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Biomedical subjects

C F Weston

Publications and source records attributed to C F Weston.

At least 19 recordsLinked to original sources
PubMed1998

Acute myocardial infarction: are there missed opportunities for reperfusion? UK Heart Attack Study Investigators.

AIMS: To investigate the current use of thrombolytic therapy in the management of patients with acute myocardial infarction and to determine the potential for an increased use of thrombolysis or percutaneous transluminal coronary angioplasty (PTCA). METHODS AND RESULTS: All hospitalised cases of acute myocardial infarction were identified in three health districts in the UK (population of 960,000) in patients under the age of 76 years during a 2-year period; 2439 patients had acute myocardial infarction, of whom 1264 (52%) received thrombolytic therapy. Failure to administer thrombolytic therapy was a result of the absence of diagnostic electrocardiograms in 712 (29.2%) patients, late presentation in 127 (5.2%), therapeutic error in 112 (4.6%), presence of a bleeding risk in 139 (5.7%) and other miscellaneous reasons in 80 (3.3%) patients. Thirty-eight of the 139 patients in whom bleeding risk was reported as a contra-indication could, in retrospect, have received thrombolytic therapy and a further 76 would have been suitable for primary PTCA. CONCLUSIONS: The potential for increasing the use of thrombolytic therapy seems to be limited and is unlikely to make a major impact on the in-hospital mortality from acute myocardial infarction. However, primary PTCA should be considered in those who are ineligible for thrombolysis because of bleeding risk as a contra-indication.

Adult↗
PubMed1997

Predicting survival from out-of-hospital cardiac arrest: a multivariate analysis.

From 954 attempts to resuscitate patients from out-of-hospital cardiac arrest two datasets were derived, namely 861 cases of cardiac arrest and 906 cases of either cardiac or primary respiratory arrest. For each dataset, multivariate analysis was performed by fitting a number of explanatory variables with respect to the outcomes of admission to hospital and discharge home in logistic regression models. There were numerous interactions between these variables. Being conscious at the time of the arrival of the ambulance crew and subsequently having cardiac arrest strongly predicted survival, as did both the presence of a witness to the arrest and the initiation of cardiopulmonary resuscitation (CPR) by a bystander; this latter effect was a marker for early CPR. The strongest predictor of a poor outcome was delay to CPR or delay to advanced cardiac life support.

Age Distribution↗
PubMed1997

Outcome of out-of-hospital cardiorespiratory arrest in south Glamorgan.

During 138 weeks an emergency medical service (EMS) of mixed skill-level attempted to resuscitate 954 patients from prehospital cardiac arrest (883 attempts per million population per year); 75% of the arrests were of cardiac cause. This paper is one of the first analyses from europe to use the 'Utstein template' to report outcomes of such arrests. In cases where an arrest rhythm could be recorded, 38.4% were ventricular fibrillation (VF), 45.5% were asystolic, and the remainder were either electromechanical dissociation or respiratory arrests. Using univariate analysis factors associated with a greater likelihood of survival include the presence of a witness, bystander-initiated cardiopulmonary resuscitation (CPR), early CPR and VF as the arrest rhythm. Twenty of 155 cases (13%) survived where VF arrest was witnessed by non-EMS personnel.

Aged↗
PubMed1996

Giant T wave inversion associated with severe aortic regurgitation.

Two patients with haemodynamically significant aortic regurgitation and angiographically normal coronary arteries developed giant T wave inversion. The T wave abnormality partially resolved in both, following valve replacement in one and medical treatment in the other. This unusual electrocardiographic appearance may be related to myocardial ischaemia caused by increased left ventricular wall stress and changes in phasic coronary blood flow, abnormalities in cerebral perfusion associated with severe aortic regurgitation, or to coincidental neurological disease.

Aged↗
PubMed1995

Failure of ambulance crew to initiate cardiopulmonary resuscitation.

The Utstein style of reporting out-of-hospital cardiac arrests requires that all confirmed cardiac arrests considered for resuscitation are analysed and that a record is made of the number of cases where no resuscitation is attempted. We report a series of 942 confirmed cardiac arrests considered for resuscitation by South Glamorgan Emergency Medical Service (EMS). There were 370 (39.3%) cases where no resuscitation was attempted by the EMS. The ages, male/female ratio and EMS response times were similar in both the group that received ambulance resuscitation and those that did not. Those not receiving resuscitation were less likely to have had an arrest of cardiac aetiology (51.3% vs. 75%, P < 0.00001). Rigor mortis or decomposition of the body was present in 50.8% of cases and in 20% a doctor had already confirmed the patient dead. In the remainder the ambulance crew failed to start resuscitation for a variety of reasons.

Aged↗
PubMed1995

Respiratory arrest outside hospital.

Of 954 attempted resuscitations outside hospital performed by ambulance personnel, 48 patients (5%) had primary respiratory arrest. Comparing this group with those manifesting cardiorespiratory arrest, patients with primary respiratory arrest were significantly more likely to be female (25 of 48 vs 269 of 906-P < 0.005), were more likely to have a non-cardiac cause (67% vs. 22%-P < 0.00001) and more likely to have witnessed arrest. Of all arrests witnessed by ambulance crew, 35% were respiratory arrests. Basic and advanced life-support was delivered sooner. Outcome was significantly better, with 19 patients (40%) being discharged compared to only 49 patients (5.1%) discharged in cases of cardiorespiratory arrest (p < 0.00001). Considering that many respiratory arrests were witnessed by ambulance crew, the type of crew (EMT or paramedic) made no difference to outcome. Our findings suggest that patients manifesting respiratory arrest outside hospital are a heterogeneous group who have a relatively good prognosis regardless of the type of ambulance crew that attends.

