Is cardiopulmonary resuscitation training deleterious for family members of cardiac patients?

The purpose of the study was to determine the attitudes toward cardiopulmonary resuscitation (CPR) training and subsequent CPR use of 172 CPR-trained family members of cardiac patients. The majority (88.9%) reported positive attitudes. Only 14 (8.1%) reported feeling too responsible for their family member. One hundred and forty-one (81.9%) said that they would perform CPR if required to do so. Family members do not feel unduly burdened by learning CPR, and CPR training should be recommended to families of patients at risk for sudden cardiac death.     

The psychological effects of sudden infant death syndrome on surviving family members

It has been estimated that 7,000 to 10,000 deaths each year may be attributed to Sudden Infant Death Syndrome (SIDS). Although some clinicians have published their personal observations regarding the psychological effects of SIDS on surviving family members, a literature search failed to reveal more thorough studies of the aftermath of SIDS. This study reports the responses to a 13-page questionnaire of 32 parents who had experienced SIDS. Several major findings were observed: (1) SIDS is the most severe crisis these parents had ever experienced, taking their families an average of 8.3 months to regain the level of family organization they had held prior to the death, and taking individual parents an average of 15.9 months to regain the level of personal happiness they had held prior to the death; (2) a majority of parents suffered personal guilt, and numerous other psychological and/or physiological difficulties; (3) relationships with other family members were affected in various ways in the vast majority of cases; and (4) 60 percent of parents who had experienced SIDS in this particular population could not be found for participation in the study; all of these parents had, within 2 1/2 years of the death, moved from their home towns. Implications for crisis prevention and intervention are outlined.     

Cost-effectiveness of cardiopulmonary resuscitation training programs.

A model is presented to analyze the cost-effectiveness of programs to train large numbers of citizens in the techniques of cardiopulmonary resuscitation (CPR). From a planner's estimates of certain key factors, the model determines the probability of intervention for various numbers of trained citizens and for several allocation strategies and patterns of population density. These key factors are the maximum distance from which a person with CPR training could intervene in an emergency, the cost of training, and loss of skill with time. The model is used to analyze possible training efforts in Houston, Texas.     

The place of cardiopulmonary resuscitation.

Following the report of a working party of the Royal College of Physicians in July 1987, a decision was taken to make the skill of cardiopulmonary resuscitation mandatory for entrants to the College. The options for introducing this criterion are discussed, including the ultimate decision reached by the Examination Board to accept presentation of a certificate of competence by candidates on application to take the examination.     

超长心肺复苏下心肺复苏仪的应用

目的 在超长心肺复苏中,比较使用心肺复苏仪与人工标准心肺复苏的疗效与优势.方法 113例超长心肺复苏分为心肺复苏仪组、人工标准心肺复苏组,比较两组复苏成效以及收缩压与血氧饱和度.结果 心肺复苏仪组在复苏失败、复苏有效、复苏成功三方面较人工标准心肺复苏组差异有统计学意义,复苏失败率较后者低而复苏有效率和复苏成功率较后者高(P＜ 0.01),收缩压与血氧饱和度明显高于人工标准心肺复苏组(P＜O.01).结论 在超长心肺复苏中,使用心肺复苏仪具有较强的优越性,复苏成效确切,值得在临床推广使用.     

The psychological and physical health of family members caring for an elderly person with dementia.

Most elderly persons with dementia are cared for at home, usually by the spouse or an adult child. The objective of the present study was to determine whether there is an excess of psychological and physical health problems among family caregivers (CGs) of elderly persons with dementia. Data were obtained by interview from close family members of dementia patients (CGs), and from a comparison group made up of close family members of patients undergoing cataract surgery (non-caregivers, NCGs). CGs had significantly higher levels of depression and physical symptoms than NCGs. The association between caregiving and the health variables was stronger among subjects who were the patient's spouse than among those who were the patient's child. Furthermore, greater behavioral disturbance in the demented patient was associated with higher levels of morbidity in the CG. The results suggest that CGs might benefit from careful monitoring of their health status, and from greater access to specialized support services.     

