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Results for “Advanced Cardiac Life Support”

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PubMed2006

Successful cardiac and cerebral resuscitation with extracorporeal circulation and mild hypothermia.

Extracorporeal circulation could be effective for cardiac resuscitation in patients who do not respond to ''Advanced cardiac life support'' (ACLS), but cannot guarantee brain survival. A case of successful cardiac and cerebral resuscitation with extracorporeal circulation and mild hypothermia, in a 48 year-old man with cardiac arrest due to cardiac tamponade, is reported. The good long term neurologic outcome of the patient is also described.

Cardiopulmonary Resuscitation↗

PubMed1991

Effect of level of patient acuity on clinical decision making of critical care nurses with varying levels of knowledge and experience.

This study is an examination of the effect of patient acuity on the clinical decision making of critical care nurses (N = 68) completing two computerized clinical simulations. Ventricular tachycardia represented the high-acuity situation and atrial flutter the lower-acuity situation. Clinical decision making was measured by proficiency score, patient outcome (cure or die), and amount of data collected. Analyses of variance were conducted to examine proficiency score and the amount of data collected. Fisher's exact test and the McNemar test of homogeneity of proportions were used to examine patient outcome. In the atrial flutter simulation, proficiency scores were higher (p = 0.000), more dysrhythmias were cured (p less than 0.005), and more data were collected (p = 0.040). Experienced and inexperienced nurses did not differ on proficiency score; however, inexperienced nurses collected more data (p = 0.048) and cured fewer atrial flutter simulations (p = 0.040). Nurses certified in advanced cardiac life support had higher proficiency scores (p = 0.033) and collected fewer data (p = 0.048).

Acute Disease↗

PubMed1991

The effect of standard- and high-dose epinephrine on coronary perfusion pressure during prolonged cardiopulmonary resuscitation.

We studied the effect of standard and high doses of epinephrine on coronary perfusion pressure during cardiopulmonary resuscitation in 32 patients whose cardiac arrest was refractory to advanced cardiac life support. Simultaneous aortic and right atrial pressures were measured and plasma epinephrine levels were sampled. Patients remaining in cardiac arrest after multiple 1-mg doses of epinephrine received a high dose of 0.2 mg/kg. The increase in the coronary perfusion pressures was 3.7 +/- 5.0 mm Hg following a standard dose, not a statistically significant change. The increase after a high dose was 11.3 +/- 10.0 mm Hg; this was both statistically different than before administration and larger than after a standard dose. High-dose epinephrine was more likely to raise the coronary perfusion pressure above the previously demonstrated critical value of 15 mm Hg. The highest arterial plasma epinephrine level after a standard dose was 152 +/- 162 ng/mL, and after a high dose, 393 +/- 289 ng/mL. Because coronary perfusion pressure is a good predictor of outcome in cardiac arrest, the increase after high-dose epinephrine may improve rates of return of spontaneous circulation.

Aorta↗

PubMed1991

[Standards for preclinical resuscitation--requirements for efficient therapy and scientific analysis. A prospective study using as an example the combined emergency medical service of the Munich administrative district and capital].

A standardized treatment protocol is essential for scientific evaluation of parameters influencing the outcome and survival of patients who have suffered cardiac arrest in a non-hospital situation. In addition, a standardized therapy algorithm permits effective, time-saving interaction of all members of the emergency team who work together to perform cardiopulmonary resuscitation (CPR) in any emergency outside the hospital. This paper gives the results obtained in 50 patients in whom on-the-spot resuscitation was performed by a specially trained team [emergency medical team (EMT) + on-scene physician] using an ACLS (advanced cardiac life support) protocol modified from the AHA (American Heart Association) standard. Two different algorithms were used one for ventricular fibrillation (VF) and pulseless ventricular tachycardia and one for asystole and pulseless bradycardia. When indicated, countershocks were first administered at a continuous energy level of 360 J, up to three times one after the other. All patients then received epinephrine intratracheally, 2 mg, immediately after intubation. In the case or persisting asystole a further 2-mg dose of epinephrine and then one 5-mg dose were given i.v. in keeping with the ACLS protocol. In the case of persisting VF or pulseless tachycardia we gave one 100-mg dose of lidocaine i.v. and then performed the next countershock at the same energy level. The time the team members actually needed for the single steps of the ACLS protocol was meticulously documented with the aid of a stop watch.(ABSTRACT TRUNCATED AT 250 WORDS)

Algorithms↗

PubMed1991

Cardiac arrest outcome in a tiered response system.

