8 male SD rats were cut to cause active bleeding. Blood was collected from the carotid arteries of another 24 male SD rats and heparinized, then the 24 rats were randomly divided into 3 equal groups: no fluid resuscitation group (NF group, carotid blood was collected as described above, the tail was cut and the blood from the tail was collected in container with heparin 30 min after, and hemostasis and heparin blood transfusion were performed 60 min after cutting of the tail), controlled fluid resuscitation group [NS40 group: isosmotic saline was infused during the period of 30 to 60 min after the tail cutting to maintain the mean arterial pressure (MAP) at about 40 mm Hg and then hemostasis and heparin blood transfusion were performed 60 min after cutting of the tail], and great quantity fluid rapid resuscitation group [NS80 group: a great quantity of isosmotic saline was infused during the period of 30 to 60 min after the tail cutting to maintain the MAP at about 80 mm Hg and then hemostasis and heparin blood transfusion were performed 60 min after cutting of the tail]. Blood specimens were collected at the time points 0, 120, and 150 min to undergo blood routine examination. Another blood specimens were collected at the time points 0, 30, 60, and 90 min to undergo lactic acid examination. The surviving rats were killed and their livers, kidneys, lungs, and small intestines were taken out to undergo pathology. Cell apoptosis was examined by flow cytometry and TUNEL. RESULTS: The survival rates of the NS40 and NS80 groups were significantly higher than that of the NF group (both P < 0.05). The blood lactic acid levels of the NS40 and NS80 groups at the time points 60 and 90 min were all significantly lower than those of the NF and control groups (all P < 0.05). Apoptosis in the liver, kidney, and small intestine mucosa of the NS80 group was significantly marked than in the NF and NS40 groups (all P < 0.01). CONCLUSION: Controlled fluid resuscitation obviously reduces the early death rate of rats with severe hemorrhagic shock and apoptosis in the liver, kidney, and small intestine mucosa thereof and may benefit the prognosis.

Animals↗
PubMed2005

Use of the Trendelenburg position as the resuscitation position: to T or not to T?

OBJECTIVE: To review the literature on use of the Trendelenburg position as a position for resuscitation of patients who are hypotensive. METHODS: PubMed online, cited bibliographies, critical care textbooks, and Advanced Cardiac Life Support guidelines were searched for information on the position used for resuscitation. Because of the heterogeneity of the data, only pertinent articles and chapters were summarized. RESULTS: Eight peer-reviewed publications on the position used for resuscitation were found. Pertinent information from 2 critical care textbooks and from the Advanced Cardiac Life Support guidelines was included in the review. Literature on the position was scarce, lacked strength, and seemed to be guided by "expert opinion." CONCLUSION: The general "slant" of the available data seems to indicate that the Trendelenburg position is probably not a good position for resuscitation of patients who are hypotensive. Further clinical studies are needed to determine the optimal position for resuscitation.

Adult↗
PubMed2005

Family presence during resuscitation: a critical review of the literature.

Presence of patients' families during resuscitation has emerged as an important practice issue, sparking considerable controversy worldwide. Early advocates of allowing patients' families to be present during resuscitation faced more resistance than did current advocates because the former had little or no scientific research results to support their ideas. In the past 15 years, a number of quantitative studies, especially descriptive surveys, have been conducted. Qualitative researchers have also explored the lived experience of family members present during resuscitation and less commonly the perspectives of patients and health care providers. In this review of the literature, the current state of the science is critically reviewed and the ethical-theoretical perspectives of respective researchers and staff participants in the reviewed studies are discussed. Surveys were used to collect data in most studies to date. Limitations of these designs include small convenience samples, low response rates, use of retrospective surveys and the associated potential selection bias, and lack of consistency in survey instruments, factors that make comparison of findings between studies difficult. Recommendations to address the gaps in the current state of knowledge about family members' presence during resuscitation are discussed. Experimental and qualitative methods are especially needed to investigate the effect of family presence during resuscitation on patients, families, nurses and physicians, and other multidisciplinary staff members.

Cardiopulmonary Resuscitation↗
PubMed2005

In-hospital cardiac arrest and resuscitation outcomes: rationale for sudden cardiac death approach.

