Basismaßnahmen zur Wiederbelebung Erwachsener (Basic Life Support)

Notfall + Rettungsmedizin - Der Europäische Rat für Wiederbelebung hat diese Leitlinie – Basismaßnahmen zur Wiederbelebung – auf Grundlage des...     

Exclusion of a patient assessment interval and extension of the CPR interval both mitigate post-resuscitation myocardial dysfunction in a swine model of cardiac arrest

AIM OF STUDY: Interruptions in cardiopulmonary resuscitation (CPR), particularly as guided by automated external defibrillators, have been implicated in poor survival from cardiac arrest. Interruptions of CPR may be reduced by eliminating repetition of shocks between periods of CPR, elimination of the interval for patient assessment before CPR, and extension of the periods of CPR. MATERIALS AND METHODS: The effects of exclusion of a 30s post-shock assessment interval prior to CPR and use of a longer interval (180s versus 90s) of CPR on resuscitation and post-resuscitation function were assessed in a factorial design using an established swine model of cardiac arrest. Repetitive shocks were excluded. Ventricular fibrillation was induced ischemically and maintained untreated for 5min. RESULTS: All subjects were resuscitated, 95% survived 3 days, and 97% of survivors had full neurological recovery. Exclusion of the assessment interval reduced the delay to first return of spontaneous circulation by 33.1s (P=0.004) and the delay to sustained resuscitation by 99.2s (P=0.004), reduced post-resuscitation ECG ST elevation by 0.12mV (P=0.03), and alleviated transient post-resuscitation ejection fraction reduction (P<0.0001). Extension of the CPR interval reduced transient post-resuscitation fractional area change impairment (P=0.003). CONCLUSIONS: Exclusion of an interval for assessment of airway, breathing and signs of circulation mitigates post-resuscitation dysfunction in a swine model of cardiac arrest. Extension of the period of CPR independently provides measurable, though less comprehensive, mitigation as well.     

Prediction of successful defibrillation in human victims of out-of-hospital cardiac arrest: a retrospective electrocardiographic analysis

In the present study we sought to examine the efficacy of an electrocardiographic parameter, 'amplitude spectrum area' (AMSA), to predict the likelihood that any one electrical shock would restore a perfusing rhythm during cardiopulmonary resuscitation in human victims of out-of-hospital cardiac arrest. AMSA analysis is not invalidated by artefacts produced by chest compression and thus it can be performed during CPR, avoiding detrimental interruptions of chest compression and ventilation. We hypothesised that a threshold value of AMSA could be identified as an indicator of successful defibrillation in human victims of cardiac arrest. Analysis was performed on a database of electrocardiographic records, representing lead 2 equivalent recordings from automated external defibrillators including 210 defibrillation attempts from 90 victims of out-of-hospital cardiac arrest. A 4.1 second interval of ventricular fibrillation or ventricular tachycardia, recorded immediately preceding the delivery of the shock, was analysed using the AMSA algorithm. AMSA represents a numerical value based on the sum of the magnitude of the weighted frequency spectrum between two and 48 Hz. AMSA values were significantly greater in successful defibrillation (restoration of a perfusing rhythm), compared to unsuccessful defibrillation (P < 0.0001). An AMSA value of 12 mV-Hz was able to predict the success of each defibrillation attempt with a sensitivity of 0.91 and a specificity of 0.97. In conclusion, AMSA analysis represents a clinically applicable method, which provides a real-time prediction of the success of defibrillation attempts. AMSA may minimise the delivery of futile and detrimental electrical shocks, reducing thereby post-resuscitation myocardial injury.     

An unusual case of pneumorrhachis following resection of lung carcinoma

We report an unusual case of a patient with a bronchopleural-subcutaneous fistula that occurred 3 years following a lobectomy and en bloc chest wall resection for carcinoma. Following a sudden resolution of subcutaneous emphysema, an epidural air collection developed. Spontaneous pneumorrhachis is a previously unreported late complication after surgical or radiation therapy for lung carcinoma.     

Diagnosis of occult meat aspiration by fiberoptic bronchoscopy

Cytologic examination of bronchial washings from a patient with a persistent localized pulmonary infiltrate revealed large numbers of striated muscle fibers. The patient died shortly after bronchoscopy, and postmortem examination provided evidence of recurrent aspiration pneumonias. Since skeletal muscle fibers are not likely to enter the tracheobronchial tree from any endogenous source, it is proposed that this unusual cytologic finding is virtually diagnostic of recent food aspiration.     

Retrospective evaluation of current-based impedance compensation defibrillation in out-of-hospital cardiac arrest

Objective

Transthoracic impedance (TTI) is a principal parameter that influences the intracardiac current flow and defibrillation outcome. In this study, we retrospectively evaluated the performance of current-based impedance compensation defibrillation in out-of-hospital cardiac arrest (OHCA) patients.

Methods

ECG recordings, along with TTI measurements were collected from multiple emergency medical services (EMSs) in the USA. All the EMSs in this study used automated external defibrillators (AEDs) which employing rectilinear biphasic (RLB) waveform. The distribution and change of TTI between successive shocks, the influence of preceding shock results on the subsequent shock outcome, and the performance of current-based impedance compensation defibrillation was evaluated.

Results

A total of 1166 shocks from 594 OHCA victims were examined in this study. The average TTI for the 1st shock was 134.8 Ω and a significant decrease in TTI was observed for the 2nd (p < 0.001) and 3rd (p = 0.033) sequential escalating shock. But TTI did not change after the 3rd shock. A higher success rate was observed for shocks with preceding defibrillation success. The success rate remained unchanged over the whole spectrum of TTI.

Conclusion

The average TTI was relatively higher in this OHCA population treated with RLB defibrillation as compared with previously reported data. TTI was significantly decreased after 1st and 2nd successive escalating shock but kept constant after the 3rd shock. Preceding shock success was a better predictor of subsequent defibrillation outcome other than TTI. Current-based impedance compensation defibrillation resulted in equivalent success rate for high impedance patients when compared with those of low impedance.