WorldWideScience

Sample records for cardiopulmonary resuscitation cpr

  1. [CPR--guidelines 2000. New international guidelines for cardiopulmonary resuscitation].

    Science.gov (United States)

    Gervais, H W

    2001-03-01

    The "Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. An International Consensus an Science" are the first true international CPR guidelines in the history of resuscitation medicine. Experts from major international resuscitation organizations (International Liaison Committee on Resuscitation, ILCOR) achieved a consensus of recommendations which had to pass a rigorous review procedure applying the tools of evidence-based medicine: all proposed guidelines or guideline changes had to be based on critically appraised pieces of evidence which had to be integrated into a final class of recommendations. The most important changes compared to previous recommendations from either the European Resuscitation Council or the American Heart Association are presented and commented upon.

  2. Marginally effective medical care: ethical analysis of issues in cardiopulmonary resuscitation (CPR)

    Science.gov (United States)

    Hilberman, M; Kutner, J; Parsons, D; Murphy, D J

    1997-12-01

    Outcomes from cardiopulmonary resuscitation (CPR) remain distressingly poor. Overuse of CPR is attributable to unrealistic expectations, unintended consequences of existing policies and failure to honour patient refusal of CPR. We analyzed the CPR outcomes literature using the bioethical principles of beneficence, non-maleficence, autonomy and justice and developed a proposal for selective use of CPR. Beneficence supports use of CPR when most effective. Non-maleficence argues against performing CPR when the outcomes are harmful or usage inappropriate. Additionally, policies which usurp good clinical judgment and moral responsibility, thereby contributing to inappropriate CPR usage, should be considered maleficent. Autonomy restricts CPR use when refused but cannot create a right to CPR. Justice requires that we define which medical interventions contribute sufficiently to health and happiness that they should be made universally available. This ordering is necessary whether one believes in the utilitarian standard or wishes medical care to be universally available on fairness grounds. Low-yield CPR fails justice criteria. Cardiopulmonary resuscitation should be performed when justified by the extensive outcomes literature; not performed when not desired by the patient or not indicated; and performed infrequently when relatively contraindicated.

  3. Apps4CPR: A review study of mobile applications for cardiopulmonary resuscitation training and support

    OpenAIRE

    Kalz, Marco

    2013-01-01

    Kalz, M. (2013, 23 September). Apps4CPR: A review study of mobile applications for cardiopulmonary resuscitation training and support. Presentation given during the 6th World Congress on Social Media, Mobile Apps and Internet/Web 2.0 in Medicine, Health, and Biomedical Research, London, UK.

  4. [Ventilation during cardiopulmonary resuscitation (CPR). A literature study and analysis of ventilation strategies].

    Science.gov (United States)

    Wenzel, V; Lindner, K H; Prengel, A W

    1997-02-01

    In a recently published German multicenter study, 25% of the patients with witnessed cardiac arrest outside the hospital were resuscitated successfully and discharged from the hospital. Approximately 100,000 people suffer a fatal cardiac arrest in Germany annually, which is approximately tenfold the number of deaths from motor vehicle accidents. Cardiopulmonary resuscitation (CPR) performed by bystanders is an important part of the chain of survival to minimize the time interval without artificial circulation and ventilation in a cardiac arrest victim. This is especially important in areas with long response times of the emergency medical service (EMS). Early examples of ventilation have been described throughout history. References to mouth-to-mouth ventilation (MTMV) are found in the Bible, in a description of the resuscitation of a coal miner in 1744, and in an experiment in 1796 demonstrating that exhaled gas was safe for breathing. In 1954, Elam and colleagues described artificial respiration with the exhaled gas of a rescuer using a mouth-to-mask ventilation method. The modern CPR era started with the combination of MTMV and chest compressions 35 years ago. However, the value of MTMV is currently under discussion because of a widespread fear of transmission of infectious diseases. Healthcare professionals have stated in several studies that they may withhold MTMV when confronted with a cardiac arrest in a stranger. Although an infection with Mycobacterium tuberculosis is more likely than one with HIV via MTMV, the fear of the public is understandable. An expert committee of the American Heart Association stated that MTMV may be omitted in the initial phase of cardiac arrest, and considered recommending chest compressions only if the EMS will arrive rapidly. In paralyzed volunteers, however, ventilation induced by chest compressions was not able to provide sufficient gas exchange, especially when the airway was not protected. Laboratory investigations studying

  5. History of the evolution of cardiopulmonary resuscitation

    OpenAIRE

    2013-01-01

    Cardiopulmonary resuscitation (CPR) is as old as humankind. The evolution of CPR represents a combination of human errors and discoveries. Aim: The present study reviews the most important moments in the history of resuscitation, from the first attempts of CPR until now. Methods: The methodology followed included bibliography research from review literature, through databases PubMed, Medline, Scopus, with the use of keywords, such as cardiopulmonary arrest, cardiopulmonary resuscitation, hist...

  6. An evaluation of 9-1-1 calls to assess the effectiveness of dispatch-assisted cardiopulmonary resuscitation (CPR instructions: design and methodology

    Directory of Open Access Journals (Sweden)

    Stiell Ian G

    2008-11-01

    Full Text Available Abstract Background Cardiac arrest is the leading cause of mortality in Canada, and the overall survival rate for out-of-hospital cardiac arrest rarely exceeds 5%. Bystander cardiopulmonary resuscitation (CPR has been shown to increase survival for cardiac arrest victims. However, bystander CPR rates remain low in Canada, rarely exceeding 15%, despite various attempts to improve them. Dispatch-assisted CPR instructions have the potential to improve rates of bystander CPR and many Canadian urban communities now offer instructions to callers reporting a victim in cardiac arrest. Dispatch-assisted CPR instructions are recommended by the International Guidelines on Emergency Cardiovascular Care, but their ability to improve cardiac arrest survival remains unclear. Methods/Design The overall goal of this study is to better understand the factors leading to successful dispatch-assisted CPR instructions and to ultimately save the lives of more cardiac arrest patients. The study will utilize a before-after, prospective cohort design to specifically: 1 Determine the ability of 9-1-1 dispatchers to correctly diagnose cardiac arrest; 2 Quantify the frequency and impact of perceived agonal breathing on cardiac arrest diagnosis; 3 Measure the frequency with which dispatch-assisted CPR instructions can be successfully completed; and 4 Measure the impact of dispatch-assisted CPR instructions on bystander CPR and survival rates. The study will be conducted in 19 urban communities in Ontario, Canada. All 9-1-1 calls occurring in the study communities reporting out-of-hospital cardiac arrest in victims 16 years of age or older for which resuscitation was attempted will be eligible. Information will be obtained from 9-1-1 call recordings, paramedic patient care reports, base hospital records, fire medical records and hospital medical records. Victim, caller and system characteristics will be measured in the study communities before the introduction of dispatch

  7. A survey of attitudes and factors associated with successful cardiopulmonary resuscitation (CPR knowledge transfer in an older population most likely to witness cardiac arrest: design and methodology

    Directory of Open Access Journals (Sweden)

    Brehaut Jamie C

    2008-11-01

    Full Text Available Abstract Background Overall survival rates for out-of-hospital cardiac arrest rarely exceed 5%. While bystander cardiopulmonary resuscitation (CPR can increase survival for cardiac arrest victims by up to four times, bystander CPR rates remain low in Canada (15%. Most cardiac arrest victims are men in their sixties, they usually collapse in their own home (85% and the event is witnessed 50% of the time. These statistics would appear to support a strategy of targeted CPR training for an older population that is most likely to witness a cardiac arrest event. However, interest in CPR training appears to decrease with advancing age. Behaviour surrounding CPR training and performance has never been studied using well validated behavioural theories. Methods/Design The overall goal of this study is to conduct a survey to better understand the behavioural factors influencing CPR training and performance in men and women 55 years of age and older. The study will proceed in three phases. In phase one, semi-structured qualitative interviews will be conducted and recorded to identify common categories and themes regarding seeking CPR training and providing CPR to a cardiac arrest victim. The themes identified in the first phase will be used in phase two to develop, pilot-test, and refine a survey instrument based upon the Theory of Planned Behaviour. In the third phase of the project, the final survey will be administered to a sample of the study population over the telephone. Analyses will include measures of sampling bias, reliability of the measures, construct validity, as well as multiple regression analyses to identify constructs and beliefs most salient to seniors' decisions about whether to attend CPR classes or perform CPR on a cardiac arrest victim. Discussion The results of this survey will provide valuable insight into factors influencing the interest in CPR training and performance among a targeted group of individuals most susceptible to

  8. Cardiopulmonary resuscitation: how far have we come?

    Science.gov (United States)

    Whitcomb, John J; Blackman, Virginia Schmied

    2007-01-01

    In the 43 years since it was first described, cardiopulmonary resuscitation (CPR) has grown from an obscure medical theory to a basic first aid skill taught to adults and is now the near-universal technique used in CPR instruction. This article provides insight into the history of CPR. We explore the phenomenon of sudden cardiac arrest, the historical roots of CPR, current practice data and recommendations, and the society's role in the development of this life-saving technique. We conclude with a review of CPR's economic impact on the healthcare system and the ethical and policy issues surrounding CPR.

  9. Survival after in-hospital Cardiopulmonary Resuscitation

    Directory of Open Access Journals (Sweden)

    M Adib Hajbaghery

    2005-05-01

    Full Text Available Background: During recent years, cardiopulmonary resuscitation (CPR in hospital has received much attention. However, the survival rate of CPR in Iran’s hospitals is unknown. This study was designed to evaluate outcome of in-hospital CPR in Kashan. Methods: A longitudinal case registry study was conducted on all cases of in-hospital CPR during 6 months at 2002. Necessary data including; age, sex, underlying disease, working shift, time from cardiac arrest until initiating of CPR and until defibrillation, duration and result of CPR, frequency of tracheal intubations and time served for it were collected in a checklist. Results: In six months study, 206 cases of cardiopulmonary resuscitation attempted. The survival rate was similar for both sexes. Short-term survival observed in19.9% of cases and only 5.3% survived to discharge. Conclusions: Duration of CPR, time of the first defibrillation, response time and the location of cardiac arrest are the key predictors of survival to hospital discharge and in-hospital CPR strategies require improvement. This study promotes a national study on post CPR survival for accurate data on our performance in attention to chain of survival. KeyWords: Cardiopulmonary Resuscitation (CPR, Survival rate, Iran

  10. Ethical issues in cardiopulmonary resuscitation.

    Science.gov (United States)

    Holm, S; Jørgensen, E O

    2001-08-01

    If patients are to benefit from resuscitation, they must regain consciousness and their full faculties. In recent years, we have acquired important information about the natural history of neurological recovery from circulatory arrest. There are clinical tests that predict the outcome, both during ongoing cardiopulmonary resuscitation (CPR) and in the period after restoration of spontaneous circulation. The ability to predict neurological outcome at this stage offers a basis for certain ethical considerations, which are not exclusively centered on "do-not-attempt-resuscitation" (DNAR)- orders. Instead of being forced to make the decision that "I do not want CPR", the patient should be able to decide that "I want resuscitation to be discontinued, if you predict that I will not recover to a level of neurological function that is acceptable to me". Ideally, no competent patient should be given a DNAR-status without his or her consent. No CPR-attempt should be stopped, and no treatment decision for a patient recovering after CPR should be taken without knowing and assessing the available information. Good ethical decision-making requires reliable facts, which we now know are available.

  11. History of the evolution of cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    George Karlis

    2013-04-01

    Full Text Available Cardiopulmonary resuscitation (CPR is as old as humankind. The evolution of CPR represents a combination of human errors and discoveries. Aim: The present study reviews the most important moments in the history of resuscitation, from the first attempts of CPR until now. Methods: The methodology followed included bibliography research from review literature, through databases PubMed, Medline, Scopus, with the use of keywords, such as cardiopulmonary arrest, cardiopulmonary resuscitation, history, evolution and combinations of them. Complementary bibliography was found through the library of the National and Kapodistrian University of Athens. Results: The first historical references on CPR go back to the era of Ancient Egypt (3100 B.C.. Although the technique for mouth to mouth ventilation was known in ancient times, its efficacy was demonstrated just in 1958. The ease and efficacy of chest compressions were demonstrated in 1960. Electrical defibrillation may have begun in 1775, but it was applied to a victim of cardiac arrest in the 1950s. Conclusion: CPR is currently a rapidly evolving field of medical science. According to latest data, there is evidence that high quality chest compressions, prompt defibrillation if applicable and treatment of reversible causes improve Cardiopulmonary resuscitation (CPR is as old as humankind. The evolution of CPR represents a combination of human errors and discoveries. Aim: The present study reviews the most important moments in the history of resuscitation, from the first attempts of CPR until now. Methods: The methodology followed included bibliography research from review literature, through databases PubMed, Medline, Scopus, with the use of keywords, such as cardiopulmonary arrest, cardiopulmonary resuscitation, history, evolution and combinations of them. Complementary bibliography was found through the library of the National and Kapodistrian University of Athens. Results: The first historical references

  12. Comparison between CPR Autopulse (zoll) Type of Instrument and Manual CPR Technique in Implementing Cardiopulmonary Resuscitation%Autopulse(zoll)型心肺复苏仪与人工心肺复苏效果比较

    Institute of Scientific and Technical Information of China (English)

    张玉莲; 张浩

    2011-01-01

    目的 比较使用Autopulse(zoll)型心肺复苏仪和人工心肺复苏的效果以评价Autopulse(zoll)型心肺复苏仪在临床应用的价值.方法 选择122例院内发生心跳呼吸骤停患者随机分为试验组和对照组,试验组使用Autopulse(zoll)型心肺复苏仪,对照组采用人工标准心肺复苏进行心肺复苏.比较两组患者的循环、呼吸恢复情况,复苏成功率及24 h存活率.结果 试验组患者平均动脉压和脉搏氧饱和度水平高于对照组,差异均有统计学意义(P<0.05);试验组自主循环恢复时间明显短于对照组[(6.1±1.8)min和(15.2±2.3)min,P<0.05];试验组复苏成功率高于对照组(70.8%和33.3%,P<0.01);试验组24 h存活率高于对照组,差异有统计学意义(35.4%和23.6%,P<0.05).结论 Autopulse(zoll)型心肺复苏仪在循环、呼吸恢复情况,复苏成功率及24 h存活率方面优于人工心肺复苏.%Objective Compare the use of Autopulse ( zoll ) type of cardiopulmonary resuscitation instrument with the manual standard CPR technique to evaluate the clinical effectiveness of Autopulse ( zoll) type CPR device. Methods 122 cardiopulmonary arrest patients occurred in hospital were carried out CPR with Autopulse ( zoll) type instrument ( named test group ) and with manual CPR technique ( named control group ) respectively. Compare the circulation, respiration, CPR success rate and 24h survival rate of the patients in the two groups. Results Mean arterial pressure and pulse oxygen saturation levels of the test group were higher than those of the control group, with statistical significance ( P < 0. 05 ); Spontaneous circulation recovery time in the test group was less than that of the control group [ ( 6. 1 ± 1. 8 ) minutes vs ( 15. 2 ± 2. 3 ) minutes, P < 0. 05 ]; CPR success rate of the test group was higher than that of the control group ( 70. 8% vs 33. 3% , P<0.0l); 24 h survival rate of the test group was higher than that of the control group, with

  13. Automated cardiopulmonary resuscitation: a case study.

    Science.gov (United States)

    Spiro, Jon; Theodosiou, Maria; Doshi, Sagar

    2014-02-01

    Rates of survival after cardiac arrest are low and correlate with the quality of cardiopulmonary resuscitation (CPR). Devices that deliver automated CPR (A-CPR) can provide sustained and effective chest compressions, which are especially useful during patient transfer and while simultaneous invasive procedures are being performed. The use of such devices can also release members of resuscitation teams for other work. This article presents a case study involving a man with acute myocardial infarction complicated by cardiogenic shock and pulmonary oedema. It describes how ED nursing and medical teams worked together to deliver A-CPR, discusses the use of A-CPR devices in a tertiary cardiac centre, and highlights the advantages of using such devices.

  14. Acute posthypoxic myoclonus after cardiopulmonary resuscitation

    NARCIS (Netherlands)

    Bouwes, Aline; van Poppelen, Daniel; Koelman, Johannes H. T. M.; Kuiper, Michael A.; Zandstra, Durk F.; Weinstein, Henry C.; Tromp, Selma C.; Zandbergen, Eveline G. J.; Tijssen, Marina A. J.; Horn, Janneke

    2012-01-01

    Background: Acute posthypoxic myoclonus (PHM) can occur in patients admitted after cardiopulmonary resuscitation (CPR) and is considered to have a poor prognosis. The origin can be cortical and/or subcortical and this might be an important determinant for treatment options and prognosis. The aim of

  15. Teamwork and leadership in cardiopulmonary resuscitation.

    Science.gov (United States)

    Hunziker, Sabina; Johansson, Anna C; Tschan, Franziska; Semmer, Norbert K; Rock, Laura; Howell, Michael D; Marsch, Stephan

    2011-06-14

    Despite substantial efforts to make cardiopulmonary resuscitation (CPR) algorithms known to healthcare workers, the outcome of CPR has remained poor during the past decades. Resuscitation teams often deviate from algorithms of CPR. Emerging evidence suggests that in addition to technical skills of individual rescuers, human factors such as teamwork and leadership affect adherence to algorithms and hence the outcome of CPR. This review describes the state of the science linking team interactions to the performance of CPR. Because logistical barriers make controlled measurement of team interaction in the earliest moments of real-life resuscitations challenging, our review focuses mainly on high-fidelity human simulator studies. This technique allows in-depth investigation of complex human interactions using precise and reproducible methods. It also removes variability in the clinical parameters of resuscitation, thus letting researchers study human factors and team interactions without confounding by clinical variability from resuscitation to resuscitation. Research has shown that a prolonged process of team building and poor leadership behavior are associated with significant shortcomings in CPR. Teamwork and leadership training have been shown to improve subsequent team performance during resuscitation and have recently been included in guidelines for advanced life support courses. We propose that further studies on the effects of team interactions on performance of complex medical emergency interventions such as resuscitation are needed. Future efforts to better understand the influence of team factors (e.g., team member status, team hierarchy, handling of human errors), individual factors (e.g., sex differences, perceived stress), and external factors (e.g., equipment, algorithms, institutional characteristics) on team performance in resuscitation situations are critical to improve CPR performance and medical outcomes of patients.

  16. Successful application of acute cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    Derya ztrk; Erturul Altinbilek; Murat Koyuncu; Bedriye Mge Snmez; ilem altili; Ibrahim Ikzcel; Cemil Kavalci; Glsm Kavalci

    2015-01-01

    Objective: To compare the quality and correct the deficiencies of cardiopulmonary resuscitation (CPR) procedures performed in patients who developed cardiopulmonary cardiopulmonary arrest before or after Emergency Department admission. Methods: This study was conducted on patients who were applied CPR atŞŞişli Etfal Training and Research and Research Hospital, Emergency Department between 01 January 2012 and 31 December 2012. Chi-square and Mann-Whitney U test were used to compare the patients' data. The study data were analyzed in SPSS 18.0 software package. A P value less than 0.05 was considered statistically significant. Results: A total of 155 patients who were applied CPR were included in the analysis. Among the study patients, seventy eight (50.3%) were brought to Emergency Department after developing cardiopulmonary arrest while 77 (49.7%) developed cardiopulmonary arrest at Emergency Department. The mean age of the study population was (66 ± 16) years and 64%of the patients were male. The initial rhythms of the CPR-applied patients were different (P 0.05). The CPR response time was longer in ED (P Conclusions: The scientific data obtained in this study suggest that an early response and therapy improves outcomes in CPR procedure.

  17. Cardiac arrest - cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    Basri Lenjani; Besnik Elshani; Nehat Baftiu; Kelmend Pallaska; Kadir Hyseni; Njazi Gashi; Nexhbedin Karemani; Ilaz Bunjaku; Taxhidin Zaimi; Arianit Jakupi

    2014-01-01

    Objective:To investigate application of cardiopulmonary resuscitation(CPR) measures within the golden minutes inEurope.Methods:The material was taken from theUniversityClinical Center ofKosovo -EmergencyCentre inPristina, during the two(2) year period(2010-2011).The collected date belong to the patients with cardiac arrest have been recorded in the patients' log book protocol at the emergency clinic.Results:During the2010 to2011 in the emergency center of theCUCK inPristina have been treated a total of269 patients with cardiac arrest, of whom159 or59.1% have been treated in2010, and110 patients or40.9% in2011.Of the269 patients treated in the emergency centre,93 or34.6% have exited lethally in the emergency centre, and176 or 65.4% have been transferred to other clinics.In the total number of patients with cardiac arrest, males have dominated with186 cases, or69.1%.The average age of patients included in the survey was56.7 year oldSD±16.0 years.Of the269 patients with cardiac arrest, defibrillation has been applied for93 or34.6% of patients.In the outpatient settings defibrillation has been applied for3 or3.2% of patients.Patients were defibrillated with application of one to four shocks. Of27 cases with who have survived cardiac arrest, none of them have suffered cardiac arrest at home,3 or11.1% of them have suffered cardiac arrest on the street, and24 or88.9% of them have suffered cardiac arrest in the hospital.5 out of27 patients survived have ended with neurological impairment.Cardiac arrest cases were present during all days of the week, but frequently most reported cases have been onMonday with32.0% of cases, and onFriday with24.5% of cases. Conclusions:All survivors from cardiac arrest have received appropriate medical assistance within10 min from attack, which implies that if cardiac arrest occurs near an institution health care(with an opportunity to provide the emergent health care) the rate of survival is higher.

  18. Cardiopulmonary resuscitation knowledge and attitude among general dentists in Kuwait

    Science.gov (United States)

    Alkandari, Sarah A.; Alyahya, Lolwa; Abdulwahab, Mohammed

    2017-01-01

    BACKGROUND: Dentists as health care providers should maintain a competence in resuscitation. This cannot be overemphasized by the fact that the population in our country is living longer with an increasing proportion of medically compromised persons in the general population. This preliminary study aimed to assess the knowledge and attitude of general dentists towards cardiopulmonary resuscitation (CPR). METHODS: A cross-sectional study was carried out among 250 licensed general dental practitioners working in ministry of health. Data were obtained through electronic self-administered questionnaire consisting of demographic data of general dentists, and their experience, attitude and knowledge about CPR based on the 2010 American Heart Association guidelines update for CPR. RESULTS: Totally 208 general dentists took part in the present study giving a response rate of 83.2%. Only 36% of the participants demonstrated high knowledge on CPR, while 64% demonstrated low knowledge. Participants’ age, gender, nationality, years of experience, career hierarchy, and formal CPR training were associated significantly with CPR knowledge. Almost all the participants (99%) felt that dentists needed to be competent in basic resuscitation skills and showed a positive attitude towards attending continuing dental educational programs on CPR. CONCLUSION: This study showed that majority of general dental practitioners in Kuwait had inadequate knowledge on CPR. It was also found that CPR training significantly influenced the CPR knowledge of the participants. Therefore, training courses on CPR should be regularly provided to general dentists in the country. PMID:28123615

  19. Evaluation of coma patients after cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    SU Ying-ying; YANG Qing-lin; PANG Ying; LV Xiang-ping

    2005-01-01

    Background Coma after cardiopulmonary resuscitation (CPR) is commonly seen in daily clinical practice. How to objectively evaluate brain function after CPR is essential to the following treatment. Coma patients after CPR had been studied prospectively at the Neuro-Intensive Care Unit of Xuanwu Hospital since 2002. In this study, we focused on the topic of how to evaluate the severity of coma after CPR .Methods From April 2002 to November 2004, patients in coma 24 hours after CPR were monitored, the evaluation methods included Glasgow coma score (GCS),brain stem reflection, and spinal reflection. Laboratory evaluation included electroencephalography (EEG),brainstem auditory evoked potential (BAEP), short latency somatosensory evoked potential (SLSEP), and transcranial Doppler (TCD) .Results Twenty-four of 35 patients(68.57%)were in deep coma. The GCS was 3 except for 2 patients;EEG was evaluated not less than grade Ⅳ except for 4 patients, BAEP was evaluated as grade Ⅲ except for 3 patients, and SLSEP was evaluated as grade Ⅲ except for 1 patient.Twenty-four patients died within 1 month and 11 of them(45.83%)were determined as brain death. Glasgow outcome score (GOS) was evaluated as grade Ⅰ. Eleven of the 35 patients survived and their consciousness changed from deep coma to coma vigil. EEG was evaluated as gradeⅠin 5 patients, BAEP and SLSEP were evaluated as grade Ⅰ in 3 patients, and GOS was all evaluated as grade Ⅱ among the 11 patients.Two patients(18.18%)regained consciousness in 35 and 90 days after cardiopulmonary resuscitation and GOS was evaluated as grade Ⅳ and Ⅲ, respectively.Conclusion Combined or continuous evaluation of clinical examinations and laboratory tests can accurately and objectively determine brain function after CPR.

  20. A method of automatic control procedures cardiopulmonary resuscitation

    Science.gov (United States)

    Bureev, A. Sh.; Zhdanov, D. S.; Kiseleva, E. Yu.; Kutsov, M. S.; Trifonov, A. Yu.

    2015-11-01

    The study is to present the results of works on creation of methods of automatic control procedures of cardiopulmonary resuscitation (CPR). A method of automatic control procedure of CPR by evaluating the acoustic data of the dynamics of blood flow in the bifurcation of carotid arteries and the dynamics of air flow in a trachea according to the current guidelines for CPR is presented. Evaluation of the patient is carried out by analyzing the respiratory noise and blood flow in the interspaces between the chest compressions and artificial pulmonary ventilation. The device operation algorithm of automatic control procedures of CPR and its block diagram has been developed.

