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Biomedical subjects

L Bossaert

Publications and source records attributed to L Bossaert.

At least 73 records · Page 4Linked to original sources
PubMed1989

Bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest. The Cerebral Resuscitation Study Group.

Prevalence of bystander CPR and effect on outcome has been evaluated on 3053 out-of-hospital cardiac arrest (CA) events. Bystander CPR was performed in 33% of recorded cases (n = 998) by lay people in 406 cases (family members 178, other lay people 228) and by bystanding health care workers in 592 cases (nurses 86, doctors 506). Family members and lay people mainly applied CPR in younger CA victims at public places, roadside or at the working place. Sudden infant death syndrome (SIDS) and drowning are highly represented. Health care workers performed CPR mainly in older patients, at public places or at the roadside and especially in case of cardiac or respiratory origin. CA caused by trauma/exsanguination and intoxication/metabolic origin received less bystander CPR (23% resp. 22%). Cardiac arrests receiving bystander CPR are more frequently witnessed and have a shorter access time to the emergency medical service (EMS) system and shorter response time of basic life support (BLS). Advanced life support (ALS) response time is significantly longer. In witnessed arrests of cardiac origin receiving bystander CPR a significantly better late survival was observed. In non-witnessed arrests of cardiac origin early and late survival are significantly higher in patients receiving bystander CPR. In CA events where response time of ALS exceeds 8 min, the beneficial effect of bystander CPR is most significant. Furthermore no deleterious effect of bad technique or inefficient bystander CPR can be demonstrated.

Adult↗
PubMed1989

Evaluation of cardiopulmonary resuscitation (CPR) techniques. The Cerebral Resuscitation Study Group.

The prevalence of different CPR techniques and the use of adjuncts during the resuscitation attempt by the members of the emergency medical service (EMS) system [bystander, emergency medical technician (EMT), ward nurse, tiered nurse or paramedic, mobile intensive care unit (MICU) has been registrated prospectively during a 5-year period by 7 major Belgian EMS systems. A total of 4548 cardiac arrests have been registered, 3083 happened outside and 1465 inside the hospital. Evaluation of the methods used for assessment of quality of the CPR techniques revealed that this approach was biased both by the status of the health care provider and by the outcome of the patient. Nevertheless, it was evident that the well-accepted standards and guidelines for CPR and emergency cardiac care (American Heart Association and Safar) are poorly applied. This seems to be influenced by the qualification, the experience and the training level of the health care provider. In 998 of 3053 studies out-of-hospital arrests (33%) CPR was initiated by bystanders. Of these, 59% were bystanding health care workers. They performed external chest compression (ECC) more frequently than mouth-to-mouth insufflation (MOMO) (poor technique: 16-19%). In 18% the rescuers were family members who applied more MOMO than ECC (poor technique: +/- 50%). Laymen (23%) performed more ECC than MOMO (poor technique: +/- 33%). EMT and ward nurses apply mainly the bag-valve-mask technique. The bag-valve-tube technique is more frequently used by nurses of a tiered system. The MICU-team applies usually the bag-valve-mask prior to intubation.

Electric Countershock↗
PubMed1989

Tolerance and pharmacokinetics of flunarizine after cardiac arrest. The Cerebral Resuscitation Study Group.

Neuronal calcium overloading after complete ischemia-anoxia of the brain might be the primary process initiating chemical cascades which lead to cell death. According to this hypothesis calcium-entry blocking agents act on the final common pathway of brain damage. Flunarizine, a selective calcium-entry blocker (without influence on heart rate and on cardiac contractile force), was administered to 12 unconscious patients, recovering from cardiac arrest (CA) of cardiac origin, according to a strict dose-range infusion protocol. Blood-pressure and heart rate (HR) were recorded before, during (t = 10 min, 20 min) and after (t = 30 min, 2 h, 4 h, 6 h, 8 h) each flunarizine infusion (maximum 4 infusions). A significant, although not clinically relevant, decrease in heart rate was noted during the first infusion. Systolic (SBP) and diastolic blood pressure (DBP) also decreased during the infusion without reaching statistical significance. Plasma levels of flunarizine were determined before and after each infusion (t = 15 min, 30 min, 1 h, 2 h, 4 h, 6 h, 8 h, 12 h). Flunarizine plasma concentrations declined very rapidly after cessation of each infusion. Sequential half-lives were in the order of 11-19 min and 5-7 h, and primarily reflect rates of distribution between the systemic circulation and the rapidly equilibrating tissues such as the brain. No substantial accumulation of flunarizine was described and plasma levels were proportional to the give dose. Therefore, flunarizine pharmacokinetics can be considered as linear for doses up to 50 mg.

Cardiovascular System↗
PubMed1989

Decision making to cease or to continue cardiopulmonary resuscitation (CPR). The Cerebral Resuscitation Study Group.

CPR should be initiated in any patient who has a cardiac arrest. This might improve overall outcome but implies that CPR is started in patients without any virtual chance for long-term survival (LTS). The aim of this study is, by analysing retrospectively 2713 out-of-hospital cardiac arrests (CA), to identify indices which might be of help in the decision making to continue or to discontinue CPR. In an important number of unsuccessful CPR attempts ALS-time did not exceed 20 min. This occurred more frequently in subgroups where limited chances of LTS are expected on clinical grounds. The decision to cease CPR might have been based on other clinical and/or ethical parameters which were not recorded in the registry. This behavior results in a "self-fulfilling prophecy". A subset of patients with limited chances for LTS (0/405) can be identified: patients in electromechanical dissociation (EMD) or asystole on arrival of the mobile intensive care unit (MICU) team, without pupil reaction to light during CPR and with inefficient cardiac massage by the MICU (405/2713). Other patients in EMD or asystole without pupil reaction to light during CPR (1373/2713) but with efficient ECC should be resuscitated for more than 30 min, especially if the patient is gasping during CPR (LTS 27/1373). Patients in EMD or asystole on arrival of the MICU with pupil reaction to light during CPR (236/2713) should have an ALS-time of at least 45 min (LTS 42/236). Cardiac arrests in ventricular fibrillation (VF) (699/2713) should be resuscitated for at least 45 min, especially when gasping during CPR (LTS 119/699).