Age Distribution↗
PubMed1995

An open, prospective comparison of beta 2 agonists given via nebuliser, Nebuhaler, or pressurised inhaler by ambulance crew as emergency treatment.

BACKGROUND: The merits of the use of beta 2 agonists by ambulance crew and best methods of delivery have not been fully explored. METHODS: A prospective comparison has been made of treatments applied in three districts in South Wales (200 micrograms salbutamol by pressurised inhaler, 5 mg salbutamol via nebuliser, and 5 mg terbutaline via Nebuhaler) by emergency ambulance personnel to acutely wheezy patients en route to hospital. Pulse rate, respiratory rate, peak expiratory flow rate (PEFR), and breathlessness scored on a visual analogue scale were compared before and after treatment. Data were collected on diagnosis, artificial ventilation, cardiorespiratory arrest, and death. RESULTS: Thirty eight patients received salbutamol inhaler, 51 salbutamol via nebuliser, and 41 terbutaline via Nebuhaler. There were greater reductions in respiratory rate and breathlessness score and more improvement in PEFR in the group receiving nebulised salbutamol than in the other two groups. No patient was ventilated and of the five deaths none was caused by asthma. CONCLUSIONS: For wheezy, breathless patients treated en route to hospital by emergency ambulance personnel, 5 mg salbutamol given by an oxygen-driven nebuliser was more effective than either 5 mg terbutaline via a Nebuhaler or 200 micrograms salbutamol via a pressurised inhaler.

Acute Disease↗
PubMed1994

Guidelines for the early management of patients with myocardial infarction. British Heart Foundation Working Group.

In light of recent publications relating to resuscitation and pre-hospital treatment of patients suffering acute myocardial infarction of British Heart Foundation convened a working group to prepare guidelines outlining the responsibilities of general practitioners, ambulance services, and admitting hospitals. The guidelines emphasise the importance of the rapid provision of basic and advanced life support; adequate analgesia; accurate diagnosis; and, when indicted, thrombolytic treatment. The working group developed a standard whereby patients with acute myocardial infarction should receive thrombolysis, when appropriate, within 90 minutes of alerting the medical or ambulance service--the call to needle time. Depending on local circumstances, achieving this standard may involve direct admissions to coronary care units, "fast track" assessments in emergency departments, or pre-hospital thrombolytic treatment started by properly equipped and trained general practitioners.

Clinical Protocols↗
PubMed1994

The need for wider dissemination of CPR skills: are schools the answer?

The value of instructing members of the public in CPR is now widely recognised, but community training schemes which rely largely on volunteers may fail to reach their targets. CPR training for lay people is often a once only activity and it has been shown that, without revision, skills deteriorate rapidly. By teaching CPR in secondary schools all social classes and ethnic groups could be reached, and retention of skills improved by regular revision. Health education has shown that it may be beneficial to use older pupils as instruction assistants.

Cardiopulmonary Resuscitation↗
PubMed1993

Pre-hospital cardiac arrest associated with coronary artery spasm.

A 37-yr-old woman with an 8-month history of chest pain, unrelated to exercise, was successfully resuscitated from out-of-hospital cardiac arrest due to ventricular fibrillation. Cardiac catheterisation revealed minor coronary artery disease. Ergometrine injection was associated with complete occlusion of the left anterior descending coronary associated with identical chest pain and pronounced ST-segment changes.

Adult↗
PubMed1993

Management of hospital survivors of pre-hospital ventricular fibrillation.

The objective of our study was to characterise 52 hospital survivors of pre-hospital ventricular fibrillation and record their initial management in hospital. A retrospective review was undertaken of ambulance report forms, hospital notes, and electrocardiograms, in one teaching hospital and three district general hospitals in South Wales, of 53 patients discharged from hospital between February 1987 and April 1992 after resuscitation from pre-hospital ventricular fibrillation by ambulance personnel. Twenty patients showed evidence of acute myocardial infarction (group 1), eight patients had a diagnosis of 'possible acute myocardial infarction' (group 2), and 25 patients had no evidence of acute myocardial infarction (group 3). Nineteen patients in group 1 experienced chest pain before collapse compared with only six patients in group 3 (p < 0.001). Five patients in group 1 had a previous history of ischaemic heart disease compared with 17 patients in group 3 (p < 0.01). A greater proportion of patients in group 3 were taking diuretic medication (15 of 25 vs 4 of 20: p < 0.01) but there was no difference in potassium levels on admission to hospital. Cardiologists were involved in the management of a minority of patients (21 of 53); only eight patients underwent cardiac catheterisation; and only three were referred for electrophysiological studies. Patients in group 3 were more likely to be discharged taking empiric antiarrhythmic drugs (13 of 25) than patients in group 1 (2 of 20) (p < 0.01). Not enough use is made of noninvasive and invasive investigations in the management of survivors of pre-hospital ventricular fibrillation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Thrombolysis following pre-hospital cardiopulmonary resuscitation.

Forty-eight patients were discharged from hospital following successful resuscitation from out-of-hospital ventricular fibrillation. Sixteen of these patients received intravenous thrombolytic therapy on admission to hospital. There were 3 significant bleeding complications and 2 cases of inappropriate administration of streptokinase. One of the patients that did not receive thrombolysis also had a significant bleeding complication of cardiopulmonary resuscitation. Patients admitted to hospital following resuscitation should only receive thrombolytic therapy when there is overwhelming electrocardiographic evidence of acute myocardial infarction, and even then with caution.

Aged↗