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At least 19 recordsLinked to original sources
PubMed1977

Cardiac arrest.

Cardiac arrest is easily recognized clinically and requires immediated cardiopulmonary resuscitation (CPR) by well trained personnel. The importance of prophylaxis is emphasized in high risk patients. The ABC regime of CPR and the technique of blind defibrillation are recommended in the management of cardiac arrest. Good results may be expected with ventricular fibrillation associated with some correctable factor or myocardial infarction. With a satisfactory CPR technique and prompt resuscitation, the incidence of complications is low.

Adult↗
PubMed1979

Antiarrhythmic drug therapy in survivors of prehospital cardiac arrest: comparison of effects on chronic ventricular arrhythmias and recurrent cardiac arrest.

We studied the long-term effects of membrane-active antiarrhythmic agents on chronic ventricular arrhythmias in patients who have survived prehospital cardiac arrest. Among 16 patients treated with a dose-adjusted, plasma level-monitored antiarrhythmic regimen, eight have survived for longer than 12 months and eight have had recurrent cardiac arrests (RCAs). Monthly Holter monitor tapes (HM) recorded during the 4 months before the eight RCAs were compared with monthly HM tapes matched for time of entry and duration of follow-up in the eight patients who did not have RCAs. Transient or persistent complex ventricular ectopic depolarizations (VEDs) have been recorded on 47 of the 63 monthly HM tapes (75%). The difference between VEDs in the RCA patients (mean 153 VEDs/hr, median 19 VEDs/hr) and VEDs in the patients who have not had RCA (mean 122 VEDs/hr, median 8 VEDs/hr) was not significant (p less than 0.2); nor was there a predictable relationship between therapeutic plasma levels of antiarrhythmic agents and the frequency and complexity of chronic asymptomatic VEDs (therapeutic levels--mean 104 VEDs/hr, median 6 VEDs/hr; subtherapeutic levels--mean 184 VEDs/hr, median 21 VEDs/hr). Differences were not significant (p greater than 0.1). In contrast, all eight RCA patients had unstable plasma levels (21 of 31 determinations subtherapeutic) while six of the eight patients who have not had RCA had consistently therapeutic levels (p less than 0.01). Thus, adequate plasma levels of antiarrhythmic agents may protect against RCA, despite failure to suppress VEDs predictably. The apparent dissociation between predictable suppression of chronic VEDs and protection against RCA suggests that clinical effectiveness of these agents may not be best measured by their effect on chronic VEDs.

Adult↗
PubMed1975

Hypothermic arrest and potassium arrest: metabolic and myocardial protection during elective cardiac arrest.

Hypothermic arrest, potassium arrest, and ischemic arrest, either singly or in combination, with or without coronary perfusion were studied in an isolated perfused rat heart preparation. Procedures that permitted the maintenance of high cellular levels of adenosine triphosphate (ATP) and creatine phosphate during arrest, e.g., coronary perfusion with hypothermic solutions or solutions containing 16.0 mM potassium, produced a fully reversible arrest with complete cardiac recovery. Cardiac arrest and coronary flow were related to the degree of hypothermia and the concentration of potassium in the coronary perfusate, and the minimum conditions required to induce complete cardiac arrest were ascertained. The effects of hypothermia and potassium were additive; total cardiac arrest could be obtained by combining small evaluations of potassium with moderate hypothermia. Under these conditions, cellular high-energy phosphates were maintained, and complete recovery was possible. Under conditions in which arrest was obtained without maintaing coronary perfusion, e.g., ischemic arrest, cellular high-energy phosphates declined rapidly, and the hearts exhibited poor recoveries. Some protection could be afforded to the ischemic myocardium by topical hypothermia or by combining the ischemia with potassium arrest. In both instances, ATP and creatine phosphate were maintained at higher levels, and improved recoveries were observed.

Adenosine Triphosphate↗
PubMed1992

High prevalence of coronary artery spasm in survivors of cardiac arrest with no apparent heart disease.