  1. Voice advisory manikin versus instructor facilitated training in cardiopulmonary resuscitation

    DEFF Research Database (Denmark)

    Isbye, Dan L; Høiby, Pernilla; Rasmussen, Maria B;

    2008-01-01

    BACKGROUND: Training of healthcare staff in cardiopulmonary resuscitation (CPR) is time-consuming and costly. It has been suggested to replace instructor facilitated (IF) training with an automated voice advisory manikin (VAM), which increases skill level by continuous verbal feedback during indi...

  2. Cardiopulmonary resuscitation: a review for clinicians.

    Science.gov (United States)

    Varon, J; Marik, P E; Fromm, R E

    1998-02-01

    Attempts at cardiopulmonary resuscitation (CPR) date from antiquity, but it is only in the last 50 years that a scientifically-based methodology has been developed. External chest compressions is the standard method for managing circulatory arrest, however, numerous alterations of this technique have been proposed in attempts to improve outcome from CPR. Defibrillation is the single most important therapy for the management of ventricular fibrillation or pulseless ventricular tachycardia. Adrenergic agents used to improve myocardial and cerebral perfusion are also the subject of considerable investigation with new agents entering clinical study. This paper reviews the history, current techniques and pharmacotherapy as well as controversial issues in the management of patients with cardiac arrest.

  3. Changing attitudes to cardiopulmonary resuscitation in older people: a 15-year follow-up study.

    LENUS (Irish Health Repository)

    Cotter, P E

    2009-03-01

    while it is well established that individual patient preferences regarding cardiopulmonary resuscitation (CPR) may change with time, the stability of population preferences, especially during periods of social and economic change, has received little attention.

  4. Continuation of cardiopulmonary resuscitation in a Chinese hospital after unsuccessful EMS resuscitation

    Institute of Scientific and Technical Information of China (English)

    Xiao-Bo Yang; Yan Zhao; Fei Wang

    2009-01-01

    Objective To evaluate the efficacy of the continuation of cardiopulmonary resuscitation (CPR) following transportation to the emergency department in a Chinese hospital after unsuccessful emergency medical services (EMS) CPR. Methods From January 2002 to December 2007, emergency records of non-traumatic patients who were transported to a tertiary teaching hospital after unsuccessful EMS CPR were reviewed. Results Eigty-five patients were included, and 13 patients (15%) accomplished restoration of spontaneous circulation in our emergency department. Resuscitative possibility reached zero at around 23 minutes. One patient was discharged with a favourable neurologic outcome. Conclusions This study shows that the continuation of CPR is not futile and may improve outcomes. The outcomes should be re-evaluatad in the future when prehospital information can be combined with in-hospital information.

  5. 影响东莞市120院前心肺复苏成功相关因素研究%Related Factors Research of 120 Prehospital Cardiopulmonary Resuscitation(CPR) Success in Dongguan

    Institute of Scientific and Technical Information of China (English)

    曹建国; 刘同刚; 黄清丽; 李海燕; 张慧锋; 刘伟权

    2014-01-01

    目的:了解东莞市120院前心肺复苏现状和影响因素。方法:做过心肺复苏152例患者填写调查表,用Epidata建立数据库,用SPSS 13.0统计学软件进行统计学分析。结果:心肺复苏术前呼吸心搏停止时间,院前和急诊科患者分别为(20.32±18.21)min和(16.92±5.13)min(P<0.05)。院前采用不同人工通气复苏效果比较差异有统计学意义(P<0.05),面罩辅助呼吸给氧优于气管插管,而在急诊科则反之。复苏术前不同心电图比较差异有统计学意义(P<0.01),以心室颤动最佳,心电静止最差。院前和急诊科生存率分别为9.76%和17.14%(P<0.01)。结论:东莞市院前120和急诊科心肺复苏比较,复苏开始的时间,通气的方法,复苏前心电图的类形和结果差异有统计学意义。%Objective:To study the statusquo and influencing factors of 120 prehospital cardiopulmonary resuscitation(CPR) in Dongguan. Method:152 cases who did CPR completed the questionnaire,establish a database with Epidata,were statistically analyzed using SPSS 13.0 statistical software. Result:Breathing and cardiac arrest time before CPR of prehospital first-aid patients and emergency department first-aid patients were (20.32±18.21)min and (16.92±20.13)min(P<0.05).The recovery effects of patients with different artificial ventilation prehospital were statistically significant(P<0.05),mask assisted respiration to oxygen was better than endotracheal intubation assisted respiration to oxygen,and that in the emergency department was opposite.The difference of different ECG before resuscitation was statistically significant(P<0.01),the best was ventricular fibrillation,the worst was ventricular still.The survival rates of prehospital and emergency department were 9.76% and 17.14%(P<0.01).Conclusion:The differences of recovery begins time,ventilation methods,ECG classes before recovery and outcome between 120 prehospital CPR and emergency department CPR in

  6. Cardiopulmonary resuscitation in the elderly: a clinical and ethical perspective

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The daily practice of cardiopulmonary resuscitation (CPR) in elderly patients has brought up the attention of outcome research and resource allocation. Determinants to predict survival have been well identified. There has been empirical evidence that CPR is of doubtful utility in the geriatric population, more studies have showed controversial data. Sometimes situations in which CPR needs to be given in the elderly, causes stress to healthcare providers, due to lack of communication of the patient's wishes and the belief that it will not be successful. It is of importance to state that we have the duty to identify on time the patients that will most likely benefit from CPR, and find out the preferences of the same. Whenever it is possible to institute these guidelines, we will avoid patient suffering.

  7. Mechanical compression of coronary artery stents: potential hazard for patients undergoing cardiopulmonary resuscitation.

    Science.gov (United States)

    Windecker, S; Maier, W; Eberli, F R; Meier, B; Hess, O M

    2000-12-01

    Mechanical compression of coronary artery stents may be associated with a fatal outcome as the result of refractory myocardial ischemia. We present the history of an 83-yr-old patient, who died owing to hemorrhagic shock 3 days after stent implantation, despite immediate cardiopulmonary resuscitation (CPR). Postmortem examination showed stent compression, probably due to mechanical deformation during CPR. This complication has been reported in two other cases in the literature, suggesting that CPR may be hazardous to patients with coronary artery stents.

  8. A Reliable Method for Rhythm Analysis during Cardiopulmonary Resuscitation

    Directory of Open Access Journals (Sweden)

    U. Ayala

    2014-01-01

    Full Text Available Interruptions in cardiopulmonary resuscitation (CPR compromise defibrillation success. However, CPR must be interrupted to analyze the rhythm because although current methods for rhythm analysis during CPR have high sensitivity for shockable rhythms, the specificity for nonshockable rhythms is still too low. This paper introduces a new approach to rhythm analysis during CPR that combines two strategies: a state-of-the-art CPR artifact suppression filter and a shock advice algorithm (SAA designed to optimally classify the filtered signal. Emphasis is on designing an algorithm with high specificity. The SAA includes a detector for low electrical activity rhythms to increase the specificity, and a shock/no-shock decision algorithm based on a support vector machine classifier using slope and frequency features. For this study, 1185 shockable and 6482 nonshockable 9-s segments corrupted by CPR artifacts were obtained from 247 patients suffering out-of-hospital cardiac arrest. The segments were split into a training and a test set. For the test set, the sensitivity and specificity for rhythm analysis during CPR were 91.0% and 96.6%, respectively. This new approach shows an important increase in specificity without compromising the sensitivity when compared to previous studies.

  9. A Reliable Method for Rhythm Analysis during Cardiopulmonary Resuscitation

    Science.gov (United States)

    Ayala, U.; Irusta, U.; Ruiz, J.; Eftestøl, T.; Kramer-Johansen, J.; Alonso-Atienza, F.; Alonso, E.; González-Otero, D.

    2014-01-01

    Interruptions in cardiopulmonary resuscitation (CPR) compromise defibrillation success. However, CPR must be interrupted to analyze the rhythm because although current methods for rhythm analysis during CPR have high sensitivity for shockable rhythms, the specificity for nonshockable rhythms is still too low. This paper introduces a new approach to rhythm analysis during CPR that combines two strategies: a state-of-the-art CPR artifact suppression filter and a shock advice algorithm (SAA) designed to optimally classify the filtered signal. Emphasis is on designing an algorithm with high specificity. The SAA includes a detector for low electrical activity rhythms to increase the specificity, and a shock/no-shock decision algorithm based on a support vector machine classifier using slope and frequency features. For this study, 1185 shockable and 6482 nonshockable 9-s segments corrupted by CPR artifacts were obtained from 247 patients suffering out-of-hospital cardiac arrest. The segments were split into a training and a test set. For the test set, the sensitivity and specificity for rhythm analysis during CPR were 91.0% and 96.6%, respectively. This new approach shows an important increase in specificity without compromising the sensitivity when compared to previous studies. PMID:24895621

  10. [Tension pneumomediastinum and tension pneumothorax following tracheal perforation during cardiopulmonary resuscitation].

    Science.gov (United States)

    Buschmann, C T; Tsokos, M; Kurz, S D; Kleber, C

    2015-07-01

    Tension pneumothorax can occur at any time during cardiopulmonary resuscitation (CPR) with external cardiac massage and invasive ventilation either from primary or iatrogenic rib fractures with concomitant pleural or parenchymal injury. Airway injury can also cause tension pneumothorax during CPR. This article presents the case of a 41-year-old woman who suffered cardiopulmonary arrest after undergoing elective mandibular surgery. During CPR the upper airway could not be secured by orotracheal intubation due to massive craniofacial soft tissue swelling. A surgical airway was established with obviously unrecognized iatrogenic tracheal perforation and subsequent development of tension pneumomediastinum and tension pneumothorax during ventilation. Neither the tension pneumomediastinum nor the tension pneumothorax were decompressed and accordingly resuscitation efforts remained unsuccessful. This case illustrates the need for a structured approach to resuscitate patients with ventilation problems regarding decompression of tension pneumomediastinum and/or tension pneumothorax during CPR.

  11. CPR - child (1 to 8 years old)

    Science.gov (United States)

    Rescue breathing and chest compressions - child; Resuscitation - cardiopulmonary - child; Cardiopulmonary resuscitation - child ... All parents and those who take care of children should learn infant and child CPR if they ...

  12. International CPR guidelines - perspectives in CPR.

    Science.gov (United States)

    Nolan, Jerry P

    2013-09-01

    The International Liaison Committee on Resuscitation (ILCOR) co-ordinates regular reviews of cardiopulmonary resuscitation (CPR) science and publishes consensus on science statements and treatment recommendations. These outputs are used by international resuscitation organisations to generate clinical guidelines. This review will outline the history behind the development of international CPR guidelines and will provide a detailed description of the current guideline generating process. A perspective is provided on the future of this process and the prospects for completely unified international CPR guidelines.

  13. Cardio-pulmonary resuscitation challenges in selected Botswana hospitals: Nurse managers’ views

    Directory of Open Access Journals (Sweden)

    Lakshmi Rajeswaran

    2013-05-01

    Full Text Available Road traffic accident victims, as well as persons experiencing cardiac and other medical emergencies, might lose their lives due to the non-availability of trained personnel to provide effective cardio-pulmonary resuscitation (CPR with functional equipment and adequate resources.The objectives of the study were to identify unit managers’ perceptions about challenges encountered when performing CPR interventions in the two referral public hospitals in Botswana. These results could be used to recommend more effective CPR strategies for Botswana’s hospitals. Interviews, comprising two quantitative sections with closed ended questions and one qualitative section with semi-structured questions, were conducted with 22 unit managers. The quantitative data indicated that all unit managers had at least eight years’ nursing experience, and could identify CPR shortcomings in their hospitals. Only one interviewee had never performed CPR. The qualitative data analysis revealed that the hospital units sometimes had too few staff members and did not have fully equipped emergency trolleys and/or equipment. No CPR teams and no CPR policies and guidelines existed. Nurses and doctors reportedly lacked CPR knowledge and skills. No debriefing services were provided after CPR encounters. The participating hospitals should address the following challenges that might affect CPR outcomes: shortages of staff, overpopulation of hospital units, shortcomings of the emergency trolleys and CPR equipment, absence of CPR policies and guidelines, absence of CPR teams, limited CPR competencies of doctors and nurses and the lack of debriefing sessions after CPR attempts.

  14. Neuroprotective role of Batroxobin in cardiopulmonary resuscitation rabbits

    Institute of Scientific and Technical Information of China (English)

    Zhoujun Kang; Hui Cao; Bing Mei

    2007-01-01

    BACKGROUND: Batroxobin has been found to have protective effect on cerebral ischemia-reperfusion,and cardiopulmonary resuscitation (CPR) is the common cause of global brain ischemia-reperfusion.OBJECTIVE: To observe the effect of Batroxobin on the morphological results of cerebral cortex and hippocampus in rabbit models of CPR, and the changes of serum concentration of tumor necrosis factor alpha (TNF- α) after CPR.DESIGN: A randomized controlled observation.SETTING: Laboratory of the Department of Burns, Changhai Hospital affiliated to the Second Military Medical University of Chinese PLA.MATERIALS: Thirty healthy New Zealand rabbits of 2.5 - 3.0 kg, either male or female, were used. Kits for TNF- α determination were provided by LIFEKEY BioMeditech Company (USA).METHODS: The experiments were carried out in the laboratory of Department of Burns, Changhai Hospital from February 2001 to January 2002. The 32 rabbits were randomly divided into sham-operated group (n=8),conventional resuscitation group (n=12) and Batroxobin-treated group (n=12). The animals in the conventional resuscitation group and Batroxobin-treated group were anesthetized, then induced into modified Pittsburg's model of mechanical ventricular fibrillation. Sham-operated group was discharged on the chest wall, which did not cause ventricular fibrillation. Conventional resuscitation group and Batroxobin-treated group were exposed to 6 minutes of cardiac arrest induced by ventricular fibrillation, then the resuscitation began. A dosage of 0.3 Bu/kg of Batroxobin was administered to the rabbits in the Batroxobin-treated group at the beginning of resuscitation. Blood sample was collected at 4 and 12 hours after CPR to determine the concentration of TNF- α in serum. After the second blood collection, brain tissue was taken out immediately,and the forms of nerve cells in cerebral cortex and hippocampal CA1 region were observed under light microscope.MAIN OUTCOME MEASURES: ① TNF-α concentration in

  15. Do-not-resuscitate Order: The Experiences of Iranian Cardiopulmonary Resuscitation Team Members

    Science.gov (United States)

    Assarroudi, Abdolghader; Heshmati Nabavi, Fatemeh; Ebadi, Abbas; Esmaily, Habibollah

    2017-01-01

    Background: One dilemma in the end-of-life care is making decisions for conducting cardiopulmonary resuscitation (CPR). This dilemma is perceived in different ways due to the influence of culture and religion. This study aimed to understand the experiences of CPR team members about the do-not-resuscitate order. Methods: CPR team members were interviewed, and data were analyzed using a conventional content analysis method. Results: Three categories and six subcategories emerged: “The dilemma between revival and suffering” with the subcategories of “revival likelihood” and “death as a cause for comfort;” “conflicting situation” with the subcategories of “latent decision” and “ambivalent order;” and “low-quality CPR” with the subcategories of “team member demotivation” and “disrupting CPR performance.” Conclusion: There is a need for the development of a contextual guideline, which is required for respecting the rights of patients and their families and providing legal support to health-care professionals during CPR. PMID:28216869

  16. Do-not-resuscitate order: The experiences of iranian cardiopulmonary resuscitation team members

    Directory of Open Access Journals (Sweden)

    Abdolghader Assarroudi

    2017-01-01

    Full Text Available Background: One dilemma in the end-of-life care is making decisions for conducting cardiopulmonary resuscitation (CPR. This dilemma is perceived in different ways due to the influence of culture and religion. This study aimed to understand the experiences of CPR team members about the do-not-resuscitate order. Methods: CPR team members were interviewed, and data were analyzed using a conventional content analysis method. Results: Three categories and six subcategories emerged: “The dilemma between revival and suffering” with the subcategories of “revival likelihood” and “death as a cause for comfort;” “conflicting situation” with the subcategories of “latent decision” and “ambivalent order;” and “low-quality CPR” with the subcategories of “team member demotivation” and “disrupting CPR performance.” Conclusion: There is a need for the development of a contextual guideline, which is required for respecting the rights of patients and their families and providing legal support to health-care professionals during CPR.

  17. Positive end-expiratory pressure improves survival in a rodent model of cardiopulmonary resuscitation using high-dose epinephrine.

    LENUS (Irish Health Repository)

    McCaul, Conán

    2009-10-01

    Multiple interventions have been tested in models of cardiopulmonary resuscitation (CPR) to optimize drug use, chest compressions, and ventilation. None has studied the effects of positive end-expiratory pressure (PEEP) on outcome. We hypothesized that because PEEP can reverse pulmonary atelectasis, lower pulmonary vascular resistance, and potentially improve cardiac output, its use during CPR would increase survival.

  18. Survival without sequelae after prolonged cardiopulmonary resuscitation after electric shock.

    Science.gov (United States)

    Motawea, Mohamad; Al-Kenany, Al-Sayed; Hosny, Mostafa; Aglan, Omar; Samy, Mohamad; Al-Abd, Mohamed

    2016-03-01

    "Electrical shock is the physiological reaction or injury caused by electric current passing through the human body. It occurs upon contact of a human body part with any source of electricity that causes a sufficient current through the skin, muscles, or hair causing undesirable effects ranging from simple burns to death." Ventricular fibrillation is believed to be the most common cause of death after electrical shock. "The ideal duration of cardiac resuscitation is unknown. Typically prolonged cardiopulmonary resuscitation is associated with poor neurologic outcomes and reduced long term survival. No consensus statement has been made and traditionally efforts are usually terminated after 15-30 minutes." The case under discussion seems worthy of the somewhat detailed description given. It is for a young man who survived after 65 minutes after electrical shock (ES) after prolonged high-quality cardiopulmonary resuscitation (CPR), multiple defibrillations, and artificial ventilation without any sequelae. Early start of adequate chest compressions and close adherence to advanced cardiac life support protocols played a vital role in successful CPR.

  19. Efficacy of vasopressin combined with epinephrine during adult cardiopulmonary resuscitation:a meta-analysis%成人 CPR 中血管加压素联合肾上腺素疗效的 Meta分析

    Institute of Scientific and Technical Information of China (English)

    邹勤华; 钱会银; 徐波; 朱建良; 周保纯; 刘一韡; 朱凌霞; 刘励军

    2016-01-01

    目的:在成人心肺复苏术( CPR)中,血管加压素联合肾上腺素的应用是否优于肾上腺素尚未定论,本研究针对现有的临床研究资料进行荟萃分析。方法在Pub Med、万方数据库检索关于成人CPR联合或单独应用肾上腺素的所有随机对照临床研究。观察指标包括复苏后自主循环恢复( ROSC)率、入院存活率(或短期存活率)、出院存活率(或长期存活率)和神经功能预后。结果在检索到的191篇文献中,最终纳入分析的有8项随机对照研究(共5740例患者),其中5项为院外心脏骤停( OHCA,5172例患者)研究,3项为院内心脏骤停( IHCA,568例患者)研究。依据患者心脏骤停( CA)最初检测到的心律,分为室颤/室速( VF/VT),无脉性电活动和心室停顿进行亚组分析。结果表明,与单用肾上腺素组比较,血管加压素联合肾上腺素组能提高成人心脏骤停患者入院存活率(短期存活率)(RR=1.15,95%CI=1.01~1.32,P=0.04),而ROSC率、出院存活率及神经功能预后比较差异无统计学意义(P>0.05)。亚组分析发现,联合用药组对于IHCA患者ROSC率(RR 1.30,95%CI=1.11~1.51,P=0.001)及短期存活率(RR1.23,95%CI=1.05~1.44,P=0.01)效果优于肾上腺素组。结论血管加压素联合肾上腺素较单用肾上腺素可明显提高CA患者入院存活率(短期存活率);对于IHCA患者,联合应用可提高患者ROSC率和短期存活率。%Objective During adult cardiopulmonary resuscitation, the efficacy of vasopressin combined with epinephrine versus epinephrine alone remains controversial. This meta - analysis was conducted on the existing clinical research data. Methods PubMed and WANFANG databases were searched for randomized controlled clinical studies on the combination or the use of epinephrine alone during adult cardiopulmonary resuscitation. The observation outcomes included the return of spontaneous circulation (ROSC) after cardiopulmonary resuscitation, admission survival

  20. Outcomes of In-Hospital Cardiopulmonary Resuscitation in Maintenance Dialysis Patients

    OpenAIRE

    2015-01-01

    Outcomes of cardiopulmonary resuscitation (CPR) in hospitalized patients with ESRD requiring maintenance dialysis are unknown. Outcomes of in-hospital CPR in these patients were compared with outcomes in the general population using data from the Nationwide Inpatient Sample (NIS; 2005–2011). The study population included all adults (≥18years old) from the general population and those with a history of ESRD. Baseline characteristics, in-hospital complications, and discharge outcomes were compa...

  1. Assessment of the success of cardiopulmonary resuscitation attempts performed in a Turkish university hospital.

    Science.gov (United States)

    Pembeci, Kamil; Yildirim, Ayse; Turan, Eser; Buget, Mehmet; Camci, Emre; Senturk, Mert; Tugrul, Mehmet; Akpir, Kutay

    2006-02-01

    The success rate of cardiopulmonary resuscitation (CPR) may differ from institution to institution, even within different sites in the same institution. A variety of factors may influence the outcome. In this study, we assessed the adequacy of CPR attempts guided by the current standards and aimed to define the factors influencing the outcome following in-hospital cardiac arrest. One hundred and thirty-four patients who required CPR were studied prospectively. Different variables for the CPR performance were recorded using forms designed for this study in the light of the guidelines. In these CPR forms various data including the demographics, history, monitoring, number, composition and experience of the anaesthesiologists, the site of CPR, time of day, the delay before onset of CPR, tracheal intubation, duration of arrest, initial rhythm in ECG monitored patients, management of CPR, drug administration and reversible causes of cardiac arrest were recorded. Our rates of immediate survival, survival at 24 h and survival to discharge 49.3%, 28.5% and 13.4%, respectively. The extent of monitoring prior to arrest, the attendance of one or more experienced anesthesiologists in the CPR team, CPR during office hours, CPR in ICU or operating room, early initiation of CPR and tracheal intubation prior to arrest were found as the factors increasing discharge survival. We conclude that early initiation of CPR with an experienced team in a well-equipped hospital sites increases the discharge survival rate following cardiac arrest.

  2. Disseminating cardiopulmonary resuscitation training by distributing 35,000 personal manikins among school children

    DEFF Research Database (Denmark)

    Isbye, Dan L; Rasmussen, Lars S; Ringsted, Charlotte

    2007-01-01

    BACKGROUND: Because most cardiac arrests occur at home, widespread training is needed to increase the incidence of cardiopulmonary resuscitation (CPR) by lay persons. The aim of this study was to evaluate the effect of mass distribution of CPR instructional materials among schoolchildren. METHODS......,140 from the second tier (mean, 2.5 persons per pupil; 95% confidence interval, 2.4 to 2.5). The teachers had used a mean of 64 minutes (95% confidence interval, 60 to 68) for preparation and a mean of 13 minutes (95% confidence interval, 11 to 15) to tidy up. Incidence of bystander CPR in the months after...... the project did not increase significantly compared with the previous year (25.0% versus 27.9%; P=0.16). CONCLUSIONS: CPR training can be disseminated in a population by distributing personal resuscitation manikins among children in primary schools. The teachers felt able to easily facilitate CPR training...

  3. Conflicting perspectives compromising discussions on cardiopulmonary resuscitation.

    LENUS (Irish Health Repository)

    Groarke, J

    2010-09-01

    Healthcare professionals, patients and their relatives are expected to discuss resuscitation together. This study aims to identify the differences in the knowledge base and understanding of these parties. Questionnaires examining knowledge and opinion on resuscitation matters were completed during interviews of randomly selected doctors, nurses and the general public. 70% doctors, 24% nurses and 0% of a public group correctly estimated survival to discharge following in-hospital resuscitation attempts. Deficiencies were identified in doctor and nurse knowledge of ethics governing resuscitation decisions. Public opinion often conflicts with ethical guidelines. Public understanding of the nature of cardiopulmonary arrests and resuscitation attempts; and of the implications of a \\'Do Not Attempt Resuscitation (DNAR)\\' order is poor. Television medical dramas are the primary source of resuscitation knowledge. Deficiencies in healthcare professionals\\' knowledge of resuscitation ethics and outcomes may compromise resuscitation decisions. Educational initiatives to address deficiencies are necessary. Parties involved in discussion on resuscitation do not share the same knowledge base reducing the likelihood of meaningful discussion. Public misapprehensions surrounding resuscitation must be identified and corrected during discussion.

  4. Acute Mallory-Weiss syndrome after cardiopulmonary resuscitation by health care providers in the emergency department

    Institute of Scientific and Technical Information of China (English)

    Dae Hee Kim; Dong Yoon Rhee; Seon Hee Woo; Woon Jeong Lee; Seung Hwan Seol; Won Jung Jeong

    2015-01-01

    A report of a 62-year-old female patient with severe Mallory-Weiss syndrome after successful cardiopulmonary resuscitation (CPR) by health care providers in the emergency department is presented. The bleeding continued for five days, and the patient’s total blood loss was estimated to be approximately 3 000 mL. After 7 days, the patient died due to respiratory distress syndrome. Severe Mallory-Weiss syndrome afterCPR may occur and should be considered as a potentially serious complication afterCPR.