Ambulances↗
PubMed1989

Lazarus sign and extensor posturing in a brain-dead patient. Case report.

A man was declared brain dead after having sustained a gunshot wound to the head. All clinical criteria for the diagnosis of brain death were met. The electroencephalogram was isoelectric, and four-vessel angiography demonstrated the absence of cerebral blood flow. However, stereotypic spontaneous movements were observed which persisted for several hours. The possible mechanism is discussed and a short review of the literature is given.

Brain Death↗
PubMed1989

[Regional differences in the Belgian national campaign for a citizen CPR education "3 minutes for a life"].

In 1986-1988 the Belgian Red Cross and the Belgian Heart Association organised a nationwide citizen-CPR campaign. In this report regional differences in attitude towards CPR, in perception of promotion and in CPR instruction are studied. In two telephone inquiries (study sample n = 2400) organised with one year interval perception of the promotional efforts of the campaign was studied. During the campaign date on 102,249 trainees (study sample n = 17491) and 9927 courses were collected. For each individual CPR course and trainee an evaluation form was generated, describing the profile of instructor, course and trainee. The telephone inquiries demonstrated that french speaking responders were less prone to personal active involvement in case of an unconscious victim (30% vs 47%) and less frequently planned to attend a CPR course (31% vs 22%) as compared to Flemish responders. Concerning CPR instruction, in the Flemish community 72613 citizens were trained in 5505 courses by 768 instructors. In the french community 29636 people were trained in 4425 courses by 524 instructors. Flemish instructors were less experienced than french instructors in CPR teaching (greater than 25 courses: FI 27%, Fr 41%). The profile of CPR instructors and CPR courses were markedly different in both communities but the trainee and teaching results were identical.

Attitude to Health↗
PubMed1988

Thrombolytic treatment of pulmonary embolism with APSAC.

BRL 26921 (Eminase registered trade mark in Belgium, Germany and The Netherlands) is the p-anisoyl derivative of the primary (human) lys plasminogen-streptokinase activator complex (APSAC). The acyl-enzyme has the theoretical advantage of causing fibrinolysis in situ in the presence of fibrin clotbound plasminogen. It was administered to 34 patients with severe pulmonary embolism (PE) in an open multicentre study. PE was suspected on clinical, blood gas, ECG, and radiographic data. Pulmonary angiograms performed pre- and post-treatment confirmed the diagnosis and were assessed using the Miller Index (MI). Fibrinogen, plasminogen, alpha-2-antiplasmin, fibrinogen degradation products (FDP), activated partial thromboplastin time (APTT), partial thromboplastin time (PTT) were closely monitored before and after each administration of APSAC. Median angiographic improvement was 50% (range 0-94%). The following adverse events were reported: bleeding at puncture sites (n = 12), haematuria (n = 1), epistaxis (n = 3), fever (n = 2). A blood transfusion was given in one patient with an inguinal haematoma. Systemic fibrinogenolysis occurred in 20/28 patients.

Adult↗
PubMed1987

A new patient registration method for intensive care department management.

A new method to describe intensive care department performance is presented. The method is a complication of available administrative and medical data, completed with a severity of illness measure (Acute Physiology And Chronic Health Evaluation, APACHE) and the registration of nursing care intensity. The development of this latter patient stratification system (Intensive Care Activity Score, INCAS) is described. The performance of the method is demonstrated by a study of 200 consecutive admissions.

Cost Control↗
PubMed1981

Myopotential inhibition of unipolar ventricular inhibited pacemakers: prevention by an insulating sheath.

To determine the occurrence of inhibition of pacing by sensing of myopotentials, forty-five patients with predominant pacemaker driven heart rhythm were studied. In eleven patients with a bipolar lead system myopotential inhibition was never observed. In the remaining group (34 patients) with unipolar pacemakers myopotential inhibition was demonstrated in fifteen patients. Three of them were symptomatic, two severely. In forty new implants a silicone-rubber insulating sheath was placed against the muscular side of the pacemaker. In none of these patients myopotential inhibition could be demonstrated. The authors conclude that myopotential inhibition occurs frequently in unipolar ventricular inhibited pacemakers, and can be prevented by insulating the muscular side of the anodal surface.

Electric Conductivity↗
PubMed1977

Idiopathic orthostatic hypotension and the Shy and Drager syndrome; Physiological studies in four cases; pathological report of one case.

Five cases of idiopathic orthostatic hypotension are presented. Physiological tests were performed in four cases which demonstrated that the lesion in the sympathetic system was most probably situated in the intermediolateral columns in three cases. In one case the lesion was localized on the efferent pathway either at the preganglionic or the postganglionic level. These four patients had also evidence of parasympathetic dysfunction. In the fifth case the clinical diagnosis of Shy and Drager syndrome was confirmed by pathological examination of the nervous system which revealed intermediolateral cell loss and the pathological findings commonly observed in the striato-nigral and olivo-ponto-cerebellar degenerations.

Aged↗