Attempts at cardiopulmonary resuscitation (CPR) date from antiquity, but it is only in the last 50 years that a scientifically-based methodology has been developed. External chest compressions is the standard method for managing circulatory arrest, however, numerous alterations of this technique have been proposed in attempts to improve outcome from ...

OBJECTIVE: The use of automatic external defibrillators (AEDs) by EMS initial responders is widely advocated. Evidence supporting the use of AEDs is based largely on the experience of one metropolitan area, with effect on survival in many systems not yet proved. We conducted this study to determine whether the addition ...

OBJECTIVE: To evaluate the effect of adrenaline on cardiac function when given early or later in the reperfusion period. DESIGN: Prospective study. SETTING: University laboratory. PARTICIPANTS: Wistar rats. INTERVENTIONS: Isolated rat hearts were subjected to 45 minutes of normothermic ischaemic arrest. During reperfusion, adrenaline was administered early (2 minutes) or ...

We reviewed the hospital records of 127 consecutive patients who were resuscitated from cardiac arrest in a retrospective cohort analysis. A cardiac arrest score utilizing time to return of spontaneous circulation, systolic blood pressure at the time of presentation, and initial neurologic exam were calculated. This score was analyzed with ...

STUDY OBJECTIVES: To assess the incidence of acute mechanical causes precipitating sudden cardiac arrest in cardiac surgery patients during the immediate postoperative period. In addition, we report the success rate of cardiopulmonary resuscitation (CPR) in which open-chest CPR was employed at an early stage of the resuscitation effort. METHODS: Data ...

This study was designed to test the hypothesis that distinct alterations in cardiac beta-adrenoceptors (betaARs) may occur during cardiopulmonary bypass (CPB) alone, during CPB with cold cardioplegic cardiac arrest (CCCA), and during CPB with electrically induced ventricular fibrillation (EIVF). We assessed the density and affinity of right atrial betaARs in ...

Myocardial damage in Chagas' disease differs, depending on the particular Trypanosoma cruzi stock. It is reasonable to expect that the extent of phylogenetic divergence between lineages will have an impact on the biological properties of the parasite. The aim of the present work was to evaluate this impact on the ...

The purpose of the study was to determine the epidemiology and the etiology of cardiac arrests witnessed by emergency medical services (EMS) personnel and the survival from resuscitation according to the Utstein style. Consecutive prehospital cardiac arrests witnessed by EMS personnel in the Helsinki City EMS system between January 1, ...

BACKGROUND: Mouth-to-mouth rescue breathing is a barrier to the performance of bystander cardiopulmonary resuscitation (CPR). We evaluated the need for assisted ventilation during simulated single-rescuer bystander CPR in a swine myocardial infarction model of prehospital cardiac arrest. METHODS AND RESULTS: Steel cylinders were placed in the mid left anterior descending ...

OBJECTIVES: We sought to describe the incidence, characteristics and survival of out-of-hospital sudden cardiac arrest (SCA) in the Maastricht area of The Netherlands. BACKGROUND: Incidence and survival rates of out-of-hospital SCA in different communities are often based on the number of victims resuscitated by the emergency medical services. Our population-based ...

BACKGROUND: As many as 1000 lives are lost annually from cardiac arrest in commercial aircraft. Ventricular fibrillation (VF), the most common mechanism, can be treated effectively only with prompt defibrillation, whereas the current policy of most airlines is to continue cardiopulmonary resuscitation pending aircraft diversion. The objective of this study ...

OBJECTIVE: To assess the association between arterial lactate concentration on admission and the duration of human ventricular fibrillation cardiac arrest, and to what degree the arterial lactate concentration on admission is an early predictor of functional neurological recovery in human cardiac arrest survivors. DESIGN: Cohort study. Arterial lactate concentrations and ...

