Biomedical subjects
Publications and source records attributed to M Baubin.
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Specific training in the techniques of cardiopulmonary resuscitation (CPR) has been the major aim of CPR education for both health care professionals and lay people over the past few decades. We performed a randomized trial to evaluate individual physiological parameters of 12 professional rescuers influencing duration and quality of standard CPR and active compression-decompression CPR. CPR duration was assessed according to individual work capacity after grouping rescuers as untrained and trained individuals, according to their work capacity of up to and including 100% and over 100%. The average work capacity of all the rescuers was determined by incremental exercise testing, resulting in 110.0 +/- 26.5% compared with data for the normal population. With 29.3 +/- 12.8 min duration, standard CPR was significantly longer than active compression-decompression CPR with 15.5 +/- 10.2 min duration (P = 0.009). No changes in the forces of compression and decompression were measured during active compression-decompression CPR, thus demonstrating maintenance of constant CPR quality. Duration of resuscitation was influenced by the CPR method performed and by the individual work capacity (P = 0.004 and P = 0.027, respectively). We conclude that the duration of CPR depends both on the method applied and the rescuers' individual work capacity and recommend improvement of work capacity by aerobic training especially for professional rescuers.
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We report echocardiographic observations during external chest compression in a patient with marked abnormalities in thoracic anatomy following emergency surgery of aortic arch aneurysm. Transesophageal echocardiography demonstrated direct right ventricular, aortic and left atrial compression, only minimal left ventricular compression and an open mitral valve during closed chest heart massage. Colour flow doppler demonstrated forward blood flow across the mitral valve and along the left ventricular outflow tract during the compression phase. Echocardiographic findings indicate that factors apart from simple cardiac pump mechanism contributed to blood flow during cardiopulmonary resuscitation (CPR) in this postoperative patient after a major thoracic surgical intervention.
The emergency medical systems (EMS) in Europe are of a high quality partly due to the presence of an emergency doctor at the scene. In those countries without emergency doctors in the field, the emergency medical technicians (EMT) are allowed by law to carry out medical interventions due to their special education including more than 2000 hrs of first aid training (paramedics). The efficiency of the EMS is essentially improved by the presence of paramedics, especially in connection with the increasing frequency of cardiac arrests due to the high incidence of cardiovascular disorders. In the non-European states where the mean life expectancy is low (< or = 70 a) bystander training is rarely introduced. The EMS in Austria is of European standard in the structure of the rescue chain. Some links of this chain require correction and improvement: bystander training has not yet reached its optimal expanse; the profession of an EMT has to be urgently recognized by law; the gaping difference between EMS in urban areas and rural areas has to be eliminated; the limited capacity of emergency admittance to hospitals is a weak link in the chain of survival.
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In this study the outcome of out-of-hospital cardiac arrest (CA) was analyzed during the first 3 years after installation of a mobile intensive care unit (MICU). The unit is staffed by an anesthesiologist as the emergency-care physician and specially trained health-care personnel. The success of cardiopulmonary resuscitation (CPR) was classified into three stages: (1) CPR with temporary cardiac output; (2) CPR primarily successful with spontaneous rhythm and a palpable pulse; (3) CPR, definitely successful resulting in the patient's discharge from the hospital without important neurological sequelae. All patients are grouped according to the disease underlying the CA. The performance of bystander CPR was recorded. The influence the factors sex, age, response time, cardiac rhythm, location of the collapse and period of investigation (1st year, 2nd year, 3rd year) had on the outcome was analyzed. RESULTS. Eighty-nine patients (32.96%) had a temporary cardiac output; 56 patients (20.74%) were primarily successfully resuscitated; and 12 patients (4.44%) survived without important neurological sequelae. Most of the diseases underlying the CA were in the internal disease group. Only 16 cases of bystander CPR performance were recorded. In the group with primarily successful CPR, significantly important factors arose with the increasing CPR success rate due to the period of investigation (1st year: 10.00%, 2nd year: 19.61%, 3rd year: 30.77%) and due to cardiac rhythm "ventricular fibrillation" (34.62%) and "asystole" (11.88%). Furthermore, significantly important factors were found for definite CPR success when comparing males (1.72%) and females (10.64%) and comparing the location of the collapse "in public places" (9.80%) and "at home" (2.00%). CONCLUSION. Our study shows that in spite of installing a MICU, the outcome of CPR is poor without supplementary measures. We consider that systematically teaching the public about basic life support measures and teaching medical students about emergency medicine will lead to a better CPR success rate in combination with continuing education of the MICU personnel.