Resuscitation time in ventricular fibrillation — a prognostic indicator

Length of resuscitation in prehospital ventricular fibrillation patients was studied to define its relationship to survival. Five hundred sixty-five patients presenting with the initial rhythm of ventricular fibrillation to the Milwaukee County Paramedic System between January 1978 and April 1982 were resuscitated successfully. Pediatric patients and patients with trauma, poisoning, and drowning were excluded. Of the 565 resuscitated patients, 262 (46%) were discharged alive and 303 (54%) died during hospitalization. For all 565 patients the resuscitation time and times from arrival of paramedics until the first sustained pulse were plotted against survival to define a curve. The curve demonstrated rapidly declining survival rates for resuscitation time up to 20 minutes; thereafter, survival declined more gradually with respect to resuscitation time. The mean resuscitation time for those eventually discharged alive was 12.6 minutes, which was statistically shorter (P less than .0001) than the mean resuscitation time of 23.9 minutes for those who eventually died. The overall survival curve of witnessed arrest patients was not statistically different from that of unwitnessed patients. The survival curve of those patients receiving bystander cardiopulmonary resuscitation (CPR) was similar to the curve of those who received no CPR. We conclude that resuscitation time is a heretofore undefined significant predictor of survival of resuscitated prehospital ventricular fibrillation patients.     

The effect of bystander CPR on survival of out-of-hospital cardiac arrest victims

The effect of bystander cardiopulmonary resuscitation (CPR) was studied in 2142 emergency medical service (EMS) cardiac arrest runs. When bystander CPR was administered to cardiac arrest victims, 22.9% of the victims survived until they were admitted to the hospital and 11.9% were discharged alive. In comparison, the statistics for cardiac arrest victims who did not receive bystander CPR were 14.6% and 4.7%, respectively (p less than 0.001). A critical factor in patient survival was the amount of time that elapsed before the EMS personnel arrived and administered CPR. Patients who received bystander CPR were more likely to have ventricular fibrillation when the EMS arrived. Other factors relating to patient survival were the location of the victim at the time of the cardiac arrest and the age of the victim. Understanding these factors is important in developing community strategies to treat patients with cardiac arrest out of hospital.     

One year's experience of early defibrillation in Stockholm

The effects of resuscitation on patients who died suddenly out of hospital were evaluated after the introduction of early defibrillation performed by ambulance personnel using semi-automatic defibrillators. Resuscitation attempts were initiated in 548 patients during the 1-year study period. Mean ambulance delay was 7.5 min, 22% of the cardiac arrest patients had received bystander cardiopulmonary resuscitation (CPR). Sensitivity and specificity for the semi-automatic defibrillator in the interpretation of ventricular fibrillation was found to be 97 and 100% respectively. Only 28 (14%) of the 206 defibrillated patients regained circulation and were admitted for further hospital care. Only three survived to be discharged. Among the 342 patients in whom defibrillation was not indicated, 16 (5%) regained circulation and were admitted for further hospital care and one (0.3%) survived to be discharged. Semi-automatic defibrillators seem reliable, safe and inexpensive; however, the isolated addition of defibrillation to basal ambulance service seems to be inadequate in Stockholm. We need to evaluate what further resources are of importance to guarantee a successful outcome.     

CPR-only survivors of out-of-hospital cardiac arrest: implications for out-of-hospital care and cardiac arrest research methodology