OBJECTIVE: To assess echocardiographic observations during in hospital cardiopulmonary resuscitation (CPR) and the utility of this information in the management of cardiac arrest. DESIGN: Echocardiographic system brought to the hospital site of cardiac arrest and applied to patients in conjunction with conventional CPR. SETTING: Large community-hospital with portable echocardiographic system ...

OBJECTIVE: The purpose of the study was to test the hypothesis that cardiac mucosa, carditis, and specialized intestinal metaplasia at an endoscopically normal-appearing cardia are manifestations of gastroesophageal reflux disease. SUMMARY BACKGROUND DATA: In the absence of esophageal mucosal injury, the diagnosis of gastroesophageal reflux disease currently rests on 24-hour ...

To describe the use of the Automatic External Defibrillation (AED) device in an urban, two-tiered Emergency Medical Service (EMS) response setting with regard to its potential effects on cardiac arrest patient survival and neurologic outcome. A retrospective and descriptive design was utilized to study all cardiac arrest patients that had ...

Cardiopulmonary resuscitation has improved outcome from cardiac arrest. However complications may occur secondary to the resuscitation efforts. We present a case of intraabdominal haemorrhage, due to traumatic rupture of the spleen and discuss the problems of diagnosing intraabdominal haemorrhage in the post cardiac arrest patient, whose hypotension may be ascribed ...

Based on work performed in many laboratories including our own, we suggest the following schematic shown in Figure 4 to explain metabolic acidosis and the effects of alkalinization therapy. Metabolic acidosis induces prompt and substantial decreases in cardiac functional performance. This is mediated by an intracellular acidosis which impairs cardiac ...

Report of a suicidal mono-intoxication with the class IC antiarrythmic drug propafenone. A 20-year-old female physician's assistant secretly ingested the substance (presumably 20 tablets per 300 mg) about 4-6 h before her death, and in the interim remained under the supervision of her physician. An ECG taken about 1/2-2 h ...

OBJECTIVES: To determine the hemodynamic effect of vasopressin on coronary perfusion pressure (CPP) in prolonged human cardiac arrest. METHODS: A prospective, open-label clinical trial of vasopressin during cardiac resuscitation was performed. Ten patients presenting in cardiac arrest initially received resuscitative measures by emergency physicians according to Advanced Cardiac Life Support ...

BACKGROUND: Neuronal damage is a possible complication of cardiac surgery. To reduce the potential risk of postoperative neurological deficit, the functional state of affected central nervous system pathways is monitored intraoperatively by recording evoked potentials (EPs). Apart from animal research, there is little clinical evidence of EPs recording during cardiac ...

Idiopathic ventricular fibrillation is defined as cardiac arrest in the absence of structural heart disease and other identifiable causes of ventricular fibrillation. It occurs in 1% to 9% of survivors of out-of-hospital cardiac arrest. The mean age of these patients is 35 to 40 years, and 70% to 75% are ...

OBJECTIVES: We sought to establish the diagnostic accuracy of transesophageal echocardiography (TEE) during cardiopulmonary resuscitation. BACKGROUND: Because of its bedside diagnostic capabilities, excellent cardiac images and lack of interference with resuscitation efforts, TEE is ideally suited to determine the cause of a circulatory arrest that is not due to severe ...

The effects of three anesthetic regimens on an established model of pediatric porcine hypoxic-hypercarbic arrest were examined. Twenty-four preadolescent miniature piglets were paralyzed, mechanically ventilated and anesthetized with one of three regimens: IM + IV pentobarbital (n = 8); IM + IV ketamine (n = 8); or IM ketamine+inhaled isoflurane ...

This report summarizes the clinical and socioeconomic characteristics of the first 542 patients entered into the Antiarrhythmics Versus Implantable Defibrillator (AVID) trial. AVID is a multicenter trial comparing a strategy of initial implantable cardioverter-defibrillator placement to initial antiarrhythmic drug therapy in preventing death in patients resuscitated from cardiac arrest who ...

