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At least 19 recordsLinked to original sources

PubMed1989

Changes in expired end-tidal carbon dioxide during cardiopulmonary resuscitation in dogs: a prognostic guide for resuscitation efforts.

Expired end-tidal carbon dioxide (PCO2) measurements made during cardiopulmonary resuscitation have correlated with cardiac output and coronary perfusion pressure when wide ranges of blood flow are included. The utility of such measurements for predicting resuscitation outcome during the low flow state associated with closed chest cardiopulmonary resuscitation remains uncertain. Expired end-tidal PCO2 and coronary perfusion pressures were measured in 15 mongrel dogs undergoing 15 min of closed chest cardiopulmonary resuscitation after a 3 min period of untreated ventricular fibrillation. In six successfully resuscitated dogs, the mean expired end-tidal PCO2 was significantly higher than that in nine nonresuscitated dogs only after 14 min of cardiopulmonary resuscitation (6.2 +/- 1.2 versus 3.4 +/- 0.8 mm Hg; p less than 0.05). No differences in expired end-tidal PCO2 values were found at 2, 7 or 12 min of cardiopulmonary resuscitation. A significant decline in end-tidal PCO2 levels during the resuscitation effort was seen in the nonresuscitated group (from 6.3 +/- 0.8 to 3.4 +/- 0.8 mm Hg; p less than 0.05); the successfully resuscitated group had constant PCO2 levels throughout the 15 min of cardiac arrest (from 6.8 +/- 1.1 to 6.2 +/- 1.2 mm Hg). Changes in expired PCO2 levels during cardiopulmonary resuscitation may be a useful noninvasive predictor of successful resuscitation and survival from cardiac arrest.

Animals↗

PubMed1992

Impact of do-not-resuscitate legislation on the use of cardiopulmonary resuscitation in three teaching hospitals.

Under New York State's unique do-not-resuscitate law, patients admitted to a hospital are assumed to consent to cardiopulmonary resuscitation unless a do-not-resuscitate order has been written in accordance with specific stipulations. This study was undertaken to determine if the law would significantly change the use of cardiopulmonary resuscitation. The charts of 952 patients who died on the medical services of Bellevue, New York University, and New York Veterans hospitals during the 12-month periods before and after the law went into effect were reviewed. The proportion of patients undergoing cardiopulmonary resuscitation was determined. To take into account the effects of potential confounders (ie, hospital, sex, race or ethnic group, age, diagnosis), a multiple logistic regression analysis was performed. The relative risk for cardiopulmonary resuscitation was found to be 0.81, (95% confidence interval: 0.59-1.10) after the law as compared with before, which was not statistically significant. Although patients with chronic or potentially reversible illness were much more likely than those with hopeless illness to undergo cardiopulmonary resuscitation (relative risk of 7.08 [3.23-15.54] and 12.89 [8.71-19.07], respectively), the data failed to show that the law had an impact on the use of cardiopulmonary resuscitation in any of the disease categories. Total use of formal do-not-resuscitate orders increased from 32.7% to 83.9% (p less than .0001), although at Bellevue, where documentation was high before the law, no further increase occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1979

Studies in shock and resuscitation, I: use of a hypertonic, albumin-containing, fluid demand regimen (HALFD) in resuscitation.