STUDY OBJECTIVE: There is little evidence that cardiopulmonary resuscitation (CPR) alone may lead to the resuscitation of cardiac arrest victims with other than respiratory causes (eg, pediatric arrest, drowning, drug overdose). The objective of this study was to identify out-of-hospital cardiac arrest survivors resuscitated without defibrillation or advanced cardiac life support. METHODS: This observational cohort included all adult survivors of out-of-hospital cardiac arrest of a cardiac cause from phases I and II of the Ontario Prehospital Advanced Life Support Study. During the study period, the system provided a basic life support/defibrillation level of care but no advanced life support. CPR-only patients were patients determined to be without vital signs by EMS personnel who regained a palpable pulse in the field with precordial thump or CPR only and then were admitted alive to the hospital. Six members of a 7-member expert review panel had to rate the patient as either probably or definitely having an out-of-hospital cardiac arrest, and a rhythm strip consistent with a cardiac arrest rhythm had to be present to be considered a patient. Criteria considered were witness status, citizen or first responder CPR, CPR duration, arrest rhythm and rate, and performance of precordial thump. RESULTS: From January 1, 1991, to June 30, 1997, 9,667 patients with out-of-hospital cardiac arrest were treated. The overall survival rate to hospital discharge was 4.6%. There were 97 apparent CPR-only patients admitted to the hospital. Application of the inclusion criteria yielded 24 CPR-only patients who had true out-of-hospital cardiac arrest and 73 patients judged not to have cardiac arrest. Of the 24 true CPR-only patients admitted to the hospital, 15 patients were discharged alive, 10 patients were witnessed by bystanders, and 7 patients were witnessed by EMS personnel. The initial arrest rhythm was pulseless electrical activity in 9 patients, asystole in 12 patients, and ventricular tachycardia in 3 patients. One patient with ventricular tachycardia converted to sinus tachycardia with a single precordial thump. CONCLUSION: CPR-only survivors of true out-of-hospital cardiac arrest do exist; some victims of out-of-hospital cardiac arrest of primary cardiac cause can survive after provision of out-of-hospital basic life support care only. However, many patients found to be pulseless by means of out-of-hospital evaluation likely did not have a true cardiac arrest. This has implications for the survival rates of most, if not all, previous cardiac arrest reports. Survival rates from cardiac arrest may actually be lower if one excludes survivors who never had a true arrest. The absence of vital signs by out-of-hospital assessment alone is not adequate to include patients in research reports or quality evaluations for cardiac arrest.     

In-hospital cardiopulmonary resuscitation during asystole. Therapeutic factors associated with 24-hour survival

The most recent American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) during asystole include ventricular defibrillation, intubation, and the administration of epinephrine and atropine. This study reports results from a retrospective analysis of clinical, demographic, and treatment data collected during in-hospital CPR efforts in 123 patients in whom the initial rhythm was asystole. Twenty-eight (22.8 percent) of these patients were alive 24 h after CPR initiation. Patients who received norepinephrine drip (N = 43) were more likely to survive than those who did not (39.5 percent vs 14.1 percent; p less than .01), and those who received lidocaine drip were more likely to survive than those who did not (47.6 percent vs 18.2 percent; p less than .01). The best survival rate (57.1 percent) occurred among those who received both norepinephrine and lidocaine (N = 14). Survivors did not differ significantly from nonsurvivors in terms of age, gender, primary diagnosis, location of arrest, or duration of CPR efforts. The results suggest that aggressive resuscitation efforts which include the addition of norepinephrine and lidocaine drips to the AHA-recommended regimen of epinephrine and atropine may substantially increase the number of 24-h survivors. A pharmacologic mechanism involving norepinephrine-induced myocardial irritability and peripheral vasoconstriction, combined with lidocaine-induced suppression of abnormal automaticity, is offered as a possible explanation of the obtained results.     

Effect of bystander initiated cardiopulmonary resuscitation on ventricular fibrillation and survival after witnessed cardiac arrest outside hospital.

OBJECTIVE--To describe the proportion of patients who were discharged from hospital after witnessed cardiac arrest outside hospital in relation to whether a bystander initiated cardiopulmonary resuscitation. PATIENTS--All patients with witnessed cardiac arrest outside hospital before arrival of the ambulance and in whom cardiopulmonary resuscitation was attempted by the emergency medical service in Gothenburg during 1980-92. RESULTS--Cardiopulmonary resuscitation was initiated by a bystander in 18% (303) of 1,660 cases. In this group 69% had ventricular fibrillation at first recording compared with 51% in the remaining patients (P < 0.001). Among patients in whom cardiopulmonary resuscitation had been initiated by a bystander 25% were discharged alive versus 8% of the remaining patients (P < 0.001). Independent predictors of survival were in order of significance: initial arrhythmia (P < 0.001), interval between collapse and arrival of first ambulance (P < 0.001), cardiopulmonary resuscitation initiated by a bystander (P < 0.001), and age (P < 0.01). Among patients who were admitted to hospital alive 30% of patients in whom cardiopulmonary resuscitation had been initiated by a bystander compared with 58% of remaining patients (P < 0.001) had brain damage and died in hospital. Corresponding figures for death in association with myocardial damage were 18% and 29% respectively (P < 0.01). CONCLUSIONS--Cardiopulmonary resuscitation initiated by a bystander maintains ventricular fibrillation and triples the chance of surviving a cardiac arrest outside hospital. Furthermore, it seems to protect against death in association with brain damage as well as with myocardial damage.     