A previously fit 37-year-old woman was admitted with acute left ventricular failure, atrial fibrillation and a left-sided thromboembolic stroke. Her ventricular rate progressively increased despite full digitalisation. She had a cardiac arrest and was successfully resuscitated. Investigations revealed evidence of hyperthyroidism and she was treated for thyrotoxic crisis. She has ...

STUDY OBJECTIVE: To determine the epidemiology of unwitnessed out-of-hospital cardiac arrest and the factors associated with survival after resuscitation using the Utstein style data collection. METHODS: We conducted a prospective cohort study in a 525,000-population city served by a single EMS system comprising a tiered response with physicians in the ...

BACKGROUND: Global left ventricular dysfunction after successful resuscitation is well documented and appears to be a major contributing factor in limiting long-term survival after initial recovery from out-of-hospital sudden cardiac death. Treatment of such postresuscitation myocardial dysfunction has not been examined previously. METHODS AND RESULTS: Systolic and diastolic parameters of ...

OBJECTIVE: Air bubbles entering the coronary artery may have harmful effects on cardiac function. From the physical point of view it is the relatively high surface tension of the blood-air interface which causes bubbles to trap in small vessels. The aim of the present study was to reduce depression of ...

Standard external cardiopulmonary resuscitation (SECPR) frequently produces very low perfusion pressures, which are inadequate to achieve restoration of spontaneous circulation (ROSC) and intact survival, particularly when the heart is diseased. Ultra-advanced life support (UALS) techniques may allow support of vital organ systems until either the heart recovers or cardiac repair ...

The "chain of survival" is important in the resuscitation of a patient who has had a cardiac arrest. The provision of Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) is essential in this "chain of survival." Both BLS and ACLS have undergone several revisions since their initial inception. ...

Alternative techniques to precordial compression are sought to improve the return of spontaneous circulation after cardiopulmonary arrest. The pathophysiology of cardiac arrest and the methods to determine the efficacy of a new technique need critical re-examination. Vest cardiopulmonary resuscitation (CPR), active compression/decompression with abdominal counterpulsation (LifeStick [Datascope, Fairfield, NJ]) CPR, ...

The rationale and specifications for a permanent non-invasive cardiac monitoring device are described, including both an alarm and a device-initiated call (giving patient residence identification) to the emergency services number 911, if cardiac arrest is detected. This device may be useful for high-risk cardiac patients, who incur an unwitnessed cardiac ...

Early milestones of resuscitation research culminated in the 1950s in the documentation of modern external cardiovascular resuscitation (CPR) steps "ABC," followed by advanced and prolonged life support. Implementation of guidelines has been suboptimal. Self-training of the public in life-supporting first aid, including CPR-ABC-available since the 1970s-is only now being re-evaluated ...

This study represents the first systematic evaluation of dysrhythmias before, during, and after spaceflight including extravehicular activity (EVA). The data, based on 7 Shuttle crew members, revealed a nonsignificant decrease in ventricular and supraventricular ectopy during EVA, suggesting that the incidence of dysrhythmias is no greater during EVA than with ...

A 71 year old man with hypertensive heart disease and chronic renal failure was wearing a Holter monitor when he had a cardiac arrest. He had ventricular fibrillation (VF) and died despite prompt resuscitation. In the 15 minutes preceding the VF there was a sudden increase in heart rate, followed ...

RATIONALE AND OBJECTIVES: Recent studies indicate that manganese dipyridoxyl diphosphate (MnDPDP) may function as a slow release agent for manganese ions (Mn++) and that MnDPDP is approximately 10 times less potent than manganese chloride (MnCl2) in depressing cardiac function. The authors examined the possibility that MnDPDP and MnCl2 may influence ...

BACKGROUND: Mouth-to-mouth rescue breathing is a barrier to the performance of bystander cardiopulmonary resuscitation (CPR). We evaluated the need for assisted ventilation during simulated single-rescuer bystander CPR in a swine model of prehospital cardiac arrest. METHODS AND RESULTS: Five minutes after ventricular fibrillation, swine were randomly assigned to 8 minutes ...