  5. Capnography during cardiopulmonary resuscitation: Current evidence and future directions

    Directory of Open Access Journals (Sweden)

    Bhavani Shankar Kodali

    2014-01-01

    Full Text Available Capnography continues to be an important tool in measuring expired carbon dioxide (CO 2 . Most recent Advanced Cardiac Life Support (ACLS guidelines now recommend using capnography to ascertain the effectiveness of chest compressions and duration of cardiopulmonary resuscitation (CPR. Based on an extensive review of available published literature, we selected all available peer-reviewed research investigations and case reports. Available evidence suggests that there is significant correlation between partial pressure of end-tidal CO 2 (PETCO 2 and cardiac output that can indicate the return of spontaneous circulation (ROSC. Additional evidence favoring the use of capnography during CPR includes definitive proof of correct placement of the endotracheal tube and possible prediction of patient survival following cardiac arrest, although the latter will require further investigations. There is emerging evidence that PETCO 2 values can guide the initiation of extracorporeal life support (ECLS in refractory cardiac arrest (RCA. There is also increasing recognition of the value of capnography in intensive care settings in intubated patients. Future directions include determining the outcomes based on capnography waveforms PETCO 2 values and determining a reasonable duration of CPR. In the future, given increasing use of capnography during CPR large databases can be analyzed to predict outcomes.

  6. Hydrogen sulfide improves neural function in rats following cardiopulmonary resuscitation

    Science.gov (United States)

    LIN, JI-YAN; ZHANG, MIN-WEI; WANG, JIN-GAO; LI, HUI; WEI, HONG-YAN; LIU, RONG; DAI, GANG; LIAO, XIAO-XING

    2016-01-01

    The alleviation of brain injury is a key issue following cardiopulmonary resuscitation (CPR). Hydrogen sulfide (H2S) is hypothesized to be involved in the pathophysiological process of ischemia-reperfusion injury, and exerts a protective effect on neurons. The aim of the present study was to investigate the effects of H2S on neural functions following cardiac arrest (CA) in rats. A total of 60 rats were allocated at random into three groups. CA was induced to establish the model and CPR was performed after 6 min. Subsequently, sodium hydrosulfide (NaHS), hydroxylamine or saline was administered to the rats. Serum levels of H2S, neuron-specific enolase (NSE) and S100β were determined following CPR. In addition, neurological deficit scoring (NDS), the beam walking test (BWT), prehensile traction test and Morris water maze experiment were conducted. Neuronal apoptosis rates were detected in the hippocampal region following sacrifice. After CPR, as the H2S levels increased or decreased, the serum NSE and S100β concentrations decreased or increased, respectively (P<0.0w. The NDS results of the NaHS group were improved compared with those of the hydroxylamine group at 24 h after CPR (P<0.05). In the Morris water maze experiment, BWT and prehensile traction test the animals in the NaHS group performed best and rats in the hydroxylamine group performed worst. At day 7, the apoptotic index and the expression of caspase-3 were reduced in the hippocampal CA1 region, while the expression of Bcl-2 increased in the NaHS group; and results of the hydroxylamine group were in contrast. Therefore, the results of the present study indicate that H2S is able to improve neural function in rats following CPR. PMID:26893650

  7. [Training program on cardiopulmonary resuscitation with the use of automated external defibrillator in a university].

    Science.gov (United States)

    Boaventura, Ana Paula; Miyadahira, Ana Maria Kazue

    2012-03-01

    Early defibrillation in cardiopulmonary resuscitation (CPR) receives increasing emphasis on its priority and rapidity. This is an experience report about the implementation of a training program in CPR using a defibrillator in a private university. The training program in basic CPR maneuvers was based on global guidelines, including a theorical course with practical demonstration of CPR maneuvers with the defibrillator, individual practical training and theoretical and practical assessments. About the performance of students in the practical assessment the mean scores obtained by students in the first stage of the course was 26.4 points, while in the second stage the mean was 252.8 points, in the theoretical assessment the mean in the first stage was 3.06 points and in the second 9.0 points. The implementation of programs like this contribute to the effective acquisition of knowledge (theory) and skill (pratice) for the care of CPR victims.

  8. What are the barriers to implementation of cardiopulmonary resuscitation training in secondary schools?

    DEFF Research Database (Denmark)

    Zinckernagel, Line; Malta Hansen, Carolina; Rod, Morten Hulvej;

    2016-01-01

    of the study was to explore barriers to implementation of CPR training in Danish secondary schools. DESIGN: A qualitative study based on individual interviews and focus groups with school leadership and teachers. Thematic analysis was used to identify regular patterns of meaning both within and across...... teachers acquired the CPR skills which they considered were needed. They considered CPR training to differ substantially from other teaching subjects because it is a matter of life and death, and they therefore believed extraordinary skills were required for conducting the training. This was mainly rooted......OBJECTIVE: Cardiopulmonary resuscitation (CPR) training in schools is recommended to increase bystander CPR and thereby survival of out-of-hospital cardiac arrest, but despite mandating legislation, low rates of implementation have been observed in several countries, including Denmark. The purpose...

  9. Cardiopulmonary resuscitation: a historical perspective leading up to the end of the 19th century.

    Science.gov (United States)

    Ekmektzoglou, Konstantinos A; Johnson, Elizabeth O; Syros, Periklis; Chalkias, Athanasios; Kalambalikis, Lazaros; Xanthos, Theodoros

    2012-01-01

    Social laws and religious beliefs throughout history underscore the leaps and bounds that the science of resuscitation has achieved from ancient times until today. The effort to resuscitate victims goes back to ancient history, where death was considered a special form of sleep or an act of God. Biblical accounts of resuscitation attempts are numerous. Resuscitation in the Middle Ages was forbidden, but later during Renaissance, any prohibition against performing cardiopulmonary resuscitation (CPR) was challenged, which finally led to the Enlightenment, where scholars attempted to scientifically solve the problem of sudden death. It was then that the various components of CPR (ventilation, circulation, electricity, and organization of emergency medical services) began to take shape. The 19th century gave way to hallmarks both in the ventilatory support (intubation innovations and the artificial respirator) and the open-and closed chest circulatory support. Meanwhile, novel defibrillation techniques had been employed and ventricular fibrillation described. The groundbreaking discoveries of the 20th century finally led to the scientific framework of CPR. In 1960, mouth-to-mouth resuscitation was eventually combined with chest compression and defibrillation to become CPR as we now know it. This review presents the scientific milestones behind one of medicine's most widely used fields.

  10. Cardiopulmonary Resuscitation in Microgravity: Efficacy in the Swine During Parabolic Flight

    Science.gov (United States)

    Johnston, Smith L.; Campbell, Mark R.; Billica, Roger D.; Gilmore, Stevan M.

    2004-01-01

    INTRODUCTION: The International Space Station will need to be as capable as possible in providing Advanced Cardiac Life Support (ACLS) and cardiopulmonary resuscitation (CPR). Previous studies with manikins in parabolic microgravity (0 G) have shown that delivering CPR in microgravity is difficult. End tidal carbon dioxide (PetCO2) has been previously shown to be an effective non-invasive tool for estimating cardiac output during cardiopulmonary resuscitation. Animal models have shown that this diagnostic adjunct can be used as a predictor of survival when PetCO2 values are maintained above 25% of pre-arrest values. METHODS: Eleven anesthetized Yorkshire swine were flown in microgravity during parabolic flight. Physiologic parameters, including PetCO2, were monitored. Standard ACLS protocols were used to resuscitate these models after chemical induction of cardiac arrest. Chest compressions were administered using conventional body positioning with waist restraint and unconventional vertical-inverted body positioning. RESULTS: PetCO2 values were maintained above 25% of both 1-G and O-G pre-arrest values in the microgravity environment (33% +/- 3 and 41 +/- 3). No significant difference between 1-G CPR and O-G CPR was found in these animal models. Effective CPR was delivered in both body positions although conventional body positioning was found to be quickly fatiguing as compared with the vertical-inverted. CONCLUSIONS: Cardiopulmonary resuscitation can be effectively administered in microgravity (0 G). Validation of this model has demonstrated that PetCO2 levels were maintained above a level previously reported to be predictive of survival. The unconventional vertical-inverted position provided effective CPR and was less fatiguing as compared with the conventional body position with waist restraints.

  11. Rib fractures in infants due to cardiopulmonary resuscitation efforts.

    Science.gov (United States)

    Dolinak, David

    2007-06-01

    Although it is widely known that adults may sustain fractures of the anterior and/or lateral aspects of the ribs due to cardiopulmonary resuscitation (CPR) efforts, relatively little is written about the generation of CPR-related rib fractures in the infant age range. In a series of 70 consecutive autopsies in infants ranging in age from 2 weeks to 8 months, with no history or indications of injury, the parietal pleura of the thoracic cage was stripped and the ribs carefully examined for fracture. Subtle fractures of the anterolateral aspects of the ribs were discovered in 8 (11%) of the 70 cases. In 7 of the 8 cases, multiple ribs were fractured (ranging up to 10 rib fractures), and in 5 of these cases, the rib fractures were bilateral. All of the rib fractures were subtle, had little if any associated blood extravasation, and would have been easily missed had the parietal pleura not been stripped. These anterolateral rib fractures in infants are the likely correlate of anterolateral rib fractures that are not uncommonly seen in the adult population, resulting from resuscitation efforts. The rib fractures are subtle and may not be identified unless the parietal pleura is stripped.

  12. Pediatric Cardiopulmonary Resuscitation: Advances in Science, Techniques, and Outcomes

    OpenAIRE

    Topjian, Alexis A.; Berg, Robert A; Nadkarni, Vinay M.

    2008-01-01

    More than 25% of children survive to hospital discharge after in-hospital cardiac arrests, and 5% to 10% survive after out-of-hospital cardiac arrests. This review of pediatric cardiopulmonary resuscitation addresses the epidemiology of pediatric cardiac arrests, mechanisms of coronary blood flow during cardiopulmonary resuscitation, the 4 phases of cardiac arrest resuscitation, appropriate interventions during each phase, special resuscitation circumstances, extracorporeal membrane oxygenati...

  13. A pilot study of effects of cardiopulmonary resuscitation training on participants' self-concepts.

    Science.gov (United States)

    Elliott, T R; Byrd, E K

    1983-10-01

    The administration of cardiopulmonary resuscitation (CPR) was taught to a group of 12 adults. The Tennessee Self-concept Scale Form-C and the Fundamental Interpersonal Relations Orientation-Behavior Scale (FIRO-B) were administered before and after their training. A control group of 12 was administered both scales twice with one day between administrations. Analysis indicated both groups showed significant differences between the pre- and posttest administrations on expressed affection on the FIRO-B. However, participants in a brief CPR course did not score significantly differently from a control group on these measures, as expected.

  14. European nursing organizations stand up for family presence during cardiopulmonary resuscitation: a joint position statement.

    Science.gov (United States)

    Moons, Philip; Norekvål, Tone M

    2008-01-01

    Empirical evidence suggests that family presence during cardiopulmonary resuscitation (CPR) has beneficial effects. Although many American professional organizations have endorsed the idea of family presence, there is less formal support in Europe. In addition, the attitude of nurses from Anglo-Saxon countries, such as United Kingdom and Ireland, is more positive toward family presence than the attitude of nurses of mainland Europe. In order to support existing guidelines and to stimulate health care organizations to develop a formal policy with respect to family witnessed CPR, 3 important European nursing organizations have recently developed a joint position statement.

  15. Resuscitation, prolonged cardiac arrest, and an automated chest compression device

    DEFF Research Database (Denmark)

    Risom, Martin; Jørgensen, Henrik; Rasmussen, Lars S;

    2010-01-01

    The European Resuscitation Council's 2005 guidelines for cardiopulmonary resuscitation (CPR) emphasize the delivery of uninterrupted chest compressions of adequate depth during cardiac arrest.......The European Resuscitation Council's 2005 guidelines for cardiopulmonary resuscitation (CPR) emphasize the delivery of uninterrupted chest compressions of adequate depth during cardiac arrest....

  16. Assessment of long-term impact of formal certified cardiopulmonary resuscitation training program among nurses

    Directory of Open Access Journals (Sweden)

    P P Saramma

    2016-01-01

    Full Text Available Context: Cardiopulmonary resuscitation (CPR and emergency cardiovascular care guidelines are periodically renewed and published by the American Heart Association. Formal training programs are conducted based on these guidelines. Despite widespread training CPR is often poorly performed. Hospital educators spend a significant amount of time and money in training health professionals and maintaining basic life support (BLS and advanced cardiac life support (ACLS skills among them. However, very little data are available in the literature highlighting the long-term impact of these training. Aims: To evaluate the impact of formal certified CPR training program on the knowledge and skill of CPR among nurses, to identify self-reported outcomes of attempted CPR and training needs of nurses. Setting and Design : Tertiary care hospital, Prospective, repeated-measures design. Subjects and Methods: A series of certified BLS and ACLS training programs were conducted during 2010 and 2011. Written and practical performance tests were done. Final testing was undertaken 3-4 years after training. The sample included all available, willing CPR certified nurses and experience matched CPR noncertified nurses. Statistical Analysis Used: SPSS for Windows version 21.0. Results: The majority of the 206 nurses (93 CPR certified and 113 noncertified were females. There was a statistically significant increase in mean knowledge level and overall performance before and after the formal certified CPR training program (P = 0.000. However, the mean knowledge scores were equivalent among the CPR certified and noncertified nurses, although the certified nurses scored a higher mean score (P = 0.140. Conclusions: Formal certified CPR training program increases CPR knowledge and skill. However, significant long-term effects could not be found. There is a need for regular and periodic recertification.

  17. Cardiopulmonary Resuscitation Pattern Evaluation Based on Ensemble Empirical Mode Decomposition Filter via Nonlinear Approaches

    Directory of Open Access Journals (Sweden)

    Muammar Sadrawi

    2016-01-01

    Full Text Available Good quality cardiopulmonary resuscitation (CPR is the mainstay of treatment for managing patients with out-of-hospital cardiac arrest (OHCA. Assessment of the quality of the CPR delivered is now possible through the electrocardiography (ECG signal that can be collected by an automated external defibrillator (AED. This study evaluates a nonlinear approximation of the CPR given to the asystole patients. The raw ECG signal is filtered using ensemble empirical mode decomposition (EEMD, and the CPR-related intrinsic mode functions (IMF are chosen to be evaluated. In addition, sample entropy (SE, complexity index (CI, and detrended fluctuation algorithm (DFA are collated and statistical analysis is performed using ANOVA. The primary outcome measure assessed is the patient survival rate after two hours. CPR pattern of 951 asystole patients was analyzed for quality of CPR delivered. There was no significant difference observed in the CPR-related IMFs peak-to-peak interval analysis for patients who are younger or older than 60 years of age, similarly to the amplitude difference evaluation for SE and DFA. However, there is a difference noted for the CI (p<0.05. The results show that patients group younger than 60 years have higher survival rate with high complexity of the CPR-IMFs amplitude differences.

  18. Toll-like receptor 4 contributes to acute kidney injury after cardiopulmonary resuscitation in mice

    Science.gov (United States)

    Zhang, Qingsong; Li, Gang; Xu, Li; Li, Qian; Wang, Qianyan; Zhang, Yue; Zhang, Qing; Sun, Peng

    2016-01-01

    Toll-like receptor 4 (TLR4) activation mediates renal injury in regional ischemia and reperfusion (I/R) models generated by clamping renal pedicles. However, it remains unclear whether TLR4 is causal in the kidney injury following global I/R induced by cardiac arrest (CA) and cardiopulmonary resuscitation (CPR). The present study used wild-type (C3H/HeN) and TLR4-mutant (C3H/HeJ) mice to produce the CA/CPR model. CA was induced by injection of cold KCl and left untreated for different time periods. After resuscitation (72 h), the level of blood urea nitrogen (BUN) and serum creatinine (Scr), as well as histological changes in renal tissue were assessed to evaluate the severity of acute kidney injury (AKI). The expression of TLR4, intercellular adhesion molecule-1 (ICAM-1), myeloperoxidase (MPO) and growth-regulated oncogene-β (GRO-β) in kidney tissues was detected. The results demonstrated that the levels of Scr and BUN increased significantly in C3H/HeN and C3H/HeJ mice after CPR. CPR also resulted in increased expression of TLR4, ICAM-1, GRO-β and MPO in a CA-duration dependent manner. However, there was decreased expression of ICAM-1, GRO-β and MPO in C3H/HeJ mice compared with that in C3H/HeN mice. C3H/HeJ mice were resistant to AKI as demonstrated by the minor changes in renal histology and function following CPR. In conclusion, mice suffered from AKI after successful CPR and severe AKI occurred in mice with prolonged CA duration. TLR4 and its downstream signaling events that promote neutrophil infiltration via ICAM-1 and GRO-β may be important in mediating inflammatory responses to renal injury after CPR. PMID:27510583

  19. "Utstein style" spreadsheet and database programs based on Microsoft Excel and Microsoft Access software for CPR data management of in-hospital resuscitation.

    Science.gov (United States)

    Adams, Bruce D; Whitlock, Warren L

    2004-04-01

    In 1997, The American Heart Association in association with representatives of the International Committee on Resuscitation (ILCOR) published recommended guidelines for reviewing, reporting and conducting in-hospital cardiopulmonary resuscitation (CPR) outcomes using the "Utstein style". Using these guidelines, we developed two Microsoft Office based database management programs that may be useful to the resuscitation community. We developed a user-friendly spreadsheet based on MS Office Excel. The user enters patient variables such as name, age, and diagnosis. Then, event resuscitation variables such as time of collapse and CPR team arrival are entered from a "code flow sheet". Finally, outcome variables such as patient condition at different time points are recorded. The program then makes automatic calculations of average response times, survival rates and other important outcome measurements. Also using the Utstein style, we developed a database program based on MS Office Access. To promote free public access to these programs, we established at a website. These programs will help hospitals track, analyze, and present their CPR outcomes data. Clinical CPR researchers might also find the programs useful because they are easily modified and have statistical functions.

  20. Effect of Prior Cardiopulmonary Resuscitation Knowledge on Compression Performance by Hospital Providers

    Directory of Open Access Journals (Sweden)

    Joshua N. Burkhardt

    2014-07-01

    Full Text Available Introduction: The purpose of this study was to determine cardiopulmonary resuscitation (CPR knowledge of hospital providers and whether knowledge affects performance of effective compressions during a simulated cardiac arrest. Methods: This cross-sectional study evaluated the CPR knowledge and performance of medical students and ED personnel with current CPR certification. We collected data regarding compression rate, hand placement, depth, and recoil via a questionnaire to determine knowledge, and then we assessed performance using 60 seconds of compressions on a simulation mannequin. Results: Data from 200 enrollments were analyzed by evaluators blinded to subject knowledge. Regarding knowledge, 94% of participants correctly identified parameters for rate, 58% for hand placement, 74% for depth, and 94% for recoil. Participants identifying an effective rate of ≥100 performed compressions at a significantly higher rate than participants identifying <100 (µ=117 vs. 94, p<0.001. Participants identifying correct hand placement performed significantly more compressions adherent to guidelines than those identifying incorrect placement (µ=86% vs. 72%, p<0.01. No significant differences were found in depth or recoil performance based on knowledge of guidelines. Conclusion: Knowledge of guidelines was variable; however, CPR knowledge significantly impacted certain aspects of performance, namely rate and hand placement, whereas depth and recoil were not affected. Depth of compressions was poor regardless of prior knowledge, and knowledge did not correlate with recoil performance. Overall performance was suboptimal and additional training may be needed to ensure consistent, effective performance and therefore better outcomes after cardiopulmonary arrest.

  1. Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions-A nationwide prospective feasibility study

    DEFF Research Database (Denmark)

    Krarup, Niels Henrik; Terkelsen, Christian Juhl; Johnsen, Søren Paaske;

    2010-01-01

    Quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome following out-of-hospital cardiac arrest. The aim of our study was to evaluate the quality of CPR provided by emergency medical service providers (Basic Life Support (BLS) capability) and emergency medical service...... providers assisted by paramedics, nurse anesthetists or physician-manned ambulances (Advanced Life Support (ALS) capability) in a nationwide, unselected cohort of out-of-hospital cardiac arrest cases....

  2. Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions--a nationwide prospective feasibility study

    DEFF Research Database (Denmark)

    Krarup, Niels Henrik; Terkelsen, Christian Juhl; Johnsen, Søren Paaske;

    2011-01-01

    Quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome following out-of-hospital cardiac arrest. The aim of our study was to evaluate the quality of CPR provided by emergency medical service providers (Basic Life Support (BLS) capability) and emergency medical service...... providers assisted by paramedics, nurse anesthetists or physician-manned ambulances (Advanced Life Support (ALS) capability) in a nationwide, unselected cohort of out-of-hospital cardiac arrest cases....

  3. Evaluation of Smartphone Applications for Cardiopulmonary Resuscitation Training in South Korea

    Directory of Open Access Journals (Sweden)

    Chiwon Ahn

    2016-01-01

    Full Text Available Objective. There are many smartphone-based applications (apps for cardiopulmonary resuscitation (CPR training. We investigated the conformity and the learnability/usability of these apps for CPR training and real-life supports. Methods. We conducted a mixed-method, sequential explanatory study to assess CPR training apps downloaded on two apps stores in South Korea. Apps were collected with inclusion criteria as follows, Korean-language instruction, training features, and emergency supports for real-life incidents, and analyzed with two tests; 15 medical experts evaluated the apps’ contents according to current Basic Life Support guidelines in conformity test, and 15 nonmedical individuals examined the apps using System Usability Scale (SUS in the learnability/usability test. Results. Out of 79 selected apps, five apps were included and analyzed. For conformity (ICC, 0.95, p<0.001, means of all apps were greater than 12 of 20 points, indicating that they were well designed according to current guidelines. Three of the five apps yielded acceptable level (greater than 68 of 100 points for learnability/usability. Conclusion. All the included apps followed current BLS guidelines and a majority offered acceptable learnability/usability for layperson. Current and developmental smartphone-based CPR training apps should include accurate CPR information and be easy to use for laypersons that are potential rescuers in real-life incidents. For Clinical Trials. This is a clinical trial, registered at the Clinical Research Information Service (CRIS, cris.nih.go.kr, number KCT0001840.

  4. Prognostic value of electroencephalography (EEG) for brain injury after cardiopulmonary resuscitation.

    Science.gov (United States)

    Feng, Guibo; Jiang, Guohui; Li, Zhiwei; Wang, Xuefeng

    2016-06-01

    Cardiac arrest (CA) patients can experience neurological sequelae or even death after successful cardiopulmonary resuscitation (CPR) due to cerebral hypoxia- and ischemia-reperfusion-mediated brain injury. Thus, it is important to perform early prognostic evaluations in CA patients. Electroencephalography (EEG) is an important tool for determining the prognosis of hypoxic-ischemic encephalopathy due to its real-time measurement of brain function. Based on EEG, burst suppression, a burst suppression ratio >0.239, periodic discharges, status epilepticus, stimulus-induced rhythmic, periodic or ictal discharges, non-reactive EEG, and the BIS value based on quantitative EEG may be associated with the prognosis of CA after successful CPR. As measures of neural network integrity, the values of small-world characteristics of the neural network derived from EEG patterns have potential applications.

  5. Kinetics of carbon dioxide during cardiopulmonary resuscitation

    DEFF Research Database (Denmark)

    Wiklund, L; Söderberg, D; Henneberg, S

    1986-01-01

    CO2 kinetics during CPR was investigated in 15 anesthetized piglets. BP, blood gases, and acid-base balance were monitored through catheters in the carotid artery and a central vein, as well as in cerebrospinal fluid. Cardiac arrest was induced by a transthoracic direct current shock. CPR was beg...

  6. Factors affecting the quality of cardiopulmonary resuscitation in inpatient units: perception of nurses

    Directory of Open Access Journals (Sweden)

    Clairton Marcos Citolino Filho

    2015-12-01

    Full Text Available Abstract OBJECTIVE To identify, in the perception of nurses, the factors that affect the quality of cardiopulmonary resuscitation (CPR in adult inpatient units, and investigate the influence of both work shifts and professional experience length of time in the perception of these factors. METHOD A descriptive, exploratory study conducted at a hospital specialized in cardiology and pneumology with the application of a questionnaire to 49 nurses working in inpatient units. RESULTS The majority of nurses reported that the high number of professionals in the scenario (75.5%, the lack of harmony (77.6% or stress of any member of staff (67.3%, lack of material and/or equipment failure (57.1%, lack of familiarity with the emergency trolleys (98.0% and presence of family members at the beginning of the cardiopulmonary arrest assistance (57.1% are factors that adversely affect the quality of care provided during CPR. Professional experience length of time and the shift of nurses did not influence the perception of these factors. CONCLUSION The identification of factors that affect the quality of CPR in the perception of nurses serves as parameter to implement improvements and training of the staff working in inpatient units.

  7. Attitude and skill levels of graduate health professionals in performing cardiopulmonary resuscitation

    Science.gov (United States)

    Gebreegziabher Gebremedhn, Endale; Berhe Gebregergs, Gebremedhn; Anderson, Bernard Bradley; Nagaratnam, Vidhya

    2017-01-01

    Background Cardiopulmonary resuscitation (CPR) is an emergency procedure used to treat victims following cardiopulmonary arrest. Graduate health professionals at the University of Gondar Teaching Hospital manage many trauma and critically ill patients. The chance of survival after cardiopulmonary arrest may be increased with sufficient attitude and skill levels. The study aimed to assess the attitude and skill levels of graduate health professionals in performing CPR. Methods A hospital-based cross-sectional study was conducted from May 1 to 30, 2013, at the University of Gondar Teaching Hospital. The mean attitude and skill scores were compared for sex, original residence, and department of the participants using Student’s t-test and analysis of variance (Scheffe’s test). P-values attitude scores of nurse, interns, health officer, midwifery, anesthesia, and psychiatric nursing graduates were 1.15 (standard deviation [SD] =1.67), 8.21 (SD =1.24), 7.2 (SD =1.49), 6.69 (SD =1.83), 8.19 (SD =1.77), and 7.29 (SD =2.01), respectively, and the mean skill scores were 2.34 (SD =1.95), 3.77 (SD =1.58), 1.18 (SD =1.52), 2.16 (SD =1.93), 3.88 (SD =1.36), and 1.21 (SD =1.77), respectively. Conclusion and recommendations Attitude and skill level of graduate health professionals with regard to CPR were insufficient. Training on CPR for graduate health professionals needs to be given emphasis.