Predictors of survival and favorable neurological outcome in patients treated with targeted temperature management after cardiac arrest: A systematic review and meta-analysis

This study was aimed at a serial evaluation of the prognostic values of initial shockable rhythm, bystander cardiopulmonary resuscitation (CPR) and gender for neurological outcome and survival in adults treated with targeted temperature management (TTM) following cardiac arrest (CA). PubMed, Embase and the Cochrane Library were searched for eligible studies. Pooled odds ratio (OR) with 95% confidence intervals (CIs) was calculated to evaluate prognostic values using RevMan 5.3. The outcomes were favorable neurological outcome (defined as cerebral performance category of 1 and 2) and survival. Seventeen studies were subjected to the meta-analysis. Favorable neurological outcome was associated with significantly higher odds of an initial shockable rhythm (OR: 7.63, 95%CI: 6.51–8.96), bystander CPR (OR: 1.44, 95%CI: 1.14–1.82), male (OR: 1.39, 95%CI: 1.20–1.61). Survival was associated with higher odds of an initial shockable rhythm (OR: 4.88, 95%CI: 3.18–4.79), higher odds of bystander CPR (OR: 1.71, 95%CI: 1.05–2.77). No significant association was found between survival and male. In adult patients treated with TTM, initial shockable rhythm, bystander CPR and male sex were associated with a higher likelihood of favorable neurological outcome. Initial shockable rhythm and bystander CPR were associated with a higher likelihood of survival. These factors could help in identifying patients who are eligible for TTM.     

Experiences from treatment of out-of-hospital cardiac arrest during 17 years in G?teborg.

AIMS: To describe changes in different factors at resuscitation and survival in a 17-year survey of patients suffering from out-of-hospital cardiac arrest. METHOD: The investigation was carried out in the community of G?teborg with 450 000 inhabitants during 1981-1997 on all patients suffering out-of-hospital cardiac arrest in whom resuscitation was attempted. RESULTS: The number of cases per year, the proportion of witnessed arrests and the proportion of arrests of cardiac aetiology remained similar over time. There was an increase in median age from 68 to 73 years (P<0.0001), in the proportion of females from 27% to 33% (P=0.035) and in the proportion of patients receiving bystander cardiopulmonary resuscitation from 14% to 28% (P<0.0001) with time. There was a shortening of the median interval from collapse until defibrillation from 9 min to 6 min (P<0.0001) over time but a decrease in the occurrence of ventricular fibrillation as the initially recorded arrhythmia from 39% to 32% (P=0.022). There was an increase in the proportion of patients having a bystander witnessed cardiac arrest of cardiac aetiology being hospitalized alive from 32% to 45% (P<0. 0001 for change over time). The proportion of patients discharged alive from hospital increased from 16% to 29% until 1993, but thereafter decreased to 13% in 1997 (P=0.002 for change over time). CONCLUSION: In a survey covering 17 years of resuscitation of out-of-hospital cardiac arrest patients we found that the occurrence of ventricular fibrillation as the initially recorded arrhythmia decreased. There was an increase in age, in the proportion of females and in the use of bystander cardiopulmonary resuscitation. The interval between collapse and defibrillation was shortened. Survival changed over time with an increase until 1993 but with a decrease thereafter.     