1432例猝死病人院前心肺复苏状况回顾分析

目的：分析影响院前心肺复苏成功的因素,探讨提高院前急救能力与具体的救治措施。方法：对1432例心肺复苏病例资料随机分成面罩气囊组（A组）和气管插管组（B组）、气管内给药组（C组）和静脉给药组（D组）、单纯肾上腺素组（E组）和联合用药组（F组）。对各组分别回顾性分析患者院前复苏成功率。结果：B组复苏成功率高于A组,差异有统计学意义（P〈0.05）,D组复苏成功率高于C组,差异有统计学意义（P〈0.05）,F组复苏成功率高于E组,差异有统计学意义（P〈0.05）。结论：院前急救能力的提高和合理的救治措施是提高院前心肺复苏成功率的重要因素。     

Review of risk factors for sudden infant death syndrome

Sudden infant death syndrome (SIDS) accounts for the largest number of deaths during the first year of life in developed countries. The possible causes of SIDS are numerous and, to date, there is no adequate unifying pathological explanation for SIDS. Epidemiological studies have played a key role in identifying risk factors, knowledge of which has underpinned successful preventive programmes. This review critically assesses information on the main risk factors and causal hypotheses put forward for SIDS, focusing on research published since 1994. The overall picture that emerges from this review is that affected infants are not completely normal in development, but possess some inherent weakness, which may only become obvious when the infant is subjected to stress. Initially there may be some minor impairment or delay in development of respiratory, cardiovascular or neuromuscular function. None of these is likely to be sufficient, in isolation, to cause death and, provided the infant survives the first year of life, may no longer be of any significance. However, when a compromised infant is confronted with one or more stressful situations, several of which are now clearly identified as risk factors, and from which the majority of infants would normally escape, the combination may prove fatal.     

Female children with incarcerated adult family members at risk for lifelong neurological decline

A secondary analysis of data from adult female prison inmates in the mid-Atlantic United States defined relationships between having incarcerated adult family members during childhood and neurological outcomes. Of 135 inmates, 99 (60%) had one or more incarcerated adult family members during childhood. Regression analyses revealed that having incarcerated adult family members was related to greater frequency and severity of childhood abuse and higher incidence of neurological deficits in adulthood, especially related to traumatic brain injuries, compared to those without incarcerated adult family members. Along with being role models, adult family members impact the neurological health of children throughout their life-span.     

Computer polygraphic system for infants at risk for sudden infant death syndrome (SIDS)

We have designed and developed a suite of equipment for polygraphic assessment of infants thought to be at risk for Sudden Infant Death Syndrome. A range of commercially available and custom made instrumentation is used to monitor cardio-respiratory function and thermal activity. The PC based system records continuous overnight trends and is able to detect apnoea, bradycardia, tachycardia, oxygen desaturation and other significant clinical events, producing summary data and graphs at the conclusion of the monitoring. The system is fully interactive and adaptable to various clinical and research requirements.     

心肺复苏成功后45例患者的护理策略

目的探讨心脏骤停心肺复苏术(CPR)初步成功后患者的护理措施,制定严密完善的护理策略。方法收集作者医院近5年来CPR成功后,病情允许转送中心重症监护室(ICU)进一步治疗者45例的临床资料、护理要领和心得。结果本组45例,经良好的循环功能、呼吸功能、脑功能的支持、维持,均于入急诊抢救室后6 h内转入中心ICU,进行进一步的生命支持和康复治疗。结论医护的密切配合、严密的护理策略预案、高质量的护理技术、敏锐的观察力和迅速高效的反应机制是提高CPR成功的不可或缺的重要环节。     

Prognosis for patients in a coma following cardiopulmonary resuscitation

Most patients with post-anoxic coma after resuscitation have a poor prognosis. Reliable prediction of poor outcomes (death or vegetative state after 1 month; death, vegetative state or severe disability after at least 6 months) at an early stage is important for both family members and treating physicians. Poor outcome can be predicted with 100% reliability in the first 3 days after resuscitation in about 80% of patients using pupillary and corneal reflexes and motor response from the neurological examination, cortical responses from somatosensory evoked potentials and EEG. The predictive value of a status epilepticus or serum levels of neuron-specific enolase is uncertain at this time. In contrast to poor outcomes, good neurological recovery cannot be predicted reliably at this time.     