The pathogenesis of cardiac arrest in the absence of any apparent heart disease remains unclear. Based on the hypothesis that coronary spasm may be a cause of cardiac arrest in the absence of apparent heart disease, ergonovine testing and/or electrophysiologic studies (EPS) were performed to evaluate the cause of cardiac arrest. Fourteen patients resuscitated from cardiac arrest had no apparent heart disease. A spontaneous episode of angina with ST-segment elevation occurred in 4 patients while under observation. Ergonovine testing was performed in 9 patients, and coronary spasm was induced in 5. EPS were performed in 8 patients, including 3 patients with coronary spasm. No electrophysiologic abnormalities were found in the 3 patients with coronary spasm. Ventricular fibrillation was induced by programmed ventricular stimulation in 2 patients with documented ventricular fibrillation at the time of resuscitation. All but one of the patients with coronary spasm had chest pain preceding cardiac arrest or at least a history of chest pain at rest, while 4 of 5 patients without coronary spasm had no prodromal symptoms. Patients with coronary spasm had a good prognosis when treated with a Ca-antagonist and/or long-acting nitrate. In conclusion, coronary spasm is the most frequent cause of cardiac arrest in cardiac arrest survivors with no apparent heart disease. Ergonovine testing should be performed to evaluate the cause of cardiac arrest when patients have no apparent heart disease.

Cardiac Pacing, Artificial↗
PubMed1979

Prevalence and prognostic significance of coma after cardiac arrest outside intensive care and coronary units.

In 181 patients resuscitated from cardiac arrest, the prevalence and duration of coma were registered and related to the site of occurrence of cardiac arrest, cardiac rhythm during arrest, age and clinical outcome of the patients. Coma was most frequent after cardiac arrest outside the hospital, as 84% of these patients were comatose for more than 1 h and 56% for more than 24 h; the corresponding values for patients with cardiac arrest in general wards were 63% and 30%, respectively, and for patients with cardiac arrest during ambulance transport, 80% and 44%. Permanent brain damage was extremely rare if the coma lasted less than 6 h (1 out of 62 patients), and relatively rare with a coma duration between 6 and 24 h (5 out of 34 patients). Of the patients, 85 remained comatose for more than 24 h and only 7 of them were discharged alive, all with cerebral impairment of a severity increasing with the duration of the coma. None regained consciousness after more than 7 days' coma, and a total of 80 patients died in coma, 20 with signs of cerebral death. Older patients were more vulnerable to coma than younger ones, but coma as such was not more frequent. We found no differences in coma after asystole and ventricular fibrillation. Problems concerning the selection of patients who have a chance of survival, although comatose after cardiac arrest, are discussed.

Adolescent↗
PubMed1977

Intrapartum fetal cardiac arrest. A preliminary observation.

In 13 patients, episodes of transient fetal cardiac arrest were observed in a group of 594 extensively monitored labors during a given 3-year period. The number of episodes per patient ranged from one to six, with a maximal duration of cardiac arrest (R-R interval) being 5.2 seconds. All of the patients responded to changing maternal position or termination of pregnancy except 1. This patient received Atropine as a premedication for cesarean section. The parasympatholytic properties of Atropine minimized the severity of cardiac arrest. The effect of cardiac arrest on fetuses is not clearly shown in these preliminary observations. The prompt elimination of cardiac arrest is thought to be imperative in reducing perinatal loss. Cardiac arrest is though to be an extensive form of severe variable deceleration. The hypothesis is made that these fetuses had an unbalanced autonomic nervous system and/or an overwhelming vagal tone. If these signs are detected early by fetal monitoring, attention should be paid to the possibility of cardiac arrest.

Acid-Base Equilibrium↗
PubMedDate not supplied

The value of moderate hypothermia during anoxic cardiac arrest for coronary artery surgery.