Study of pre-hospital care of out of hospital cardiac arrest victims and their outcome in a tertiary care hospital in India

BackgroundIndia does not have a formal cardiac arrest registry or a centralized emergency medical system. In this study, we aimed to assess the prehospital care received by the patients with OHCA and predict the factors that could influence their outcome.MethodsOut-of-hospital cardiac arrest patients presenting to the emergency department in a tertiary care centre were included in the study. Prehospital care was assessed in terms of bystander cardiopulmonary resuscitation (CPR), mode of transport, resuscitation in ambulance. OHCA outcomes like Return of spontaneous circulation (ROSC), survival to hospital discharge and favourable neurological outcome at discharge were assessed.ResultsAmong 205 patients, the majority were male (71.2%) and were above 60 years of age (49.3%); Predominantly non-traumatic (82.4%). 30.7% of the patients had sustained cardiac arrest in transit to the hospital. 41.5% of patients reached hospital by means other than ambulance. Only 9.8% patients had received bystander CPR. Only 12.5% ambulances had BLS trained personnel. AED was used only in 1% of patients. The initial rhythm at presentation to the hospital was non-shockable (96.5%). Return of spontaneous circulation (ROSC) was achieved in 17 (8.3%) patients, of which only 3 (1.4%) patients survived till discharge. The initial shockable rhythm was a significant predictor of ROSC (OR 18.97 95%CI 3.83–93.89; p < 0.001) and survival to discharge (OR 42.67; 95%CI 7.69–234.32; p < 0.001).ConclusionThe outcome of OHCA in India is dismal. The pre-hospital care received by the OHCA victim needs attention. Low by-stander CPR rate, under-utilised and under-equipped EMS system are the challenges.     

Prehospital cardiac arrest: the impact of witnessed collapse and bystander CPR in a metropolitan EMS system with short response times

OBJECTIVE: Numerous studies have shown initiation of bystander CPR to significantly improve survival from prehospital cardiac arrest. However, in emergency medical services (EMS) systems with very short response times, bystander CPR has not been shown to impact outcome. The purpose of this study was to determine the effect of bystander CPR on survival from out-of-hospital cardiac arrest in such a system. DESIGN: Prehospital, hospital, and death certificate data from a medium-sized metropolitan area were retrospectively analyzed for adult, nontraumatic cardiac arrest during a 16-month period. RESULTS: A total of 298 patients met study criteria. One hundred ninety-five arrests (65.4%) were witnessed, and 103 (34.6%) were unwitnessed. Twenty-five witnessed victims (12.8%) were discharged alive, whereas no unwitnessed victims survived (P less than .001). Patients suffering a witnessed episode of ventricular fibrillation/tachycardia (VF/VT) were more likely to survive (21.9%) than were other patients (2.0%, P less than .0001). Among witnessed patients, initiation of bystander CPR was associated with a significant improvement in survival (20.0%) compared with the no-bystander CPR group (9.2%, P less than .05). Bystander CPR was also associated with improved outcome when witnessed patients with successful prehospital resuscitation were evaluated as a group; 18 had bystander CPR, of whom 13 (72.2%) survived compared with only 12 of 38 patients with no bystander CPR (31.6%, P less than .01). CONCLUSION: Our data revealed improved survival rates when bystander CPR was initiated on victims of witnessed cardiac arrest in an EMS system with short response times.     

Thrombolytic therapy in patients requiring cardiopulmonary resuscitation

Cardiopulmonary resuscitation (CPR) is often considered a contraindication to thrombolytic therapy for acute myocardial infarction. Of 708 patients involved in the first 3 Thrombolysis and Angioplasty in Myocardial Infarction trials of lytic therapy for acute infarction, 59 patients required less than 10 minutes of CPR before receiving lytic therapy (CPR greater than 10 minutes was an exclusion of the trials) or required CPR within 6 hours of treatment. The patients receiving CPR were similar to the remainder of the group with respect to baseline demographics. The indication for CPR was usually ventricular fibrillation (73%) or ventricular tachycardia (24%). The median duration of CPR was 1 minute, with twenty-fifth and seventy-fifth percentiles of 1 and 5 minutes, respectively. The median number of cardioversions/defibrillations performed was 2 (twenty-fifth and seventy-fifth percentiles of 1 and 3 minutes, respectively). Patients receiving CPR were more likely to have anterior infarctions (66 vs 39%), the left anterior descending artery as the infarct-related artery (63 vs 38%) and lower ejection fractions on the initial ventriculogram (46 +/- 11 vs 52 +/- 12%) than those not receiving CPR. In-hospital mortality was 12 vs 6% with most deaths due to pump failure (57%) or arrhythmia (29%) in the CPR group and pump failure (38%) or reinfarction (25%) in the non-CPR group. At 7 day follow-up the CPR group had a significant increase in ejection fraction (+5 +/- 9%) compared with no change in non-CPR group. There were no bleeding complications directly attributed to CPR.(ABSTRACT TRUNCATED AT 250 WORDS)     

