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L Wik

Publications and source records attributed to L Wik.

29 records · Page 2Linked to original sources
PubMed1996

The ventilation/compression ratio influences the effectiveness of two rescuer advanced cardiac life support on a manikin.

Time is of crucial importance during advanced cardiac life support (ACLS). Several parallel tasks have to be performed more or less simultaneously. The guidelines recommend a ventilation/ compression ratio of 1:5 in two-rescuer ACLS. This was compared with respect to time and CPR quality to an alternative method of a 2:15 ratio performed by one of the two rescuers freeing one rescuer to concentrate on other tasks than ventilation and chest compression. Seventeen paramedic students were trained in pairs in ACLS according to the European Resuscitation Council guidelines using an Ambu Mega Code trainer manikin. From a starting point of asystole paramedics were required to perform ECG analysis, intubation, i.v. access, adrenalin and atropine injection, flushing of the drug bolus before conversion to ventricular fibrillation followed by defibrillation in addition to ventilation and chest compression. Unpaired two-tailed Student t-test and the Fisher's exact test were used for statistical analysis, with a P-value less than 0.05 regarded as significant. It took significantly less time to perform successful CPR with the 2:15 ratio compared to the 1:5 ratio. The quality of the ventilations and compressions performed were not significantly different between 2:15 and 1:5 ratio. When two rescuers are performing ACLS, the 2:15 ratio method appears to be time saving vs. the 1:5. This could potentially improve the outcome after cardiac arrest.

Allied Health Personnel↗
PubMed1996

Future directions for resuscitation research. II. External cardiopulmonary resuscitation basic life support.

In sudden cardiac deaths outside hospitals, the present performance of external cardiopulmonary resuscitation-basic life support (CPR-BLS), as a bridge to advanced life support (ALS) attempts for restoration of spontaneous circulation (ROSC), still yields suboptimal results. Therefore, future education research should develop more effective, simpler and quicker ways to enable everyone to acquire the necessary BLS skills. Individualized self-training by lay persons is being revived. Although airway control and direct mouth-to-mouth ventilation skills are difficult to acquire, they must continue to be taught to the lay public and health professionals, primarily for use on relatives and friends where infection risk is not a problem. In children and trauma victims, steps A and B alone may be lifesavers. The best way to ventilate and oxygenate during the initiation of brief external CPR-BLS should be re-evaluated. There is a great difference between animals and humans in the behavior of the airway and thorax during coma, and thus in the need for added positive pressure ventilation. During chest compressions in humans, steps A and B are needed. Details deserve re-evaluation. The low perfusion pressures (borderline blood flows) produced by standard external CPR remain the most serious limitation of this method. In spite of extensive efforts so far, novel laboratory research to remedy this limitation is important for the development of more effective emergency artificial circulation. The results of such studies are greatly influenced by different details in animal models. Active compression-decompression (ACD) external CPR, also called 'push-pull' CPR, with a plunger-type device used by hand or a machine, and intermittent abdominal compression (IAC) external CPR are both promising modifications of standard external CPR. Both need further experimental and clinical clarification. For BLS, developing a more effective purely manual CPR-BLS method for help in rapid ROSC should be given high priority. Portable external CPR machines need improvements. They will serve for bridging ROSC-resistant cases through transport and ALS attempts, primarily by freeing the hands of health professionals for more effective sophisticated ALS measures.

Cardiopulmonary Resuscitation↗
PubMed1996

Active compression-decompression cardiopulmonary resuscitation--instructor and student manual for teaching and training. Part I: The workshop.

In an attempt to standardize the teaching and training of active compression-decompression cardiopulmonary resuscitation (ACD-CPR), a group of leading emergency physicians, cardiologists, anesthesiologists, paramedics and nurses with practical, theoretical, educational, and scientific experience in the subject met in June 1995. The group was called The International Working Group of Teaching and Training Active Compression-Decompression CPR. The group was 'born' as a result of the first International Conference of Active Compression-Decompression CPR held in Copenhagen in March 1995. The following paper describes the background, development and text of and ACD-CPR course manual for both students and instructors.

Cardiopulmonary Resuscitation↗
PubMed1996

A comparison of prolonged manual and mechanical external chest compression after cardiac arrest in dogs.

The effects of manual and a new mechanical chest compression device (Heartsaver 2000) during prolonged CPR with respect to haemodynamics and outcome were tested in a prospective, randomized, controlled experimental trial during ventricular fibrillation in 12 dogs of 9-13 kg body weight after 1 min of cardiac arrest. During the first 10 min of CPR the dogs were resuscitated according to the Basic Life Support (BLS) algorithm, followed by 20 min of Advanced Life Support (ALS) algorithm. After 30 min of CPR both manual and mechanical CPR groups were resuscitated following a standardized ALS protocol. During CPR, coronary perfusion pressure and end tidal CO2 were greater with mechanical CPR. All animals were successfully resuscitated and neurological deficit scores were not different. The CPR trauma score was less in the mechanical group. Mechanical external chest compression provided better haemodynamics than the manual technique, though outcome did not differ. Both optimally performed manual and mechanical techniques produce flow sufficient to maintain organ viability for 30 min of CPR after a 1 min arrest interval.