Anoxic cardiac arrest, as opposed to induced ventricular fibrillation, greatly facilitates accurate distal anastomosis in aortocoronary bypass surgery. In order to diminish the anoxic insult, general and topical hypothermia may be used. In an attempt to establish the value of moderate hypothermia during anoxic cardiac arrest two groups of patients were compared. In group I coronary artery bypass procedures were performed under normothermic conditions with anoxic cardiac arrest. Patients in group II underwent similar procedures but under hypothermic conditions. General body hypothermia to an esophageal temperature of 30 degrees C and topical hypothermia with iced saline lavage were used. Using these techniques, the average intramyocardial temperature was 26 degrees C. Nonfatal cardiac complications did not occur more frequently in the hypothermic group. Operative mortality was decreased from 6.3% in the normothermic group to 1.5% in the hypothermic group. However, in group II, in addition to hypothermia, a second factor in the reduction of mortality was the completeness of the revascularization procedure: 58.5% of the patients had three or more bypass grafts in the hypothermic group. The mean anoxic arrest time was over 50 min for all patients--those who survived as well as those who died with postoperative low cardiac output or myocardial infarction. Therefore, anoxic arrest time should be kept as short as possible and certainly less than 50 min. Intermittent aortic occlusion and performance of the proximal anastomoses using a partial occluding clamp on the aorta are currently being used and, together with moderate hypothermia, provide a further reduction in postoperative myocardial complications.

Arrhythmias, Cardiac↗
PubMed1979

Paramedic programs and out-of-hospital cardiac arrest: II. Impact on community mortality.

Out-of-hospital cardiac arrest was studied in suburban King County, Washington in an attempt to determine the impact of paramedic services on community cardiac mortality. A portion of the study area received paramedic services and the remainder received basic emergency medical technician (EMT) services. A surveillance system identified all prehospital cardiac arrest incidents. The etiology and outcome were determined. Deaths due to primary heart disease (ICDA) codes 410-414) were compared to community cardiac mortality figures for the same period of time and in the paramedic and EMT areas. Between April 1, 1976 and August 31, 1977, 1,449 deaths due to primary heart disease occurred (annual rate of 19.2/10,000 in the EMT area and 13.4/10,000 in the paramedic area). For the same period, 487 patients with out-of-hospital cardiac arrest received emergency resuscitation. The annual incidence of out-of-hospital cardiac arrest was similar in the EMT and paramedic areas (5.6 and 6.0/10,000 respectively). Proportionately more lives of persons with cardiac arrest were saved in the paramedic area than in the MET area. During this 17 month period, the reduction in community cardiac mortality was 8.4 per cent in the paramedic area and 1.3 per cent in the EMT area. These findings suggest that paramedic services have a small but measurable effect on community cardiac mortality.

Aged↗
PubMed1977

Cardiac arrest complicating acute myocardial infarction: predictability and prognosis.

Eleven percent of 905 consecutive patients with acute myocardial infarction admitted to the coronary care unit at Duke University Medical Center experienced cardiac arrest. Subgroups of patients at high and low risk for cardiac arrest were identified. Cardiac arrest was experienced by 17 percent of patients with signs of heart failure on admission but by only 3 percent of patients without diabetes mellitus, prior myocardial infarction or heart failure by history or on admission. Only 59 percent of patients with cardiac arrest survived hospitalization compared with 88 percent of those without cardiac arrest. Long-term survival for the 765 hospital survivors was significantly greater in the group without than in the group with arrest at each yearly interval from 1 through 5 years; the 2 year survival rate was 50 and 77 percent, respectively, in these two groups. Many of the deaths among the hospital survivors occurred in patients with signs of heart failure during hospitalization. Among 668 hospital survivors who had mild or no heart failure during hospitalization, cardiac arrest continued to be a significant predictor of mortality. The mode of death among hospital survivors did not differ in the groups with and without cardiac arrest; for example, the incidence rate of sudden death in the two groups was 44 and 37 per cent, respectively. In light of recent reports suggesting that the prophylactic use of antiarrhythmic agents can virtually eliminate virtually fibrillation during the hospital phase of acute myocardial infarction, we contend that such use may substantially reduce both long-term and hospital mortality after acute myocardial infarction.

Female↗
PubMed1975

Cardiac arrest due to oral potassium administration.

