The percutaneous cardiopulmonary support system (PCPS) has been widely accepted for the treatment of patients with severe cardiac failure. This system, which uses Seldinger's method through a percutaneous approach, enables rapid application in emergency situations. However, the indication for deployment and discontinuation of PCPS has not yet been established. We ...

OBJECTIVES: To determine whether there is an association between bystander mouth-to-mouth ventilation and regurgitation in prehospital cardiac arrest patients. DESIGN: Prospectively conducted observational study. SETTING: Data were collected from patients treated by the emergency medical service (EMS) systems in three middle-sized or large Finnish urban communities, the Tampere District EMS ...

BACKGROUND: Administration of high doses of prostaglandins is a frequently performed and effective method for the treatment of atonic uterine haemorrhage in order to increase uterine muscle tone. Rarely, however, these drugs may cause life-threatening complications including bronchospasm, acute pulmonary oedema and myocardial infarction caused by coronary spasms. METHODS: We ...

BACKGROUND: Sudden cardiac arrest is a common mechanism of premature death in the community. Resuscitation is often possible, but no large study of resuscitation by doctors who practice there has been published. METHODS: General practitioners (GPs) equipped with defibrillators reported 555 patients with cardiac arrest in whom they attempted resuscitation. ...

BACKGROUND: Patients suffering in-hospital cardiac arrest (IHCA) often have abnormal clinical observations documented prior to the arrest. This study assesses whether these patients have a less favourable outcome following IHCA. METHODS: A multiple logistic regression analysis of retrospectively collected hospital chart data and prospectively collected Utstein style resuscitation data. Patients ...

Our group has developed a rat model of cardiac arrest and cardiopulmonary resuscitation (CPR). However, the current rat model uses healthy adult animals. In an effort to more closely reproduce the event of cardiac arrest and CPR in humans with chronic coronary disease, a rat model of coronary artery constriction ...

BACKGROUND: Mild hypothermia improves outcome when induced after cardiac arrest in humans. Recent studies in both dogs and mice suggest that induction of mild hypothermia during cardiopulmonary resuscitation (CPR) greatly enhances its efficacy. In this study, we evaluate the time window for the beneficial effect of intra-arrest cooling in the ...

Cardiac surgery is performed in approximately 770,000 adults and 30,000 children in the United States of America annually. In this review we outline the mechanistic links between post-operative myocardial stunning and the development of myocardial edema. These interrelated processes cause a decline in myocardial performance that account for significant morbidity ...

BACKGROUND: The fundamental goal of cardiopulmonary resuscitation (CPR) is recovery of the heart and the brain. This is best achieved by (1) immediate CPR for coronary and cerebral perfusion, (2) correction of the cause of cardiac arrest, and (3) controlled cardioplegic cardiac reperfusion. Failure of such an integrated therapy may ...

PURPOSE OF REVIEW: This review examines the clinical significance of agonal respirations associated with cardiac arrest. RECENT FINDINGS: Observational data indicate that agonal respirations are frequent (55% of witnessed cardiac arrests and probably higher) and that they are associated with successful resuscitation. They also are found more commonly in ventricular ...

Sudden cardiac arrest is a major public heath problem, affecting more than 450,000 individuals annually. Response time and the initiation of cardiopulmonary resuscitation (CPR) remain the most important factors determining successful revival. During resuscitation, sympathomimetics are given to enhance cerebral and coronary perfusion pressures in an attempt to achieve restoration ...

PURPOSE OF REVIEW: Patients who are successfully resuscitated following cardiac arrest often have a significant medical condition termed postresuscitation disease. This includes myocardial stunning, metabolic abnormalities and neurologic injury from global ischemia. There are no clinical signs or diagnostic tests for 24-72 h to distinguish patients who will and will ...

OBJECTIVES: To determine, by means of autopsy, the cause of death following unsuccessful cardiopulmonary resuscitation of patients with a witnessed prehospital cardiac arrest of unclear origin. METHOD: Observational study of all prehospital-witnessed cardiac arrest of unclear origin over a period of 19 months in the emergency medical service region of ...

BACKGROUND: Patients with cardiac arrest have been excluded from most randomized trials on percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). OBJECTIVE: The aim of the study was to evaluate the outcome of patients undergoing primary PCI for acute myocardial infarction who suffered from cardiac arrest prior to the ...

PURPOSE OF REVIEW: This review identifies the most serious complications likely to be encountered in the current practice of paediatric anaesthesia. RECENT FINDINGS: The findings of the ASA Closed Claims Project, published in 1993, showed a higher proportion of closed paediatric malpractice claims related to respiratory events than to cardiovascular ...

This report describes a 43 yr old man diagnosed with U.K. acquired cyclospora cayetanensis infection resulting in fever and diarrhoea. In course of the febrile illness, he suffered an out of hospital cardiac arrest. Extensive cardiac investigation including a transthoracic echocardiogram, coronary angiogram, and cardiac electrophysiological studies failed to identify ...

Life-history theory has suggested that individual body size can strongly affect the allocation of resources to reproduction and away from other traits such as survival. In many insects, adults eclose with a proportion of their potential lifetime egg production that is already mature (the ovigeny index). We establish for the ...