We have reevaluated and clinically tested the current concepts of shock and resuscitation on a logical, physiological, and physical basis. We have considered the currently accepted resuscitation paradigm which is based upon the thesis that early rapid resuscitation of "lost" fluid volume is mandatory and that adequacy of resuscitation can be evaluated by central venous pressure, PAP, PAWP, pulse rate, blood pressure, and/or urine volume. Such methods also accept as natural concomitants that capillary beds are "damaged by injury"; that they "leak" salt, fluid, and albumin; and that these are expected occurrences which are injury-related. We have also examined and clinically evaluated the thesis that MAP is a primary reflector of the relationships between volume and the size of the currently available functional vascular space. (Currently available functional vascular space is mediated through the baroreceptor (stretch receptor)/neuroendocrine mechanisms.) Under this hypothesis, fluid resuscitation comprises infusion of a volume per unit time given so as to replete currently measurable fluid losses and to normalize and/or sustain MAP and the normal osmolar and oncotic relationships at the capillary/tissue interface while holding hydrostatic pressure at normal. Using burn injury as a model, we compared statistically homogeneous, randomly selected groups of burn patients who were resuscitated using a hypotonic fluid (130 mOsm/liter) alone (group R: 7 patients), hypertonic fluid (240 mOsm/liter) alone group H: 5 patients), or the hypertonic fluid containing albumin (12.5 g/liter) (group A: 7 patients). The results indicate that significantly smaller volumes of fluid were needed to resuscitate the patients in group A with a significantly more rapid normalization of physical, physiological, and biochemical parameters. We conclude that the physically and physiologically appropriate method of resuscitation, demonstrated in burn injury, comprises the use of a fluid given at a rate: (1) to maintain mean arterial and hydrostatic pressures within normal range; (2) that delivers a volume per unit time which does not exceed the capacity of the currently available functional vascular space; (3) that replaces concurrent measurable fluid losses; (4) that is hypertonic (to normalize capillary/tissue osmotic gradients); and (5) that contains colloid (to normalize capillary/tissue osmotic gradients); and (5) that contains colloid (to normalize capillary/tissue oncotic gradients). We further conclude that salt, fluid, and colloid loss into the interstitium during resuscitation frequently is due to the rate delivered and/or the physical nature of the fluid used and not to capillary bed damage outside the zone of injury.

Adult↗

PubMed1977

Sepsis in the baboon: factors affecting resuscitation and pulmonary edema in animals resuscitated with Ringer's lactate versus Plasmanate.

Septic shock and the formation of pulmonary edema were studied in 19 baboons. Four animals served as controls. Four were subjected to deep septic shock by infusion of live E. coli and then deliberately killed while in deep shock. Four were subjected to septic shock, resuscitated with Ringer's lactate (RL), and then killed 11/2 hours after resuscitation was started. Seven were subjected to shock and resuscitation attempted with Plasmanate (PL). Resuscitation with RL was successful for 11/2 hours in all four RL-animals. Resuscitation with PL was successful for 11/2 hours in three of the 7 PL-animals. There was an increased tendency for albumin to extravasate into the interstitium of the lungs after resuscitation. The amount of pulmonary edema, measured by both the thermodye technique and by analysis of post-mortem lung composition, was the same in animals resuscitated with RL and PL. Administration of pure colloid offers no protection to the lungs in resuscitating patients from septic shock.

Animals↗

PubMed1987

Cardiopulmonary resuscitation in long-term care facilities: a survey of do-not-resuscitate orders in nursing homes.

Growing public debate regarding no cardiopulmonary resuscitation (no-CPR) policies in acute care hospitals, together with recent changes in the patient population of long-term care facilities, has led nursing homes to examine their need for resuscitation policies. To determine current cardiopulmonary resuscitation policies and procedures in nursing homes, medical directors and directors of nursing service in long-term care facilities in Portland, Oregon, were surveyed. Seventy-five percent responded; of these, only 41% reported having a resuscitation policy. Of those with no policy, 70% thought one was needed. Most nursing homes reported that resuscitation was infrequently discussed with patients and families. When a no-CPR determination was made, it was usually documented in the patient's chart. Training in basic life support was required for registered nurses in two thirds of the facilities. Few homes had equipment necessary for advanced life support. It is recommended that: a) nursing homes develop cardiopulmonary resuscitation policies; b) resuscitation orders be made part of the medical record; and c) nursing home personnel increase their ability to perform basic life support.

Aged↗

PubMedDate not supplied

Comparison of ventilation performance: standard resuscitation bag and the resuscitation bag controller.