Cardiac arrest developed in two patients after the administration of oral potassium. Neither patient had renal insufficiency, but both had underlying heart disease. In one patient fatal ventricular fibrillation developed 4 days after he received an aortic valve replacement for aortic stenosis and while he was receiving oral potassium supplements. The serum potassium level before cardiac arrest was 8.1 meq. The second patient had angina and was given 40 meq of potassium orally 15 minutes after an exercise test which produced chest pain and S-T segment depression. One hour later, ventricular fibrillation developed. Resuscitation was successful. Both patients had electrocardiographic evidence of hyperkalemia. Oral administration of potassium may produce severe cardiac toxicity in patients with heart disease even when renal function is clinically normal.

Administration, Oral↗
PubMed1976

Unexpected cardiac arrest during anesthesia and surgery. An environmental study.

Medical and legal records of 41 cases of cardiac arrest that occurred during surgery were supplied by a professional liability insurance company and a review was undertaken in an attempt to identify recurring or common factors. The majority of patients in this study were healthy and required relatively routine elective surgical procedures. Only three of the patients survived the cardiac arrest and returned to normal activities. The remaining patients either died in the hospital or had a major central nervous system deficit. Hypoxia from hypoventilation and low levels of inspired oxygen appeared to be the chief cause of cardiac arrest in this study. Because of the unknown frequency of cardiac arrest during surgery, we recommend the establishment of a national registry of cardiac arrest cases that occur in surgical patients, in order to monitor incidence, causes, and outcome. Only in this way will it be possible to lessen the frequency of this disastrous event.

Anesthesia↗
PubMed1979

Prognosis after cardiac arrest occurring outside intensive care and coronary units.

Emergency calls to a total of 1686 patients with verified cardiac arrest in the University Hospital, Arhus, were made in the 8-year period 1969-1977. Among the patients, cardiac arrest occurred outside the hospital in 1347, in the general wards in 240, while it was present on arrival at the emergency room in 99. Resuscitation was attempted in 1172 patients; 181 survived for at least 24 hours, and 72 were discharged alive, including 13 with residual brain damage. The prognosis was best when cardiac arrest occurred in the general wards (13% discharged) and poorest when it occurred outside the hospital (4% discharged). However, in the latter group, the prognosis showed considerable improvement when resuscitation was initiated at once by a doctor or by laymen present at the accident site (16% discharged). As regards the mechanism of cardiac arrest, ventricular fibrillation was found to be a relatively favourable prognostic sign (10% discharged), whereas almost none of the patients with asystole or severe bradycardia survived. The possibility of improving the prognosis of cardiac arrest occurring outside hospital by the establishment of mobile coronary care units and by instructing lay people in the technique of cardiopulmonary resuscitation is discussed.

Adolescent↗
PubMed1976

Significance of cardiac arrhythmias preceding first cardiac arrest in patients with acute myocardial infarction.

In 417 consecutive cases of acute myocardial infarction (AMI) within a minimum of 21 days' stay in the Coronary Care Unit (CCU), primary cardiac arrest occurred in 41 patients (9.9%), the first episode occurring during ECG monitoring in 24 patients. After cessation of ECG monitoring, and within 2-25 days after admission, it occurred in 17 patients. Cardiac arrhythmias before the first cardiac arrest were analysed in these two groups of patients, and compared with the occurrence of cardiac arrhythmias within the first 5 days in 100 consecutive patients with AMI without complicating cardiac arrest. No significant difference in the frequency of cardiac arrhythmias could be demonstrated between the two groups with cardiac arrest and the control series. Moreover, complete absence of rhythm disturbances right up to the beginning of cardiac arrest was as frequent in the patient groups as in the control series (around 20%). As there is not sufficient evidence that treatment with antiarrhythmic drugs can provide safe prophylaxis against the occurrence of cardiac arrest, it is concluded that all patients with AMI should be kept in the CCU and monitored, by cable or by telemetry, for the duration of their stay. To achieve this, the cost in financial terms, manpower and reorganization is not a deterrent. Furthermore, this study does not give any support to the usual practice of confining possible attempts of prophylactic antiarrhythmic treatment to patients with arrhythmias of certain frequencies and/or types.

Acute Disease↗
PubMed1977

Management of cardiac arrest: seven steps to survival.