  8. Necessity of immediate cardiopulmonary resuscitation in trauma emergency

    Directory of Open Access Journals (Sweden)

    Luciano Baitello

    2010-08-01

    Full Text Available Abstract The ability to respond quickly and effectively to a cardiac arrest situation rests on nurses being competent in the emergency life-saving procedure of cardiopulmonary resuscitation. The objective of the current study was to evaluate the types of trauma and survival of patients that require immediate cardiopulmonary resuscitation in trauma emergencies. A total of 13301 patients treated as accident victims between July 2004 and December 2006 were evaluated in a prospective study. Patients requiring immediate cardiopulmonary resuscitation at admission were identified. The type of injury and the survival of these patients were evaluated. Of the 65 patients included in the study, 30% had suffered from gunshot wounds, 19% had been run over, 18% had been involved in car crashes, 13% in motor cycle accidents, 9% stabbings, 1% by cycle accidents and 10% other types of accidents including burns, hangings and falls. In only 12 of these patients, immediate resuscitation was successful and procedure such as chest drainage, exploratory laparotomy and interventions in the surgical center were performed. However all patients evolved to death; eight within 24 hours, two between 24 and 48 hours and the other 2 after 48 hours. Immediate cardiopulmonary resuscitation after accidents is a sign of high mortality requiring further studies to review indication and the ethical aspects involved.

  9. Clinical Practice Guidelines for Cardiopulmonary and Cerebral Resuscitation.

    Directory of Open Access Journals (Sweden)

    Victor Rene Navarro Machado

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Cardiopulmonary and Cerebral Resuscitation. It is the group of procedures that should be accomplished to restore circulation and ventilation in a patient with cardiac arrest, including actions to reintegrate upper neurological functions after restoring cardiac function. This document includes a review of concepts, aetiology and updates the main clinical aspects related with diagnosis and treatment aimed at the post-resuscitation syndrome. It includes assessment guidelines focused on the most important aspects to be accomplished.

  10. Echocardiography integrated ACLS protocol versus con-ventional cardiopulmonary resuscitation in patients with

    Directory of Open Access Journals (Sweden)

    Chardoli Mojtaba

    2012-11-01

    Full Text Available 【Abstract】Objective: To examine the utility of bedside echocardiography in detecting the reversible causes of pulseless electrical activity (PEA cardiac arrest and pre-dicting the resuscitation outcomes. Methods: In this prospective interventional study, pa-tients presenting with PEA cardiac arrest were randomized into two groups. In Group A, ultrasound trained emergency physicians performed echocardiography evaluating cardiac activity, right ventricle dilation, left ventricle function, peri-cardial effusion/tamponade and IVC size along with the ad-vanced cardiac life support (ACLS protocol. Patients in Group B solely underwent ACLS protocol without applying echocardiography. The presence or absence of mechanical ventricular activity (MVA and evidences of PEA reversible causes were recorded. The return of spontaneous circulation (ROSC and death were evaluated in both groups. Results: One hundred patients with the mean age of (58±6.1 years were enrolled in this study. Fifty patients (Group A had echocardiography detected in parallel with cardiopulmonary resuscitation (CPR. Among them, 7 pa-tients (14% had pericardial effusion, 11 (22% had hypovolemia, and 39 (78% were revealed the presence of MVA. In the pseudo PEA subgroup (presence of MVA, 43% had ROSC (positive predictive value and in the true PEA subgroup with cardiac standstill (absence of MVA, there was no recorded ROSC (negative predictive value. Among patients in Group B, no reversible etiology was detected. There was no significant difference in resuscitation results between Groups A and B observed (P=0.52. Conclusion: Bedside echocardiography can identify some reversible causes of PEA. However, there are no sig-nificant changes in survival outcome between the echo group and those with traditional CPR. Key words: Heart arrest; Echocardiography; Car-diopulmonary resuscitation

  11. Kinetics of carbon dioxide during cardiopulmonary resuscitation

    DEFF Research Database (Denmark)

    Wiklund, L; Söderberg, D; Henneberg, S;

    1986-01-01

    CO2 kinetics during CPR was investigated in 15 anesthetized piglets. BP, blood gases, and acid-base balance were monitored through catheters in the carotid artery and a central vein, as well as in cerebrospinal fluid. Cardiac arrest was induced by a transthoracic direct current shock. CPR was begun...... immediately by artificial ventilation and simultaneous external chest compressions. Epinephrine was administered after 8 min of CPR. One group (n = 5) of animals received no buffer treatment while another (n = 5) received an infusion of 75 mmol sodium bicarbonate and a third group (n = 5) received......, bicarbonate and tris-buffer mixture both quickly passed through the blood-brain barrier. When buffer treatment is indicated during CPR, a buffer which does not increase tissue PCO2 may be the drug of choice....

  12. Impaired Cerebral Mitochondrial Oxidative Phosphorylation Function in a Rat Model of Ventricular Fibrillation and Cardiopulmonary Resuscitation

    Directory of Open Access Journals (Sweden)

    Jun Jiang

    2014-01-01

    Full Text Available Postcardiac arrest brain injury significantly contributes to mortality and morbidity in patients suffering from cardiac arrest (CA. Evidence that shows that mitochondrial dysfunction appears to be a key factor in tissue damage after ischemia/reperfusion is accumulating. However, limited data are available regarding the cerebral mitochondrial dysfunction during CA and cardiopulmonary resuscitation (CPR and its relationship to the alterations of high-energy phosphate. Here, we sought to identify alterations of mitochondrial morphology and oxidative phosphorylation function as well as high-energy phosphates during CA and CPR in a rat model of ventricular fibrillation (VF. We found that impairment of mitochondrial respiration and partial depletion of adenosine triphosphate (ATP and phosphocreatine (PCr developed in the cerebral cortex and hippocampus following a prolonged cardiac arrest. Optimal CPR might ameliorate the deranged phosphorus metabolism and preserve mitochondrial function. No obvious ultrastructural abnormalities of mitochondria have been found during CA. We conclude that CA causes cerebral mitochondrial dysfunction along with decay of high-energy phosphates, which would be mitigated with CPR. This study may broaden our understanding of the pathogenic processes underlying global cerebral ischemic injury and provide a potential therapeutic strategy that aimed at preserving cerebral mitochondrial function during CA.

  13. Outcomes of In-Hospital Cardiopulmonary Resuscitation in Maintenance Dialysis Patients.

    Science.gov (United States)

    Saeed, Fahad; Adil, Malik M; Malik, Ahmed A; Schold, Jesse D; Holley, Jean L

    2015-12-01

    Outcomes of cardiopulmonary resuscitation (CPR) in hospitalized patients with ESRD requiring maintenance dialysis are unknown. Outcomes of in-hospital CPR in these patients were compared with outcomes in the general population using data from the Nationwide Inpatient Sample (NIS; 2005-2011). The study population included all adults (≥ 18 years old) from the general population and those with a history of ESRD. Baseline characteristics, in-hospital complications, and discharge outcomes were compared between the two groups. The effects of in-hospital CPR on mortality, length of stay, hospitalization charges, and discharge destination were analyzed. Yearly national trends in survival, discharge to home, and length of stay were also examined using the Cochran-Armitage trend test. During the study period, 56,069 patients with ESRD underwent in-hospital CPR compared with 323,620 patients from the general population. Unadjusted in-hospital mortality rates were higher in patients with ESRD (73.9% versus 71.8%, PCPR improved in the year 2011 compared with 2005 (31% versus 21%, PCPR are improving in patients with ESRD but remain worse than outcomes in the general population. Patients with ESRD who survive are more likely to be discharged to nursing homes.

  14. Pre- and postconditioning effect of Sevoflurane on myocardial dysfunction after cardiopulmonary resuscitation in rats.

    Science.gov (United States)

    Knapp, Jürgen; Bergmann, Greta; Bruckner, Thomas; Russ, Nicolai; Böttiger, Bernd W; Popp, Erik

    2013-10-01

    Post-resuscitation myocardial dysfunction is an important cause of death in the intensive care unit after initially successful cardiopulmonary resuscitation (CPR) of pre-hospital cardiac arrest (CA) patients. Volatile anaesthetics reduce ischaemic-reperfusion injury in regional ischaemia in beating hearts. This effect, called anaesthetic-induced pre- or postconditioning, can be shown when the volatile anaesthetic is given either before regional ischaemia or in the reperfusion phase. However, up to now, little data exist for volatile anaesthetics after global ischaemia due to CA. Therefore, the goal of this study was to clarify whether Sevoflurane improves post-resuscitation myocardial dysfunction after CA in rats. Following institutional approval by the Governmental Animal Care Committee, 144 male Wistar rats (341±19g) were randomized either to a control group or to one of the 9 interventional groups receiving 0.25 MAC, 0.5 MAC or 1 MAC of Sevoflurane for 5min either before resuscitation (SBR), during resuscitation (SDR) or after resuscitation (SAR). After 6min of electrically induced ventricular fibrillation CPR was performed. Before CA (baseline) as well as 1h and 24h after restoration of spontaneous circulation (ROSC), continuous measurement of ejection fraction (EF), and preload adjusted maximum power (PAMP) as primary outcome parameters and end systolic pressure (ESP), end diastolic volume (EDV) and maximal slope of systolic pressure increment (dP/dtmax) as secondary outcome parameters was performed using a conductance catheter. EF was improved in all Sevoflurane treated groups 1h after ROSC in comparison to control, except for the 0.25 MAC SDR and 0.25 MAC SAR group (0.25 MAC SBR: 38±8, p=0.02; 0.5 MAC SBR: 39±7, p=0.04; 1 MAC SBR: 40±6, p=0.007; 0.5 MAC SDR: 38±7, p=0.02; 1 MAC SDR: 40±6, p=0.006; 0.5 MAC SAR: 39±6, p=0.01; 1 MAC SAR: 39±6, p=0.002, vs. 30±7%). Twenty-four hours after ROSC, EF was higher than control in all interventional groups

  15. Cardiopulmonary resuscitation and contrast media reactions in a radiology department

    Energy Technology Data Exchange (ETDEWEB)

    O' Neill, John M.; McBride, Kieran D

    2001-04-01

    AIM: To assess current knowledge and training in the management of contrast media reactions and cardiopulmonary resuscitation within a radiology department. MATERIALS AND METHODS: The standard of knowledge about the management of contrast media reactions and cardiopulmonary resuscitation among radiologists, radiographers and nurses were audited using a two-section questionnaire. Our results were compared against nationally accepted standards. Repeat audits were undertaken over a 28-month period. Three full audit cycles were completed. RESULTS: The initial audit confirmed that although a voluntary training programme was in place, knowledge of cardiopulmonary resuscitation techniques were below acceptable levels (set at 70%) for all staff members. The mean score for radiologists was 50%. Immediate changes instituted included retraining courses, the distribution of standard guidelines and the composition and distribution of two separate information handouts. Initial improvements were complemented by new wallcharts, which were distributed throughout the department, a series of lectures on management of contrast reactions and regular reviews with feedback to staff. In the third and final audit all staff groups had surpassed the required standard. CONCLUSION: Knowledge of contrast media reactions and resuscitation needs constant updating. Revision of skills requires a prescriptive programme; visual display of advice is a constant reminder. It is our contention all radiology departmental staff should consider it a personal duty to maintain their resuscitation skills at appropriate standards. O'Neill, J.M., McBride, K.D.(2001). Clinical Radiology 00, 000-000.

  16. Evaluation of upper body muscle activity during cardiopulmonary resuscitation performance in simulated microgravity

    Science.gov (United States)

    Waye, A. B.; Krygiel, R. G.; Susin, T. B.; Baptista, R.; Rehnberg, L.; Heidner, G. S.; de Campos, F.; Falcão, F. P.; Russomano, T.

    2013-09-01

    Performance of efficient single-person cardiopulmonary resuscitation (CPR) is vital to maintain cardiac and cerebral perfusion during the 2-4 min it takes for deployment of advanced life support during a space mission. The aim of the present study was to investigate potential differences in upper body muscle activity during CPR performance at terrestrial gravity (+1Gz) and in simulated microgravity (μG). Muscle activity of the triceps brachii, erector spinae, rectus abdominis and pectoralis major was measured via superficial electromyography in 20 healthy male volunteers. Four sets of 30 external chest compressions (ECCs) were performed on a mannequin. Microgravity was simulated using a body suspension device and harness; the Evetts-Russomano (ER) method was adopted for CPR performance in simulated microgravity. Heart rate and perceived exertion via Borg scores were also measured. While a significantly lower depth of ECCs was observed in simulated microgravity, compared with +1Gz, it was still within the target range of 40-50 mm. There was a 7.7% decrease of the mean (±SEM) ECC depth from 48 ± 0.3 mm at +1Gz, to 44.3 ± 0.5 mm during microgravity simulation (p muscular and cardiovascular deconditioning that occurs during space travel.

  17. [Cardiopulmonary resuscitation in cardiac arrest following trauma].

    Science.gov (United States)

    Leidel, B A; Kanz, K-G

    2016-11-01

    For decades, survival rates of cardiac arrest following trauma were reported between 0 and 2 %. Since 2005, survival rates have increased with a wide range up to 39 % and good neurological recovery in every second person injured for unknown reasons. Especially in children, high survival rates with good neurologic outcomes are published. Resuscitation following traumatic cardiac arrest differs significantly from nontraumatic causes. Paramount is treatment of reversible causes, which include massive bleeding, hypoxia, tension pneumothorax, and pericardial tamponade. Treatment of reversible causes should be simultaneous. Chest compression is inferior following traumatic cardiac arrest and should never delay treatment of reversible causes of the traumatic cardiac arrest. In massive bleeding, bleeding control has priority. Damage control resuscitation with permissive hypotension, aggressive coagulation therapy, and damage control surgery represent the pillars of initial treatment. Cardiac arrest due to hypoxia should be resolved by airway management and ventilation. Tension pneumothorax should be decompressed by finger thoracostomy, pericardial tamponade by resuscitative thoracotomy. In addition, resuscitative thoracotomy allows direct and indirect bleeding control. Untreated impact brain apnea may rapidly lead to cardiac arrest and requires quick opening of the airway and effective oxygenation. Established algorithms for treatment of cardiac arrest following trauma enable a safe, structured, and effective management.

  18. Effects of matrix metalloproteinase 9 inhibition on the blood brain barrier and inflammation in rats following cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    HE Zhi-jie; HUANG Zi-tong; CHEN Xiao-tong; ZOU Zi-jun

    2009-01-01

    Background Neuroprotective strategies following cardiopulmonary resuscitation (CPR) are an important focus in emergency and critical care medicine. Matrix metalloproteinases (MMPs), especially MMP9 attracted much attention because of its function in focal brain ischemia/reperfusion injury. In the focal cerebral ischemia model in rats, SB-3CT can suppress the expression of MMP9, relieving brain edema, and there was no studies on global cerebral ischemia-reperfusion injury after CPR.Methods One hundred and twenty rats were randomly assigned to sham-operated (n=40), resuscitation treatment (n= 40), and resuscitation control (n= 40) groups. Sham-operated group rats were anesthetized only and intubated tracheally, while the resuscitation treatment and resuscitation control groups also received cardiac arrest by asphyxiation. In the resuscitation treatment group, SB-3CT was injected intraperitoneally after restoring spontaneous circulation (ROSC), defined as restoration of supraventricular rhythm and mean arterial pressure (MAP) ≥ 60 mm Hg for more than 5 minutes. The resuscitation control group also implemented ROSC without injection of SB-3CT. The rats were executed and samples were taken immediately after death, then at 3, 9, 24, and 48 hours (n=8). Brain tissue expression of MMP9 protein, MMP9 mRNA, water content, Evans blue content, TNF-a, IL-1, and IL-6 was measured, and the brain tissue ultramicrostructure studied with electron microscopy.Results In the resuscitation control group, brain tissue expression of MMP9 protein and mRNA, water content, Evans blue content, TNF-a, IL-1, and IL-6 were significantly elevated at 3 hours, and peaked at 24 hours after resuscitation, when compared with the sham-operated group (P <0.05). Tissue ultramicrostructure also changed in the resuscitation control group. By contrast, although all these indexes were increased in the resuscitation treatment group compared with the sham-operated group (P<0.05), they were lower than in the

  19. Time Matters: Realism in Resuscitation Training

    DEFF Research Database (Denmark)

    Krogh, Kristian; Høyer, Christian Bjerre; Eika, Berit

    2014-01-01

    Background: The advanced life support guidelines recommend 2 min of cardiopulmonary resuscitation (CPR) and minimal hands-off time to ensure sufficient cardiac and cerebral perfusion. We have observed doctors who shorten the CPR intervals during resuscitation attempts. During simulation-based res...

  20. Family presence during cardiopulmonary resuscitation and invasive procedures in children

    OpenAIRE

    Ferreira, Cristiana Araujo G.; Flavia Simphronio Balbino; Balieiro,Maria Magda F. G.; Myriam Aparecida Mandetta

    2014-01-01

    Objective:To identify literature evidences related to actions to promote family's presence during cardiopulmonary resuscitation and invasive procedures in children hospitalized in pediatric and neonatal critical care units.Data sources : Integrative literature review in PubMed, SciELO and Lilacs databases, from 2002 to 2012, with the following inclusion criteria: research article in Medicine, or Nursing, published in Portuguese, English or Spanish, using the keywords family, invasive procedur...

  1. Ruptured subcapsular liver haematoma following mechanically-assisted cardiopulmonary resuscitation.

    Science.gov (United States)

    Joseph, John R; Freundlich, Robert Edward; Abir, Mahshid

    2016-02-02

    A 64-year-old man with a history of ascending aortic surgery and pulmonary embolus presented with shortness of breath. He rapidly decompensated, prompting intubation, after which he lost pulses. Manual resuscitation was initiated immediately, with subsequent use of a LUCAS-2 mechanical compression device. The patient was given bolus thrombolytic therapy and regained pulses after 7 min of CPR. Compressions were reinitiated with the LUCAS-2 twice more during resuscitation over the subsequent hour for brief episodes of PEA. After confirmation of massive pulmonary embolism on CT, the patient underwent interventional radiology-guided ultrasonic catheter placement with local thrombolytic therapy and experienced immediate improvement in oxygenation. He later developed abdominal compartment syndrome, despite cessation of thrombolytic and anticoagulation therapy. Bedside exploratory abdominal laparotomy revealed a ruptured subcapsular haematoma of the liver. The patient's haemodynamics improved following surgery and he was extubated 11 days postarrest with intact neurological function.

  2. Echocardiography integrated ACLS protocol versus conventional cardiopulmonary resuscitation in patients with pulseless electrical activity cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    Mojtaba Chardoli; Farhad Heidari; Helaleh Rabiee; Mahdi Sharif-Alhoseini; Hamid Shokoohi; Vafa Rahimi-Movaghar

    2012-01-01

    Objective: To examine the utility of bedside echocardiography in detecting the reversible causes of pulseless electrical activity (PEA) cardiac arrest and predicting the resuscitation outcomes.Methods: In this prospective interventional study,patients presenting with PEA cardiac arrest were randomized into two groups.In Group A,ultrasound trained emergency physicians performed echocardiography evaluating cardiac activity,right ventricle dilation,left ventricle function,pericardial effusion/tamponade and ⅣC size along with the advanced cardiac life support (ACLS) protocol.Patients in Group B solely underwent ACLS protocol without applying echocardiography.The presence or absence of mechanical ventricular activity (MVA) and evidences of PEA reversible causes were recorded.The return of spontaneous circulation (ROSC) and death were evaluated in both groups.Results: One hundred patients with the mean age of (58±6.1) years were enrolled in this study.Fifty patients (Group A) had echocardiography detected in parallel with cardiopulmonary resuscitation (CPR).Among them,7 patients (14%) had pericardial effusion,11 (22%) had hypovolemia,and 39 (78%) were revealed the presence of MVA.In the pseudo PEA subgroup (presence of MVA),43% had ROSC (positive predictive value) and in the true PEA subgroup with cardiac standstill (absence of MVA),there was no recorded ROSC (negative predictive value).Among patients in Group B,no reversible etiology was detected.There was no significant difference in resuscitation results between Groups A and B observed (P=0.52).Conclusion: Bedside echocardiography can identify some reversible causes of PEA.However,there are no significant changes in survival outcome between the echo group and those with traditional CPR.

  3. A national survey of prevalence of cardiopulmonary resuscitation training and knowledge of the emergency number in Ireland.

    LENUS (Irish Health Repository)

    Jennings, S

    2009-07-06

    AIM: The aim of this survey was to establish prevalence of cardiopulmonary resuscitation (CPR) training within the last 5 years and reasons preventing training and initiation of CPR in Ireland as well as awareness of the emergency numbers. METHODS: An in-home omnibus survey was undertaken in 2008 with quota sampling reflecting the age, gender, social class and geography of Ireland. RESULTS: Of the 974 respondents, 23.5% had undergone CPR training in the previous 5 years with lower social class and age 65 years and older significantly less likely to be trained. The workplace was both a major source of awareness as well as training for those trained. In the untrained group lack of awareness of the need for CPR training was the most significant reason for non-training. Cost was not cited as a barrier. 88.9% of people gave a correct emergency number with geographical variation. Notably, the European emergency number 112 was not well known. CONCLUSION: Previous Irish and American population targets for CPR training have been surpassed in Ireland in 2008. New internationally agreed targets are now required. Meanwhile older people and those in lower socio-economic groups should be targeted for training. Awareness of at least one emergency number is very high in Ireland. Some geographical variation was found and this should be studied further.

  4. Efficiency of the prehospital cardiopulmonary resuscitation of 785 patients treaded by the team of the Berlin-Friedrichshain-ambulance between 1995 and 1998

    OpenAIRE

    2010-01-01

    Between 1995 and 1998 the Berlin-Friedrichshain-Ambulance (BFA) started 785 cardiopulmonary resuscitations (CPR) (96,2 % adults). Registered are 498 (66,0 %) male and 257 (34,0 %) female persons at the age between 18 and 94 years (ys) (63,7 ± 16,7 ys). In 40,7 % the CPR has been initial successful. 37 patients have been discharged from the hospital. That means only 4,9 % of all registered adults (n = 755) have been discharged, it also means that 12,1 % of the initial successful treated...

  5. Neurological and circulatory outcomes of cardiopulmonary resuscitation in progress: influence of pre-arrest and arrest factors.

    Science.gov (United States)

    Jørgensen, E O

    1998-01-01

    Possible correlations between the circulatory and neurological responses to cardiopulmonary resuscitation (CPR) and the influence of pre-arrest factors (demographic data, medical history and aetiology of circulatory arrest) and arrest factors (location of arrest, ECG configurations, and duration of resuscitation) on the course of circulatory and neurological recovery were investigated in 111 victims of circulatory arrest. At the start of resuscitation 57 patients (Group I) had some brain function and 54 (Group II) had no brain function. Sixty nine patients (62%) had circulation restored but 54 (78%) were left with heart failure. Forty one patients (39%) survived the first day, 26 (63%) with heart failure; only 34 (31%) were alive after 48 h, 17 (50%) with heart failure. Half of the patients surviving 24 or 48 h had awakened. Consciousness returned in 32 patients (29%) during the first 48 h, more frequently in Group I than in Group II. Patients in Group I had a higher incidence of in-hospital arrest and had their circulation restored more often than those in Group II. Survival and post-resuscitation heart failure was alike in the groups. The pre-arrest factors explored did not modify the circulatory or neurological outcome whereas initial ventricular fibrillation was significantly related to recovery of consciousness. The revivability of spontaneous circulation and of neurological functions was found thus mainly to be determined by global ischaemia sustained prior to and during CPR.

  6. Willingness to Perform Chest Compression Only in Witnessed Cardiac Arrest Victims versus Cardiopulmonary Resuscitation in Iran

    Directory of Open Access Journals (Sweden)

    Nesreen Yaghmour

    2015-03-01

    Full Text Available Background: Performing immediate bystander Cardio Pulmonary Resuscitation (CPR is the most important factor that determines survival from cardiac arrest. Recommended mouth to mouth ventilation maneuver during CPR has led to lower rate of CPR performance in the population. Objectives: The present survey aimed to evaluate the willingness of nurses at Shiraz University of Medical Sciences for performing CPR versus chest-compression-only CPR. Patients and Methods: During a CPR course, we performed a survey on 25 nurses from Shiraz University of Medical Sciences, Iran. This survey included age and gender of the participants. In the first question, they were asked about their willingness to perform CPR with mouth to mouth breathing for witnessed cardiac arrest victims. In the second question, they were asked about their willingness to perform chest compression only for cardiac arrest victims. Results: Among the participating nurses, 96% were female with a mean age of 31 years. Only 40% were willing to perform CPR that requires mouth to mouth ventilation. On the other hand, 92% were willing to perform chest compression only without mouth to mouth ventilation. The mean age of the nurses who would do CPR was lower compared to those who would not. Conclusions: In this survey, we demonstrated that eliminating mouth to mouth ventilation maneuver could lead to markedly higher willingness to perform CPR for witnessed cardiac arrest victims in CPR trained nursing personnel. Our study is in agreement with other studies advocating that chest-compression-only CPR could lead to higher bystander resuscitation efforts.