The Emergency Medical Service system must provide prompt CPR, early defibrillation and full advanced cardiac life support (ACLS) within the time 'window of effectiveness.' Timely availability of these combined components determines the chance for survival.

Allied Health Personnel↗

PubMed1990

Outcome and predictors of outcome in pediatric submersion victims receiving prehospital care in King County, Washington.

Predictors of outcome in pediatric submersion victims treated by Seattle and King County's prehospital emergency services were studied. Victims less than 20 years old were identified from hospital admissions and paramedic and medical examiners' reports. The proportion of fatal or severe outcomes in patients were compared with various risk factors. Of 135 patients, 45 died and 5 had severe neurologic impairment. A subset of 38 victims found in cardiopulmonary arrest had a 32% survival rate, with 67% of survivors unimpaired or only mildly impaired. The two risk factors that occurred most commonly in victims who died or were severely impaired were submersion duration greater than 9 minutes (28 patients) and cardiopulmonary resuscitation duration longer than 25 minutes (20 patients). Both factors were ascertained in the prehospital phase of care. Submersion duration was associated with a steadily increasing risk of severe or fatal outcomes: 10% risk (7/67) for 0 to 5 minutes, 56% risk (5/9) for 6 to 9 minutes, 88% risk (21/25) for 10 to 25 minutes, 100% risk (4/4) for greater than 25 minutes. None of 20 children receiving greater than 25 minutes of cardiopulmonary resuscitation escaped death or severe neurologic impairment. Our rates for saving all victims, particularly victims in cardiopulmonary arrest, are considerably higher than has been reported before the children. Prompt prehospital advanced cardiac life support is the most effective means of medical intervention for the pediatric submersion victim. Prehospital information provided the most valuable predictors of outcome.

Adolescent↗

PubMedDate not supplied

Cardiac arrest after hypertonic citrate anticoagulation for chronic hemodialysis.

The use of regional citrate anticoagulation as an alternative to standard therapy in hemodialysis patients at risk for bleeding complications has been well described. Recently, a method using hypertonic citrate has been reported as being safe and efficacious, and having several advantages over the usual techniques. Two patients who suffered cardiac arrests after dialysis using hypertonic citrate are discussed. Both received anticoagulation as described in the literature, although the citrate infusion rate was lower than recommended. Electrocardiograms obtained during the first such session showed no change in the Q-Tc interval with initiation of the infusion in either patient. Both were noted to have cardiac arrest within 5 minutes of discontinuation of dialysis, without warning symptoms, following the second and fifteenth treatments, respectively. The initial rhythm of ventricular fibrillation did not respond to standard advanced cardiac life support therapy, and the patients were not successfully resuscitated until they received intravenous calcium. The authors postulate that the loss of positive calcium flux from the dialysate, in conjunction with circulating unmetabolized citrate, caused an electrolyte imbalance leading to the potentially fatal arrhythmia. Caution is recommended in using this method of regional anticoagulation.

Adult↗

PubMed1990

An advanced resuscitation training course for preregistration house officers.

Preregistration house officers need to be able to manage the first 5-10 minutes of a cardiac arrest. A course has been designed based on the recommendations of the Resuscitation Council UK 1984 and the format of the American Heart Association advanced cardiac life support course. Fifty-nine newly qualified doctors from the same medical school class were studied in two consecutive groups: Group 1 (n = 31) were commencing their first post and Group 2 (n = 28), whose first preregistration post had been at other hospitals without practical resuscitation training, were commencing their second post. They were pretested and taught in three 2-hour sessions. Five months later they were tested to measure retention of knowledge and skills. Before training there was no difference in knowledge between the two groups but Group 1 were more skilled. The knowledge and skills of both groups immediately after training were significantly improved and at 5 months skills were subject to modest decay only. Experience of managing cardiac arrests was not a substitute for formal practical training.