Clinical evaluation of ventilation performance during resuscitation is largely subjective. A mechanical device, the resuscitation bag controller (RC), which encircles the bag and allows controlled compression may improve the precision and accuracy of ventilation with manual resuscitation bags (MRB). We hypothesize that more precise, controlled pressure ventilation can be delivered with the RC, compared to the MRB. Prehospital (N = 13) and hospital personnel (N = 12) who routinely perform manual ventilation were randomized to either method of ventilation. Operators were instructed to ventilate an intubated adult mannequin. The percent of breaths delivered within a specified range, 800 to 1200 mL, was compared using simple regression analysis. The precision of tidal volume (TV) and peak airway pressure (PAP) was compared between methods and groups using the coefficient of variation. Comparison for significant differences between methods and groups in the number of breaths with a TV less than 800 mL and those with pressures greater than 30 cm H20 was performed using chi square or Fisher's exact test. There were no significant differences in the percent of acceptable breaths or mean TV delivered between methods or groups. The precision (i.e., reproducibility of the same value) of TV for both methods was best for hospital personnel. PAPS were less than or equal to 30 cm H2O for 93% of all breaths. Hospital personnel delivered a significantly greater percent of inadequate (less than 0.8 L) breaths, 19 versus 7.4%, and excessive pressure breaths, 9.2 versus 4.2%, when compared to prehospital personnel. We conclude that the resuscitation bag controller offers little advantage over standard bag resuscitation for adult resuscitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

Saline resuscitation after fixed-volume hemorrhage. Role of resuscitation volume and rate of infusion.

The authors have reported previously that small-volume resuscitation (1.8 x bled volume) with 0.9% NaCl restores blood volume and attenuates hormonal responses after large hemorrhage without correction of arterial hypotension. The authors studied the role of rate of infusion in this observation in chronically prepared dogs (aortic flow probe, right atrial pressure and volume, and arterial catheters) after 30% hemorrhage (24.1 +/- 0.4 mL/kg). After 30 minutes, subjects were observed either without treatment (no resuscitation) or with infusion of 43 mL/kg 0.9% NaCl over 3 hours by one of three protocols: (1) impulse infusion over 10 minutes, (2) variable rate infusion, bolus with tapering infusion, or (3) constant rate infusion. Significant improvement in cardiac output and in blood volume and significant decreases of vasopressin and arterial catecholamines were observed in all fluid-treated groups. This benefit was relatively independent of rate of infusion, although impulse infusion produced greater early improvement, which dissipated with time, and constant rate infusion produced better late results. In none of the fluid-treated groups were these improvements reflected in improved mean arterial pressure compared with the no resuscitation group. The authors conclude that small-volume, slow-rate saline infusion produces physiologic benefits that cannot be assessed by easily measured clinical parameters. Thus, early resuscitation after trauma could aid patients even if arterial pressure is unchanged. This benefit might be even greater in patients with uncontrolled bleeding because arterial pressure, and hence bleeding, may not be increased by resuscitation of this type. A reassessment of the value of prehospital fluid resuscitation in the injured patient is warranted.

Animals↗

PubMed1986

The pharmacology of neonatal resuscitation and cardiopulmonary intensive care. Part I--Immediate resuscitation.

Resuscitation of a neonate requires both immediate cardiopulmonary resuscitation and extended intensive care. Initial resuscitation of the neonate, as for adults, must include support of the airway, breathing and circulation. Because of the unique physiology of a newborn infant, some aspects of drug therapy differ significantly from their counterparts in the resuscitation of adults, and hypoglycemia and hypothermia pose special threats to a distressed neonate. Epinephrine and atropine can be administered via an endotracheal tube, but vascular access, which is most easily obtained by cannulating an umbilical vessel, is required for administering other drugs. Initial drug therapy, including glucose, oxygen and bicarbonate, is intended to restore metabolic homeostasis. Bicarbonate administration must be preceded by adequate alveolar ventilation. Drugs used to increase cardiac output early in resuscitation include those that increase heart rate, increase preload or improve myocardial function. Other drugs used in extended intensive care may also improve cardiac output, alter the distribution of the circulation or alter pulmonary function or gas exchange. These agents will be reviewed in a subsequent article.

Atropine↗

PubMed1989

Glycemia in the post-resuscitation period. The Cerebral Resuscitation Study Group.