  7. Mild Hypothermia Protects Pigs’ Gastric Mucosa After Cardiopulmonary Resuscitation via Inhibiting Interleukin 6 (IL-6) Production

    Science.gov (United States)

    Wang, Yan; Song, Jian; Liu, Yuhong; Li, Yaqiang; Liu, Zhengxin

    2016-01-01

    Background The purpose of this study was to determine the effect of mild hypothermia therapy on gastric mucosa after cardiopulmonary resuscitation (CPR) and the underlying mechanism. Material/Methods Ventricular fibrillation was induced in pigs. After CPR, the surviving pigs were divided into mild hypothermia-treated and control groups. The changes in vital signs and hemodynamic parameters were monitored before cardiac arrest and at intervals of 0.5, 1, 2, 4, 6, 12, and 24 h after restoration of spontaneous circulation. Serum IL-6 was determined at the same time, and gastroscopy was performed. The pathologic changes were noted, and the expression of IL-6 was determined by hematoxylin and eosin (HE) staining and immunohistochemistry under light. Results The heart rate, mean arterial blood pressure, and cardiac output in both groups did not differ significantly. The gastric mucosa ulcer index evaluated by gastroscopy 2 h and 24 h after restoration of spontaneous circulation (ROSC) in the mild hypothermic group was lower than that the control group (Pgastric mucosa in the mild hypothermic group 6–24 h after ROSC was lower than that in the control group (Pgastric mucosa IL-6 expression 0.5–4 h and 6, 12, and 24 h after ROSC was lower in the mild hypothermic group than in the control group (Pgastric mucosa after ROSC via inhibiting IL-6 production and relieving the inflammatory reaction. PMID:27694796

  8. [Virtual educational proposal in cardiopulmonary resuscitation for the neonate care].

    Science.gov (United States)

    Gonçalves, Gilciane Ribeiro; Peres, Heloisa Helena Ciqueto; Rodrigues, Rita de Cássia; Tronchin, Daisy Maria Rizatto; Pereira, Irene Mari

    2010-06-01

    The purpose of this study was to develop an educational proposal using virtual multimedia resources, to innovate, stimulate and diversify areas of communication and interaction, facilitating nurses' autonomous and reflexive process of teaching and learning. This is an applied research, following the cyclical and interactive phases of designing, planning, developing and implementing. The educational proposal was developed on the TelEduc platform, using specific tools for content organization and communication between students and administrator. The teaching modules were on the following themes: Module 1--Fundamentals of the heart anatomy and physiology in newborns; Module 2--Risk factors for the occurrence of cardiorespiratory arrest in newborns; Module 3--Planning nursing care; Module 4--Medications used in cardiopulmonary arrests in newborns; and Module 5--Cardiorespiratory arrest care in newborns. This study may contribute to innovating teaching in nursing from a virtual educational proposal on the important issue of newborn cardiopulmonary resuscitation care.

  9. Smaller self-inflating bags produce greater guideline consistent ventilation in simulated cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Boyle Malcolm J

    2009-02-01

    Full Text Available Abstract Background Suboptimal bag ventilation in cardiopulmonary resuscitation (CPR has demonstrated detrimental physiological outcomes for cardiac arrest patients. In light of recent guideline changes for resuscitation, there is a need to identify the efficacy of bag ventilation by prehospital care providers. The objective of this study was to evaluate bag ventilation in relation to operator ability to achieve guideline consistent ventilation rate, tidal volume and minute volume when using two different capacity self-inflating bags in an undergraduate paramedic cohort. Methods An experimental study using a mechanical lung model and a simulated adult cardiac arrest to assess the ventilation ability of third year Monash University undergraduate paramedic students. Participants were instructed to ventilate using 1600 ml and 1000 ml bags for a length of two minutes at the correct rate and tidal volume for a patient undergoing CPR with an advanced airway. Ventilation rate and tidal volume were recorded using an analogue scale with mean values calculated. Ethics approval was granted. Results Suboptimal ventilation with the use of conventional 1600 ml bag was common, with 77% and 97% of participants unable to achieve guideline consistent ventilation rates and tidal volumes respectively. Reduced levels of suboptimal ventilation arouse from the use of the smaller bag with a 27% reduction in suboptimal tidal volumes (p = 0.015 and 23% reduction in suboptimal minute volumes (p = 0.045. Conclusion Smaller self-inflating bags reduce the incidence of suboptimal tidal volumes and minute volumes and produce greater guideline consistent results for cardiac arrest patients.

  10. Time matters--realism in resuscitation training

    DEFF Research Database (Denmark)

    Krogh, Kristian; Høyer, Christian; Ostergaard, Doris;

    2014-01-01

    BACKGROUND: The advanced life support guidelines recommend 2min of cardiopulmonary resuscitation (CPR) and minimal hands-off time to ensure sufficient cardiac and cerebral perfusion. We have observed doctors who shorten the CPR intervals during resuscitation attempts. During simulation...... better to the recommended 2-min CPR cycles (time-120s) (mean 13; standard derivation (SD) 8) than the shortened CPR cycle group (mean 45; SD 19) when tested (ptime is an important part of fidelity. Variables critical for performance, like adherence to time......-based resuscitation training, the recommended 2-min CPR cycles are often deliberately decreased in order to increase the number of scenarios. The aim of this study was to test if keeping 2-min CPR cycles during resuscitation training ensures better adherence to time during resuscitation in a simulated setting...

  11. Outcomes of cardiopulmonary resuscitation and predictors of survival in patients undergoing coronary angiography including percutaneous coronary interventions.

    Science.gov (United States)

    Sprung, Juraj; Ritter, Matthew J; Rihal, Charanjit S; Warner, Mary E; Wilson, Gregory A; Williams, Brent A; Stevens, Susanna R; Schroeder, Darrell R; Bourke, Denis L; Warner, David O

    2006-01-01

    We studied the outcome of cardiopulmonary resuscitation (CPR) in patients undergoing coronary angiography (CA) and/or percutaneous coronary interventions (PCI). Of 51,985 CA and PCI patients treated between January 1, 1990, and December 31, 2000, 114 required CPR. Records were reviewed for relationships between patient characteristics and various procedures and short-term survival. Long-term survival was compared with that of a matched cohort of patients who did not have an arrest during catheterization and a matched cohort from the general Minnesota population. Over the 11-year period, the overall incidence of CPR was 21.9 per 10,000 procedures. This rate decreased from 33.9 per 10,000 before 1995 to 13.1 per 10,000 after 1995. Overall survival to hospital discharge after CPR was 56.1%. Survival to discharge was less frequent with a history of congestive heart failure, previous coronary artery bypass graft surgery, hemodynamic instability during the procedure, and with prolonged or emergent catheterizations. Pulseless electrical activity (versus asystole or ventricular fibrillation) indicated very poor short-term survival. Interestingly, short-term survival was not related to the extent of coronary artery disease. Long-term survival of patients who survived cardiac arrest was comparable to that of those who did not have arrest during catheterization. In conclusion, the incidence of periprocedural CPR during diagnostic or interventional coronary procedures decreased after 1995. Patients who received CPR in the cardiac catheterization lab have a remarkably frequent survival to hospital discharge rate. Long-term survival of these patients is only minimally reduced.

  12. [Cardiopulmonary resuscitation already in Egypt 5,000 years ago?].

    Science.gov (United States)

    Ocklitz, A

    1997-06-06

    In light of the medically relevant features of the ancient Egyptian mouth-opening ceremony, the question of the effectiveness of medical practices in Egypt thousands of years ago is examined, whereby the religious and cultural framework also plays a significant role. In the Land on the Nile myth and reality clearly generated special conditions which favoured the systematic treatment of questions of resuscitation. Numerous examples show that this had practical consequences in the area of everyday medicine. In addition, rebirth and resurrection were central elements of the cult of the dead which had exact medical equivalents. These equivalents may demonstrate the advanced state of resuscitation practices in Egypt at that time. In this context, a reconstruction of an ancient Egyptian mouth-opening instrument is presented. In the cult of the dead, this instrument played a role which can be compared to the function of a modern laryngoscope. It appears possible that at the time of the pyramids the Egyptians already had an understanding of the technology required to perform instrument-aided artificial respiration. Whether or not they actually possessed a fundamental knowledge of the principles of cardio-pulmonary resuscitation remains unclear. Nevertheless, the astonishingly functional characteristics of the reconstructed mouth-opening instrument suggest that it was developed for more than purely symbolic purposes.

  13. Old age and poor prognosis increase the likelihood of disagreement between cancer patients and their oncologists on the indication for resuscitation attempt

    DEFF Research Database (Denmark)

    Saltbaek, Lena; Michelsen, Hanne M; Nelausen, Knud M;

    2013-01-01

    The do-not-resuscitate decision is a common ethical problem. However, the concordance between patients' preferences and physicians' assessments of the indication for cardiopulmonary resuscitation attempt (CPR) has only been modestly investigated....

  14. Mild hypothermia alleviates brain oedema and blood-brain barrier disruption by attenuating tight junction and adherens junction breakdown in a swine model of cardiopulmonary resuscitation

    Science.gov (United States)

    Li, Jiebin; Li, Chunsheng; Yuan, Wei; Wu, Junyuan; Li, Jie; Li, Zhenhua; Zhao, Yongzhen

    2017-01-01

    Mild hypothermia improves survival and neurological recovery after cardiac arrest (CA) and cardiopulmonary resuscitation (CPR). However, the mechanism underlying this phenomenon is not fully elucidated. The aim of this study was to determine whether mild hypothermia alleviates early blood–brain barrier (BBB) disruption. We investigated the effects of mild hypothermia on neurologic outcome, survival rate, brain water content, BBB permeability and changes in tight junctions (TJs) and adherens junctions (AJs) after CA and CPR. Pigs were subjected to 8 min of untreated ventricular fibrillation followed by CPR. Mild hypothermia (33°C) was intravascularly induced and maintained at this temperature for 12 h, followed by active rewarming. Mild hypothermia significantly reduced cortical water content, decreased BBB permeability and attenuated TJ ultrastructural and basement membrane breakdown in brain cortical microvessels. Mild hypothermia also attenuated the CPR-induced decreases in TJ (occludin, claudin-5, ZO-1) and AJ (VE-cadherin) protein and mRNA expression. Furthermore, mild hypothermia decreased the CA- and CPR-induced increases in matrix metalloproteinase-9 (MMP-9) and vascular endothelial growth factor (VEGF) expression and increased angiogenin-1 (Ang-1) expression. Our findings suggest that mild hypothermia attenuates the CA- and resuscitation-induced early brain oedema and BBB disruption, and this improvement might be at least partially associated with attenuation of the breakdown of TJ and AJ, suppression of MMP-9 and VEGF expression, and upregulation of Ang-1 expression. PMID:28355299

  15. CPR in the nursing home: fool's errand or looming dilemma?

    LENUS (Irish Health Repository)

    Lyons, D

    2011-09-01

    The indications for CPR (cardiopulmonary resuscitation) have expanded greatly since the technique was introduced and theoretically it can be attempted on all prior to death. Policy initiatives (such as the British Medical Association\\/Royal College of Nursing guidelines) have attempted to provide a clinical rationale for the withholding of inappropriate CPR. Traditionally a care home was felt to be an inappropriate environment to attempt CPR but increased use of advance directives may bring the issue to the fore in this setting.

  16. Relationship between intrathoracic pressure and hemodynamics during cardiopulmonary resuscitation in a porcine model of prolonged cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    WANG Shuo; LI Chun-sheng; WU Jun-yuan; GUO Zhi-jun; YUAN Wei

    2012-01-01

    Background The influences of intrathoracic pressure (ITP) to hemodynamic and respiratory parameters during cardiopulmonary resuscitation (CPR) are confusing.In this research,we investigated the phasic changes of ITP during CPR and reveal the relationships among the hemodynamics,respiratory parameters,and ITP.Methods After 8 minutes of untreated ventricular fibrillation,which was induced in twenty intubated male domestic pigs,12 minutes of 30:2 CPR was performed.Continuous respiratory variables,hemodynamics,ITP and blood gas analysis were measured during CPR.After that,defibrillation was done and prognostic indicators after CPR was recorded.Results Average ITP at baseline was -(14.1±1.6) mmHg (1 mmHg=0.133 kPa).When gasping inspirations were going on,it decreased sharply to near -50 mmHg.ITP fluctuated up and down quickly from near -20 mmHg to 20 mmHg when compressions were performed.These phasic changes became mild as the CPR was performed,the contrast of high and low ITP decreased to (12.95±2.91) mmHg at the end of 12 minutes of CPR.Total alveolus minute volume decreased too,because of the decrease of compression and gasp related ventilations.Curve correlation was found between the tidal volume of compression and ITP:ITP=607.33/(1+3134×e-0.58×TV),(e:natural constant,R2=0.895).Negative correlations were found between the right atrial diastolic pressure and ITP (r=-0.753,P <0.01); and positive correlations were found between the coronary perfusion pressure and ITP (r=-0.626,P<0.01 ).Conclusions ITP is one of the key factors which can influence the prognosis of CPR.Correlations were found between the changes of ITP and the tidal volumes of compressions,right atrial diastolic pressure and coronary perfusion pressure during CPR.More positive ITP during compression and more negative during decompression were good to ventilation and perfusion.

  17. Impact of cerebral cardiopulmonary resuscitation maneuvers in a general hospital: prognostic factors and outcomes

    Directory of Open Access Journals (Sweden)

    Bartholomay Eduardo

    2003-01-01

    Full Text Available OBJECTIVE: To assess survival of patients undergoing cerebral cardiopulmonary resuscitation maneuvers and to identify prognostic factors for short-term survival. METHODS: Prospective study with patients undergoing cardiopulmonary resuscitation maneuvers. RESULTS: The study included 150 patients. Spontaneous circulation was re-established in 88 (58% patients, and 42 (28% were discharged from the hospital. The necessary number of patients treated to save 1 life in 12 months was 3.4. The presence of ventricular fibrillation or tachycardia (VF/VT as the initial rhythm, shorter times of cardiopulmonary resuscitation maneuvers and cardiopulmonary arrest, and greater values of mean blood pressure (BP prior to cardiopulmonary arrest were independent variables for re-establishment of spontaneous circulation and hospital discharge. The odds ratios for hospital discharge were as follows: 6.1 (95% confidence interval [CI] = 2.7-13.6, when the initial rhythm was VF/VT; 9.4 (95% CI = 4.1-21.3, when the time of cerebral cardiopulmonary resuscitation was 70 mmHg. CONCLUSION: The presence of VF/VT as the initial rhythm, shorter times of cerebral cardiopulmonary resuscitation and of cardiopulmonary arrest, and a greater value of BP prior to cardiopulmonary arrest were independent variables of better prognosis.

  18. Cardiopulmonary resuscitation: biomedical and biophysical analysis (Chapter XXX)

    DEFF Research Database (Denmark)

    Noordergraaf, G.J; Ottesen, Johnny T.; Scheffer, G.J.;

    2004-01-01

    of thousands each year. This chapter will address functional aspects of CPR required for a working understanding of the biomedical aspects of CPR. It does not purport to be a CPR course, although practical aspects relevant to understanding will be addressed, but not exhaustively. The development in CPR...

  19. New guidelines for cardiopulmonary resuscitation Nuevas directrices para la resucitación cardiopulmonar Novas diretrizes da ressuscitação cardiopulmonar

    Directory of Open Access Journals (Sweden)

    Maria Celia Barcellos Dalri

    2008-12-01

    Full Text Available Cardiopulmonary arrest (CPA poses a severe threat to life; cardiopulmonary resuscitation (CPR represents a challenge for research and assessment by nurses and their team. This study presents the most recent international recommendations for care in case of cardiopulmonary heart arrest, based on the 2005 Guidelines by the American Heart Association (AHA. These CPR guidelines are based on a large-scale review process, organized by the International Liaison Committee on Resuscitation (ILCOR. High-quality basic and advanced CPR maneuvers can save lives.La parada cardiorrespiratoria (PCR es una ocurrencia que presenta una grave amenaza a la vida; la resucitación cardiopulmonar (RCP representa un desafío para la investigación y la evaluación por parte del enfermero y su equipo. Este estudio presenta las más recientes recomendaciones internacionales sobre la atención a la parada cardiorrespiratoria, basada en las Directrices de 2005 de la American Heart Asociation (AHA. Esas directrices sobre RCP se fundamentan en un proceso de revisión extenso, organizado por el International Liasion Committee on Resuscitation (ILCOR. Las maniobras básicas y avanzadas de RCP ofrecidas con calidad pueden salvar vidas.A parada cardiorrespiratória (PCR é intercorrência de grave ameaça à vida; a ressuscitação cardiopulmonar (RCP representa desafio para a investigação e a avaliação por parte do enfermeiro e sua equipe. Esse estudo apresenta as mais recentes recomendações internacionais sobre atendimento da parada cardiorrespiratória, baseado nas Diretrizes de 2005 da American Heart Association (AHA. Essas diretrizes sobre RCP fundamentam-se num processo de revisão extenso, organizado pelo International Liasion Committee on Resuscitation (ILCOR. As manobras básicas e avançadas de RCP com qualidade podem salvar vidas.

  20. Coronary blood flow during cardiopulmonary resuscitation in swine

    Energy Technology Data Exchange (ETDEWEB)

    Bellamy, R.F.; DeGuzman, L.R.; Pedersen, D.C.

    1984-01-01

    Recent papers have raised doubt as to the magnitude of coronary blood flow during closed-chest cardiopulmonary resuscitation. We will describe experiments that concern the methods of coronary flow measurement during cardiopulmonary resuscitation. Nine anesthetized swine were instrumented to allow simultaneous measurements of coronary blood flow by both electromagnetic cuff flow probes and by the radiomicrosphere technique. Cardiac arrest was caused by electrical fibrillation and closed-chest massage was performed by a Thumper (Dixie Medical Inc., Houston). The chest was compressed transversely at a rate of 66 strokes/min. Compression occupied one-half of the massage cycle. Three different Thumper piston strokes were studied: 1.5, 2, and 2.5 inches. Mean aortic pressure and total systemic blood flow measured by the radiomicrosphere technique increased as Thumper piston stroke was lengthened (mean +/- SD): 1.5 inch stroke, 23 +/- 4 mm Hg, 525 +/- 195 ml/min; 2 inch stroke, 33 +/- 5 mm Hg, 692 +/- 202 ml/min; 2.5 inch stroke, 40 +/- 6 mm Hg, 817 +/- 321 ml/min. Both methods of coronary flow measurement (electromagnetic (EMF) and radiomicrosphere (RMS)) gave similar results in technically successful preparations (data expressed as percent prearrest flow mean +/- 1 SD): 1.5 inch stroke, EMF 12 +/- 5%, RMS 16 +/- 5%; 2 inch stroke, EMF 30 +/- 6%, RMS 26 +/- 11%; 2.5 inch stroke, EMF 50 +/- 12%, RMS 40 +/- 20%. The phasic coronary flow signal during closed-chest compression indicated that all perfusion occurred during the relaxation phase of the massage cycle. We concluded that coronary blood flow is demonstrable during closed-chest massage, but that the magnitude is unlikely to be more than a fraction of normal.

  1. Impact of advanced cardiac life support training program on the outcome of cardiopulmonary resuscitation in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Kanwalpreet Sodhi

    2011-01-01

    Full Text Available Background: Guidelines on performing cardiopulmonary resuscitation (CPR have been published from time to time, and formal training programs are conducted based on these guidelines. Very few data are available in world literature highlighting the impact of these trainings on CPR outcome. Aim: The aim of our study was to evaluate the impact of the American Heart Association (AHA-certified basic life support (BLS and advanced cardiac life support (ACLS provider course on the outcomes of CPR in our hospital. Materials and Methods : An AHA-certified BLS and ACLS provider training programme was conducted in our hospital in the first week of October 2009, in which all doctors in the code blue team and intensive care units were given training. The retrospective study was performed over an 18-month period. All in-hospital adult cardiac arrest victims in the pre-BLS/ACLS training period (January 2009 to September 2009 and the post-BLS/ACLS training period (October 2009 to June 2010 were included in the study. We compared the outcomes of CPR between these two study periods. Results: There were a total of 627 in-hospital cardiac arrests, 284 during the pre-BLS/ACLS training period and 343 during the post-BLS/ACLS training period. In the pre-BLS/ACLS training period, 52 patients (18.3% had return of spontaneous circulation, compared with 97 patients (28.3% in the post-BLS/ACLS training period (P < 0.005. Survival to hospital discharge was also significantly higher in the post-BLS/ACLS training period (67 patients, 69.1% than in the pre-BLS/ACLS training period (12 patients, 23.1% (P < 0.0001. Conclusion : Formal certified BLS and ACLS training of healthcare professionals leads to definitive improvement in the outcome of CPR.

  2. 113例心脏骤停患者的院前急救分析%Analysis of the Impact of Pre-hospital Cardiopulmonary Resuscitation Success Factors

    Institute of Scientific and Technical Information of China (English)

    赵伟

    2016-01-01

    Objective:Analysis of the impact of pre-hospital cardiopulmonary resuscitation success factors.Methods:Clinical information of pre-hospital CPR from January 2008 to January 2013 was analyzed retrospectively, to explore the influencing factors related to the successful rate of CPR.Results:The success rate was 18.58%(21/113).The success rate of CPR was correlated with the age, history, time of initial CPR, Intubation, early defibrillation and adrenaline dose.Conclusion:Cardiovascular and Cerebrovascular disease are the main causes of car-diopulmonary arrest.Age is an important factor in re-suscitation.Complication of It cerebral vascular diseases and respiratory diseases are high risk factors of cardiopulmonary arrest.Early initiation of CPR and early defibrillation are key factors for successful CPR.%目的:分析院前影响心搏呼吸骤停患者心肺复苏( CPR)成功的因素。方法:回顾性分析2008年1月~2013年1月在院前发生的113例心脏骤停患者,探讨各因素对CPR成功的影响。结果:113例患者抢救成功21例(成功率18.58%),CPR的成功与年龄、既往器质性疾病、CPR开始时间、气管插管、早期除颤、肾上腺素用量有明显关系。结论:心、脑血管疾病是心脏骤停的主要原因,年龄是复苏成功的重要因素,CPR开始时间和早期除颤是复苏成功的关键。

  3. Development of Manual External Chest Compression Cardiopulmonary Resuscitation Device%手动胸外按压复苏仪的研制

    Institute of Scientific and Technical Information of China (English)

    吴建刚; 贾建革; 武文君; 张亚冬; 李岩峰; 宋立为

    2014-01-01

    本文阐述了一种便携式手动胸外按压复苏仪的研制过程。该装置以国际心肺复苏指南为标准,根据正负压心肺复苏术原理设计而成,主要由真空吸盘、压力弹簧、硬件电路、按压手柄以及指针组件等构成。该装置体积小,操作简单,能够提供稳定的按压频率和按压/通气比提示音,并且能够显示按压力度,能辅助非专业急救人员为心脏骤停患者实施心肺复苏急救。%A portable manual external chest compression cardiopulmonary resuscitation (CPR) device is designed with intertional guideline for cardiopulmonary resuscitation as its design standard andactive compression-decompression CPR method as its design principle. The small-sized device with simple operation method is mainly made up of vacuum chuck, pressure spring, hardware circuit, compression handle andpointer components. The device which can provide steady indication voice for chest compression frequency and compression-ventilation ratio and display the level of compression intensity will help non-professional medical staff to perform CPR for patients with cardiac arrest.

  4. Serum Cortisol Levels as a Predictor of Neurologic Survival inSuccessfully Resuscitated Victims of Cardiopulmonary Arrest

    Directory of Open Access Journals (Sweden)

    Nader Tavakoli

    2012-10-01

    Full Text Available Introduction: Out-of-hospital cardiac arrest (OHCA is the most stressful lifetime event for the victims and an important issue for the emergency physicians. The status of the hypothalamic pituitary- adrenal axis (HPA function in successfully resuscitated victims of cardiopulmonary arrest has been recently of an interest for the researchers. Methods: In a prospective cohort study, 50 successfully resuscitated OHCA victims’ serum cortisol levels were measured 5 minutes and 1 hour after return of spontaneous circulation (ROSC. The data were analyzed comparing the one-week neurologic survival. Results: Fifty blood samples were obtained for serum cortisol levels after 5 minutes of ROSC. Fourteen patients (28% pronounced death during one hour after CPR. Blood sample from living 36 patients after one hour post-CPR were obtained for second cortisol assay. Eleven patients (22% were neurologically survived after one week. Seven patients (14% were discharged finally from hospital with good neurologic recovery. The serum cortisol levels in both the neurologically surviving and the non-surviving after 5 minutes of ROSC patients were 63.4 ±13.6 and 43.2±25.5(microg/ml, (mean±S.D., respectively and after 1 hour of ROSC patients’ serum cortisol levels were 64.9±13.1 and 47.3±27.1(microg/ml, (mean±S.D., respectively. The difference was significantly higher in neurologically survived group in both 5 minutes and 1 hour after ROSC (P= 0.015 and 0.013 respectively. Conclusion: serum cortisol levels after 5 minutes and one hour of ROSC in victims of cardiopulmonary arrest are significantly higher in neurologically survived than non-survived patients.

  5. Cardiopulmonary resuscitation of adults with in-hospital cardiac arrest using the Utstein style

    Science.gov (United States)

    da Silva, Rose Mary Ferreira Lisboa; Silva, Bruna Adriene Gomes de Lima e; Silva, Fábio Junior Modesto e; Amaral, Carlos Faria Santos

    2016-01-01

    Objective The objective of this study was to analyze the clinical profile of patients with in-hospital cardiac arrest using the Utstein style. Methods This study is an observational, prospective, longitudinal study of patients with cardiac arrest treated in intensive care units over a period of 1 year. Results The study included 89 patients who underwent cardiopulmonary resuscitation maneuvers. The cohort was 51.6% male with a mean age 59.0 years. The episodes occurred during the daytime in 64.6% of cases. Asystole/bradyarrhythmia was the most frequent initial rhythm (42.7%). Most patients who exhibited a spontaneous return of circulation experienced recurrent cardiac arrest, especially within the first 24 hours (61.4%). The mean time elapsed between hospital admission and the occurrence of cardiac arrest was 10.3 days, the mean time between cardiac arrest and cardiopulmonary resuscitation was 0.68 min, the mean time between cardiac arrest and defibrillation was 7.1 min, and the mean duration of cardiopulmonary resuscitation was 16.3 min. Associations between gender and the duration of cardiopulmonary resuscitation (19.2 min in women versus 13.5 min in men, p = 0.02), the duration of cardiopulmonary resuscitation and the return of spontaneous circulation (10.8 min versus 30.7 min, p < 0.001) and heart disease and age (60.6 years versus 53.6, p < 0.001) were identified. The immediate survival rates after cardiac arrest, until hospital discharge and 6 months after discharge were 71%, 9% and 6%, respectively. Conclusions The main initial rhythm detected was asystole/bradyarrhythmia; the interval between cardiac arrest and cardiopulmonary resuscitation was short, but defibrillation was delayed. Women received cardiopulmonary resuscitation for longer periods than men. The in-hospital survival rate was low. PMID:28099640

  6. A ventilation technique for oxygenation and carbon dioxide elimination in CPR: Continuous insufflation of oxygen at three levels of pressure in a pig model

    NARCIS (Netherlands)

    Ordelman, S.C.; Aelen, P.; Woerlee, P.H.; Berkom, P.F. van; Scheffer, G.J.; Noordergraaf, G.J.