AIM: To assess the frequency of cardiac arrest and outcomes and predictors of survival after cardiopulmonary resuscitation in hospitalized patients. METHODS: We prospectively analyzed the data on all patients who experienced cardiac arrest while hospitalized at the Split University Hospital between January and December 2003. Data were collected on patients' demographic characteristics, etiology and presentation of cardiac arrest, time, site, methods, and outcomes of cardiopulmonary resuscitation. RESULTS: Out of 120 cases of cardiac arrest among 32,861 hospitalized patients, 76.7% were witnessed. Ninety-six (80.0%) patients with cardiac arrest underwent resuscitation, and 22.5% of them were discharged alive. The survival rate was 20.0% at the Department of Internal Medicine, 29.2% in the Coronary Care Unit, and only 7.1% in other departments (P=0.058, chi2 test). Out of 92 patients with witnessed cardiac arrest, 28.3% survived to discharge, whereas only one of 28 patient with unwitnessed cardiac arrest survived to discharge (P=0.004, Fisher's exact test). More patients with cardiac arrest due to ventricular fibrillation or pulseless ventricular tachycardia survived than patients with asystole and pulseless electrical activity (47.6% vs 10.7%, respectively, P<0.001, Fisher's exact test). None of the patients with unclassified cardiac arrest survived until discharge. Cardiac arrest survivors were significantly younger (60.8+/-12.9 vs 71.1+/-11.7 years, P<0.001, Student t-test). Sex had no influence on survival. There were no significant circadian or hospital shift differences in the frequency rate of cardiac arrest, but the rate of successful resuscitation was lower during the night shift. CONCLUSION: The rate of successful resuscitation was higher in the coronary care unit, during the day and in younger witnessed cardiac arrest patients with ventricular fibrillation or pulseless ventricular tachycardia.

Aged↗
PubMed2005

[Changes of myocardial dynamics in early stage of burn and effect of rapid fluid replacement in delayed resuscitation].

OBJECTIVE: To investigate the changes in myocardial dynamics in early phases of burn shock of dogs and the effects of rapid fluid infusion in delayed resuscitation. METHODS: Twelve mongrel dogs were randomly divided into control (n=6) and burn (n=6) groups. The dogs in burn group were subjected to 35% total body surface area (TBSA) III degree burn and were resuscitated with lactate Ringer's solution 6 hours postburn. The volumes and rates of fluid infusion were controlled basically on the urinary output of 1.0 mlxkg(-1)xh(-1) and cardiac output (CO) of 70%-80% of pre-burn values. The mean arterial pressure (MAP), left ventricular systolic pressure (LVSP), maximum rate of intraventricular pressure rise/down (+/-dp/dt max) and cardiac index (CI) were determined at 0.5, 1,2, 6, 7, 8, 10 and 24 hours postburn. RESULTS: The MAP, LVSP, +/-dp/dt max and CI were significantly lowered from their baseline and those of control group at 0.5 hour postburn, and they kept declining until 6 hours postburn. They showed a tendency of elevation and reached or approached the levels of that in control group within 2 hours of resuscitation, and the differences were not significant between the two groups 4 hours after burn (all P>0.05). The amount of infusion fluid within the first 4 hours of resuscitation was (3.63+/-0.99) ml/kg per 1% TBSA. CONCLUSION: The myocardial dynamics is depressed in the early stage of burn, the effective way to improve it is to infuse a large amount of fluid rapidly when resuscitation is delayed.

Animals↗
PubMed2006

[Effect of treatment with ethyl pyruvate on multiple organ dysfunction and mortality following delayed resuscitation after burn injury in rat].

