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PubMed1981

[Limits of resuscitation. I. Thanatophysiologic and therapeutic limits].

Neither apodictic demands nor administration measures are suited to satisfy the various problems of the duty of treatment in the borderline region between life and death. An exact knowledge of the thanatophysiologic limits of the possibility of resuscitation during and after an anoxia and ischaemia is necessary. By effective cardiopulmonary measures of resuscitation, such as external heart massage with production of systolic pressure of 8-13 kPa as well as respiration with F1O2 1.0, the cardiac resuscitation time with immediate sufficiency (1. limit 4-41/2 min) may be prolonged to the cerebral resuscitation time from 8-10 minutes. Probably, the new concept of specific measures of cerebral resuscitation may definitively prolong also this 2nd limit. Furthermore, the fundamentals of the decision are discussed, for omitting or finishing a reanimation, or for reducing the intensive treatment. If the clinical syndrome of the dissociated cerebral death is present, without planned taking off an organ there is no necessity to render the finish of the intensive therapy dependent on legal regulations concerning the performance of organ transplantations.

Attitude to Death↗
PubMed1978

Cardiopulmonary resuscitation: impact on hospital mortality--a ten-year study.

The effectiveness of cardiopulmonary resuscitation as a vital aspect of health care delivery in hospital was the basis for a ten-year study. All instances of cardiac arrest occurring outside the operating room and nursery were included. Variations in degrees of success of cardiopulmonary resuscitation as related to the duration of the program, differences among varying subsets such as patients' type of illness and hospital location (emergency room, coronary care unit, intensive care unit or nursing floor) at the time of cardiopulmonary arrest, are presented. The relationship between cardiopulmonary resuscitation frequency and success with increasing instrumentation is reviewed. A simple technique for expressing effect of cardiopulmonary resuscitation on hospital mortality is presented. The study shows the ability of a community hospital to establish, maintain and document a high level cardiopulmonary resuscitation program.

California↗
PubMed1994

Resuscitation in uncontrolled hemorrhage.

Fluid resuscitation is considered to be an integral component of the management of hemorrhagic shock. Numerous experimental studies of hypovolemic shock have confirmed the value of volume infusions, but in these models the rate, volume, and duration of bleeding are carefully controlled. The results of such studies may not be applicable to clinical hemorrhage, in which bleeding continues unabated. Male Sprague-Dawley rats weighing 250 to 390 g were anesthetized, and a femoral artery and vein were cannulated for constant blood pressure monitoring and fluid infusion. Through a midline abdominal incision, the distal ileocolic artery and vein were transected and allowed to bleed freely into the peritoneal cavity. The abdomen was closed and the animals were randomized to one of five groups: no resuscitation; small volume lactated Ringer's solution; large volume lactated Ringer's; small volume hetastarch; or large volume hetastarch. After 3 hours or at spontaneous death, blood was withdrawn to measure hematocrit, platelet count, and fibrinogen. Blood in the peritoneal cavity was collected and measured. Animals that received either lactated Ringer's or hetastarch had more bleeding into the peritoneal cavity and a greater dilution of clotting factors than animals that received no resuscitation fluids (P < 0.05). In addition, survival was highest in unresuscitated animals, although only the small volume hetastarch group had a significantly lower survival when independently compared with no resuscitation (P < 0.05). These results suggest that in traumatic shock, fluid resuscitation should be minimized until mechanical control of bleeding can be achieved.

Abdomen↗
PubMed1995

Resuscitation of the injured child.

Unintentional injury is the leading cause of death for children less than 14 years of age. Optimal injury control includes prevention, acute care, and rehabilitation. When prevention efforts fail, a dedicated well-trained team must be prepared to resuscitate and treat the injured child. This article presents an approach to resuscitation that emphasizes the primary and secondary survey. Early and aggressive airway control with cervical spine protection is stressed, followed by a rapid assessment of ventilatory mechanics and circulatory status. Clinical indicators of inadequate tissue perfusion are described, with priorities concerning intravenous access highlighted. Initial resuscitation steps, complemented by laboratory and radiological assessment, occur before the secondary survey. The secondary survey completes the early resuscitation phase and consists of a systematic and complete physical examination. Resuscitation priorities specific to the multiply-injured child are also discussed. Finally, the importance of rehabilitation and prevention efforts are included.

Abdominal Injuries↗
PubMed1995

Ethanol added to resuscitation improves survival in an experimental model of hemorrhagic shock.