    2015-01-01

    AIM: Pulmonary ventilation remains an important part of cardiopulmonary resuscitation, affecting gas exchange and haemodynamics. We designed and studied an improved method of ventilation for CPR, constructed specifically to support both gas exchange and haemodynamics. This method uses continuous ins

  7. CPR - adult and child 9 years and older

    Science.gov (United States)

    Cardiopulmonary resuscitation - adult; Rescue breathing and chest compressions - adult; Resuscitation - cardiopulmonary - adult; Cardiopulmonary resuscitation - child 9 years and older; Rescue breathing ...

  8. Effect of four resuscitation methods on lung ventilation of pigs with respiratory arrest

    Directory of Open Access Journals (Sweden)

    Ya-hua LIU

    2012-03-01

    Full Text Available Objective To observe the effects of four cardiopulmonary resuscitation (CPR methods on lung ventilation of pigs with respiratory arrest. The four CPR methods included chest compression CPR (C-CPR, compression under the diaphragm CPR (D-CPR, abdominal compression CPR (A-CPR, and abdominal wall lifting and compression CPR (L-CPR. Methods  A total of 28 healthy domestic pigs were randomly divided into four groups. The pig respiratory arrest model was reproduced by intravenous injection of suxamethonium. Instantly after respiratory arrest, one of the 4 CPR methods was performed immediately on the groups of pigs respectively. After 2min of CPR, compression was stopped. The experimental pigs were given assisted respiration using a ventilator until autonomous respiration recovered. The tidal volume (VT in basic status and that during resuscitation by the four respective resuscitation methods was determined, and minute ventilation (MV was calculated. Furthermore, heart rate (HR, mean arterial blood pressure, and recovery time of autonomous respiration were compared between all the groups. Results In basic status, there was no statistical difference (P > 0.05 in VT and MV between the four groups. Approximately 2min after resuscitation, the VT and MV of D-CPR were higher than that of C-CPR; that of A-CPR was higher than that of D-CPR; and that of L-CPR was higher than that of A-CPR. The differences were statistically significant (P 0.05. HR in C-CPR and D-CPR were notably lower than the basic value (P < 0.01. Two minutes after resuscitation, mechanical ventilation was given, and HR in all the groups was close to the basic value 5 min after resuscitation. In the respiratory arrest pig model, L-CPR could provide more effective VT and MV than the other methods. Conclusion For the porcine respiratory arrest model, L-CPR can provide more effective lung ventilation than the other methods.

  9. Comparison of different inspiratory triggering settings in automated ventilators during cardiopulmonary resuscitation in a porcine model

    Science.gov (United States)

    Fu, Yangyang; Sun, Feng; Zhang, Yazhi; Hu, Yingying; Walline, Joseph; Zhu, Huadong; Yu, Xuezhong

    2017-01-01

    Background Mechanical ventilation via automated in-hospital ventilators is quite common during cardiopulmonary resuscitation. It is not known whether different inspiratory triggering sensitivity settings of ordinary ventilators have different effects on actual ventilation, gas exchange and hemodynamics during resuscitation. Methods 18 pigs enrolled in this study were anaesthetized and intubated. Continuous chest compressions and mechanical ventilation (volume-controlled mode, 100% O2, respiratory rate 10/min, and tidal volumes 10ml/kg) were performed after 3 minutes of ventricular fibrillation. Group trig-4, trig-10 and trig-20 (six pigs each) were characterized by triggering sensitivities of 4, 10 and 20 (cmH2O for pressure-triggering and L/min for flow-triggering), respectively. Additionally, each pig in each group was mechanically ventilated using three types of inspiratory triggering (pressure-triggering, flow-triggering and turned-off triggering) of 5 minutes duration each, and each animal matched with one of six random assortments of the three different triggering settings. Blood gas samples, respiratory and hemodynamic parameters for each period were all collected and analyzed. Results In each group, significantly lower actual respiratory rate, minute ventilation volume, mean airway pressure, arterial pH, PaO2, and higher end-tidal carbon dioxide, aortic blood pressure, coronary perfusion pressure, PaCO2 and venous oxygen saturation were observed in the ventilation periods with a turned-off triggering setting compared to those with pressure- or flow- triggering (all P<0.05), except when compared with pressure-triggering of 20 cmH2O (respiratory rate 10.5[10/11.3]/min vs 12.5[10.8/13.3]/min, P = 0.07; coronary perfusion pressure 30.3[24.5/31.6] mmHg vs 27.4[23.7/29] mmHg, P = 0.173; venous oxygen saturation 46.5[32/56.8]% vs 41.5[33.5/48.5]%, P = 0.575). Conclusions Ventilation with pressure- or flow-triggering tends to induce hyperventilation and

  10. Ventilation strategies during and after cardiopulmonary resuscitation in children%儿童心肺复苏期间与复苏后通气策略

    Institute of Scientific and Technical Information of China (English)

    王莹

    2012-01-01

    During cardiopulmonary resuscitation (CPR),ventilation is provided by either mouth-to-mouth or bag-mask technique,and give 12 to 20 times breaths per minute.Ventilation should deliver 8 to 10 times breaths per minute after endotracheal intubation.Compression-ventilation ratio is 30∶2 for one rescuerand 15∶2 for two rescuers.After the return of spontaneous circulation,if no spontaneous breathing or irregular,respiratory insufficiency,mechanical ventilation is required.High oxygen and excessive ventilation after CPR should be avoided.When acute lung injury or acute respiratory distress syndrome occurs after CPR,lung protective ventilation strategy is applicable.%心肺复苏(cardiopulmonary resuscitation,CPR)期间,予以口对口送气或球囊面罩加压通气,通气频率12~20次/min.气管插管通气后通气频率8~10次/min.儿童胸外按压和通气比30∶2(1人施救)或15∶2(2人施救)较为合理.CPR后自主循环恢复,仍无自主呼吸或自主呼吸不规则、呼吸功能不全或部分患儿需要吸人高浓度氧,则需要机械通气.目前公认CPR后避免高氧和过度通气,并发急性肺损伤/急性呼吸窘迫综合征时采用肺保护通气策略.

  11. Electroencephalography reactivity for prognostication of post-anoxic coma after cardiopulmonary resuscitation: A comparison of quantitative analysis and visual analysis.

    Science.gov (United States)

    Liu, Gang; Su, Yingying; Jiang, Mengdi; Chen, Weibi; Zhang, Yan; Zhang, Yunzhou; Gao, Daiquan

    2016-07-28

    Electroencephalogram reactivity (EEG-R) is a positive predictive factor for assessing outcomes in comatose patients. Most studies assess the prognostic value of EEG-R utilizing visual analysis; however, this method is prone to subjectivity. We sought to categorize EEG-R with a quantitative approach. We retrospectively studied consecutive comatose patients who had an EEG-R recording performed 1-3 days after cardiopulmonary resuscitation (CPR) or during normothermia after therapeutic hypothermia. EEG-R was assessed via visual analysis and quantitative analysis separately. Clinical outcomes were followed-up at 3-month and dichotomized as recovery of awareness or no recovery of awareness. A total of 96 patients met the inclusion criteria, and 38 (40%) patients recovered awareness at 3-month followed-up. Of 27 patients with EEG-R measured with visual analysis, 22 patients recovered awareness; and of the 69 patients who did not demonstrated EEG-R, 16 patients recovered awareness. The sensitivity and specificity of visually measured EEG-R were 58% and 91%, respectively. The area under the receiver operating characteristic curve for the quantitative analysis was 0.92 (95% confidence interval, 0.87-0.97), with the best cut-off value of 0.10. EEG-R through quantitative analysis might be a good method in predicting the recovery of awareness in patients with post-anoxic coma after CPR.

  12. 影响儿童院内心肺复苏预后的因素分析%Univariate analysis of pediatric in-hospital cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    胡馨; 卢仲毅

    2016-01-01

    目的:探讨儿童院内心肺复苏(cardiopulmonary resuscitation,CPR)预后的影响因素。方法通过回顾性观察研究,对2012年1月至2014年10月我院发生的281例心肺复苏病例进行单因素分析,以自主循环恢复﹥20 min 作为近期复苏成功标准,分析心肺复苏预后的影响因素。结果纳入的281例患儿中,男∶女为1.34∶1,年龄1~191个月,其中自主循环恢复﹥20 min 共129例(45.9%),出院存活20例(8.8%)。性别、年龄、体重、呼吸心跳骤停(cardiopulmonary arrest,CPA)发生时间、CPA 初始心电图、pH 值、乳酸水平对心肺复苏预后无明显影响。基础疾病、CPA 发生地点、CPR 组织人员、通气方式、CPR 总时间、初期复苏时使用肾上腺素的次数、使用碳酸氢钠及血糖情况对复苏成功率有影响。结论目前 CPR 成功率及出院存活率仍较低。呼吸系统疾病成功率相对较高。CPR 时间﹥20 min、需要使用碳酸氢钠以及初期复苏中使用肾上腺素大于3次是影响 CPR 成功的不利因素。%Objective To study the influencing factors of pediatric in-hospital cardiopulmonary resuscitation(CPR).Methods It was a retrospective observational study.We studied a total of 281 children who suffered in-hospital cardiopulmonary arrest(CPA).The outcome was defined as sustained return of spon-taneous circulation ﹥20 min.Results A total of 281 patients met study entry criteria.In 129 children (45.9%),return of spontaneous circulation sustained ﹥20 min and 20 cases(8.8%)survived to hospital discharge.In the univariate analysis,gender,age,weight,time of CPA happened,first cardiac rhythm,pH, blood lactate had no obvious influence on the outcome.Underlying disease,the place of CPA,personnel fac-tors,airway support,the duration of CPR,doses of adrenaline,use of bicarbonate and blood glucose level were associated with outcome.Conclusion At present,the rate of successful CPR and discharge of hospital is still low

  13. Cardiopulmonary Resuscitation Training by Avatars: A Qualitative Study of Medical Students’ Experiences Using a Multiplayer Virtual World

    Science.gov (United States)

    Hedman, Leif; Felländer-Tsai, Li

    2016-01-01

    Background Emergency medical practices are often team efforts. Training for various tasks and collaborations may be carried out in virtual environments. Although promising results exist from studies of serious games, little is known about the subjective reactions of learners when using multiplayer virtual world (MVW) training in medicine. Objective The objective of this study was to reach a better understanding of the learners’ reactions and experiences when using an MVW for team training of cardiopulmonary resuscitation (CPR). Methods Twelve Swedish medical students participated in semistructured focus group discussions after CPR training in an MVW with partially preset options. The students’ perceptions and feelings related to use of this educational tool were investigated. Using qualitative methodology, discussions were analyzed by a phenomenological data-driven approach. Quality measures included negotiations, back-and-forth reading, triangulation, and validation with the informants. Results Four categories characterizing the students’ experiences could be defined: (1) Focused Mental Training, (2) Interface Diverting Focus From Training, (3) Benefits of Practicing in a Group, and (4) Easy Loss of Focus When Passive. We interpreted the results, compared them to findings of others, and propose advantages and risks of using virtual worlds for learning. Conclusions Beneficial aspects of learning CPR in a virtual world were confirmed. To achieve high participant engagement and create good conditions for training, well-established procedures should be practiced. Furthermore, students should be kept in an active mode and frequent feedback should be utilized. It cannot be completely ruled out that the use of virtual training may contribute to erroneous self-beliefs that can affect later clinical performance. PMID:27986645

  14. Improving workplace safety training using a self-directed CPR-AED learning program.

    Science.gov (United States)

    Mancini, Mary E; Cazzell, Mary; Kardong-Edgren, Suzan; Cason, Carolyn L

    2009-04-01

    Adequate training in cardiopulmonary resuscitation (CPR) and use of an automated external defibrillator (AED) is an important component of a workplace safety training program. Barriers to traditional in-classroom CPR-AED training programs include time away from work to complete training, logistics, learner discomfort over being in a classroom setting, and instructors who include information irrelevant to CPR. This study evaluated differences in CPR skills performance between employees who learned CPR using a self-directed learning (SDL) kit and employees who attended a traditional instructor-led course. The results suggest that the SDL kit yields learning outcomes comparable to those obtained with traditional instructor-led courses and is a more time-efficient tool for CPR-AED training. Furthermore, the SDL kit overcomes many of the barriers that keep individuals from learning CPR and appears to contribute to bystanders' confidently attempting resuscitation.

  15. Load-distributing band improves ventilation and hemodynamics during resuscitation in a porcine model of prolonged cardiac arrest

    Directory of Open Access Journals (Sweden)

    Wang Shuo

    2012-09-01

    Full Text Available Abstract Background The use of mechanical cardiopulmonary resuscitation (CPR has great potential for the clinical setting. The purpose of present study is to compare the hemodynamics and ventilation during and after the load-distributing band CPR, versus the manual CPR in a porcine model of prolonged cardiac arrest, and to investigate the influence of rescue breathing in different CPR protocols. Methods Sixty-four male pigs (n = 16/group, weighing 30 ± 2 kg, were induced ventricular fibrillation and randomized into four resuscitation groups: continuous load-distributing band CPR without rescue ventilation (C-CPR, load-distributing band 30:2 CPR (A-CPR, load-distributing band CPR with continuous rescue breathing (10/min (V-CPR or manual 30:2 CPR (M-CPR. Respiratory variables and hemodynamics were recorded continuously; blood gas was analyzed. Results Tidal volume produced by compressions in the A-, C- and V-CPR groups were significantly higher compared with the M-CPR group (all p 2 of the A-, C- and V-CPR groups were significantly higher and PaCO2 were significantly lower compared with the M-CPR (both p  Conclusions The load-distributing band CPR significantly improved respiratory parameters during resuscitation by augmenting passive ventilation, and significantly improved coronary perfusion pressure. The volume of ventilation produced by the load-distributing band CPR was adequate to maintain sufficient gas exchange independent of rescue breathing.

  16. 43名护士单人心肺复苏操作精确性研究%The accuracy of cardiopulmonary resuscitation skill of nurses

    Institute of Scientific and Technical Information of China (English)

    应菊素; 郑小伟

    2011-01-01

    Objective: To explore the accuracy of cardiopulmonary resuscitation (CPR) skill of nurses. Methods: Totally 43 nurses were evaluated for cardiopulmonary resuscitation skill. The accuracy and time of every round were record. Results: More than 90% nurses mastered the process of CPR. The pass percentage of breath was 31.63%. The pass percentage of compression was 39.07%. The average rate of compression was 127.37 per minute. The interval between every round of compression was 13.65 second. Conclusion:Nurses master the CPR process but lack accuracy. It should pay attention to compression speed and the interval between compressions.%目的:探讨护士单人心肺复苏操作的精确性.方法:对43名护士进行心肺复苏操作考核,记录每个循环的时间和操作的精确性.结果:90%以上的护士能够掌握心肺复苏操作程序,人工呼吸合格率为31.63%,胸外按压合格率为39.07%,胸外按压平均速率为127.37次/分钟,两次胸外按压间隔时间为13.65秒.结论:护士基本掌握了心肺复苏操作流程.但操作精确性有待于进一步提高,应重视胸外按压的速率和每个循环按压的间隔时间.

  17. Study on adaptable cardiopulmonary resuscitation technique on the train%列车上适应性心肺复苏技术研究

    Institute of Scientific and Technical Information of China (English)

    周娟; 王仙园; 李雪薇; 程琳

    2011-01-01

    [目的]探讨列车上适应性心肺复苏技术.[方法]按照单人操作法在陆地上进行训练,操作者准确掌握之后,在开动的列车上实施心肺复苏,对复苏的结果进行评价,找出列车上复苏失败的原因,研究改进技术方法,采用改进后的技术在开动的列车上再次进行心肺复苏,并评价正确率.[结果]采用陆地训练的技术方法,列车上实施人工呼吸和胸外按压正确率低,与陆地上实施正确率比较,差异有统计学意义(P<0.01);改进后的心肺复苏技术在列车上实施较改进前人工呼吸和胸外心脏按压正确率显著提高(P<0.01).[结论]特定的环境应有相适应的护理技术,改进后的心肺复苏技术能较好地适应列车上抢救需求,初步形成了列车上的心肺复苏技术方案.%Objective: To probe into the adaptable "cardiopulmonary resuscitation (CPR) and emergency cardiovascular (ECC) techniques" on the train. Methods : Based on the 2005 international cardioplmonary resuscitation guidelines for single operation training on the land, after grasping the knowledge accurately, the operator carried the CPR in a moving train. And the effects of the resuscitation were evaluated. And causes of the failed to resuscitate on the train were found. Then to study on improved techniques and methods, to apply the improved techniques and methods to carry out CPR in a moving train again. And the correct rate of the CPR was evaluated. Results: By adopting technical methods of training on the land, the correct rate of carrying out artificial respiration and chest compressions on the train was lower than that of implementation on the land. There was statistical significant difference between them (P<O. 01). The correct rate of carrying out artificial respiration and chest compressions by applying improved method of CPR techniques on the train was higher remarkably than that of before (P<O. 01). Conclusion: Corresponding nursing techniques and

  18. Advances of ventilation during cardiopulmonary resuscitation%心肺复苏中通气的研究进展

    Institute of Scientific and Technical Information of China (English)

    谈定玉; 付阳阳; 徐军; 于学忠

    2016-01-01

    As one of the cornerstones of modern cardiopulmonary resuscitation (CPR), ventilation received controversy and challenges in the past two decades. From 2000 to 2015, the changes in CPR guidelines of American Heart Association (AHA) showed that the position of ventilation declined gradually as compared to chest compressions. Chest compressions only CPR has been strongly advocated in recent years, especially in witnessed cardiogenic cardiac arrest (CA). Passive oxygenation and cardiocerebral resuscitation (CCR) also showed good effect in the early stage of cardiogenic CA. However, clinical validation in a larger context is still needed. An impedance threshold device (ITD) transiently blocks air from entering the lungs during recoil, decreases the intrathoracic pressure, facilitates venous return to the chest and increases coronary blood flow. However, the relevant research findings are not consistent, and the guidelines do not recommend routine use of ITD. Positive-pressure ventilation, which can increases intrathoracic pressure, affects the coronary perfusion pressure (CPP) and cerebral perfusion, is thought to be not only useless, but also has adverse effects within the first few minutes of CPR. This view is accepted by many scholars, however, ventilation is essential in late-start CPR, prolonged CPR and non-cardiogenic CA. Mechanical ventilation, especially special ventilation modes for CPR showed some prospects. Positive-pressure ventilation remains the gold standard in CPR in clinical practice at present. It was shown by existing research that hyperventilation significantly reduce the success rate of resuscitation, thus a consensus had been reached about avoiding hyperventilation. Currently, the number of studies on ventilation during CPR is very limited, and many of the conclusions are not consistent among studies. Therefore, more high-quality studies are needed in future to further clarify the application of ventilation during CPR.%作为现代心肺复苏

  19. Animation shows promise in initiating timely cardiopulmonary resuscitation: results of a pilot study.

    Science.gov (United States)

    Attin, Mina; Winslow, Katheryn; Smith, Tyler

    2014-04-01

    Delayed responses during cardiac arrest are common. Timely interventions during cardiac arrest have a direct impact on patient survival. Integration of technology in nursing education is crucial to enhance teaching effectiveness. The goal of this study was to investigate the effect of animation on nursing students' response time to cardiac arrest, including initiation of timely chest compression. Nursing students were randomized into experimental and control groups prior to practicing in a high-fidelity simulation laboratory. The experimental group was educated, by discussion and animation, about the importance of starting cardiopulmonary resuscitation upon recognizing an unresponsive patient. Afterward, a discussion session allowed students in the experimental group to gain more in-depth knowledge about the most recent changes in the cardiac resuscitation guidelines from the American Heart Association. A linear mixed model was run to investigate differences in time of response between the experimental and control groups while controlling for differences in those with additional degrees, prior code experience, and basic life support certification. The experimental group had a faster response time compared with the control group and initiated timely cardiopulmonary resuscitation upon recognition of deteriorating conditions (P < .0001). The results demonstrated the efficacy of combined teaching modalities for timely cardiopulmonary resuscitation. Providing opportunities for repetitious practice when a patient's condition is deteriorating is crucial for teaching safe practice.

  20. Knowledge and skill retention of in-service versus preservice nursing professionals following an informal training program in pediatric cardiopulmonary resuscitation: a repeated-measures quasiexperimental study.

    Science.gov (United States)

    Sankar, Jhuma; Vijayakanthi, Nandini; Sankar, M Jeeva; Dubey, Nandkishore

    2013-01-01

    Our objective was to compare the impact of a training program in pediatric cardiopulmonary resuscitation (CPR) on the knowledge and skills of in-service and preservice nurses at prespecified time points. This repeated-measures quasiexperimental study was conducted in the pediatric emergency and ICU of a tertiary care teaching hospital between January and March 2011. We assessed the baseline knowledge and skills of nursing staff (in-service nurses) and final year undergraduate nursing students (preservice nurses) using a validated questionnaire and a skill checklist, respectively. The participants were then trained on pediatric CPR using standard guidelines. The knowledge and skills were reassessed immediately after training and at 6 weeks after training. A total of 74 participants-28 in-service and 46 preservice professionals-were enrolled. At initial assessment, in-service nurses were found to have insignificant higher mean knowledge scores (6.6 versus 5.8, P = 0.08) while the preservice nurses had significantly higher skill scores (6.5 versus 3.2, P nurses performing better in knowledge test (10.5 versus 9.1, P = 0.01) and the preservice nurses performing better in skill test (9.8 versus 7.4, P skills of in-service and preservice nurses in pediatric CPR improved with training. In comparison to preservice nurses, the in-service nurses seemed to retain knowledge better with time than skills.

  1. Rhythm recognition is accountable for the majority of hands-off time during cardiopulmonary resuscitation

    DEFF Research Database (Denmark)

    Hansen, Lars Koch; Brabrand, Mikkel

    2014-01-01

    . Rhythms were presented to physicians who identified whether they were shockable and whether they would defibrillate. We measured time to stated decision. Thirty-five doctors participated, 32 had completed advanced life support training. The mean time to make a decision on whether to defibrillate......Cardiopulmonary resuscitation guidelines are constantly optimized to increase survival. Keeping hands-off time brief is vital. Our hypothesis is that rhythm recognition is time-consuming during cardiopulmonary resuscitation. A Laerdal Sim-Man simulated three shockable and four nonshockable rhythms...... or not was 3.4 s [95% confidence interval (CI): 2.8-3.9] for shockable and 4.4 s (95% CI: 3.6-5.3) for nonshockable rhythms (Ptime was 4.0 s (95% CI: 3.5-4.5). Of all shockable rhythms, 95.2 % were correctly diagnosed as shockable, compared with 88.6 % of nonshockable rhythms...

  2. Critical incidents during prehospital cardiopulmonary resuscitation: what are the problems nobody wants to talk about?

    Science.gov (United States)

    Hohenstein, Christian; Rupp, Peter; Fleischmann, Thomas

    2011-02-01

    We wanted to identify incidents that led or could have led to patient harm during prehospital cardiopulmonary resuscitation. A nationwide anonymous and Internet-based critical incident reporting system gave the data. During a 4-year period we received 548 reports of which 74 occurred during cardiopulmonary resuscitation. Human error was responsible for 85% of the incidents, whereas equipment failure contributed to 15% of the reports. Equipment failure was considered to be preventable in 61% of all the cases, whereas incidents because of human error could have been prevented in almost all the cases. In most cases, prevention can be accomplished by simple strategies with the Poka-Yoke technique. Insufficient training of emergency medical service physicians in Germany requires special attention. The critical incident reports raise concerns regarding the level of expertize provided by emergency medical service doctors.

  3. [Prognosis for patients in a coma following cardiopulmonary resuscitation].

    Science.gov (United States)

    Horn, J; Zandbergen, E G J; Koelman, J H T M; Hijdra, A

    2008-02-09

    Most patients with post-anoxic coma after resuscitation have a poor prognosis. Reliable prediction of poor outcomes (death or vegetative state after 1 month; death, vegetative state or severe disability after at least 6 months) at an early stage is important for both family members and treating physicians. Poor outcome can be predicted with 100% reliability in the first 3 days after resuscitation in about 80% of patients using pupillary and corneal reflexes and motor response from the neurological examination, cortical responses from somatosensory evoked potentials and EEG. The predictive value of a status epilepticus or serum levels of neuron-specific enolase is uncertain at this time. In contrast to poor outcomes, good neurological recovery cannot be predicted reliably at this time.

  4. Estimation of cerebral blood flow during cardiopulmonary resuscitation in humans

    DEFF Research Database (Denmark)

    Christensen, S F; Stadeager, Carsten Preben; Siemkowicz, E

    1990-01-01

    /kg/min). The cortical CBF was found between 14 and 211 ml 100 g-1.min-1 with mean 42 ml 100 g-1.min-1 and mean white matter CBF equal to 27 ml 100 g-1.min-1. It is suggested that the external cardiac massage in humans may be of poor efficacy in terms of brain revival. Cortical CBF after long-lasting cardiopulmonary...

  5. The Universal Form of Treatment Options (UFTO as an alternative to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR orders: a mixed methods evaluation of the effects on clinical practice and patient care.

