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Biomedical subjects

D A Chamberlain

Publications and source records attributed to D A Chamberlain.

At least 19 recordsLinked to original sources
PubMed1992

Survey of 3765 cardiopulmonary resuscitations in British hospitals (the BRESUS Study): methods and overall results.

OBJECTIVE: To determine the circumstances, incidence, and outcome of cardiopulmonary resuscitation in British hospitals. DESIGN: Hospitals registered all cardiopulmonary resuscitation attempts for 12 months or longer and followed survival to one year. SETTING: 12 metropolitan, provincial, teaching, and non-teaching hospitals across Britain. SUBJECTS: 3765 patients in whom a resuscitation attempt was performed, including 927 in whom the onset of arrest was outside the hospital. MAIN OUTCOME MEASURE: Survival after initial resuscitation, at 24 hours, at discharge from hospital, and at one year, calculated by the life table method. RESULTS: There were 417 known survivors at one year, with 214 lost to follow up. By life table analysis for every eight attempted resuscitations there were three immediate survivors, two at 24 hours, 1.5 leaving hospital alive, and one alive at one year. Survival at one year was 12.5% including out of hospital cases and 15.0% not including these cases. Each hospital year averaged 30 survivors at one year: three who had an arrest outside hospital, seven who had one in the accident and emergency department, seven in the cardiac care unit, 10 in the general wards, and three in other, non-ward areas. Within the hospitals survival rates were best in those who had an arrest in the accident and emergency department, the cardiac care unit, or other specialised units. Outcome varied 12-fold in subgroups defined by age, type of arrest, and place of arrest. CONCLUSION: 71% of the mortality at one year in patients undergoing attempted resuscitation occurred during the initial arrest. Hospital resuscitation is life saving and cost effective and warrants appropriate attention, training, coordination, and equipment.

Age Factors↗
PubMed1979

Haemodynamic effects of salbutamol in patients with acute myocardial infarction and severe left ventricular dysfunction.

The haemodynamic effects of salbutamol infusions at rates of 10,20, and 40 micrograms/min were measured in 11 patients with acute myocardial infarction complicated by left ventricular failure. Four patients also had cardiogenic shock. Consistent increases were observed in cardiac outputs at all doses (up to 56% at 40 micrograms/min), while the mean systemic arterial pressure fell slightly (average 5 mm Hg), implying a reduction in peripheral vascular resistance. Changes in right atrial pressure and indirect left atrial pressure (measured as pulmonary artery end-diastolic pressure) were small and not significant. Analysis of data from individual patients showed that the greatest increment in cardiac output was reached at 10 micrograms/min in two cases, 20 microgram/min in three, and 40 micrograms/min in the remaining six. Heart rate at these doses increased by an average of only 10 beats/min. Salbutamol failed to reduce left ventricular filling pressure and cannot be recommended for the treatment of pulmonary oedema in acute myocardial infarction. The increase in cardiac output, however, was considerable, so that the drug may be important in the management of low-output states. This action is probably a result of peripheral arteriolar dilatation (itself a result of beta 2-adrenoreceptor stimulation) and is achieved with little alteration in the principal determinants of myocardial oxygen requirement.

Adult↗
PubMed1979

Hospital resuscitation from ventricular fibrillation in Brighton.

The overall results over three and a half years of the treatment of ventricular fibrillation secondary to ischaemic heart disease in the Royal Sussex County Hospital were reviewed. Records of all patients who were brought to hospital by resuscitation ambulances or who were admitted to the coronary care unit from any source were analysed. Eighty-seven of the 174 patients (50%) who developed ventricular fibrillation were discharged. The survivors included 13 out of 61 patients (21%) in whom fibrillation was secondary to cardiogenic shock or severe left ventricular failure. The presence of resuscitation equipment and nursing staff trained to use it in the general wards and emergency areas ensured a uniformly high success rate throughout the hospital, similar to that achieved in the coronary care unit. Prompt defibrillation in the general wards and the accident and emergency department may improve overall survival.

Adult↗
PubMed1979

1028 neonatal electrocardiograms.

Electrocardiograms were recorded from 1028 (99.4%) of 1034 consecutively born babies on the 1st or 2nd day of life. Abnormalities of cardiac rhythm or conduction were found in 49 (4.8%) babies. 17 babies had single or multiple premature beats during the recordings, and 7 babies showed sudden increases in R-R interval possibly due to sinoatrial node dysfunction. One baby had sinus or junctional bradycardia of less than 80 beats/min. One baby had an incessant reciprocating tachycardia and subsequently required digoxin for heart failure. Continuous 24-hour ECG monitoring in 25 babies with abnormalities of the screening ECG, and 25 babies without such abnormalities, failed to show any additional tachyarrhythmias or bradyarrhythmias warranting treatment. In view of the uncertain clinical significance of many neonatal arrhythmias and cardiac conduction disorders, more information concerning their natural history and relationship to sudden unexpected death in infancy is needed before recommending that neonatal ECG screening be generally adopted.

Arrhythmias, Cardiac↗
PubMed1979

Low voltage electrical activity preceding right atrial depolarisation in man.

Electrical recordings were made in the high right atrium in 28 patients undergoing cardiac catheterisation and in 3 healthy volunteers. After filtering and amplification by 3 to 10 million times, the signals were passed through a signal averaging process in a digital computer. Of the 28 subjects who had technically satisfactory recordings, 23 showed low voltage electrical activity preceding the conventionally-recorded atrial depolarisation. The low voltage activity started 50 to 200 ms before the atrial deflection and was variable in shape. These early signals may be the result of activity in the region of the sinus node.

Arrhythmia, Sinus↗
PubMed1979

Sinus node disease affecting both parents and both children.

A family is described in which both parents and both of their children developed conducting system disease before the age of 40. They all had evidence of possible sinus node dysfunction. The father and son had an unexplained polyneuritis during childhood.

Adolescent↗
PubMed1978

The Brighton resuscitation ambulances: review of 40 consecutive survivors of out-of-hospital cardiac arrest.

In three years 40 patients were resuscitated by ambulancemen after out-of-hospital cardiac arrest and survived to be discharged. Twenty-six of these had had circulatory arrest before an ambulance arrived and a further three had developed ventricular fibrillation before they were moved. Thirty-two patients were alive at the time of review six months to three and a half years later. Resuscitation by ambulancemen can be effective for patients with unheralded sudden cardiac arrest as well as for patients with recent myocardial infarction. Survivors of out-of-hospital ventricular fibrillation may have a favourable long-term prognosis.

Adult↗
PubMed1978

Wolff-Parkinson-White syndrome (type A) complicated by heart block in both normal and accessory pathways.

A 67-year-old man with Wolff-Parkinson-White syndrome type A presented with second degree atrioventricular block in anomalous pathway and complete infra-Hisian block in the His-Purkinje pathway. He had increasingly frequent attacks of dizziness not related to exercise. A permanent ventricular demand pacemaker was successfully implanted following intracardiac electrophysiological studies.

Aged↗