Ethyl alcohol induces systemic vasodilation, decreases platelet aggregation, and inhibits neutrophil activation in vivo. Alcohol may thus be of potential benefit in resuscitation from shock by improving microcirculation. The purpose of this study was to test the effects of ethanol (ETOH) in resuscitation from hemorrhagic shock. Blood pressure, tissue pO2, white blood cell (WBC) and platelet adhesiveness, and survival were measured for 60 male Sprague-Dawley rats in a blinded and randomized study. Anesthetized animals were phlebotomized to 60 per cent of their blood volume, and maintained in shock for 45 minutes. Resuscitation was by continuous infusion of Lactated Ringers (LR) at 2 x shed blood volume over 1 hour. The experimental group received LR and ETOH (1.25 mL/kg). Control rats received LR and placebo. Mean arterial pressure was not significantly different, nor was WBC adhesiveness index different. However, postresuscitation platelet adhesiveness index was significantly higher in control rats than in ETOH rats. Postresuscitation total platelet arterial-venous difference was also greater in controls than in ETOH rats. Average tissue pO2 for ETOH rats (47 +/- 8.2 mm Hg) was significantly higher than controls (39.0 +/- 9.8 mm Hg) during resuscitation (P = 0.0001). Survival for ETOH rats (70%) was significantly higher than controls (20%) (P = 0.003). Our data suggests that ETOH added to resuscitation from shock improves survival by inhibiting platelet activation and increasing tissue perfusion.

Animals↗
PubMed1993

Splanchnic mucosal perfusion effects of hypertonic versus isotonic resuscitation of hemorrhagic shock.

A porcine hemorrhagic shock (HS) model was used to assess the splanchnic mucosal and systemic effects of hypertonic versus isotonic crystalloid resuscitation. Animals were bled to a mean arterial pressure of 40 mm Hg for 1 hour and then resuscitated with equivalent sodium loads of LR, 7.5 per cent hypertonic saline (HSS), or 7.5 per cent HSS with 6 per cent Dextran (HSD). Intestinal mucosal blood flow (IMBF) was measured by a laser Doppler flow probe placed on the mucosa of the small bowel. Following resuscitation the cardiac output (CO) (relative to baseline values) was significantly higher with HSD (158 17 per cent) and HSS (137 24 per cent) than with LR (84 27 per cent) (P < 0.005). There was prompt restoration of IMBF with both HSD (126 31 per cent) and HSS (106 22 per cent) (vs baseline). Resuscitation with LR was associated with a persistent reduction in IMBF (52 16 per cent) despite restoration of mean arterial pressure and cardiac output to baseline levels (P < 0.05). Thus, hypertonic saline solutions may serve an adjunctive role in the resuscitation of hemorrhagic shock by restoring intestinal nutrient blood flow and, thereby, preventing gut barrier impairment, bacterial translocation, and organ failure.

Animals↗
PubMed1995

Effect of race on survival following in-hospital cardiopulmonary resuscitation.

BACKGROUND: Race has been shown to be a significant predictive factor in a number of treatment decisions and outcomes, including survival following out-of-hospital cardiopulmonary resuscitation (CPR). The goal of this study was to determine whether race is associated with the rate of survival to discharge following in-hospital CPR. METHODS: Consecutive adult patients undergoing attempted CPR at three teaching hospitals were identified. Demographic, clinical, and laboratory data from the time of admission, information about the resuscitation attempt, and the outcome of CPR were recorded for each patient. The characteristics of black and non-black patients were compared. Logistic regression was used to determine whether race was a significant independent predictor of CPR outcome. RESULTS: A total of 656 patients were identified. Black patients had a higher mean severity of illness as measured by the Acute Physiology and Chronic Health Evaluation (APACHE) III score, were more likely to have an initial rhythm of electromechanical dissociation or asystole, were less likely to have an admitting diagnosis of myocardial infarction or a history of coronary artery disease, and had a higher serum creatinine level, lower serum albumin value, and lower 24-hour urine output for the first 24 hours. There was no difference between black and nonblack patients regarding the rate of survival of the resuscitative effort itself. However, black patients were significantly less likely than nonblack patients to survive to discharge following resuscitation (Mantel-Haenszel odds ratio, 0.31; 95% confidence interval, 0.15 to 0.68). This relationship persisted after adjusting for potential confounders such as age, sex, initial cardiac rhythm, diagnosis of pneumonia, serum creatinine level, hospital, and APACHE III score. CONCLUSIONS: Black race is significantly associated with a lower rate of survival to discharge following in-hospital CPR. Further work is needed to explore this association in other settings; to examine the effect of other possible confounding variables, such as tobacco use, socioeconomic status, and marital status; and to further study the determinants of physician decision-making about resuscitation.