    Directory of Open Access Journals (Sweden)

    Zoë Fritz

    Full Text Available AIMS: To determine whether the introduction of the Universal Form of Treatment Options (the UFTO, as an alternative approach to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR orders, reduces harms in patients in whom a decision not to attempt cardiopulmonary resuscitation (CPR was made, and to understand the mechanism for any observed change. METHODS: A mixed-methods before-and-after study with contemporaneous case controls was conducted in an acute hospital. We examined DNACPR (103 patients with DNACPR orders in 530 admissions and UFTO (118 decisions not to attempt resuscitation in 560 admissions practice. The Global Trigger Tool was used to quantify harms. Qualitative interviews and observations were used to understand mechanisms and effects. RESULTS: RATE OF HARMS IN PATIENTS FOR WHOM THERE WAS A DOCUMENTED DECISION NOT TO ATTEMPT CPR WAS REDUCED: Rate difference per 1000 patient-days was 12.9 (95% CI: 2.6-23.2, p-value=0.01. There was a difference in the proportion of harms contributing to patient death in the two periods (23/71 in the DNACPR period to 4/44 in the UFTO period (95% CI 7.8-36.1, p-value=0.006. Significant differences were maintained after adjustment for known confounders. No significant change was seen on contemporaneous case control wards. Interviews with clinicians and observation of ward practice revealed the UFTO helped provide clarity of goals of care and reduced negative associations with resuscitation decisions. CONCLUSIONS: Introducing the UFTO was associated with a significant reduction in harmful events in patients in whom a decision not to attempt CPR had been made. Coupled with supportive qualitative evidence, this indicates the UFTO improved care for this vulnerable group. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN85474986 UK Comprehensive Research Network Portfolio 7932.

  6. A prospective study to determine the circumstances, incidence and outcome of cardiopulmonary resuscitation in a referral hospital in India, in relation to various factors

    Directory of Open Access Journals (Sweden)

    Muralidhar Joshi

    2015-01-01

    Full Text Available Background and Aims: Cardiac arrest has multifactorial aetiology and the outcome depends on timely and correct interventions. We decided to investigate the circumstances, incidence and outcome of cardiopulmonary resuscitation (CPR at a tertiary hospital in India, in relation to various factors, including extensive basic life support and advanced cardiac life support training programme for all nurses and doctors. Methods: It has been over a decade and a half with periodical updates and implementation of newer guidelines prepared by various societies across the world about CPR for both in-hospital and out-of hospital cardiac arrests (IHCA and OHCA. We conducted a prospective study wherein all cardiac arrests reported in the hospital consecutively for 12 months were registered for the study and followed their survival up to 1-year. Statistical analysis was performed by using Chi-square test for significant differences in proportions applied to various parameters of the study. Results: The main outcome measures were; (following CPR return of spontaneous circulation, survival for 24 h, survival from 24 h to 6 weeks or discharge, alive at 1-year. For survivors, an assessment was made about their cerebral performance and overall performance and accordingly graded. All these data were tabulated. Totally 419 arrests were reported in the hospital, out of which 413 were in-hospital arrests. Out of this 260 patients were considered for resuscitation, we had about 27 survivors at the end of 1-year follow-up (10.38%. Conclusion: We conclude by saying there are many factors involved in good clinical outcomes following IHCAs and these variable factors need to be researched further.

  7. Foundings from the history of the cardiopulmonary resuscitation%心肺复苏的历史回顾与启示

    Institute of Scientific and Technical Information of China (English)

    孟庆义; 王立祥

    2015-01-01

    本文对中西方心肺复苏的历史进行了回顾,分析了古代心肺复苏各种方法的特点与内涵,及其对现代心肺复苏的启示,认为在心肺复苏时体位放置与脑复苏的关系,体温调整在复苏中的意义,人工呼吸的实施要点,四肢与腹部等胸外器官在人工循环中的作用,以及直肠等新的给药途径等方面,应汲取东西方古代复苏的精华,这对指导心肺复苏的理论研究和临床实践有重要意义。%This paper reviewed the key point of cardiopulmonary resuscitation (CPR) history in the east and west world, and analyzed the characteristics and connotation of the various CPR methods and its meaning and the inspiration for the modern CPR study. Many of ancient methods should be pay more attention, such as the patient’s position in the recovery of the brain, body temperature modulation in the CPR, the methods of the artiifcial respiration, and the function of limbs and abdomen in the artiifcial circulation, new administration of the rectum and other aspects. That was important to guide the theoretical study and clinical practice.

  8. An innovative design for cardiopulmonary resuscitation manikins based on a human-like thorax and embedded flow sensors

    Science.gov (United States)

    Thielen, Mark; Joshi, Rohan; Delbressine, Frank; Bambang Oetomo, Sidarto; Feijs, Loe

    2017-01-01

    Cardiopulmonary resuscitation manikins are used for training personnel in performing cardiopulmonary resuscitation. State-of-the-art cardiopulmonary resuscitation manikins are still anatomically and physiologically low-fidelity designs. The aim of this research was to design a manikin that offers high anatomical and physiological fidelity and has a cardiac and respiratory system along with integrated flow sensors to monitor cardiac output and air displacement in response to cardiopulmonary resuscitation. This manikin was designed in accordance with anatomical dimensions using a polyoxymethylene rib cage connected to a vertebral column from an anatomical female model. The respiratory system was composed of silicon-coated memory foam mimicking lungs, a polyvinylchloride bronchus and a latex trachea. The cardiovascular system was composed of two sets of latex tubing representing the pulmonary and aortic arteries which were connected to latex balloons mimicking the ventricles and lumped abdominal volumes, respectively. These balloons were filled with Life/form simulation blood and placed inside polyether foam. The respiratory and cardiovascular systems were equipped with flow sensors to gather data in response to chest compressions. Three non-medical professionals performed chest compressions on this manikin yielding data corresponding to force–displacement while the flow sensors provided feedback. The force–displacement tests on this manikin show a desirable nonlinear behaviour mimicking chest compressions during cardiopulmonary resuscitation in humans. In addition, the flow sensors provide valuable data on the internal effects of cardiopulmonary resuscitation. In conclusion, scientifically designed and anatomically high-fidelity designs of cardiopulmonary resuscitation manikins that embed flow sensors can improve physiological fidelity and provide useful feedback data. PMID:28290239

  9. Awareness and knowledge of pediatric cardio- pulmonary resuscitation in the community of Al-Khobar city

    OpenAIRE

    2014-01-01

    Background: The history of resuscitation going back thousands of years has been reported in literature throughout history. This concept has undergone several decisive revolutionary changes particularly in pediatrics. Although the cardio-pulmonary resuscitation (CPR) is relatively new in pediatrics, progress has been remarkable in the last a few decades. As it becomes more popular, especially under the influence of globalizing media, CPR also becomes a life requirement that is not restricted t...

  10. Value of serum brain natriuretic peptide levels in the prognosis of brain damage after cardiopulmonary resuscitation%血清脑钠肽水平对心肺复苏后脑损伤的预测价值研究

    Institute of Scientific and Technical Information of China (English)

    李钦浩; 巩晓娜; 周娆娆; 刘朋; 张磊; 亓雪梅; 蒋芳杰

    2013-01-01

    OBJECTIVE To evaluate the effect of serum brain natriuretic peptide levels on brain damage at the early stage after cardiopulmonary resuscitation (CPR). METHODS There were 34 patients with restoration of spontaneous circulation after successful CPR.After 2 months of successful cardiopulmonary resuscitation (CPR) , patients with GCS score ≥ 12 were mild brain damage (I group, male 6 cases, female 8 cases); GCS score 9 ≤ GCS ≤ 11 were moderate brain damage (II group, male 4 cases, female 6 cases); GCS score 3 ≤ GCS ≤ 8 were severe brain damage (Ⅲ group, male 5 cases, and female 5 cases) . Control group was consisted of 15 healthy volunteers. All of the patients' venous blood were respectively collected and BNP was detected by enzyme linked immunosorbent assay at 2, 8, 12, 24 and 48 h after restoring of independent circulation. RESULTS Compared the age, sex, start time of cardiac arrest to recovery in cardiopulmonary resuscitation (CPR) group and control group, differences were not statistically significant (P> 0.05); at 2, 8, 12, 24 and 48 h, serum BNP levels in I , II and Ⅲ groups were significantly higher than the control group (P < 0.05); And in the trail group, I group was significantly lower than the II group (P< 0.05); II group and was significantly lower than the HI group (P< 0.05). CONCLUSION Serum BNP levels can reflect cardiopulmonary resuscitation (CPR) early after HPC ischemia brain damage, and for the assessment of the recovery cardiopulmonary resuscitation (CPR) has an important value.%目的 探讨血清脑钠肽(BNP)对心肺复苏后脑损伤的预测的价值.方法 34例经心肺复苏后自主循环恢复的患者,以心肺复苏成功后2个月格拉斯哥昏迷评分(GCS)≥12为轻度脑损伤(Ⅰ组),男6例,女8例;9≤GCS≤11为中度脑损伤(Ⅱ组),男4例,女6例;3≤GCS≤8为重度脑损伤(Ⅲ组),男5例,女5例.另外选取14例健康者(女8例,男6例)作为对照组.所有患者均在自主循环恢复后2、8

  11. Evaluation of a Brief Intervention Designed to Increase CPR Training among Pregnant Pool Owners

    Science.gov (United States)

    Girasek, Deborah C.

    2011-01-01

    This study evaluated whether a brief videotape could motivate pregnant pool owners to be trained in infant/child cardiopulmonary resuscitation (CPR). Women were recruited from prenatal classes in South Florida. Eligible volunteers were randomized to view a video or receive standard treatment, after completing a questionnaire. The video explained…

  12. 护理实习生心肺复苏术的认知及需求调查%Survey of Nursing Students' Cognitive Knowledge and Demands on Cardiopulmonary Resuscitation

    Institute of Scientific and Technical Information of China (English)

    马素芳; 彭幼清; 张梅英; 张晓莉

    2011-01-01

    目的 了解护理实习生心肺复苏术(cardiopulmonary resuscitation,CPR)的理论知识掌握及培训需求情况,为实习护生的CPR知识及技能培训提供依据及建议.方法 采用自行设计的"护理实习生认知及需求调查问卷",对上海市同济大学附属东方医院202名护理实习生进行调查.结果 护生CPR理论知识认知水平不高;及格率不高(49.00%),良好率及优秀率低(6.93%及2.97%);不同学历护生理论知识掌握情况间差异有统计学意义(P<0.01);护生接受CPR系统培训只占17.82%,从未接受过培训的占8.42%;实习护生对CPR有强烈的培训需求(95.05%).结论 实习护生CPR的认知水平有待提高,应采取相应措施加大培训力度.%Objective To explore the status of theoretical knowledge, training demands in nursing students,so as to provide evidence and some proposals for cardiopulmonary resuscitation(CPR) training.Methods A total of 202 nursing students were randomly selected from a hospital in Shanghai by using a self-designed questionnaire on awareness and demands for nursing students. Results The level of nursing students' theoretical cognitive knowledge of CPR was not high. The pass rate was not high(49.00%).Meanwhile, the good and distinguished achiever ratios were low(6.93 % vs 2.97 %). The levels of theoretical knowledge in students with different educational history were significantly different ( P < 0. 01). Besides,students who received CPR trainings just accounted for 17.82%. And 8.42% of the students didn't receive CPR trainings at all. Through the investigation it can also be seen that students showed strong demands on CPR trainings(95.05%). Conclusion Nursing students' cognitive knowledge on CPR needs to be improved and some measures should be taken to strengthen the trainings.

  13. Cardiopulmonary resuscitation of apparently stillborn infants: survival and long-term outcome.

    Science.gov (United States)

    Jain, L; Ferre, C; Vidyasagar, D; Nath, S; Sheftel, D

    1991-05-01

    To determine the outcome of apparently stillborn infants who received cardiopulmonary resuscitation, we studied the short- and long-term outcome of 93 infants who had an Apgar score of 0 at 1 minute of age and were resuscitated at birth. Sixty-two (66.6%) responded and left the delivery room alive; 26 (42%) of the 62 infants died in the neonatal period and 36 infants were discharged home; of the 36 infants, three subsequently died during infancy. Of the 33 survivors, ten were lost to follow-up after discharge. Developmental assessment of 23 of 33 long-term survivors revealed normal outcome in 14 (61.7%), abnormal results in 6 (26%), and suspect status in 3 (13%). Fifty-eight infants had an Apgar score of 0 at greater than or equal to 10 minutes of age and all except one died; the surviving infant has an abnormal developmental outcome. We conclude that 39% of apparently stillborn infants who were resuscitated survived beyond the neonatal period and that 61% of the 23 survivors who were available for developmental follow-up had normal development at the time of last examination. Survival was unlikely if there was no response after 10 minutes of resuscitation.

  14. Do resuscitation-related injuries kill infants and children?

    Science.gov (United States)

    Matshes, Evan W; Lew, Emma O

    2010-06-01

    Occasionally, individuals accused of inflicting fatal injuries on infants and young children will claim some variant of the "CPR defense," that is, they attribute the cause of injuries found at autopsy to their "untrained" resuscitative efforts. A 10-year (1994-2003) historical fixed cohort study of all pediatric forensic autopsies at the Miami-Dade County Medical Examiner Department was undertaken. To be eligible for inclusion in the study, children had to have died of atraumatic causes, with or without resuscitative efforts (N(atraumatic) = 546). Of these, 382 had a history of cardiopulmonary resuscitation (CPR; average age of 4.17 years); 248 had CPR provided by trained individuals only; 133 had CPR provided by both trained and untrained individuals; 1 had CPR provided by untrained individuals only. There was no overlap between these 3 distinct groups. Twenty-two findings potentially attributable to CPR were identified in 19:15 cases of orofacial injuries compatible with attempted endotracheal intubation; 4 cases with focal pulmonary parenchymal hemorrhage; 1 case with prominent anterior mediastinal emphysema; and 2 cases with anterior chest abrasions. There were no significant hollow or solid thoracoabdominal organ injuries. There were no rib fractures. The estimated relative risk of injury subsequent to resuscitation was not statistically different between the subset of decedents whose resuscitative attempts were made by trained individuals only, and the subset who received CPR from both trained and untrained individuals. In the single case of CPR application by an untrained individual only, no injuries resulted. The remaining 164 children dying from nontraumatic causes and who did not undergo resuscitative efforts served as a control group; no injuries were identified. This study indicates that in the pediatric population, injuries secondary to resuscitative efforts are infrequent or rare, pathophysiologically inconsequential, and predominantly orofacial in

  15. Out-of-hospital cardiac arrest: determinant factors for immediate survival after cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Daniela Aparecida Morais

    2014-08-01

    Full Text Available OBJECTIVE: to analyze determinant factors for the immediate survival of persons who receive cardiopulmonary resuscitation from the advanced support units of the Mobile Emergency Medical Services (SAMU of Belo Horizonte.METHOD: this is a retrospective, epidemiological study which analyzed 1,165 assistance forms, from the period 2008 - 2010. The collected data followed the Utstein style, being submitted to descriptive and analytical statistics with tests with levels of significance of 5%.RESULTS: the majority were male, the median age was 64 years, and the ambulance response time, nine minutes. Immediate survival was observed in 239 persons. An association was ascertained of this outcome with "cardiac arrest witnessed by persons trained in basic life support" (OR=3.49; p<0.05; CI 95%, "cardiac arrest witnessed by Mobile Emergency Medical Services teams" (OR=2.99; p<0.05; CI95%, "only the carry out of basic life support" (OR=0.142; p<0.05; CI95%, and "initial cardiac rhythm of asystole" (OR=0.33; p<0.05; CI 95%.CONCLUSION: early access to cardiopulmonary resuscitation was related to a favorable outcome, and the non-undertaking of advanced support, and asystole, were associated with worse outcomes. Basic and advanced life support techniques can alter survival in the event of cardiac arrest.

  16. Cardiopulmonary resuscitation decisions in the emergency department: An ethnography of tacit knowledge in practice.

    Science.gov (United States)

    Brummell, Stephen P; Seymour, Jane; Higginbottom, Gina

    2016-05-01

    Despite media images to the contrary, cardiopulmonary resuscitation in emergency departments is often unsuccessful. The purpose of this ethnographic study was to explore how health care professionals working in two emergency departments in the UK, make decisions to commence, continue or stop resuscitation. Data collection involved participant observation of resuscitation attempts and in-depth interviews with nurses, medical staff and paramedics who had taken part in the attempts. Detailed case examples were constructed for comparative analysis. Findings show that emergency department staff use experience and acquired tacit knowledge to construct a typology of cardiac arrest categories that help them navigate decision making. Categorisation is based on 'less is more' heuristics which combine explicit and tacit knowledge to facilitate rapid decisions. Staff then work as a team to rapidly assimilate and interpret information drawn from observations of the patient's body and from technical, biomedical monitoring data. The meaning of technical data is negotiated during staff interaction. This analysis was informed by a theory of 'bodily' and 'technical' trajectory alignment that was first developed from an ethnography of death and dying in intensive care units. The categorisation of cardiac arrest situations and trajectory alignment are the means by which staff achieve consensus decisions and determine the point at which an attempt should be withdrawn. This enables them to construct an acceptable death in highly challenging circumstances.

  17. Improving the hemodynamics of CPR. AHA guidelines support timely and effective CPR.

    Science.gov (United States)

    Wesley, A Keith

    2006-03-01

    More research is needed to improve our understanding of what constitutes the most effective method of cardiopulmonary resuscitation; however, we know more now than ever in the history of medicine. We know that CPR is more than simply pushing on the chest and defibrillating the heart. We know that there exists an optimal physiologic condition to facilitate successful resuscitation that relies on quality coronary and cerebral artery perfusion and preparation of the heart before defibrillation. There are many questions yet to be answered, such as how long defibrillation should be delayed following CPR, which devices or techniques provide the most effective CPR, and what are the most effective ratios of compression and ventilation? The answer may lie within a combination of approaches using multiple devices and techniques simultaneously in an attempt to meet the goals for performing the most effective CPR. What is clear is that the science of cardiac arrest is maturing, and what began in the early ages as an act of faith and desperation has now become grounded in logical reason and understanding of the physiology of cardiac arrest and the hemodynamics of CPR.

  18. Efficacy analysis of intravenous thrombolysis after cardiopulmonary resuscitation for patients with acute myocardial infarction and cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    张晓丽

    2014-01-01

    Objective To explore the clinical value of intravenous thrombolysis in the treatment of patients with acute myocardial infarction(AMI)and cardiac arrest after cardiopulmonary resuscitation.Methods 120 patients with AMI and cardiac arrest admitted in our hospital from Mar2009 to Mar 2013 were divided into thrombolytic group(n=50)and control group(n=70)according to the

  19. Cardiopulmonary Arrest and Resuscitation in Severe Sepsis and Septic Shock: A Research Model.

    Science.gov (United States)

    Chalkias, Athanasios; Spyropoulos, Vaios; Koutsovasilis, Anastasios; Papalois, Apostolos; Kouskouni, Evaggelia; Xanthos, Theodoros

    2015-03-01

    Cardiopulmonary resuscitation in patients with severe sepsis and septic shock is challenging and usually unsuccessful. The aim of the present study is to describe our swine model of cardiac arrest and resuscitation in severe sepsis and septic shock. In this prospective randomized animal study, 10 healthy female Landrace-Large White pigs with an average weight of 20 ± 1 kg (aged 19 - 21 weeks) were the study subjects. Septicemia was induced by an intravenous infusion of a bolus of 20-mL bacterial suspension in 2 min, followed by a continuous infusion during the rest of the experiment. After septic shock was confirmed, the animals were left untreated until cardiac arrest occurred. All animals developed pulseless electrical activity between the fifth and sixth hours of septicemia, whereas five (50%) of 10 animals were successfully resuscitated. Coronary perfusion pressure was statistically significantly different between surviving and nonsurviving animals. We found a statistically significant correlation between mean arterial pressure and unsuccessful resuscitation (P = 0.046), whereas there was no difference in end-tidal carbon dioxide (23.05 ± 1.73 vs. 23.56 ± 1.70; P = 0.735) between animals with return of spontaneous circulation and nonsurviving animals. During the 45-min postresuscitation monitoring, we noted a significant decrease in hemodynamic parameters, although oxygenation indices and lactate clearance were constantly increased (P = 0.001). This successful basic swine model was for the first time developed and may prove extremely useful in future studies on the periarrest period in severe sepsis and septic shock.

  20. Effects of active compression-decompression cardiopulmonary resuscitation on cardiac functions during ventricular fibrillation by two-dimensional echocardiography in dogs%二维超声观察主动性心肺复苏对心室颤动犬心功能的影响

    Institute of Scientific and Technical Information of China (English)

    刘红臻; 钟敬泉; 孟祥林; 陶文; 张运

    2010-01-01

    Objective To compare the effect of active compression-decompression cardiopulmonary resuscitation(ACD-CPR) with standard- cardiopulmonary resuscitation(S-CPR) on ventricular function in a canine ventricular fibrillation model. Methods Ventricular fibrillation was induced in anesthetized and instrumented canine. Twenty-four dogs were randomly assigned to either ACD-CPR group or S-CPR group.After 4 minutes of untreated VF,two-dimension echocardiography was used to evaluate the left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV) and left ventricular ejection fraction (LVEF) of every canine of the two groups when they were undergoing cardiopulmonary resuscitation. Results During ventricular fibrillation, both ACD-CPR group and S-CPR group showed decreased LVEDV compared with pre-ventricular fibrillation, but not statistically significant( P >0.05).LVEDV was increased in ACD-CPR group compared with S-CPR group, but not statistically significant (P> 0. 05). Both ACD-CPR group and S-CPR group showed significantly increased LVESV compared with pre-ventricular fibrillation,of which the difference was statistically significant ( P <0. 001). Both ACD-CPRgroup and S-CPR group showed significantly decreased LVEF compared with pre-ventricular fibrillation,of which the difference was statistically significant (P <0. 001). LVEF was increased in ACD-CPR group compared with S-CPR group,of which the difference was statistically significant ( P = 0.019). Conclusions Compared with S-CPR,ACD-CPR resulted in higher LVEF.%目的 探讨主动性心肺复苏对犬心室颤动(室颤)时心功能的影响.方法 应用经胸二维超声心动图分别测量犬室颤时主动性心肺复苏组(ACD-CPR组,12只)和标准心肺复苏组(S-CPR组,12只)左心室舒张末期容积、左心室收缩末期容积,计算左心室射血分数(LVEF),比较两组间各项测量结果.结果 室颤时,两组左心室舒张末期容积较室颤前均有下降,

  1. Clinical experience in successful treatment of cardiac arrest in adult patients using extracorporeal cardiopulmonary resuscitation%体外心肺复苏技术救治成人心搏骤停患者的临床体会

    Institute of Scientific and Technical Information of China (English)

    杜传琼

    2013-01-01

    Objective To evaluate the clinical efficacy of extracorporeal cardiopulmonary resuscitation (CPR) for treatment of adult cardiac arrest patients. Methods The clinical records of 20 adult cardiac arrest patients who were admitted to our hospital from January 2011 to June 2013 were retrospectively analyzed. Results The most common cause of cardiac arrest in these patients was cardiovascular disease (40%), followed by trauma (25%). Return of spontaneous circulation had a high success rate of 50%, while cerebral resuscitation was associated with a low success rate of 10%only. Patients who underwent successful CPR had a significantly shorter time to CPR and establishment of an artificial airway and significantly higher epinephrine usage than those who underwent unsuccessful cardiopulmonary resuscitation (P0.05).Conclusion The shorter time to CPR and establishment of an artificial airway and higher adrenaline usage can improve the success rate of treatment for cardiac arrest patients.%目的:分析体外心肺复苏技术救治成人心搏骤停患者的临床效果。方法回顾性分析我院2011年1月至2013年6月收治的20例心搏骤停成人患者的临床资料。结果成年心搏骤停患者最主要的发病原因是心血管系统疾病,其次为外伤,分别占总发病人数的40%和25%;ROSC具有较高的成功率,为50%,而脑复苏成功则具有较低的成功率,仅为10%;成功组患者的心肺复苏开始时间、建立人工气道时间均明显比失败组短,肾上腺素用量明显比失败组多,二者相比具有显著的统计学差异(P0.05)。结论体外心肺复苏技术救治心搏骤停患者时尽可能短的心肺复苏开始时间、人工气道建立时间及较多的肾上腺素用量能够提高救治成功率。

  2. What are the barriers to implementation of cardiopulmonary resuscitation training in secondary schools?

    DEFF Research Database (Denmark)

    Zinckernagel, Line; Malta Hansen, Carolina; Rod, Morten Hulvej;

    2016-01-01

    teachers acquired the CPR skills which they considered were needed. They considered CPR training to differ substantially from other teaching subjects because it is a matter of life and death, and they therefore believed extraordinary skills were required for conducting the training. This was mainly rooted...... in their insecurity about their own CPR skills. CPR training kits seemed to lower expectations of skill requirements to conduct CPR training, but only among those who were familiar with such kits. CONCLUSIONS: To facilitate implementation of CPR training in schools, it is necessary to have clear guidelines regarding...... the required proficiency level to train students in CPR, to provide teachers with these skills, and to underscore that extensive skills are not required to provide CPR. Further, it is important to familiarise teachers with CPR training kits....