Changes in demographic factors and mortality after out-of-hospital cardiac arrest in Sweden

OBJECTIVE: To describe changes between 1992 and 2003 in age, sex, factors at resuscitation and survival among patients suffering from out-of-hospital cardiac arrest in Sweden. METHODS: This was a prospective observational study including various ambulance organizations in Sweden. Patients suffering from out-of-hospital cardiac arrest between 1992 and 2003 included in the Swedish Cardiac Arrest Registry were followed for survival to 1 month. RESULTS: In all 19 791 cases took part in the survey. There was a slight increase in mean age from 68 to 70 years (P = 0.025) and an increase of females from 29 to 32% (P = 0.0001). There was a change in witnessed status (P < 0.0001) with an increase in crew-witnessed cases and a decrease in non-witnessed cases. There was a decrease in cases of a cardiac etiology from 75 to 61% (P < 0.0001) and a decrease in the percentage found in ventricular fibrillation from 36 to 25% (P < 0.0001). When crew-witnessed cases were excluded the proportion receiving bystander cardiopulmonary resuscitation (CPR) increased from 30 to 42% (P < 0.0001). There was a slight increase in the overall proportion of patients hospitalized alive from 16 to 20% (P = 0.032). There was no significant change in the overall proportion of survivors at 1 month after cardiac arrest (4.5% in 1992 and 5.0% in 2003). CONCLUSIONS: Among patients suffering from out-of-hospital cardiac arrest in Sweden some changes took place. The most important ones were a decrease in the proportion of patients found in ventricular fibrillation and an increase in the proportion of patients receiving bystander CPR. The proportion of patients admitted alive to hospital increased moderately, whereas the proportion of patients alive after 1 month remained unchanged.     

Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation.

BACKGROUND. Coronary perfusion pressure has been shown to be a significant determinant of return of spontaneous circulation from cardiac arrest during asystole and electromechanical dissociation. The addition of interposed abdominal compression to otherwise standard cardiopulmonary resuscitation (CPR) increases coronary perfusion pressure in animal and human models. METHODS AND RESULTS. Accordingly, we conducted a randomized prospective study of 143 consecutive patients experiencing cardiac arrest in a large university-affiliated teaching hospital in whom the initial arrest rhythm was asystole or electromechanical dissociation. Patients were randomized to receive either interposed abdominal compression-CPR or standard CPR. The two end points studied were return of spontaneous circulation and 24-hour survival. In addition, we studied the complications associated with interposed abdominal compression-CPR. Sixty-nine men and 74 women with a mean age of 64 years (range, 19-97 years) were studied. The overall rate of return of spontaneous circulation was 38%. Return of spontaneous circulation was significantly greater in the group receiving interposed abdominal compression-CPR compared with the group receiving standard CPR (49% versus 28%, p = 0.01). At 24 hours, there was a significantly greater number of patients alive in the experimental group than in the control group (33% versus 13%, p = 0.009). We found no complication directly related to the procedure of interposed abdominal compression in a small subset of patients who died and underwent necropsy. CONCLUSIONS. We conclude that the addition of interposed abdominal compression may be a useful adjunct to otherwise standard CPR that can improve resuscitation outcome of patients experiencing in-hospital cardiac arrest from asystole and electromechanical dissociation.     