Volatile anesthetics reduce ciliary beat frequency in vitro. It has been reported that impaired bronchial mucus transport velocity (BTV) is associated with significantly increased pulmonary complications. In this study, we sought to determine in vivo differences in BTV, comparing patients having total IV anesthesia (TIVA) with propofol and remifentanil to ...

BACKGROUND: Studies have confirmed the neuroprotective effect of diazoxide in canines undergoing hypothermic circulatory arrest (HCA). A decreased N-acetyl-asparate:choline (NAA:Cho) ratio is believed to reflect the severity of neurologic injury. We demonstrated that noninvasive measurement of NAA:Cho with magnetic resonance spectroscopy facilitates assessment of neuronal injury after HCA and allows ...

BACKGROUND: Extradural lidocaine exerts several adverse effects which are seldom fatal. While cardiac arrest following extradural lidocaine injection has been reported in human beings, it has not hitherto been reported in dogs. OBSERVATIONS: The emergency management of a dog with complete urethral obstruction is described. We intended to perform vaginoscopy ...

The aim of this study was to assess the effect of dextrose administration during and following cardiac resuscitation on mortality and morbidity. Thirty-one dogs anesthetized with halothane were subjected to six minutes of ventricular fibrillation and were resuscitated with open chest cardiac message. All dogs were successfully resuscitated. Thirteen received ...

The fatal outcome of victims after initially successful resuscitation for cardiac arrest has been attributed both to global myocardial ischemia during the cardiac arrest and the adverse effects of reperfusion. Postresuscitation syndrome comprises 2 major components; pathophysiologic postresuscitation disease and postresuscitation hemodynamic changes. Both components predict the myocardial function, which ...

PURPOSE: To present a case of survival of a cognitively intact Jehovah's Witness patient with an aortic dissection who underwent hypothermic arrest. Recombinant factor VIIa, but no blood products were administered. CLINICAL FEATURES: An 83-yr-old female with an acute type A aortic dissection underwent emergent surgical repair. Proximal extension of ...

PURPOSE OF REVIEW: During cardiopulmonary resuscitation, no specific drug therapy has been shown to improve survival to hospital discharge after cardiac arrest, and only few drugs have a proven benefit for short-term survival. This article reviews recent experimental and clinical data about vasopressor, antiarrhythmic and thrombolytic agents. RECENT FINDINGS: General ...

BACKGROUND AND GOAL OF STUDY: Cardiopulmonary resuscitation (CPR) is an integral part of anaesthetic training. In Nigeria, these skills are taught mainly during medical school and postgraduate training. International guidelines were introduced in 2000 and new guidelines were produced in November 2005. The study sought to assess how closely anaesthetists ...

BACKGROUND: Prospective and retrospective studies have shown that empiric use of fibrinolytic agents in sudden cardiac arrest is safe and may improve outcomes in sudden cardiac arrest. Use of fibrinolytic agents for this indication is increasing in response to these data. METHODS: A prospective multicenter observational trial was performed in ...

A 50-year-old patient had status epilepticus and no adequate reactions nine days after prolonged out-of-hospital cardiac arrest. The cause of the arrest was acute myocardial infarction which was treated successfully with percutaneous cardiac intervention (PCI) and a stent placement. He was treated with therapeutic hypothermia (33 degrees C) for 24h ...

OBJECTIVE: To evaluate the outcome and the factors concerned with of out-of-hospital cardiac arrest patients according to the location of the collapse. METHODS: From May 1st, 1998 to April 30th, 2001, 15,211 consecutive out-of-hospital cardiac arrest cases considered for resuscitation were recorded. Of these cases 7540 arrests in subjects aged ...

BACKGROUND: Recently introduced cardiopulmonary bypass techniques to avoid circulatory arrest were proposed to improve organ function of the modified Norwood operation for hypoplastic left heart syndrome. This study compares postoperative hemodynamics and survival in patients who underwent Norwood procedure on the beating heart to those operated on with cardioplegic cardiac ...

More research is needed to improve our understanding of what constitutes the most effective method of cardiopulmonary resuscitation; however, we know more now than ever in the history of medicine. We know that CPR is more than simply pushing on the chest and defibrillating the heart. We know that there ...

Spinal anesthesia is a widely practiced technique for both elective and emergency procedures. It is so recommended because of its efficacy and safety. Cardiac arrest during spinal anesthesia is considered as a "very rare", "unusual", and "unexpected" event. We report here two instances of cardiac arrest during spinal anesthesia in ...

Acute myocardial infarction (AMI) and pulmonary embolism (PE) account for about 70% of cardiac arrest. Although thrombolytic therapy is an effective therapy for both AMI and PE, it is not routinely recommended during cardiopulmonary resuscitation (CPR) for fear of life threatening bleeding complications. Numerous case reports and retrospective studies have ...

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 ...

Cardiac function is depressed and circulating IL-6 levels increase following trauma-hemorrhage (T-H). Although sustained elevated IL-6 after T-H correlate with poor outcome, the mechanism by which IL-6 produces cardiac dysfunction remains unknown. We hypothesized that IL-6-mediated cardiac depression is due to upregulation of NF-small ka, CyrillicB, ICAM, CINC and neutrophil ...