An association between high glycemia on admission after resuscitation from an out-of-hospital cardiac arrest and poor neurological recovery has been reported. It remains controversial whether the high glycemia on admission causes the poor outcome or is just an epiphenomenon. The Cerebral Resuscitation Study Group therefore registered the glycemia on admission in 417 patients resuscitated after an out-of-hospital cardiac arrest. Our data confirm that a high glycemia on admission is related to a poor outcome. There is no relationship between the glycemia on admission and the duration of cardiopulmonary resuscitation (CPR). However, there is a positive but weak correlation between the dose of adrenaline administered during CPR and the glycemia on admission. This indicates that the higher glycemia on admission in patients with a poor outcome may, at least in part, be due to CPR parameters, such as the amount of adrenaline used, that are linked with a bad prognosis. However, it cannot be excluded that a high glycemia contributes to the brain damage after cardiac arrest.

Blood Glucose↗

PubMed1991

Comparison of different doses of epinephrine on myocardial perfusion and resuscitation success during cardiopulmonary resuscitation in a pig model.

Published results of dose-response effects of adrenergic drugs (epinephrine [E]) vary so much between studies because of differences in animal models and duration of ischemia before drug administration. In this investigation the effects of different doses of E on coronary perfusion pressure (CPP), left ventricular myocardial blood flow (MBF) and resuscitation success were compared during closed-chest cardiopulmonary resuscitation (CPR) after a 4-minute period of ventricular fibrillation in 28 pigs. MBF was measured during normal sinus rhythm using tracer microspheres. After 4 minutes of ventricular fibrillation CPR was performed with the use of a pneumatic piston compressor. After 4 minutes of mechanical measures only, the animals were randomly allocated into four groups of seven, receiving 0.015, 0.030, 0.045, and 0.090 mg/kg E intravenously respectively. MBF measurements were started 45 seconds after E administration; hemodynamic measurements after 90 seconds. Four minutes after the first administration, the same E dose was given before defibrillation. The CPP of animals given 0.015, 0.030, 0.045 and 0.090 mg/kg E were as follows: 16.3 +/- 6.1, 25.6 +/- 5.8, 33.2 +/- 8.4 and 30.4 +/- 6.3 mm Hg. The left ventricular MBF values were: 14 +/- 9, 27 +/- 11, 43 +/- 6, 46 +/- 10 mL/min/100 g. The differences between the groups receiving 0.015 and 0.045 mg/kg and between the groups receiving 0.015 mg/kg and 0.090 mg/kg were statistically significant (P less than .05). Resuscitation success was 14.3%, 42.9%, 100% and 86.7% respectively. A significant difference in resuscitation success was found only between 0.015 mg/kg and 0.045 mg/kg E.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1992

[New standards for catecholamine therapy in cardiopulmonary resuscitation? Results of a modified application in a resuscitation model].

Using a standardized porcine CPR-model (3 min of cardiac arrest induced by ventricular fibrillation) the effects of epinephrine (10 micrograms/kg iv, 50 micrograms/kg iv, 100 micrograms/kg endobronchially, eb) and norepinephrine (10 micrograms/kg iv, 100 micrograms/kg eb) on resuscitability and early post-resuscitation haemodynamics were compared. Success rate was 100% after epinephrine 10 micrograms/kg iv and 100 micrograms/kg eb, 75% after epinephrine 50 micrograms/kg iv, 80% after norepinephrine iv and 60% after norepinephrine eb. In an unmedicated control group 50% of all animals were successfully resuscitated. Early post-resuscitation haemodynamics in the high dose epinephrine group were characterized by tachycardia and progredient myocardial failure, while in the norepinephrine groups a low cardiac output was accompanied by small cardiac stroke volumes and an increased vascular resistance. It is concluded that iv or eb epinephrine given in standard doses has still to be considered as the drug therapy of choice after short term cardiac arrest or in the presence of ventricular fibrillation. Before different drugs or dosing strategies can be recommended, further experimental and clinical validation is required.

Administration, Inhalation↗

PubMed1992

Does on-scene resuscitation affect in-hospital "do not resuscitate" decisions and mortality in patients with severe head injuries?