Bystander/first responder CPR: ten years experience in a paramedic system

The effectiveness of bystander CPR recently has been challenged. We undertook a ten-year retrospective review of our prehospital experience with witnessed cardiorespiratory arrest to ascertain save rates in patients receiving and not receiving CPR before paramedic advanced life support (ALS). Traumatic and poisoning arrests and children less than 18 years old were excluded. A total of 1,905 patients presenting to a paramedic system from November 1, 1973, to October 31, 1983, were bystander-witnessed arrests and attempted paramedic resuscitations. Four hundred five paramedic-witnessed arrests were excluded. One hundred eighty-two of 1,248 (14.6%) who had CPR initiated before paramedic ALS arrival were saves, compared to 38 of 252 (15%) who had no CPR initiated until paramedic arrival (P = NS). A save was defined as a patient discharged from the hospital. The respective save rates for coarse ventricular fibrillation were 148 of 628 (23.6%) (CPR before paramedic arrival) vs 35 of 151 (CPR delayed until paramedic arrival) (23.2%); electromechanical dissociation (EMD), 11 of 209 (5.3%) vs 0 of 38; asystole, 19 of 401 (4.7%) vs 3 of 61 (4.9%); and ventricular tachycardia, four of ten (40%) vs 0 of two. In this prehospital system, bystander/first responder CPR was found not to improve hospital discharge rates except in patients with initially documented rhythm of EMD.     

Different forms of bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest

Out-of-hospital cardiac arrest (OHCA) is a major cause of death in the Western world with an estimated number of 275 000 treated with resuscitation attempts by the Emergency Medical Services (EMS) in Europe each year. Overall survival rates remain low, and most studies indicate that around 1 out 10 will survive to 30 days. Amongst the strongest factors associated with survival in OHCA is first recorded rhythm amendable to defibrillation, early defibrillation and prompt initiation of cardiopulmonary resuscitation (CPR). Overall, CPR started prior to EMS arrival has repeatedly been shown to be associated with survival rates 2–3 times higher compared with no such initiation. The primary goal of CPR is to generate sufficient blood flow to vital organs, mainly the brain and heart, until restoration of spontaneous circulation can be achieved. Barriers to the initiation of CPR by bystanders in OHCA include fear of being incapable, causing harm, and transmission of infectious diseases. Partly due to these barriers, and low rates of CPR, the concept of CPR with compression only was proposed as a simpler form of resuscitation with the aim to be more widely accepted by the public in the 1990s. But how reliable is the evidence supporting this simpler form of CPR, and are the outcomes after CO-CPR comparable to standard CPR?     

Out-of-hospital cardiac arrest: recent advances in resuscitation and effects on outcome

Successful treatment of out-of-hospital cardiac arrest remains an unmet health need. Key elements of treatment comprise early recognition of cardiac arrest, prompt and effective cardiopulmonary resuscitation (CPR), effective defibrillation strategies and organised post-resuscitation care. The initiation of bystander CPR followed by a prompt emergency response that delivers high quality CPR is critical to outcomes. The integration of additional tasks such as defibrillation, airway management, vascular access and drug administration should avoid interruptions in chest compressions. Evidence for the routine use of CPR prompt/feedback devices, mechanical chest compression devices and pharmacological therapy is limited.     

Association Between Number of Volunteer Responders and Interventions Before Ambulance Arrival for Cardiac Arrest

BackgroundVolunteer responder (VR) programs for activation of laypersons in out-of-hospital cardiac arrest (OHCA) have been deployed worldwide, but the optimal number of VRs to dispatch is unknown.ObjectivesThe purpose of this study was to investigate the association between the number of VRs arriving before Emergency Medical Services (EMS) and the proportion of bystander cardiopulmonary resuscitation (CPR) and defibrillation.MethodsWe included OHCAs not witnessed by EMS with VR activation from the Capital Region (September 2, 2017, to May 14, 2019) and the Central Region of Denmark (November 5, 2018, to December 31, 2019). We created 4 groups according to the number of VRs arriving before EMS: 0, 1, 2, and 3 or more. Using a logistic regression model adjusted for EMS response time, we examined associations between the number of VRs arriving before EMS and bystander CPR and defibrillation.ResultsWe included 906 OHCAs. The adjusted ORs for bystander CPR were 2.40 (95% CI: 1.42-4.05), 3.18 (95% CI: 1.39-7.26), and 2.70 (95% CI: 1.32-5.52) when 1, 2, or 3 or more VRs arrived before EMS (reference), respectively. The adjusted OR for bystander defibrillation increased when 1 (1.97 [95% CI: 1.12-3.52]), 2 (2.88 [95% CI: 1.48-5.58]), or 3 or more (3.85 [95% CI: 2.11-7.01]) VRs arrived before EMS (reference). The adjusted OR of bystander defibrillation increased to 1.95 (95% CI: 1.18-3.22) when ≥3 VRs arrived first compared with 1 VR arriving first (reference).ConclusionsWe found an association of increased bystander CPR and defibrillation when 1 or more VRs arrived before the EMS with a trend toward increased bystander defibrillation with increasing number of VRs arriving first.     