Educational Measurement↗

PubMed1990

Hyperkalemic electromechanical dissociation.

Two patients with hyperkalemic electromechanical dissociation are described. Electrocardiograms at the time of the cardiac arrests demonstrated normal appearing QRS complexes. Both patients responded to intravenous calcium chloride administration with prompt restoration of normal blood pressure. Implications of these observations with respect to current advanced cardiac life support guidelines are discussed.

Adult↗

PubMed1986

Cardiovascular pharmacology. II: The use of catecholamines, pressor agents, digitalis, and corticosteroids in CPR and emergency cardiac care.

The Cardiovascular Pharmacology II panel met during the AHA National Conference on Standards and Guidelines for CPR and emergency cardiac care to consider the use of catecholamines, pressor agents, digitalis, and corticosteroids during advanced cardiac life support. During cardiac arrest, catecholamines and pressor agents have been shown to improve the rate of success of resuscitation. The useful properties of these drugs are mediated by strong alpha-adrenergic stimulation resulting in improved coronary perfusion. beta-Adrenergic stimulation during cardiac arrest is unimportant for resuscitation and potentially harmful. Studies have not demonstrated a difference between mixed agonists and alpha-agonists with respect to overall outcome. Consequently, the panel recommended that epinephrine continue to be the primary vasopressor for use during cardiac arrest. For cardiovascular support in the hemodynamically unstable patient, the panel recommended that drugs be chosen for specific pharmacologic actions that will allow the needed physiologic manipulation guided by objective hemodynamic measurements. The panel found that digitalis preparations and corticosteroids have very limited use in emergency cardiac care.

Adrenal Cortex Hormones↗

PubMed1986

Cardiovascular pharmacology. III: Atropine, calcium, calcium blockers, and beta-blockers.

Atropine, calcium, calcium-channel blockers, beta-adrenergic-receptor blockers, oxygen, morphine, vasodilators, and potent diuretics are frequently used in advanced cardiac life support (ACLS). Since the last AHA conference on ACLS standards, little controversy has arisen regarding the use of oxygen, morphine, vasodilators, or potent diuretics. In 1979, a full vagolytic dose of atropine was recommended for use early in the course of asystolic or bradycardiac arrest. Since then reports suggest that this higher dose of atropine may be of some limited value in treating this highly resistant form of arrest. The routine use of calcium for asystole, bradycardiac arrest, and electromechanical dissociation has come under intense scrutiny. Studies have failed to demonstrate improved survival and have found potentially deleterious levels of serum calcium when calcium was administered according to AHA standards. It is also possible that postanoxic cerebral injury is exacerbated by the use of calcium. No controversy exists, however, concerning the use of calcium for the moribund patient with possible hypocalcemia or with an excess of calcium-channel blockers. The use of calcium-channel blockers has been advocated to prevent or retard the intracellular accumulation of calcium, which may cause irreversible postanoxic tissue damage. Calcium-channel blockers may also be useful in preventing or decreasing cerebral and coronary arteriospasm. These drugs have antianginal properties that may decrease ischemia. The antiarrhythmic effect of verapamil is particularly useful in the treatment of uncomplicated paroxysmal supraventricular tachycardia. Verapamil and diltiazem slow conduction through the atrioventricular node and may be used to slow the ventricular response in atrial fibrillation and flutter.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗

PubMed1989

Can family members of high-risk cardiac patients learn cardiopulmonary resuscitation?