Animals↗
PubMed1995

A peer-training model for instruction of basic cardiac life support.

This study evaluates a peer-training model for cardiopulmonary resuscitation (CPR) instruction for laypersons. Forty-one Norwegian factory employees were trained in CPR and given instructor training. These first trainees then trained 311 co-workers. These employees then trained 873 family members and associates at home. The reference group consists of employees in a Massachusetts commercial hotel trained in seven American Red Cross (ARC): Adult CPR classes. The Norwegian home trainees learned CPR using a cardboard training manikin and were trained by Norwegian factory employees who had learned CPR from co-workers. Trainees were evaluated using skill sheets and a Laerdal Skillmeter manikin. The performance of the Norwegians trained at home by peers did not differ from that of the ARC: Adult CPR trainees in six skills of the initial sequence of CPR. The home trainees outperformed the ARC: Adult CPR trainees in the proportion of compressions delivered correctly (P = 0.032) and ventilations delivered correctly (P = 0.015). Peer training may provide CPR instruction comparable to training in CPR classes at lower cost and with potential to reach new population segments.

Analysis of Variance↗
PubMed1995

The first European pre-hospital active compression-decompression (ACD) cardiopulmonary resuscitation workshop: a report and a review of ACD-CPR.

Active compression-decompression cardiopulmonary resuscitation (ACD-CPR) has been evaluated in animal cardiac arrest models and in human outcome studies. Blood flow to the brain and heart is significantly increased during ACD-CPR compared to standard CPR. Transoesophageal Doppler analysis indicates that ACD-CPR increases left ventricular blood volume, velocity of blood flow through the mitral valve (82-140%), and stroke volume (85%). Pressures, such as coronary perfusion-, systolic-, mean-, and diastolic aortic pressures, ETCO2, and tidal volume generated by chest compression and decompression, increase during ACD-CPR compared to standard CPR. Prehospital outcome studies have shown both positive and no extra benefit of ACD-CPR on return of spontaneous circulation, hospital admission, and discharge rates. The ACD-CPR method should be evaluated in patients with witnessed arrest receiving bystander CPR who are found in ventricular fibrillation and do not respond to the three initial DC shocks. There is no evidence that ACD-CPR is worse than standard CPR. Appropriate ACD-CPR training using a standardized curriculum must preceed its implementation. Long-term neurologic outcome studies are needed.

Animals↗
PubMed1994

Simultaneous active compression-decompression and abdominal binding increase carotid blood flow additively during cardiopulmonary resuscitation (CPR) in pigs.

The effects of adding active compression-decompression and abdominal binding separately or combined to standard compression CPR was tested in a randomized cross-over design during ventricular fibrillation in eight pigs. The flow and pressure effects of the two techniques appeared to be additive with no interference between the two. Carotid blood flow increased 22% with active compression-decompression, 34% with abdominal binding and 59% with the combination compared to flow with standard compression. Peak antegrade carotid flow occurred in early systole with retrograde flow in early diastole and close to zero in late diastole with no profound alterations induced by active decompression or abdominal binding. Abdominal binding increased the intrathoracic pressure during the compression phase as estimated from the esophageal pressure, while active decompression caused a negative esophageal pressure during the decompression phase. Neither active decompression nor abdominal binding caused any changes in the coronary perfusion pressure, nor in the left ventricular transmural pressure except for a rise in mid-diastolic pressure with active decompression.

Animals↗
PubMed1994

Quality of bystander cardiopulmonary resuscitation influences outcome after prehospital cardiac arrest.

To evaluate the influence of quality of bystander cardiopulmonary resuscitation (CPR) on outcome in prehospital cardiac arrest we consecutively included patients with prehospital cardiac arrest treated by paramedics in a community run ambulance system in Oslo, Norway from 1985 to 1989. Good CPR was defined as palpable carotid or femoral pulse and intermittent chest expansion with inflation attempts. Outcome measure was hospital discharge rate. One hundred and forty-nine of 334 patients (45%) received bystander CPR. The discharge rate after good BCPR (23%) was higher than after no good BCPR (1%, P < 0.0005) or after no BCPR (6%, P < 0.0005). There was no difference between no good and no BCPR (P = 0.1114). There were no differences in paramedic response interval between the groups, but the mean interval from start of unconsciousness to initiation of CPR (arrest-CPR interval) was significantly shorter in the group receiving good bystander CPR (2.5 min, 95% confidence interval (CI): 1.7-3.3 min) than no good CPR (6.6 min, CI: 5.2-8.0 min) or no bystander CPR (7.8 min, CI: 7.2-8.4 min). Bystanders started CPR more frequently in public than in the patient's home (58 vs. 34%, P < 0.0005). Good bystander CPR was associated with a shorter arrest-CPR interval and improved hospital discharge rate as compared to no good BCPR or no BCPR.

Adolescent↗