Adult↗
PubMed1994

[The physician's cognition during cardiopulmonary resuscitation of the human].

The cognitions of 20 emergency-physicians while working on a mobile resuscitation unit were examined by means of questionnaire in over 260 situations of resuscitation. A pattern of cognitions could be detected: Emergency physicians appear not to think very much during resuscitation. If there are thoughts, these usually concern the obvious, or what is immediately present in the situation, i.e. the patient or the patient's relatives; repression may also play a role. Cognitions which are reflective of self are rare and only develop late in the situation, depending on the surroundings and the amount of stress. The cognitions concerning the relatives are frequent in those situations with direct physician-relative contact. The physicians often report in retrospect having felt compelled to a decision for resuscitation by the presence of the relatives; nevertheless, the decision itself appears to be a result, rather, of their cognitions of the relatives. Distancing by means of cognition was ubiquitously employed as a coping strategy by physicians when in situations which were perceived as not having a positive outcome. Thoughts about "own death" or "about the patient" are specific, however, for certain groups of doctors. Results of the present investigation suggest that physicians have cognitions about relatives during the process of decision making, and cognitions about the patient during the resuscitation manoeuvre.

Adult↗
PubMed1994

Neonatal resuscitation using the laryngeal mask airway.

BACKGROUND: For a newborn requiring positive-pressure ventilation (PPV), the American Heart Association recommends bag-and-mask ventilation, a challenging procedure for those inexperienced in neonatal resuscitation. The objective of this prospective study was to evaluate the laryngeal mask airway (LMA) as an alternative method of airway management in neonates requiring PPV at birth. METHODS: With the approval of the institutional ethics committee, consent was obtained from women in labor at a tertiary care-perinatal center. Inclusion criteria consisted of an expected birth weight of at least 2.5 kg, gestational age of at least 35 weeks, and resuscitation requiring PPV. Neonates meeting these criteria were resuscitated with PPV by means of the LMA. The ease of insertion, number of attempts required, time to establish effective ventilation, skin color, heart rate, respiratory effort, and Apgar scores were recorded. RESULTS: Attendance by the investigators at delivery was achieved in 93 cases, with 21 meeting the inclusion criteria. In all cases, the LMA was successfully inserted on the first attempt and provided a clinically patent airway. Twenty neonates were successfully resuscitated with the LMA to provide PPV, with no complications directly attributable to its use. One neonate required LMA removal and tracheal intubation to facilitate administration of epinephrine; data from this case was removed from the study. CONCLUSIONS: Providing PPV at birth via a size-1 LMA is effective and easily learned by personnel with expertise in neonatal resuscitation. The LMA should be further assessed as an alternative to bag-and-mask ventilation for this purpose.

Evaluation Studies as Topic↗
PubMed1993

[Thrombolytic therapy after prolonged cardiorespiratory resuscitation in acute myocardial infarct with primary ventricular fibrillation].

Treatment of acute myocardial infarction with intravenous thrombolytic agents improves survival and limits the infarct's size. Despite its proved efficacy, thrombolytic therapy is currently used for only a minority of patients with acute myocardial infarction. Because of the possibility of significant haemorrhagic complications, certain groups of patients traditionally have been excluded from receiving this therapy. Patients with acute myocardial infarction following prolonged cardiopulmonary resuscitation are often considered ineligible for thrombolytic therapy, because an higher bleeding risk. The Authors report the case of a 52 yr old man with primary ventricular fibrillation and acute myocardial infarction treated with streptokinase i.v. after having a prolonged (20 min.) cardiopulmonary resuscitation. The patient did not report gross trauma and recovered to a completely functional status without any relevant bleeding complication. To date, only few case reports exist on thrombolysis in patients with recent prolonged resuscitation, and most of them are favourable. The literature on thrombolytic therapy in acute myocardial infarction following cardiopulmonary resuscitation is reviewed. Recent (< 2 w) prolonged (< 1 min.) cardiopulmonary resuscitation, per se, should not be regarded as absolute contraindication for thrombolytic therapy in patients with acute myocardial infarction if gross trauma and oldest age are absent. Prospective controlled studies are necessary to remove definitively this contraindication for thrombolysis.

Acute Disease↗
PubMedDate not supplied

A comparison of resuscitation skills of qualified general nurses and ambulance nurses in The Netherlands.

