Hepatic portal venous gas associated with poor outcome in out-of-hospital cardiac arrest patients

Objectives: To determine the incidence of sonographic hepatic portal venous gas (HPVG) and to clarify the relationship between the presence of HPVG and clinical outcomes in patients with out-of-hospital cardiac arrest (OHCA). Methods: From April 2002 to January 2003, patients with non-traumatic OHCA were prospectively enrolled in a tertiary medical centre in Taipei, Taiwan. Emergency abdominal sonography during resuscitation was performed to detect the presence of HPVG within the first 10 min on arrival of the emergency department (ED). Results: HPVG was detected in 16 (36%) of the 44 patients enrolled in this study. The patients with HPVG were older (P=0.039), their cardiac arrest was witnessed less frequently (P=0.01), they received more prolonged resuscitation (P=0.008), and needed more accumulated doses of adrenaline (epinephrine) (P=0.002). These patients had a considerably lower incidence of return of spontaneous circulation (ROSC) (P<0.001), less survival to hospital admission (P<0.001), less 24 h survival (P<0.001) and less survival to discharge (P=0.036). In a multiple regression analysis, HPVG was noted as an independent factor negatively associated with ROSC. Conclusion: HPVG is not uncommon in patients receiving resuscitation for OHCA and is associated with poor outcome in these patients.     

Decrease in the occurrence of ventricular fibrillation as the initially observed arrhythmia after out-of-hospital cardiac arrest during 11 years in Sweden

Aim: To describe the change in the occurrence of ventricular fibrillation as initially observed arrhythmia among patients suffering from out-of-hospital cardiac arrest in Sweden. Patients: All patients included in the Swedish cardiac arrest registry between 1991 until 2001. The registry covers 85% of the population in Sweden. Methods: All patients with bystander witnessed out-of-hospital cardiac arrest included in the Swedish Cardiac Arrest Registry between 1991 and 2001 from the same ambulance organisation each year were included in the survey. Results: Over 11 years, among patients in Sweden with a bystander witnessed out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation (CPR) was attempted (n=9666), the occurrence of ventricular fibrillation as the initially obseved arrhythmia decreased from 45% in 1991 to 28% in 2001 (P<0.0001) if the arrest occurred at home, and from 57% to 41% if the arrest occurred outside home (P<0.0001). This was found despite the fact that the proportion who received bystander CPR increased from 29% in 1991 to 39% in 2001 if the arrest occurred at home (P<0.0001) and from 54% to 60% if the arrest occurred outside home (NS). There was a significant increase in age among patients with out-of-hospital cardiac arrest at home, no change in the estimated interval between collapse and call but an increase in the interval between call and arrival of the ambulance among patients with out-of-hospital cardiac arrest outside home. Conclusion: During 11 years in Sweden, there was a marked decrease in the proportion of patients found in ventricular fibrillation among patients with a bystander witnessed cardiac arrest regardless whether the arrest occurred at home or outside home. A modest increase in age and interval between call for, and arrival of, the ambulance was associated with these findings.     

A randomized trial of suprasternal palpation to determine endotracheal tube position in neonates

Objective: To compare suprasternal palpation, a previously described bedside technique, with standard chest radiography for correct positioning of the endotracheal tube (ETT) in newborn infants. Study design: A randomized single-blinded study in an academic medical center. Preterm and term newborn infants requiring intubation were eligible, provided that they had not had their initial chest roentgenogram (CXR). Infants were randomized to ETT palpation and non-adjustment (Controls), or to ETT palpation and adjustment (Treatment), following digital palpation of the ETT tip in the suprasternal notch. ETT position was considered correct when only the tip of the ETT was palpable in the suprasternal notch. ETT position by CXR was blindly assessed by an experienced pediatric radiologist. Results: Fifty-five infants were enrolled in the delivery room or neonatal intensive care unit. Correct tube placements improved from 48% pre-study to 85 and 93% in the Control and Treatment arms, respectively. The majority of incorrect estimations were that the ETT position using palpation was judged to be too low when it was, in fact, in correct position, as noted in 11 infants. ETT palpation had a 70% concordance with the position determined by CXR. No difficulties or complications were associated with the use of suprasternal palpation. Conclusions: Suprasternal palpation is a simple, safe, teachable, method of confirming ETT position in neonates when CXR is unavailable, and may especially helpful during neonatal resuscitation prior to surfactant administration.