BACKGROUND: We describe a new manual method of phased chest and abdominal compression-decompression with a Lifestick resuscitator for cardiopulmonary resuscitation (CPR). METHODS AND RESULTS: Ventricular fibrillation (VF) was induced in 20 domestic pigs. After either 5 or 7 minutes of untreated VF, either phased chest and abdominal compression-decompression (Lifestick resuscitator) ...

Penetrating injuries to the thoracic great vessels have been diagnosed with increased frequency because of the escalating use of automatic weapons. The overall incidence is 5.3% of gunshot wounds and 2% of stab wounds to the chest. Most of these patients reach the hospital dead or in severe shock. The ...

Miconazole is an imidazole antifungal agent that is available in topical, vaginal, and parenteral formulations. Indications for the parenteral product have become rare with the development of newer, more effective agents. A 54-year-old man who had undergone orthotopic heart transplantation developed a widespread subcutaneous Scopulariopsis infection that progressed despite treatment ...

From 954 attempts to resuscitate patients from out-of-hospital cardiac arrest two datasets were derived, namely 861 cases of cardiac arrest and 906 cases of either cardiac or primary respiratory arrest. For each dataset, multivariate analysis was performed by fitting a number of explanatory variables with respect to the outcomes of ...

BACKGROUND: A wide variety of structural abnormalities are associated with the vast majority of cardiac arrests. However, there is no evidence of structural heart disease in approximately 5% of victims of sudden death, indicating that cardiac arrest in the absence of organic heart disease is more common than previously recognized. ...

The report deals with a 27-year-old male who was standing in a tent and was injured by lightning as it struck a tree about 1.5 m away. He immediately lost consciousness and exhibited ventricular fibrillation when the emergency physician arrived. A clinical picture of hypoxaemic brain damage emerged after initially ...

A 20-year-old bulimic woman ingested 20 g of caffeine in a suicide attempt. After being evaluated and discharged from the emergency department, she was readmitted with ECG changes and ultimately found to have sustained a subendocardial infarction. This case highlights the wide-ranging health consequences of eating disorders and the toxicity ...

Several new CPR techniques and devices have been developed and tested since the first report of manual closed-chested cardiopulmonary resuscitation (CPR) nearly four decades ago. These devices and techniques include vest CPR, interposed abdominal counterpulation CPR, active compression-decompression CPR, an impedance threshold valve, intra-aortic balloon pump and phased thoracic-abdominal counterpulsation. ...

A 45-year old morbidly obese man with diabetes and severe chest problem had sudden bradycardia and sinus arrest in the Recovery Ward after an uneventful spinal anaesthesia. He responded promptly to "attempts" at external cardiac message with each thump producing a QTS complex until Atropine could be given to restore ...

The outcome of cardiopulmonary resuscitation (CPR) following cardiac surgery is not known to date. A retrospective analysis of all patients subjected to CPR during their hospital stay following heart surgery was conducted; 1.4% of patients required CPR 0.5-192 h following surgery. The mean duration of CPR was 42 +/- 29 ...

We report a case of four-year-old girl who suffered a cardiac arrest under anaesthesia, due to complete heart block without ventricular escape, during the flushing of an errantly placed longterm central venous catheter. It was subsequently found that the central line was placed in a persistent left superior vena cava ...

BACKGROUND: The early defibrillation of patients having a cardiac arrest and who are in ventricular fibrillation has been shown to increase survival and is recommended by the European Resuscitation Council (ERC) and the American Heart Association. General practitioners (GPs) may expect to encounter a cardiac arrest in 5% of patients ...

Firm myocardium in cardiopulmonary resuscitation (CPR) is a rarely described yet potentially important condition. To investigate the clinical nature and implications of firm myocardium in CPR, we retrospectively analyzed 59 adult patients with nontraumatic out-of-hospital cardiac arrest who underwent open-chest CPR in the emergency department and had heart consistency recorded. ...