To evaluate the effect of on-scene versus in-hospital resuscitation of patients with severe head injuries with regard to "do not resuscitate" (DNR) decisions and in-hospital mortality, 561 patients were prospectively studied. Patients were grouped according to whether resuscitation initially occurred at the scene of the injury (group 1), in a regional hospital before transfer (group 2), or after direct admission to our neurosurgical center (group 3). The DNR and mortality rates within the first 48 hours (13%, 10%, 10%, respectively) as well as for the entire stay in the surgical intensive care unit (SICU) were comparable for the three groups. It has been pointed out that efficient resuscitation at the scene of the injury may, instead of improving overall outcome, increase morbidity and mortality rates because more severely injured patients now reach the hospital alive. We conclude, however, that primary aggressive treatment at the scene of the injury did not increase DNR and in-hospital mortality rates within the 48-hour follow-up period, nor for the total stay in the SICU. Investigation of long-term outcome will be important to further establish the efficacy of this approach.

Adult↗

PubMed1990

Effect of New York State's do-not-resuscitate legislation on in-hospital cardiopulmonary resuscitation practice.

PURPOSE: On April 1, 1988, New York State enacted legislation governing the withholding of cardiopulmonary resuscitation (CPR). Suggestions that the mandated protocol for withholding CPR is too cumbersome and will result in an increase in CPR attempts led us to study the effect of the new law on in-hospital resuscitation practice. PATIENTS AND METHODS: We retrospectively reviewed the charts of 245 adult in-patients at a county teaching hospital who died during three-month periods before and after the law took effect. RESULTS: There was a statistically nonsignificant decline in the frequency of CPR attempts at the time of death, from 59 (50%) of 119 patients in 1987 to 57 (45%) of 126 patients in 1988. Use of explicit written "do-not-resuscitate" (DNR) orders increased significantly from 13 (22%) of 60 patients who died without CPR in 1987 to 64 (93%) of 69 patients in 1988. Patient and family involvement in decisions to withhold CPR was common before the law and did not change significantly. CONCLUSION: Although changing the way DNR decisions are documented, the legislation resulted in no significant change either in the frequency of CPR or in the degree to which patients are involved in these decisions.

Adult↗

PubMed1989

Serum electrolyte disturbances in the post-resuscitation period. The Cerebral Resuscitation Study Group.

In the context of the registration project of the Belgian Cerebral Resuscitation Study Group, the presence or absence of electrolyte disturbances (serum K+ less than 3.0 or greater than 5.5 mEq/l and/or serum Na+ less than 130 or greater than 150 mEq/l) was registered during the 24-h period following resuscitation after an out-of-hospital cardiac arrest. The analysis of 161 consecutive patients seen in the period 1983-1987 at the University Hospital of Gent indicates that patients with such electrolyte disturbances do not have a worse prognosis. Moreover, we also looked at the serum concentrations of potassium and magnesium in 100 and 90 patients respectively by means of a retrospective analysis of the files of 113 consecutive patients seen during 1985-1988 at the University Hospital of Gent and the Free University of Brussels. Hypokalemia (serum K+ less than 3.5 mEq/l) was observed in 30% of the patients and was not related to outcome. The hypokalemia could not be explained by alkalosis; no relationship was found with either the amount of adrenaline administered during resuscitation or the duration of CPR. An abnormal magnesium level (serum less than 1.8 or greater than 2.4 mg/dl) was found in 42% of the patients and our data suggest that the prognosis may be worse in this group. A prospective study on the clinical significance of disturbances in magnesemia would be of interest.

Dose-Response Relationship, Drug↗

PubMedDate not supplied

The effect of resuscitation technique and pre-arrest state of oxygenation on blood-gas values during cardiopulmonary resuscitation in dogs.