OBJECTIVE: To investigate the ability of qualified general nurses to perform cardiopulmonary resuscitation and to compare these skills with those of a group of ambulance nurses. DESIGN: Cross-sectional assessment of practical cardiopulmonary resuscitation skills. SUBJECTS: 141 Dutch general nurses. OUTCOME MEASURES: The practical skills were tested with six primary variables that describe the quality of cardiopulmonary resuscitation techniques in a training situation. A total score on the skills was computed based on a predefined scoring system. RESULTS: The percentage of general nurses who were able to achieve a pass score (i.e., the total score did not exceed 15 penalty points) was 6.4 percent. The average score was 37.8 penalty points. Eighty-eight percent of the ambulance nurses achieved a pass score. The average number of penalty points was 10.5. CONCLUSIONS: The practical skills in cardiopulmonary resuscitation are insufficient in the majority of this sample of general nurses in The Netherlands. The findings of this study should be used as a base to design an optimal form and content of an educational re-instruction program. We expect that a considerable improvement could be achieved by more frequent cardiopulmonary resuscitation re-instruction.

Adult↗
PubMed1994

[Application of PCPS (percutaneous cardiopulmonary support) to the resuscitation of DOA (dead on arrival) patients].

We report three cases of DOA patients who were resuscitated by using PCPS. All had resisted standard advanced life support methods. The conditions responsible for the heart arrest were acute myocardial infarction (AM1) in 2 (case 1 and 3) and subarachnoid hemorrhage (SAH) in the other (case 2). All 3 were resuscitated by PCPS. Case 1 survived with a slight neurological deficit. Case 2 succumbed to SAH 3 days later. Case 3 was transferred to left heart bypass but succumbed to hemorrhagic infarction of the brain 6 days later. Although this system allows rapid and simple deployment and provides a benefit in resuscitation of DOA patients in a state that is refractory to standard cardiopulmonary resuscitation, the problem of indication for resuscitation remains to be solved.

Angioplasty, Balloon, Coronary↗
PubMed1993

Fluid resuscitation in circulatory shock.

Over the past century, the treatment of various forms of circulatory shock has included fluid resuscitation with either crystalloidal or colloidal solutions. Despite decades of investigation, there still is considerable controversy over the beneficial and adverse effects of each fluid type. Most authors agree that the initial resuscitation of any form of shock should be performed with crystalloid solutions. Trauma resuscitation uses crystalloid therapy almost exclusively. Much controversy exists when the shock state involves increased microvascular permeability, such as seen in sepsis, anaphylaxis, and burns. Concerns involve increased permeability pulmonary edema and whether colloid or crystalloid therapy may contribute to its formation. Regardless of fluid type used for resuscitative efforts, it is essential to ensure adequate invasive and noninvasive monitoring to guide therapy. Endpoints to resuscitation should include stabilization of vital signs, adequate urine output, adequate cardiac output, and evidence of supply-independent oxygen consumption. Side effects of aggressive fluid loading are frequent and include intravascular volume overload, pulmonary edema, increased myocardial water content, brain swelling, gastrointestinal ischemia, and massive systemic edema. These complications can best be minimized by careful fluid titration, using physiologic and hemodynamic endpoints.

Clinical Protocols↗
PubMed1996

Fluid resuscitation of the trauma patient: how much is enough?

Patient management in the prehospital resuscitative phase after trauma is vitally important to the outcome. Early definitive care remains the essential element in improving morbidity and mortality. In Canada, where a large proportion of trauma occurs at sites distant from a trauma centre, the prehospital resuscitative phase is long and has even greater potential to affect outcome. Conventional teaching about the end points of resuscitation has promoted the concept of normalization of hemodynamic parameters with maintenance of end-organ perfusion, as measured by the hourly urine output. Recent work in patients with a closed head injury and in patients with penetrating torso trauma challenge the notion that trauma patients are homogeneous with respect to these end points. In the Canadian setting of blunt injury, where a closed head injury is usually suspected and often present, the evidence from clinical studies suggests that an aggressive approach to maintaining blood pressure is warranted. In penetrating torso injury in an urban setting, there is evidence to suggest that delaying resuscitation until hemorrhage is controlled is beneficial. More Canadian clinical trials are required in this area. In the meantime, the priorities of resuscitation must be carefully assessed for each patient and pattern of injury.

Canada↗
PubMed1996

Funding resuscitation research.