Cardiac arrest is a common medical emergency. It usually occurs suddenly and results in irreversible brain damage unless prompt, effective treatment is instituted. One plan for dealing effectively with this emergency consists of seven steps of cardiopulmonary resuscitation: (1) establishing the diagnosis and deciding whether to resuscitate; (2) administering a precordial thump, noting the time and summoning aid; (3) establishing a patent airway and performing artificial ventilation and external cardiac compression; (4) instituting general supportive measures; (5) diagnosing the cardiac arrhythmia responsible for the arrest; (6) treating the arrhythmia; and (7) managing the patient after resuscitation.

Airway Obstruction↗
PubMed1978

Electroencephalographic prediction of anoxic brain damage after resuscitation from cardiac arrest in patients with acute myocardial infarction.

The short-term prognostic value of routine electroencephalography (EEG), carried out on the days after cardiac arrest, was evaluated in a consecutive study of 185 patients with acute myocardial infarction together with an episode of clinical cardiac arrest. The individual EEGs were classified on a 5-grade scale. Of the 89 patients who survived, 18 had signs of anoxic brain damage; 96 patients died, 76 as a result of cerebral anoxia. Only 2 patients survived out of the total of 72 for whom the first EEG was classified as grades III--V. The EEGs of both these patients were recorded within a few hours after the cardiac arrest. None of the patients with an EEG of grade I died of cerebral anoxia, while all degrees of brain damage were otherwise observed in connection with EEGs of both grades I and II. It is concluded that an EEG of grades III--V indicates a fatal outcome, provided it has been recorded more than 24 hours after the cardiac arrest. A grade III--V EEG that is recorded within 24 hours after a cardiac arrest should be repeated some days later. It is not possible, on the basis of a single EEG, to predict the extent of the anoxic brain damage.

Acute Disease↗
PubMed1979

The CSF pressure-volume relationship before and after cardiac arrest in the cat.

The CSF pressure-volume (P-V) function was evaluated before and after cardiac arrest in 15 cats. The CSF volume change was produced by bolus loading (loading rate, greater than 0.1 mL/s) of the CSF space. Comparison of the CSF P-V function before and after cardiac arrest was made over a CSF pressure range of 5 to 46 mm Hg and for a CSF volume change of up to 9% of total CSF volume. After cardiac arrest, all CSF P-V curves were well described by the mathematical model konwn to be valid under normal physiological conditions. In eight animals, there was no significant difference between the prearrest and postarrest P-V functions. For the seven animals demonstrating a significant difference between prearrest and postarrest P-V data, all but one of the postarrest P-V curves were within the normal range. These results suggest that the shape of the CSF P-V curve is not substantially altered by cardiac arrest. We conclude that under normal circumstances material properties of brain tissue are the most important factors in determining the configuration of the CSF P-V curve and that under normal circumstances cerebral hemodynamic factors do not affect the shape of this curve.

Animals↗
PubMed1975

Unexpected cardiac arrest in patients after surgical correction of tetralogy of Fallot.

Four of 220 patients without bifasicular block (complete right bundle branch block and left anterior hemiblock) or transient complete heart block immediately after surgery had an unexpected cardiac arrest one to 15 years after satisfactory surgical repair of tetralogy of Fallot. The postoperative electrocardiograms (ECG) revealed complete right bundle branch block in two patients and no intraventricle conduction abnormality in two patients. Each of the four patients had premature ventricular contractions on previous postoperative ECG. The cardiac arrest occurred during normal activity in three patients and mild exercise in one. Following the cardiac arrest, three patients died and one patient survived. Eighteen months before the cardiac arrest, the survivor had a stress test which revealed multifocal premature ventricular contractions with short bursts of ventricular tachycardia after exercise. This ventricular arrhythmia was suppressed with quinidine therapy. Although complete heart block cannot be excluded in these four patients, we reasoned that the cardiac arrests were probably preceded by ventricular tachyarrhythmia. Because of this experience, we believe that any patient who has had intraventricular surgery should be evaluated for ventricular arrhythmia. If frequent premature ventricular contractions or serious ventricular arrhythmias are documented, we seriously consider antiarrhythmic therapy in an attempt to prevent ventricular tachyarrhythmias and sudden death.

Adolescent↗