The immediate delivery of bystander-administered cardiopulmonary resuscitation (CPR), coupled with the rapid delivery of advanced cardiac life support, can significantly reduce mortality from out-of-hospital cardiac arrest. Because the majority of sudden cardiac deaths occur in the victim's home with family members present, family members of cardiac patients at high risk for sudden death are the logical focus of CPR training. However, previous research has shown that only a small minority of family members of cardiac patients actually learn CPR and that health care professionals have failed to recommend CPR training in this population, in part due to concerns about their ability to learn CPR. The purpose of this study was to describe learning capabilities in this population and to identify characteristics of unsuccessful learners. To this end, we taught CPR to 83 family members of cardiac patients who were at risk for sudden cardiac death. Subjects had no CPR training within the past two years. Eighty-one percent of the subjects successfully learned CPR. Of the demographic and psychological characteristics examined, only gender, age, and depression were significant in explaining differences in CPR skills attainment ability. The elderly, the depressed, and males were more likely to be unsuccessful in demonstrating adequate CPR skills. Our results suggest that the majority of family members of cardiac patients can learn CPR successfully. Specific training strategies may need to be developed and tested to enhance CPR training in those family members of cardiac patients predicted to have difficulty learning CPR.

Adult↗

PubMedDate not supplied

Evaluation of assessment methods of cardiac arrest simulations.

Evaluation of advanced cardiac life support performance requires a consistent assessment process. This study compares a new objective method of evaluation to the currently used method to determine if this objective method improves evaluator concordance on critical errors and whether or not this method is reasonable when compared to the current evaluation method. The design compared two experienced evaluator groups consisting of two evaluators in each group, with one group utilizing written guidelines and the other without these guidelines. Each evaluator independently reviewed student performances on 36 videotaped simulations. Results indicate that evaluators with the written guidelines identified critical errors more often than evaluators without these guidelines (30 versus 20 of 36 cases). When the critical errors observed by the no guideline evaluators were compared to the written guidelines, the critical errors were consistent with the written guidelines in 32 of 36 cases. These results suggest that written guidelines improve evaluator identification of critical errors observed and are reasonable when compared to two experienced evaluators without these guidelines.

Educational Measurement↗

PubMed1986

Dextrose containing intravenous fluid impairs outcome and increases death after eight minutes of cardiac arrest and resuscitation in dogs.

Use of dextrose in intravenous resuscitation fluids is common practice; however, this study indicates that 5% dextrose solutions, even if administered in physiologic quantities, greatly worsens the outcome of survivable cardiac arrest. Twelve adult male mongrel dogs were premedicated with morphine, anesthetized with halothane, instrumented, intubated, and ventilated. Each dog was first given 500 ml of either lactated Ringer's (LR) (n = 6) or 5% dextrose in LR (D5LR) (n = 6). Halothane was stopped and fibrillation was induced (60 Hz). Blood glucose just before cardiac arrest was 129 mg/dl in the LR dogs and was increased to 335 mg/dl in the D5LR dogs. After eight minutes of arrest, resuscitation, including internal cardiac massage and standard advanced cardiac life support drug protocols (modified for dogs), was begun. When stable cardiac rhythm was obtained, the chest was closed, and LR or D5LR continued until a total of 1L was given. A neurologic score (0 = normal to 100 = dead) was assigned at 1, 2, 6, and 24 hours. The LR group did not differ statistically from the D5LR group in operative time, number of defibrillatory shocks, time to spontaneous ventilation, time to extubation, or drugs required. Resuscitation was successful in all six LR and five of six D5LR group; however, by 2 hours after resuscitation and thereafter, D5LR group had a significantly greater neurologic deficit (p less than 0.05) than did the LR group. By 9 hours, four of six D5LR dogs displayed convulsive activity and died. At 24 hours the D5LR group had a greater (p less than 0.008) neurologic deficit (82 +/- 11) than did the LR group (21 +/- 7), which walked and ate. We conclude that the addition of 5% dextrose to standard intravenous fluids greatly increases the morbidity and mortality associated with cardiac resuscitation.

Animals↗

PubMed1987

Postdefibrillation idioventricular rhythm--a salvageable condition.