The present trend in managed care has meant downsizing expectations concerning the availability of support for resuscitation research. This trend applies to funding possibilities from industry, governmental agencies, and nongovernmental agencies (Table 1). There will be increasing barriers to making innovations. Truth, science, and good patient care alone will not make potential donors give grants. Investigators must also understand the potential donors' expectations and be persuasive. "Delight your donor". Industries' concerns include intellectual property rights and publications. The National Institutes of Health, recently favoring molecular biology over lifesaving therapies or integrated physiologic research, is an anomaly. The current peer review system propagates itself without having advocates for resuscitation research. This system has become a self-fulfilling prophecy. The American Heart Association is only recently, after 30 yrs of educational activities concerning cardiopulmonary resuscitation, considering putting some basic research money into resuscitation research. In university hospitals, where clinical departments have made significant contributions to innovative, clinically relevant life-support research, funded with incomes from patient care, the sky is beginning to fall. Resuscitation researchers need persuasive advocates with clout and hard data to convince funding agencies to give support to multilevel research and development in areas of pathophysiology and reversibility of terminal states and clinical death--to give these topics a higher priority than is currently available.

American Heart Association↗
PubMed1996

[Cardiopulmonary resuscitation skills. A survey among health and rescue personnel outside hospital].

The aim of this study was to survey practical skills and theoretical knowledge in lifesaving first aid among health and rescue workers outside hospital. 45 police officers, 46 firemen, 57 nurses and 42 general practitioners participated. Unprepared, they were presented with a "patient" (resuscitation doll) without respiration or heart beat, and were asked to do what was necessary to revive the "patient". They were afterwards questioned about specific emergency medical situations, how they assessed their own achievement and when they last had training in cardiopulmonary resuscitation. Only 1% were able to perform satisfactory basic cardiopulmonary resuscitation of a cardiac arrest according to the accepted guidelines, and only 17% ventilated and compressed efficiently with a rhythm of 2:15 or 1:5. 50% believed they were efficient in lifesaving first aid. Those who had taken a course in first aid during the previous year achieved significantly better results than the rest. It is concluded that health and rescue workers outside hospital follow the European Resuscitation Council's guidelines for basic cardiopulmonary resuscitation to only a small degree, but that the situation can be improved by more regular training.

Cardiopulmonary Resuscitation↗
PubMed1996

Effect of resuscitation on bacterial translocation in haemorrhagic shocked rats.

The aim of this study was to investigate the resuscitative effects of various intravenous solutions on intestinal mucosal damage and bacterial translocation due to haemorrhagic shock. Seventy Sprague-Dawley rats were anaesthetised and subjected to thirty minutes of haemorrhagic shock (systolic blood pressure 40 mmHg). Resuscitation was established with either autologous-blood, three per cent hypertonic saline (HS), 7.5% HS, 0.9% NaCl and Ringer's lactate and Dextran 70 solution. Animals in sham shock group were only cannulated and not resuscitated. Bacterial translocation was evaluated by culture of mesenteric lymph nodes taken 24 hours after resuscitation. The rates of bacterial translocation observed were 50% in autologous blood group, 60% in Dextran 70 group, 40% in Ringer's lactate group, 10% each in 3% HS and 7.5% HS group and 20% in 0.9% NaCl group. A statistically significant difference was observed between the groups resuscitated with HS solution and the other solutions. No meaningful difference was noted between the various concentrations of hypertonic saline solution. The reduction in the rate bacterial translocation with hypertonic solution is assumed to be due to preservation of intestinal microcirculation and thus prevention of intestinal ischaemia.

Animals↗
PubMed1997

The impact of do-not-resuscitate orders on nursing workload in an ICU.

BACKGROUND: The meaning of do-not-resuscitate orders and their impact on nursing care have been a source of confusion, and the results of the few studies that have examined nursing care of ICU patients with these orders have been conflicting. OBJECTIVES: To assess nursing workload associated with caring for patients with do-not-resuscitate orders and to better understand the patients and selected events associated with these orders. METHOD: Sixty patients from medical, surgical, and neuroscience ICUs met the criteria for the study. The Medicus Systems Corporation InterAct 2000 Workload and Productivity System was used to classify patients by type; the results reflected the number of hours of nursing care required per 24 hours. Data on patient type for 1 day before and 1 day after do-not-resuscitate orders were written were available for 31 of the 60 patients. These data were analyzed. RESULTS: The number of hours of nursing care required 1 day before and 1 day after a do-not-resuscitate order did not change. The amount of nursing care remained the same or increased for 74% (23/31) of the patients after the order was written. Patients were classified as types IV (n = 8), V (n = 20), and VI (n = 3) after the order was written. CONCLUSIONS: A high level of nursing care was required for this group of critically ill patients, and the do-not-resuscitate order did not alter the number of hours of nursing care required after the order was written.

APACHE↗