OBJECTIVE: To observe the effects of ethyl pyruvate (EP) treatment on multiple organ dysfunction and mortality following delayed resuscitation after burn injury in rat, and investigate the mechanisms of its protective effect. METHODS: Male Wistar rats were subjected to 30% full-thickness scald injury followed with delayed resuscitation (6 hours postburn). (1) One hundred and thirty male Wistar rats were randomly divided into sham scald group (n=10), scald group (n=60) and EP-treatment group (n=60). In the scald group, 40 ml/kg normal saline was injected intraperitoneally 6 hours after scald injury for resuscitation, and it was repeated periodically. Following delayed resuscitation after burn injury, EP was injected at a dose of 40 mg/kg every 12 hours in EP-treatment group for 3 days. According to the interventional time points, rats of scald and EP-treatment groups were respectively divided in three subgroups: 2 hours prior to scald (n=20), 2 hours after scald (n=20), and 12 hours after scald (n=20). The mortality of animals was observed with 7 days as the cut point. (2) Seventy male rats were randomly divided into sham scald group (n=10), scald group (n=30), and EP-treatment group (n=30). In EP-treatment group, 40 mg/kg EP was injected intraperitoneally 2 hours after scald. Animals were sacrificed at 12, 24, and 72 hours postburn, and serum samples were collected to determine the organ functional parameters, and lung tissue was obtained for measurement of myeloperoxidase (MPO) activity. RESULT: The 7-day mortality in scald and EP-treatment groups (EP given 12 hours postburn) was 75.0% and 35.0% respectively (P<0.05). Compared with scald group, serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), creatinine (Cr) and creatine kinase (CK) levels were markedly decreased in EP-treatment group at 12 to 24 hours postburn (P<0.05 or P<0.01), and pulmonary MPO activities were also significantly declined at 12 to 72 hours following burns (P<0.05 or P<0.01). CONCLUSION: EP can obviously improve the outcome in rats with delayed resuscitation after burn injury, and prevent the development of multiple organ dysfunction secondary to major burns.

Animals↗
PubMed2005

Synthes Award for Resident Research on Brain and Craniofacial Injury: normoxic ventilatory resuscitation after controlled cortical impact reduces peroxynitrite-mediated protein nitration in the hippocampus.

Resuscitation with 100% ventilatory oxygen is routinely initiated after severe traumatic brain injury (TBI). Despite the objective to improve oxygenation of the injured brain, there are concerns about the increased production of reactive oxygen species (ROS), which can lead to further neuronal damage. 3-nitrotyrosine (3-NT), the product of peroxynitrite-meditated tyrosine residue nitration, has been used as a marker for ROS-induced oxidative damage to proteins. We hypothesized that posttraumatic resuscitation with hyperoxic ventilation with a fraction of inspired oxygen (Fio2, 100%) results in increased ROS-induced damage to proteins compared with resuscitation with normoxic ventilation or room air (Fio2, 21%). Male Sprague-Dawley rats underwent controlled cortical impact (CCI) and were resuscitated with either normoxic or hyperoxic ventilation for 1 hour after injury (n = 5 per group). Sham-operated control groups received 1 hour of normoxic or hyperoxic ventilation without CCI (n = 4-5 per group). Twenty-four hours after injury, rats were perfused with fixative, and hippocampi were evaluated for levels of 3-NT immunostaining. In a second experiment, for a delayed assessment of neuronal survival, another set of rats similarly underwent CCI and normoxic or hyperoxic ventilation for 1 hour (n = 4 per group), and a sham-operated group was used as a control (n = 4). One week after injury, neuronal cell counts and abnormal cell quantification were performed after staining with the neuron-specific NeuN antibody. Quantification of 3-NT staining revealed significantly increased levels in the ipsilateral hippocampus in the hyperoxic CCI group. The normoxic group showed a 51.0% reduction of staining in CA1 when compared with those rats resuscitated with hyperoxia and a 50.8% reduction in CA3 (both P < 0.05). There was no significant difference in staining between the injured normoxic group and the sham-operated groups. In the delayed analysis of neuronal survival, although neuronal counts were reduced in the hippocampus on the injured side in both injured groups, there was no significant difference between hyperoxic and normoxic groups. Similarly, abnormal cell counts were not significantly different between groups.

Animals↗
PubMed1992

A study of chest compression rates during cardiopulmonary resuscitation in humans. The importance of rate-directed chest compressions.

A prospective, cross-over trial was performed comparing two different rates of precordial compression using end-tidal carbon dioxide as an indicator of the efficacy of cardiopulmonary resuscitation in 23 adult patients. A second purpose of this study was to determine the effect of audio-prompted, rate-directed chest compressions on the end-tidal carbon dioxide concentrations during cardiopulmonary resuscitation. Patients with cardiac arrest received external chest compressions, initially in the usual fashion without rate direction and then with rhythmic audiotones for rate direction at either 80 compressions per minute or 120 compressions per minute. Nineteen of 23 patients had higher end-tidal carbon dioxide levels at the compression rate of 120 per minute. The mean end-tidal carbon dioxide level during compressions of 120 per minute was 15.0 +/- 1.8 mm Hg, slightly but significantly higher than the mean level of 13.0 +/- 1.8 mm Hg at a compression rate of 80 per minute. However, end-tidal carbon dioxide levels increased rather dramatically when audiotones were used to guide the rate of chest compressions. Mean end-tidal carbon dioxide concentration was 8.7 +/- 1.2 mm Hg during standard cardiopulmonary resuscitation immediately before audio-prompted, rate-directed chest compression and increased to 14.0 +/- 1.3 mm Hg after the first 60 seconds of audible tones directing compressions. Using end-tidal carbon dioxide as an indicator of cardiopulmonary resuscitation efficacy, we conclude that audible rate guidance during chest compressions may improve cardiopulmonary resuscitation performance.