While patients who present with a pulseless idioventricular rhythm have a dismal prognosis, such a rhythm following electrical defibrillation from ventricular fibrillation (VF) may have an entirely different clinical significance. By reviewing the cases of 100 consecutive patients with prehospital ventricular fibrillation, we found the following: Subsequent development of field pulses, survival to hospital admission and hospital discharge in 49 patients who initially had pulseless idioventricular rhythm following defibrillation were statistically significantly worse (P<.05) than for 20 patients successfully defibrillated into any other organized rhythm. They were statistically significantly better, however, than for 25 patients who failed to achieve any organized rhythm in the field. Outcomes were statistically no different in 40 patients who received standard advanced cardiac life support drug therapy for pulseless idioventricular rhythm after defibrillation than in 9 patients who spontaneously progressed to another rhythm before drug therapy could be given. These findings suggest that pulseless idioventricular rhythm may be a transient recovery rhythm following defibrillation from prehospital VF, that it can in this circumstance be associated with a good outcome in a reasonable number of patients and that a short trial of cardiopulmonary resuscitation only, without immediate drug therapy, may be appropriate in these patients.

Arrhythmias, Cardiac↗

PubMed1982

Subclavian vein catheterization during cardiopulmonary resuscitation. A prospective comparison of the supraclavicular and infraclavicular percutaneous approaches.

Percutaneous access to the central venous circulation is indicated in the management of some cardiopulmonary arrests. We prospectively studied 89 attempted subclavian vein catheterizations in a total of 76 patients. There were 44 supraclavicular (SC) and 45 infraclavicular (IC) approaches. We found that the percutaneous SC route provides a better technique than the IC approach: it is associated with fewer failures, less difficulty in the mechanics of line insertion, a higher incidence of proper catheter tip location, and much less interference with cardiopulmonary resuscitation in normal, obese, and cachectic patient subgroups. Successful performance occurred despite a documented lack of physician experience with the SC technique, indicating that it should be taught during advanced cardiac life support training courses.

Cardiac Catheterization↗

PubMed1995

Nurse anesthesia admission qualifications.

This study describes criteria used by graduate nurse anesthesia educational programs (GNAEPs) in selecting students for admission. The investigators prepared and distributed a 15-item questionnaire to 71 GNAEPs as listed by the Council on Accreditation of Nurse Anesthesia Eduational Programs for December 1992. Thirty-eight of 71 (54%) of GNAEPs participated in this study. Upon examination of standardized test scores, mean Graduate Record Exam scores were: analytical 533, quantitative 512, verbal 510, and cumulative 1,552. The mean Millers Analogy Test score was 47. The mean overall grade point average (GPA) was 3.32 and the mean science GPA was 3.20. Experience in critical care nursing averaged 5 years, with 54% of students coming from surgical intensive care units and 81% Advanced Cardiac Life Support certified. The most commonly identified prerequisite course was organic/biochemistry. All programs required references, 97% required interviews, and 68% required essays. Program directors ranked overall GPA, interview, and science GPA among the factors considered most in the selection process. The sample revealed an acceptance rate of 22% for those applying to GNAEPs.

Education, Nursing, Graduate↗

PubMed1995

Rural Alberta thrombolysis study. Survey of practice patterns for managing acute myocardial infarction.

OBJECTIVE: To determine current practice patterns for managing acute myocardial infarction in rural Alberta, particularly to examine the availability of thrombolytic therapy. DESIGN: Mailed questionnaire based on a clinical vignette. SETTING: All 104 acute care hospitals in rural Alberta with fewer than 100 beds. PARTICIPANTS: The Chief of Staff at each hospital. MAIN OUTCOME MEASURES: Proportion of hospitals providing thrombolytic therapy, choice of thrombolytic agent, rates of elective transfer after thrombolysis, and barriers preventing universal use of thrombolytic therapy. RESULTS: Questionnaires were completed by 101 physicians. Three hospitals had no medical staff. Thrombolytic therapy was available in 80.8% of the hospitals. Hospitals that did not offer thrombolysis were smaller (average bed capacity 21.9 versus 37.7, P < 0.001), had fewer medical staff (average number 2.4 versus 5.5, P < 0.001), and had fewer nurses holding Advanced Cardiac Life Support certification (P = 0.015) than hospitals providing thrombolysis. Physicians identified inadequate nursing resources as the greatest barrier to providing thrombolysis. Of physicians using thrombolysis, 71.4% chose streptokinase. Half of the physicians preferred elective transfer after the procedure. CONCLUSIONS: Thrombolytic therapy for acute myocardial infarction is standard practice in small hospitals in Alberta.

Alberta↗