Large mongrel dogs were anesthetized, instrumented, and subjected to electrically induced ventricular fibrillation after breathing either 100% oxygen (O2) or 10% O2 and 90% nitrogen for 10 minutes before arrest. Four minutes after arrest, open chest cardiopulmonary resuscitation (CPR) or intermittent abdominal compression closed chest CPR was initiated and continued for 20 minutes, at which time defibrillation was attempted. Central arterial and mixed venous blood samples were collected serially for the measurement of pH, carbon dioxide partial pressure (PCO2), and O2 partial pressure (PO2), and calculation of bicarbonate concentration and base excess. Mixed venous blood was collected serially for the measurement of lactate concentration. Hemodynamically variable resuscitation techniques and pre-arrest hypoxia or hyperoxia did not significantly influence blood-gas values during CPR. Mixed venous lactate concentrations after 20 minutes of CPR were significantly higher when hypoxia preceded the arrest and when intermittent abdominal compression closed chest CPR was used for resuscitation. Mixed venous PCO2 was significantly higher than arterial PCO2 in all dogs during CPR but was not significantly different before arrest.

Animals↗

PubMed2026

Severe Fetal Cardiomyopathy: Considerations for Extracorporeal Cardiopulmonary Resuscitation During Neonatal Resuscitation.

Primary cardiomyopathies are associated with poor neonatal outcomes, including high mortality rates. Neonatal care of infants with significant prenatal cardiac diagnoses may warrant additional management considerations beyond standard Neonatal Resuscitation Program guidelines. Many of these management considerations are described in the Neonatal Resuscitation, 9th Edition, which details several congenital cardiac lesions and their delivery room management; still, a prenatal primary cardiomyopathy diagnosis warrants additional, unique predelivery care planning, especially in more severe cases. This case report describes our multidisciplinary team's approach to predelivery planning and neonatal resuscitation and stabilization of an infant with prenatal diagnosis of severe cardiomyopathy. The case underscores that with continued refinement in patient selection, timing, and technology, a similar approach undertaken in a future case might yield a favorable outcome.

Adult↗

PubMed1986

A randomized clinical study of cardiopulmonary-cerebral resuscitation: design, methods, and patient characteristics. Brain Resuscitation Clinical Trial I Study Group.

The Brain Resuscitation Clinical Trial (BRCT) was established as a multi-institutional, clinical study of brain resuscitation. The BRCT was designed to test the hypothesis that the addition of thiopental loading to the protocol of standard therapy for cardiac arrest survivors, comatose at 10-50 minutes after restoration of spontaneous circulation, would significantly increase the number of patients recovering good cerebral function. Twelve hospitals in nine countries collaborated in this randomized, controlled clinical trial. The study was designed to take into account numerous problems including the reliability of information on complex events surrounding cardiac arrest, the difficulty of maintaining uniform treatment protocols, and the difficulty of obtaining informed consent within the constraints of the time the therapy was hypothesized to be effective. The major outcome measurements of the study were neurological status at the end of various time intervals following resuscitation and the best neurological performance ever attained during follow-up. Mortality and other untoward events were closely monitored to establish treatment safety. Of the 262 patients entered into the study between 1979 and 1982, 45% were over 65 years of age, and 75% were men. The majority of the arrests (74%) occurred out of hospital, and major pathology underlying arrest was cardiac. Arrest time was greater than 5 minutes in 36% of the patients. As a result of randomization, patient characteristics at entry as well as the characteristics associated with the brain insult in the standard group were similar to those in the thiopental group.

Aged↗

PubMed1990

Deferred consent: use in clinical resuscitation research. Brain Resuscitation Clinical Trial II Study Group.

Deferred consent, a new approach to the requirement for informed consent in clinical research, was used in a randomized clinical trial of brain resuscitation after cardiac arrest. Because patients were comatose and therapy had to be initiated immediately, traditional prospective consent usually could not be obtained. Using the deferred consent mechanism, family members were contacted after the first dose of experimental drug or placebo was administered and asked to consent for continued study participation. The vast majority of families were satisfied with the deferred consent mechanism. Their main concerns were about the safety of the experimental drug and whether the active drug or placebo was given. The concepts of randomization, blinding, and placebo-treated controls were generally not well understood. Although our experiences confirmed the impracticality of attempting to obtain traditional prospective consent in clinical resuscitation research, deferred consent was found to be a reasonable solution.

Ethics, Medical↗