Aged↗
PubMed1991

Cerebral hemodynamic effects of fluid resuscitation in the presence of an experimental intracranial mass.

We addressed the impact on intracranial pressure (ICP) of posthemorrhage fluid resuscitation with a protocol in which additional fluid was infused to maintain a stable cardiac output after an initial bolus of fluid was infused. Anesthetized, mechanically ventilated mongrel dogs (n = 27) underwent a 30-minute interval of hemorrhagic shock (mean arterial pressure = 55 mm Hg) during which inflation of a subdural balloon maintained ICP at 15 mm Hg. After shock, animals were resuscitated with one of four randomly assigned fluids: (1) slightly hypotonic crystalloid (Na+, 125 mEq.L-1; designated Na-125); (2) hypertonic crystalloid (Na+, 250 mEq.L-1; designated Na-250); (3) slightly hypotonic crystalloid plus 10% pentastarch (Na-125P); or (4) hypertonic crystalloid plus 10% pentastarch (Na-250P). Supplemental fluid was administered as needed to maintain cardiac output comparable to baseline values. ICP increased progressively in all fluid groups during resuscitation. Cerebral blood flow, measured by the cerebral venous outflow method, increased immediately after resuscitation and then declined steadily over time in all groups. Fluids containing pentastarch maintained hemodynamic stability with minimal supplementation throughout most of the postresuscitation period, compared with crystalloid alone, which required substantial additional volume. If decreased intracranial compliance and hemorrhage are combined, ongoing resuscitation is associated with significantly increased ICP and significantly decreased cerebral blood flow, independent of the tonicity and oncotic pressure of the infused fluid.

Animals↗
PubMed1991

Buffer solutions may compromise cardiac resuscitation by reducing coronary perfusion presssure.

OBJECTIVE: --To investigate the effects of hypertonic buffer solutions on coronary perfusion pressure (CPP) and resuscitability during experimental closed-chest cardiac resuscitation. DESIGN: --Randomized, placebo-controlled trial. SETTING: --Mammalian research laboratory. PARTICIPANTS: --Forty-four domestic pigs. INTERVENTIONS: --Cardiac arrest was induced by ventricular fibrillation in mechanically ventilated pigs anesthetized with pentobarbital sodium. Precordial compression was started at the third minute of untreated ventricular fibrillation and maintained for an interval of 8 minutes. A hypertonic solution of sodium bicarbonate, Carbicarb (an equimolar mixture of sodium bicarbonate and sodium carbonate [International Medication Systems, Ltd]), or sodium chloride or an isotonic solution of sodium chloride was infused into the right atrium over a 1-minute interval starting at the sixth minute of ventricular fibrillation. Restoration of spontaneous circulation was attempted by DC transthoracic countershock after 11 minutes of ventricular fibrillation. MAIN OUTCOME MEASURES: --Plasma osmolality, CPP, and cardiac resuscitability. RESULTS: --Infusion of hypertonic buffer and sodium chloride solutions increased plasma osmolality from an average of 280 to 330 mOsm/kg. This was accompanied by a significant decrease in the aortic pressures and CPPs generated during precordial compression. No such changes occurred after infusion of isotonic sodium chloride. Restoration of spontaneous circulation, as in earlier studies, was contingent on the levels of CPP prior to attempted defibrillation. Accordingly, none of 13 animals in which the CPP declined to less than 10 mm Hg after infusion of the hypertonic solutions were successfully resuscitated. This contrasted with nine animals that received isotonic sodium chloride and served as controls. Coronary perfusion pressure consistently exceeded 10 mm Hg in these control animals, and spontaneous circulation was restored in each instance. CONCLUSIONS: --Hypertonic solutions and specifically buffer solutions administered in the absence of vasopressor agents may adversely affect cardiac resuscitation efforts by reducing CPP below critical thresholds.

Animals↗