Naloxone distribution and cardiopulmonary resuscitation training for injection drug users to prevent heroin overdose death: A pilot intervention study

Fatal heroin overdose has become a leading cause of death among injection drug users (IDUs). Several recent feasibility studies have concluded that naloxone distribution programs for heroin injectors should be implemented to decrease heroin overdose deaths, but there have been no prospective trials of such programs in North America. This pilot study was undertaken to investigate the safety and feasibility of training injection drug using partners to perform cardiopulmonary resuscitation (CPR) and administer naloxone in the event of heroin overdose. During May and June 2001, 24 IDUs (12 pairs of injection partners) were recruited from street settings in San Francisco. Participants took part in 8-hour training in heroin overdose prevention, CPR, and the use of naloxone. Following the intervention, participants were prospectively followed for 6 months to determine the number and outcomes of witnessed heroin overdoses, outcomes of participant interventions, and changes in participants’ knowledge of overdose and drug use behavior. Study participants witnessed 20 heroin overdose events during 6 months follow-up. They performed CPR in 16 (80%) events, administered naloxone in 15 (75%) and did one or the other in 19 (95%). All overdose victims survived. Knowledge about heroin overdose management increased, whereas heroin use decreased. IDUs can be trained to respond to heroin overdose emergencies by performing CPR and administering naloxone. Future research is needed to evaluate the effectiveness of this peer intervention to prevent fatal heroin overdose.     

The development of a model for predicting infants at high risk of sudden infant death syndrome in Tasmania

A statutory 'Notification of Birth' form, containing obstetric and perinatal information, has been routinely collected for Tasmanian deliveries since 1974. For the period 1980 to 1984, birth notification data was collected for over 99% of Tasmanian deliveries. This data was examined for the 130 cases of sudden infant death syndrome (SIDS) that occurred from 1980 to 1984 and for 610 controls. It was then used to construct an at-birth scoring system to predict infants at higher risk of SIDS in the postneonatal period. A predictive model of the relative risk of SIDS was developed by fitting a binomial/logistic generalised linear model to the binary 1980-1984 case control data with birth variables used as predictors. The final predictive model contained five variables (maternal age, infant sex, birth weight, month of birth and feeding practice) and had a sensitivity of 62% and specificity of 73%. The model was then tested on independent birth cohorts from 1985 and 1986 and found to have a sensitivity of 47% and specificity of 77%. The risk of SIDS in the group of infants classified as high risk was 7.9 per 1000 live births and in the group at low risk it was 2.5 per 1000 live births. In addition, the model predicted 74% of neonatal deaths occurring during these 2 years. This compares well with other predictive models developed elsewhere. The predictive model will be used to identify infants at high risk for SIDS in a prospective cohort study.     

The development of a model for predicting infants at high risk of sudden infant death syndrome in Tasmania

Summary. A statutory 'Notification of Birth' form, containing obstetric and perinatal information, has been routinely collected for Tasmanian deliveries since 1974. For the period 1980 to 1984, birth notification data was collected for over 99% of Tasmanian deliveries. This data was examined for the 130 cases of sudden infant death syndrome (SIDS) that occurred from 1980 to 1984 and for 610 controls. It was then used to construct an at-birth scoring system to predict infants at higher risk of SIDS in the postneonatal period. A predictive model of the relative risk of SIDS was developed by fitting a binomial/logistic generalised linear model to the binary 1980–1984 case control data with birth variables used as predictors. The final predictive model contained five variables (maternal age, infant sex, birth weight, month of birth and feeding practice) and had a sensitivity of 62% and specificity of 73%. The model was then tested on independent birth cohorts from 1985 and 1986 and found to have a sensitivity of 47% and specificity of 77%. The risk of SIDS in the group of infants classified as high risk was 7.9 per 1000 live births and in the group at low risk it was 2.5 per 1000 live births. In addition, the model predicted 74% of neonatal deaths occurring during these 2 years. This compares well with other predictive models developed elsewhere, The predictive model will be used to identify infants at high risk for SIDS in a prospective cohort study.