A large proportion of deaths in the Western World are caused by ischaemic heart disease. Among these patients a majority die outside hospital due to sudden cardiac death. The prognosis among these patients is in general, poor. However, a significant proportion are admitted to a hospital ward alive. The proportion ...

Although ganglia in the heart are well known to be cholinergic, many other neurotransmitters and neuropeptides also influence (and are produced in) cardiac neurons, including adrenergic and purinergic compounds. Recently, histamine was suggested as a possible neurotransmitter in cardiac tissue. Although histamine does elicit many effects in the heart, does ...

OBJECTIVE: To evaluate the results of the first epidemiological study on out-of-hospital resuscitation in Estonia. METHODS: A prospective cohort study of 2108 consecutive standardized reports on out-of-hospital resuscitation attempts from 1 January 1999 to 31 December 2002 was conducted according to the Utstein style. RESULTS: In all, 67.3% (1419/2108) of ...

We describe a case of a 2-year-old boy who ingested 35 mg.kg(-1) of amitriptyline. He developed central nervous system toxicity, as demonstrated by coma and seizures and cardiac toxicity (cardiac arrest) within 1 h of ingestion. The cardiac toxicity was refractory to standard therapy. His cardiac rhythm alternated between ventricular ...

Neuronal injury following global cerebral ischemia continues to bea central problem of patients in the postresuscitation phase following cardiocirculatory arrest. In addition to measures focusing on rapid restoration of spontaneous circulation, the most effective treatment after cardiac arrest, as shown by large randomized trials,is the use of therapeutic mild hypothermia. ...

The use of IH for 24 hours in patients who remain comatose following resuscitation from out-of-hospital cardiac arrest improves outcomes. How-ever, the induction of hypothermia has several physiologic effects that need to be considered. A protocol for the rapid induction of hypothermia is described. At present, the rapid infusion of ...

BACKGROUND: We studied haemodynamic and metabolic variables, and cerebral function after cardiac arrest induced by high dose of adenosine in patients undergoing thoracic aorta endovascular repair. METHODS: Arterial blood pressure, blood gas values and EEG were recorded continuously in 15 patients undergoing anaesthesia (isoflurane) for endovascular thoracic aorta repair. Cardiac ...

Survival rates from out-of-hospital cardiac arrest continue to be low despite periodic updates in the Guidelines for Emergency Medical Services and periodic improvements such as the addition of automatic external defibrillators (AEDs). The low incidence of bystander cardiopulmonary resuscitation (CPR), substantial time without chest compressions throughout the resuscitation effort, and ...

Success of advanced cardiac life support (ACLS) depends on several factors: character and severity of the primary insult, time interval between cardiac arrest and effective basic life support (BLS) and the ensuing ACLS, patient's general condition before the insult, environmental circumstances and efficacy of BLS and ACLS. From these factors, ...

BACKGROUND: Microwave ablation has been used to replace the traditional incisions used in the surgical treatment of atrial fibrillation. However, dose-response curves have not been established in surgically relevant models. The purpose of this study was to develop dose-response curves for the Flex 10 (Guidant, Inc) microwave device in both ...

A 47-year-old woman was referred to our hospital for an intracardiac electrophysiological study. The procedure was complicated by cardiac arrest due to massive pulmonary embolism, which only successfully resolved after the administration of a thrombolytic agent. This case suggests that there is a real risk of venous thromboembolism in certain ...

We studied the outcome of cardiopulmonary resuscitation (CPR) in patients undergoing coronary angiography (CA) and/or percutaneous coronary interventions (PCI). Of 51,985 CA and PCI patients treated between January 1, 1990, and December 31, 2000, 114 required CPR. Records were reviewed for relationships between patient characteristics and various procedures and short-term ...

The use of pulmonary artery catheters is under debate yet again. We look at two recent trials evaluating their impact on mortality. Our suspicions regarding obesity are proven and we also look at a simple, cost effective method of reducing ventilator-associated pneumonia. Finally, an intervention to improve the poor outcome ...

One of the pioneers of open chest cardiac massage was Cemil Topuzlu Pasha, in Turkey. He presented his experience in open heart cardiac massage in several papers published in Ottoman and French and German. On 27 August 1903 one of his patients undergoing external urethrotomy under chloroform anaesthesia developed cardiac ...

BACKGROUND: Sudden unexpected intraoperative cardiac arrests in patients undergoing elective non-cardiac operations are rare but catastrophic complications. The efficacy and utility of transoesophageal echocardiography (TOE) in the diagnosis and management of these events have not been reported earlier. METHODS: Unexpected intraoperative cardiac arrests in patients undergoing elective non-cardiac operations were ...

The Resuscitation Council (UK) Advanced Life Support (ALS) Course is a multidisciplinary training course which teaches participants how to manage the resuscitation of a patient at risk of or in cardiac arrest. To reduce variability in assessments, four standardised patient scenarios have been developed with common performance criteria. The aim ...