Analysis of the outcomes of cardiopulmonary resuscitation in an emergency department

OBJECTIVE: The aim of this study is to analyse the factors affecting emergency department (ED) cardiopulmonary resuscitation (CPR) outcome. METHODS: A standard CPR protocol was performed in all patients and certain pre and postresuscitation parameters including age, sex, initial arrest rhythm, primary underlying disease, initiation time of advanced cardiac life support, duration of return of spontaneous circulation were recorded. Patients were followed up to determine rates of successful CPR, survival and one-year survival. RESULTS: From December 1999 to May 2001, 80 consecutive adult patients in whom a standard CPR was performed in the ED were prospectively included in the study. The overall rate for successful CPR, survival and one-year survival were found to be 58.8% (47/80), 15% (12/80) and 10% (8/80), respectively. Survival and one-year survival rates were better in patients with an initial arrest rhythm of ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT) than both pulseless electrical activity (pEA) and asystole; survival and one-year survival rates were better in patients with a primary underlying disease of cardiac origin than non-cardiac origin. Acute myocardial infarction had the best prognosis among conditions causing arrest. Presence of sudden death was found to have a better survival and one-year survival rate. CONCLUSION: Initial cardiac rhythm of VF/pVT, cardiac origin as the primary disease causing cardiopulmonary arrest and presence of sudden death were found to be good prognostic factors in CPR.     

Long-term survival with open-chest cardiac massage after ineffective closed-chest compression in a canine preparation

The ultimate goal of cardiopulmonary resuscitation (CPR) is long-term, neurologically intact survival. This study examined whether open-chest cardiac massage could improve 7 day survival and neurologic function when instituted after the failure of standard closed-chest compression CPR. Twenty-nine mongrel dogs were anesthetized and then instrumented with catheters to monitor right atrial and ascending aortic pressures. Ventricular fibrillation was induced and after 3 min standard CPR was begun. Standard CPR was performed with a Thumper programmed for 2 inch chest compressions at 60/min with a 50% duty cycle. External defibrillation was attempted twice after 15 min of ventricular fibrillation. Unsuccessfully defibrillated animals were randomly assigned to either an additional 2 min of continued closed-chest compressions, or 2 min of open-chest cardiac massage. All animals underwent a period of advanced cardiac life support and were followed until they were resuscitated or died. Follow-up care, including scoring of neurologic deficit, was performed for 7 days. In dogs receiving open-chest cardiac massage there was significantly more immediate resuscitation success (14/14 vs 5/14; p less than .005), 24 hr survival (12/14 vs 4/14; p less than .005), and 7 day survival (11/14 vs 4/14; p less than .02) than in those receiving continued closed-chest compression. Open-chest cardiac massage significantly improved long-term outcome when instituted after 15 min of ineffective closed-chest compression.     

心肺复苏成功率与除颤时间窗关系的临床分析

目的:探讨心肺复苏成功率与除颤时间窗的关系及临床意义。方法:对86 例各种原因导致的心脏骤停患者在心肺复苏中及早使用电除颤时间窗与复苏成功率的相关性进行观察分析。结果:发现在心肺复苏中恢复自主呼吸与循环的44 例心脏骤停患者中尽早使用电除颤与复苏成功率有着密切的相关性,除颤开始的时间距心脏骤停发作越短复苏成功率越高。结论:心脏骤停患者尽早实施电除颤可明显提高心肺复苏成功率。