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Biomedical subjects

T Silfvast

Publications and source records attributed to T Silfvast.

9 recordsLinked to original sources
PubMed1996

The effect of experience of on-site physicians on survival from prehospital cardiac arrest.

Outcome from prehospital cardiac arrest was studied 1 year before (Period I) and after (Period II) a reorganisation of the work and the simultaneous change of all physicians participating in the care of prehospital patients in the emergency medical service system in Helsinki. There were 444 patients during Period I and 395 patients during Period II. Resuscitation was initiated in 279 patients during Period I and in 323 patients (P < 0.001) during Period II. The number of patients with ventricular fibrillation who suffered a witnessed cardiac arrest due to presumed heart disease was 120 and 130, respectively. During Period I, 70 of these patients were successfully resuscitated and admitted to hospital, 41 (34%) survived to discharge home from hospital. Corresponding figures during Period II were 79 and 33 (25%, NS). Compared with Period I, a larger proportion of the successfully resuscitated patients either died in hospital or were discharged to an institution during Period II (P < 0.05).

Cardiopulmonary Resuscitation↗
PubMed1996

Pediatric prehospital care provided by a physician-staffed emergency medical helicopter unit in Finland.

During an 18-month period ending on March 15, 1994, data on all patients treated by the Helsinki Area Emergency Medical Air Service (HEMS) in Southern Finland were collected. The HEMS operates a physician-staffed helicopter unit which is dispatched by alarm centers connected to a national 112 emergency phone system. Of 1481 emergency missions during the study period, 89 (8%) involved children less than 17 years old. Common pediatric emergencies were trauma (31%), seizures (29%), respiratory problems (14%), and cardiac arrest (9%). Fourteen patients were intubated, an intravenous line was started in 58 patients, and 32 patients received intravenous medication. Cardiopulmonary resuscitation was initiated in nine patients. Ten patients were evacuated by helicopter, and 22 patients were transported by ground ambulance with a HEMS physician escort to the hospital. According to this study, the HEMS physician play an important role also in pediatric prehospital care in their operating area.

Adolescent↗
PubMed1993

[Emergency medical service in Finland].

The article consists in a review of the development of prehospital care in Finland and of emergency medical services in Helsinki. Based on 20 years' accumulated experience at a physician staffed prehospital emergency care unit in Helsinki, emergency medical services throughout the country have begun implementing the various links in the 'chain of survival' concept.

Education, Medical, Continuing↗
PubMed1991

Cause of death in unsuccessful prehospital resuscitation.

During 1987-1988, prehospital resuscitation was unsuccessful in 204 of 381 patients who suffered a witnessed cardiac arrest due to presumed coronary heart disease in Helsinki. The cause of death was verified by autopsy in 80 (39%) of the 204 patients. Their cause of death could not be estimated on the basis of previous patient history, and their autopsy diagnoses were then related to the initial cardiac rhythm recorded at the scene. At autopsy, coronary heart disease was considered to have been the cause of death in 78% of the patients with ventricular fibrillation, in 43% of the patients with electromechanical dissociation (EMD), and in 60% of the patients in asystole. Cardiac tamponade or massive pulmonary embolism was the cause of death in 15 of the 28 patients with EMD who underwent autopsy. These findings support previously noted relationships between some causes of cardiac arrest and the initial cardiac rhythm, and also in prehospital cardiac arrest patients with unsuccessful resuscitation.

Aged↗
PubMed1990

Initiation of resuscitation in patients with prehospital bradyasystolic cardiac arrest in Helsinki.

The factors influencing the decision to initiate resuscitation in prehospital cardiac arrest patients encountered in bradyasystole due to presumed heart disease were studied. For this purpose, the characteristics and circumstances of arrest of the patients encountered in asystole and electromechanical dissociation, seen by a physician-staffed prehospital emergency care unit in a tiered emergency medical system, were reviewed. During the study period, resuscitation was initiated in 83 bradyasytolic patients. The characteristics of these patients were compared with those of 72 patients in asystole or electromechanical dissociation declared dead on the scene without resuscitation. The presence of EMD was the most important factor influencing the decision to resuscitate (P less than 0.001), even if the arrest was unwitnessed, while the patient's age was of less importance. For the patients with a witnessed arrest, the delay before treatment was initiated also affected the decision. Successful resuscitation and survival of the patients was similar to earlier reports. The results provide guidelines in the decision making of initiation of resuscitation when developing our emergency care system into one with non-physicians as advanced life support providers.

Adult↗
PubMed1990

Prehospital resuscitation in Helsinki, Finland.

Helsinki, a city of 500,000 inhabitants, is served by a two-tiered emergency medical system with basic emergency medical technicians in ordinary ambulances and one physician-staffed prehospital emergency care unit. All 266 patients with prehospital cardiopulmonary resuscitation during 1987 were studied. Two hundred twelve patients with presumed heart disease and a witnessed arrest were analyzed further. Their response times for basic life support and advanced life support were 5.5 and 10.7 minutes, respectively. The initial cardiac rhythm in 144 patients (68%) was ventricular fibrillation. In 79 of these patients, cardiopulmonary resuscitation was successful, and 39 patients (27%) were discharged from hospital. The patients who survived had shorter response times for basic life support and their arrest locations was more often outside home, compared with the nonsurvivors. The results seem comparable with emergency medical systems in the United States, but a need to reduce response times is identified.

Aged↗
PubMed1985

Comparison of adrenaline and phenylephrine in out-of-hospital cardiopulmonary resuscitation. A double-blind study.

Phenylephrine, a strong alpha-adrenergic receptor-stimulating agent, was compared with adrenaline in 65 patients with out-of-hospital cardiac arrest, in a double-blind study. The resuscitation was performed by the physician-staffed Prehospital Emergency Care Unit of Helsinki University Central Hospital. The patients received either 1.0 mg of phenylephrine or 0.5 mg of adrenaline i.v. in the treatment of fine ventricular fibrillation, asystole or electromechanical dissociation. If two doses of either drug did not restore circulation, 0.5 mg of known 0.01% adrenaline was given i.v., maximally twice. In the adrenaline group, which consisted of 36 patients with a mean age of 61 years, 10 patients (28%) were successfully resuscitated. The phenylephrine group consisted of 29 patients with a mean age of 62 years. In this group nine patients (31%) were successfully resuscitated. The two groups were comparable regarding their apnoea-times, and there was no difference in the need for extra adrenaline between the groups. No adverse effects, such as hypertension or bradycardia, were noted in the patients treated with either adrenaline or phenylephrine, nor did the overall rate of successful resuscitation fall during the test period. It is concluded that phenylephrine seems as effective as adrenaline in the treatment of cardiac arrest, but further studies seem warranted.

Adult↗