  3. Dantrolene versus amiodarone for cardiopulmonary resuscitation: a randomized, double-blinded experimental study

    Science.gov (United States)

    Wiesmann, Thomas; Freitag, Dennik; Dersch, Wolfgang; Eschbach, Daphne; Irqsusi, Marc; Steinfeldt, Thorsten; Wulf, Hinnerk; Feldmann, Carsten

    2017-01-01

    Dantrolene was introduced for treatment of malignant hyperthermia. It also has antiarrhythmic properties and may thus be an alternative to amiodarone for the treatment of ventricular fibrillation (VF). Aim of this study was to compare the return of spontaneous circulation (ROSC) with dantrolene and amiodarone in a pig model of cardiac arrest. VF was induced in anesthetized pigs. After 8 min of untreated VF, chest compressions and ventilation were started and one of the drugs (amiodarone 5 mg kg−1, dantrolene 2.5 mg kg−1 or saline) was applied. After 4 min of initial CPR, defibrillation was attempted. ROSC rates, hemodynamics and cerebral perfusion measurements were measured. Initial ROSC rates were 7 of 14 animals in the dantrolene group vs. 5 of 14 for amiodarone, and 3 of 10 for saline). ROSC persisted for the 120 min follow-up in 6 animals in the dantrolene group, 4 after amiodarone and 2 in the saline group (n.s.). Hemodynamics were comparable in both dantrolene group amiodarone group after obtaining ROSC. Dantrolene and amiodarone had similar outcomes in our model of prolonged cardiac arrest, However, hemodynamic stability was not significantly improved using dantrolene. Dantrolene might be an alternative drug for resuscitation and should be further investigated. PMID:28098197

  4. Investigation on the clinical nursing interns' theoretical knowledge, skills and will to implement in terms of cardiopulmonary resuscitation%临床护理实习生心肺复苏知识、技能与实施意愿调查

    Institute of Scientific and Technical Information of China (English)

    魏晓侠; 武礼琴

    2016-01-01

    Objective To investigate the clinical nursing interns' theoretical knowledge, skills and will to im-plement out of the hospital in terms of cardiopulmonary resuscitation, so as to provide reference for CPR train-ing. Methods A total of 176 clinical nursing interns ' of a certain A-grade hospital were investigated in terms of their knowledge, skills, and willingness to implement on site of CPR by Questionnaire on CPR for the clinical nursing interns and Evaluation Form on the practice for CPR with single freehand and without others' help. Results Basic knowledge on CPR was well mastered by most of the clinical nursing interns. The mastery of skills on CPR of nursing interns' needed to be improved. There were significant differences on the theory of CPR knowledge and skills among nursing interns with different educational background ( P<0. 05 ) . There was difference for the attitude towards the will to implement CPR on acquaintances and strangers and the difference was statistically significant ( P<0. 05 ) , and there was significant difference for the willingness to carry out artificial respiration and chest compressions toward the same object, and the difference was statistically significant ( P<0. 05 ) . Conclusions Clinical nursing interns ' CPR skills needs to be im-proved. Medical universities and hospitals should pay more attention to strengthening cardiopulmonary resuscitation train-ing and retraining and find out the obstacle factors of emergency on the site so as to promote the clinical nursing interns' willingness to perform cardiopulmonary resuscitation out of hospital.%目的:了解临床护理实习生心肺复苏( cardiopulmonary resuscitation,CPR)理论知识和技能掌握情况以及院外实施心肺复苏意愿,为开展心肺复苏培训提供参考依据。方法采用“临床护理实习生心肺复苏调查问卷”与“单人徒手心肺复苏行为操作考核评分表”对某三甲医院176名护理实习生进行心肺复苏知识

  5. Changes of Tumor Necrosis Factor-α and the Effects of Ulinastatin Injection during Cardiopulmonary Cerebral Resuscitation

    Institute of Scientific and Technical Information of China (English)

    王卫; 黄唯佳; 陈寿权; 李章平; 王万铁; 王明山

    2004-01-01

    Summary: The changes of tumor necrosis factor-α (TNF-α) and brain ultrastructure during cardiopulmonary resuscitation and the effects of ulinastation injection were observed, and the mechanism was investigated. Twenty-four adult healthy Sprague-Dawley rats were randomly divided into.control group (8 rats), resuscitation group (8 rats) and ulinastatin (UTI) group (8 rats). Rats in control group underwent tracheotomy without clipping the trachea to induce circulatory and respiratory standstill. Rats in resuscitation and ulinastatin group were subjected to the procedure of establishing the model of cardiopulmonary cerebral resuscitation (CPCR). Rats in ulinastatin group were given with UTI 104 U/kg once after CPCR. In the control group, the plasma was collected immediate,30 min, 2 h, 4 h, and 6 h after tracheotomy. In resuscitation group and UTI group, plasma was collected immediate after tracheotomy, 30 min, 2 h, 4 h and 6 h after successful resuscitation. The plasma levels of TNF-α were determined by radioimmunoassay (RIA). At the end of the experi-ment, 2 rats were randomly selected from each group and were decapitated. The cortex of the brain was taken out immediately to observe the ultrastructure changes. In control group, there were nosignificant differences in the level of TNF-α among different time points (P>0.05). In resuscitation group, the level of TNF-α was increased obviously after resuscitation (P<0.01) and reached its peak 2 h later after resuscitation. An increasing trend of TNF-α showed in UTI group. There were no differences in TNF-α among each sample taken after successful resuscitation and that after tracheotomy. The utrastructure of brains showed the injury in UTI group was ameliorated as compared with that in resuscitation group. In early period of CPCR, TNF-α was expressed rapidly and kept increasing. It indicated that TNF-α might take part in the tissue injury after CPCR. The administration of UTI during CACR could depress TNF

  6. A comparative study of dispatcher-assisted telephone-cardiopulmonary resuscitation and smart phone APPs for conducting cardiopulmonary resuscitation%智能手机APP指导模式与调度员指导模式对目击者实施心肺复苏的作用及比较研究

    Institute of Scientific and Technical Information of China (English)

    王晓巍; 桂莉; 孙洁琼

    2016-01-01

    目的 研究应用智能手机APP或调度员电话指导目击者进行现场心肺复苏(cardiopulmonary resuscitation,CPR)的效用.方法 将74名未经心肺复苏培训的志愿者随机分为非指导组(n=13)、调度员指导(dispatcher-assisted telephone-cardiopulmonary resuscitation,T-CPR)组(n=34)和APP指导组(n=27);在模拟心搏骤停场景中,借助QCPR模拟人,记录3组志愿者实施5 min单纯按压的心肺复苏过程中按压中断时间、按压位置、频率、深度和胸廓回弹的指标,并作比较.其中非指导组不接受任何心肺复苏指导;调度员指导组通过语音接受心肺复苏指导;APP指导组通过预先安装在安卓智能手机中的APP,以文字、语音和动画的方式向志愿者提供心肺复苏指导.采用SPSS 19.0对各组指标行秩和检验.结果 在按压中断时间(1.0 s vs.1.5 s vs.5.0 s)、按压平均速率(121.0次/min vs.127.5次/min vs.58.0次/min)、正确按压频率占比(99.0% vs.98.0% vs.0.0%)和按压平均深度(33.0 cm vs.26.5cm vs.16.0 cm)方面,APP指导组和调度员指导组表现相当,组间差异无统计学意义(P>0.05),且均优于非指导组,差异有统计学意义(P<0.05).结论 在提高目击者胸外按压质量方面,智能手机APP能起到和调度员电话指导相同的作用,从而提升目击者实施心肺复苏的效果.%Objective The purpose of our study was to assess the onset effect of bystander CPR assisted by a smart phone APP or by a dispatcher.Methods 74 volunteers,without any experience in basic life support measures,was randomly divided into three groups:no-assisted group (n=13),dispatcher-assisted group (n=34) and smart phone APP-assisted group (n=27).Under the condition of a simulative SCA,a QCPR mannequin was used to record the hands-off time,hand placement,rate,depth and complete chest recoil after each compression of the three different groups to make analysis.The no-assisted group didn't receive any CPR instruction

  7. Successful Prolonged Mechanical CPR in a Severely Poisoned Hypothermic Patient: A Case Report

    Directory of Open Access Journals (Sweden)

    Alberto Piacentini

    2012-01-01

    Full Text Available Mechanical cardiopulmonary resuscitation (m-CPR devices are an alternative to manual CPR, but their efficacy has been subject to debate. We present a case of a patient with full-neurologic recovery after prolonged m-CPR. The patient presented with severe hypothermia (internal temperature 24°C and poisoning (sedatives/hypnotics. Hepatic perfusion and metabolism are considered keys to restore spontaneous circulation. During this period no problems related to the device or patient positioning were encountered. Delivery of high-quality CPR and prolonged resuscitation were achieved. We confirm that ventilations asynchronous with chest compressions can be a problem. Reduction in chest measurements can hamper lung ventilation. A synchronous mode of manual ventilation (30 : 2 seems to be the best solution. The patient had an initial period of manual CPR. No damage to any organ or structure was noted. This case is of further interest because our EMS helicopters can fly 24 hours a day and m-CPR devices could play an important role as a “bridge” in patients when active rewarming by cardiopulmonary bypass is indicated (CPB.

  8. 临床实习医生现场心肺复苏培训的问题及对策%Problems and solutions of the cardiopulmonary resuscitation training for clinical interns

    Institute of Scientific and Technical Information of China (English)

    张奕威; 陈咏佳; 梁庆元; 关常青; 巫丽萍

    2011-01-01

    Objective To investigate the problems found during the cardiopulmonary resuscitation (CPR) training for clinical interns,and guide the training so as to improve the CPR level of clinical interns.Methods The CPR skills of the clinical interns were examined by the CPR si-ms(Laerdal Resusci Anne).After taking a training the shortage was found and targeted in the anterior examination,trainees should be reexamined to show the training effect.Resulta The total pass rate of the first CPR examination was relatively low,the common mistakes included wrong position,wrong press frequency,blowing too fast or excessively,etc.After targeted training,the pass rate increased obviously.Conclusion Finding the problems during the CPR examination and training for clinical interns and taking a targeted training can increase their CPR level obviously.%目的 探讨临床实习医生现场心肺复苏培训遇到的问题,从而指导提高临床实习医生的现场心肺复苏水平.方法 应用电脑模拟复苏人对临床实习医生进行现场心肺复苏的操作技能考核,据培训前考核发现的不足采取针对性培训,再行培训后考核.结果 培训前现场心肺复苏操作总体合格率较低,尤其以姿势不正确、按压频率不正确、吹气速度过快、吹气过大错误明显,培训后明显提高合格率.结论 找出临床实习医生现场心肺复苏培训遇到的问题,针对性加强培训后明显改善.

  9. Emergency Medical Technicians Are Often Consulted on Termination of Resuscitation, and Will Terminate Resuscitation Based on Controversial Single Factors

    DEFF Research Database (Denmark)

    Mygind-Klausen, Troels; Glerup Lauridsen, Kasper; Bødtker, Henrik;

    2016-01-01

    that according to an EMT should lead to termination of CPR. Methods: This was a pilot-study including EMTs from a Danish Emergency Medical Service. Data was collected using a structured questionnaire. All responses were collected anonymously. Results: In total, 50 EMTs (male: 88%, median age: 38, response rate......Introduction: Many out-of-hospital cardiopulmonary resuscitation (CPR) attempts have to be terminated. Previous studies have investigated knowledge on abandoning resuscitation among physicians. In the prehospital setting emergency medical technicians (EMTs) may be involved in the decision...... arrest (12%), witnessed cardiac arrest without bystander CPR within 10 minutes (30%), age above 80 years (20%), age above 90 years (62%), living at a nursing home (62%), known cancer (24%) and absence of pupillary light reflex (54%) during resuscitation. Conclusion: The majority of EMTs have been...

  10. Association between Body Temperature Patterns and Neurological Outcomes after Extracorporeal Cardiopulmonary Resuscitation

    Science.gov (United States)

    Ryu, Jeong-Am; Park, Taek Kyu; Chung, Chi Ryang; Cho, Yang Hyun; Sung, Kiick; Suh, Gee Young; Lee, Tae Rim; Sim, Min Seob; Yang, Jeong Hoon

    2017-01-01

    We evaluated the association of body temperature patterns with neurological outcomes after extracorporeal cardiopulmonary resuscitation (ECPR). Between December 2013 and December 2015, we enrolled 48 patients with cardiac arrest who survived for at least 24 hours after ECPR. Based on their body temperature patterns and the intention to control fever, we divided the patients into those in whom fever was actively controlled (N = 25), those with normothermia (N = 17), and those with unintended hypothermia (N = 6). The primary outcome was the Cerebral Performance Categories (CPC) scale at discharge. Of the 48 ECPR patients, 23 patients (47.9%) had good neurological outcomes (CPC 1 and 2) and 27 patients (56.3%) survived to discharge. The normothermia group showed a pattern of higher temperatures compared with the other groups during 48 hours after ECPR. Not only poor neurological outcomes but also intensive care unit (ICU) mortality occurred more often in the unintended hypothermia group than in the other two groups, regardless of the fever control strategy (p = 0.023 and p = 0.002, respectively). There were no differences in neurological outcomes and ICU mortality between the actively controlled fever group and the normothermia group (p = 0.845 and p = 0.616, respectively). Unintentionally sustained hypothermia may be associated with poor neurological outcomes after ECPR. These findings suggest that patients who are unable to generate a fever following ECPR may incur severe hypoxic brain injury. PMID:28114337

  11. Respiratory and Cardiac Resuscitation Skills of the High School Athletic Coach.

    Science.gov (United States)

    Furney, Steven

    Athletic coaches (n=149) responded to a survey questionnaire on two cardiac and respiratory emergency procedures: cardiopulmonary resuscitation (CPR) and the Heimlich maneuver. The coaches were asked to indicate how proficient they were at these skills, how important these skills were to their job, the availability and the need for in-service…

  12. Experimental Study of a Novel Method of Cardiopulmonary Resuscitation Using a Combination of Percutaneous Cardiopulmonary Support and Liposome-encapsulated Hemoglobin (TRM645

    Directory of Open Access Journals (Sweden)

    Ogata,Yoshitaka

    2008-08-01

    Full Text Available Percutaneous cardiopulmonary support (PCPS has been applied for cardiopulmonary arrest (CPA. We have developed a novel method of cardiopulmonary resuscitation using PCPS combined with liposome-encapsulated hemoglobin (TRM645 to improve oxygen delivery to vital organs. Ventricular fibrillation was electrically induced to an adult goat for 10 min. Next, PCPS (30 ml/kg/min, V/Q: 1 was performed for 20 min. Then, external defibrillation was attempted and observed for 120 min. The TRM group (n5 was filled with 300 mL of TRM645 for the PCPS circuit. The control group (n5 was filled with the same volume of saline. The delivery of oxygen (DO2 and oxygen consumption (VO2 decreased markedly by PCPS after CPA, compared to the preoperative values. DO2 was kept at a constant level during PCPS in both groups, but VO2 slowly decreased at 5, 10, and 15 min of PCPS in the control groups, demonstrating that systemic oxygen metabolism decreased with time. In contrast, the decreases in VO2 were small in the TRM group at 5, 10, and 15 min of PCPS, demonstrating that TRM645 continuously maintained systemic oxygen consumption even at a low flow rate. AST and LDH in the TRM group were lower than the control. There were significant differences at 120 min after the restoration of spontaneous circulation (p<0.05.

  13. 大学生对心肺复苏的态度现状及其影响因素分析%Attitudes toward Cardiopulmonary Resuscitation among University Students and Its Influence Factors

    Institute of Scientific and Technical Information of China (English)

    陆翠; 靳英辉; 马雯靖; 史晓彤; 孙文茜; 王云云

    2015-01-01

    Objective To investigate the attitudes of university students toward performing, learning and disseminating CPR (cardiopulmonary resuscitation), and to examine its influence factors, therefore to provide evidence for CPR popularization among university students. Methods In this cross-sectional method, the survey with a self-designed anonymous electronic questionnaire was conducted and 404 valid questionnaires collected finally. The influence factors were analyzed in logistic regression model. Results The results showed that 76.0% of the university students were willing to perform bystander CPR (chest compression plus mouth-to-mouth ventilation); 89.1% to do chest compression; 97.8% to learn and master CPR knowledge and technique; 95.0% o disseminate CPR if they had learned and mastered CPR knowledge and technique and 60.9% agreed that CPR training course should be a compulsory course. The results of the logistic regression analysis showed that self-assessed ability to perform bystander CPR affects respondents’ attitudes toward perform chest compression and mouth-to-mouth ventilation; self-assessed ability to perform bystander CPR, gender, heart disease history, family residence affect respondents ’ attitudes toward performing chest compression;self-assessed ability to perform bystander CPR, the experience of witnessing other ’s fainting, having family members working as healthcare provider affects respondents attitudes toward learning CPR; self-assessed ability to perform bystander CPR, self-perceived health status, the experience of witnessing other’s fainting affect respondents’ attitudes toward disseminating CPR. Conclusion There is positive attitude toward performing, learning and disseminating CPR among university students and its influence factors include self-assessed ability to perform bystander CPR, gender, heart disease history, family residence, self-perceived health status, the experience of witnessing other’s fainting, having family members

  14. A Mobile Device App to Reduce Time to Drug Delivery and Medication Errors During Simulated Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial

    Science.gov (United States)

    Combescure, Christophe; Lacroix, Laurence; Haddad, Kevin; Sanchez, Oliver; Gervaix, Alain; Lovis, Christian; Manzano, Sergio

    2017-01-01

    Background During pediatric cardiopulmonary resuscitation (CPR), vasoactive drug preparation for continuous infusion is both complex and time-consuming, placing children at higher risk than adults for medication errors. Following an evidence-based ergonomic-driven approach, we developed a mobile device app called Pediatric Accurate Medication in Emergency Situations (PedAMINES), intended to guide caregivers step-by-step from preparation to delivery of drugs requiring continuous infusion. Objective The aim of our study was to determine whether the use of PedAMINES reduces drug preparation time (TDP) and time to delivery (TDD; primary outcome), as well as medication errors (secondary outcomes) when compared with conventional preparation methods. Methods The study was a randomized controlled crossover trial with 2 parallel groups comparing PedAMINES with a conventional and internationally used drugs infusion rate table in the preparation of continuous drug infusion. We used a simulation-based pediatric CPR cardiac arrest scenario with a high-fidelity manikin in the shock room of a tertiary care pediatric emergency department. After epinephrine-induced return of spontaneous circulation, pediatric emergency nurses were first asked to prepare a continuous infusion of dopamine, using either PedAMINES (intervention group) or the infusion table (control group), and second, a continuous infusion of norepinephrine by crossing the procedure. The primary outcome was the elapsed time in seconds, in each allocation group, from the oral prescription by the physician to TDD by the nurse. TDD included TDP. The secondary outcome was the medication dosage error rate during the sequence from drug preparation to drug injection. Results A total of 20 nurses were randomized into 2 groups. During the first study period, mean TDP while using PedAMINES and conventional preparation methods was 128.1 s (95% CI 102-154) and 308.1 s (95% CI 216-400), respectively (180 s reduction, P=.002). Mean

  15. Serum cortisol level and adrenal reserve as a predictor of patients’ outcome after successful cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Reza Mosaddegh

    2016-06-01

    Conclusion: Current study could not show the statistically significant difference in initial and post-ACTH serum cortisol levels between survivor and non-survivor patients with cardiac arrest who had initial successful CPR, except to that of minute 60.

  16. The Effect of High-Fidelity Cardiopulmonary Resuscitation (CPR) Simulation on Athletic Training Student Knowledge, Confidence, Emotions, and Experiences

    Science.gov (United States)

    Tivener, Kristin Ann; Gloe, Donna Sue

    2015-01-01

    Context: High-fidelity simulation is widely used in healthcare for the training and professional education of students though literature of its application to athletic training education remains sparse. Objective: This research attempts to address a wide-range of data. This includes athletic training student knowledge acquisition from…

  17. Mechanical CPR devices compared to manual CPR during out-of-hospital cardiac arrest and ambulance transport: a systematic review

    Directory of Open Access Journals (Sweden)

    Ong Marcus

    2012-06-01

    Full Text Available Abstract Aims The aim of this paper was to conduct a systematic review of the published literature to address the question: “In pre-hospital adult cardiac arrest (asystole, pulseless electrical activity, pulseless Ventricular Tachycardia and Ventricular Fibrillation, does the use of mechanical Cardio-Pulmonary Resuscitation (CPR devices compared to manual CPR during Out-of-Hospital Cardiac Arrest and ambulance transport, improve outcomes (e.g. Quality of CPR, Return Of Spontaneous Circulation, Survival”. Methods Databases including PubMed, Cochrane Library (including Cochrane database for systematic reviews and Cochrane Central Register of Controlled Trials, Embase, and AHA EndNote Master Library were systematically searched. Further references were gathered from cross-references from articles and reviews as well as forward search using SCOPUS and Google scholar. The inclusion criteria for this review included manikin and human studies of adult cardiac arrest and anti-arrhythmic agents, peer-review. Excluded were review articles, case series and case reports. Results Out of 88 articles identified, only 10 studies met the inclusion criteria for further review. Of these 10 articles, 1 was Level of Evidence (LOE 1, 4 LOE 2, 3 LOE 3, 0 LOE 4, 2 LOE 5. 4 studies evaluated the quality of CPR in terms of compression adequacy while the remaining six studies evaluated on clinical outcomes in terms of return of spontaneous circulation (ROSC, survival to hospital admission, survival to discharge and Cerebral Performance Categories (CPC. 7 studies were supporting the clinical question, 1 neutral and 2 opposing. Conclusion In this review, we found insufficient evidence to support or refute the use of mechanical CPR devices in settings of out-of-hospital cardiac arrest and during ambulance transport. While there is some low quality evidence suggesting that mechanical CPR can improve consistency and reduce interruptions in chest compressions, there is no

  18. 463例院内心肺复苏Utstein模式注册研究%A report of 463 in-hospital cardiopulmonary resuscitation based on the "Utstein Style"

    Institute of Scientific and Technical Information of China (English)

    宋维; 莫德番; 蓝宝琼; 高允锁

    2008-01-01

    Objective Assessment of outcomes and outcome-related factors of in-hospital cardiopul-monary resuscitation (CPR) based on the " Utstein Style". Methods The study was designed as a prospective, single-institution, registry investigation of 463 patients (included adult and pediatric patients) for whom a CPR was attempted. Results The study population consisted of 320 (69.1 %) male patients and 143 (30. 9%) female patients. The age range of 45- 54, 55- 64, 65- 74 were ranked the first, the second and third highest. In the past medical history, cardiovascular disease and cerebrovascular disorder were two main disorders, accounting for 36. 30% (168/463) and 9. 9% (46/463), respectively. Ventricular fibrillation (VF) was the initial electrocardiographic (ECG) change in 74 patients (16.0%). Two hundred and seventy-three patients received the in-hospital CPR, and 190 patients received the pre-hospital CPR. Spontaneous circulation returned in 34. 6% (160/273) of the in-hospital patients after CPR, and 16. 60% (77/273) survived for 24 hours and 10. 4% (48/273) survived up to the time of discharge. The rates of restoration of spontaneous circulation (ROSC) and survival of the in-hospital CPR were higher than those of the pre-hosptial CPR [47. 6% (130/273) vs. 15. 8% (30/190), 13. 9% (38/273) vs. 5. 3% (10/190), both P<0. 013. Conclusion Prospective "Utstein Style" data collection for CPR is proved to be a valuable tool for the evaluation of management and outcome following in-hospital cardiopulmonary arrest, but the rate of survival for in-hospital resuscitation still seems to be too low. The further improvement of CPR outcome is necessary.%目的 应用心肺复苏(CPR)Utstein指南模式原则评价CPR效果与影响因素.方法 按照CPRUtstein评价指南设计CPR注册登记表,应用注册研究方法,研究院内463例(包括成人和儿童)CPR患者流行病学特征,CPR效果与影响因素.结果 心搏、呼吸骤停患者中男320例,占69.1%,女143例,占30.9%;

  19. Prolonged cardiopulmonary resuscitation and outcomes after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Rajan, Shahzleen; Folke, Fredrik; Kragholm, Kristian;

    2016-01-01

    ) of the study population achieved 30-day survival. Thirty-day survival was inversely related to minutes of CPR to ROSC: ranging from 59.6% (127/213) for ≤5min to 13.8% (19/138) for >25min. If bystander initiated CPR before ambulance arrival, corresponding values ranged from 70.4% (107/152) to 21.8% (12....../55). Of 30-day survivors, patients discharged to own home rather than nursing home ranged from 95.0% (124/127) to 84.7% (18/19), respectively. Of 30-day survivors, patients discharged without diagnosis of anoxic brain damage ranged from 98.4% (125/127) to 73.7% (14/19) for corresponding intervals. CONCLUSION...

  20. Using Virtual World Training to Increase Situation Awareness during Cardiopulmonary Resuscitation.

    Science.gov (United States)

    Creutzfeldt, Johan; Hedman, Leif; Felländer-Tsai, Li

    2014-01-01

    Situation awareness (SA) is a critical non-technical skill which affects outcome during emergency medical endeavors. Using a modified self-report instrument a significant increase of SA was found during multiplayer virtual world CPR team training among 12 medical students. Further a correlation between SA and attention was noted. Being a vital factor during the process of video-game play, we argue that this skill is suitably practiced using this training method.

  1. Implementation of a High-Performance Cardiopulmonary Resuscitation Protocol at a Collegiate Emergency Medical Services Program

    Science.gov (United States)

    Stefos, Kathryn A.; Nable, Jose V.

    2016-01-01

    Out-of-hospital cardiac arrest (OHCA) is a significant public health issue. Although OHCA occurs relatively infrequently in the collegiate environment, educational institutions with on-campus emergency medical services (EMS) agencies are uniquely positioned to provide high-quality resuscitation care in an expedient fashion. Georgetown University's…

  2. Mechanical cardiopulmonary resuscitation in in-hospital cardiac arrest : a systematic review

    NARCIS (Netherlands)

    Lameijer, Heleen; Immink, Rosa S.; Broekema, Josien J.; Ter Maaten, Jan C.

    2015-01-01

    With increasing rates of in-hospital cardiac arrest, improving resuscitation outcomes is essential. Mechanical chest compressors seem to be related to improved outcome in out-of hospital cardiac arrest; however, the literature on its use in in-hospital cardiac arrest is scarce. We used the Medline p

  3. Smartphone Apps for Cardiopulmonary Resuscitation Training and Real Incident Support: A Mixed-Methods Evaluation Study

    NARCIS (Netherlands)

    Kalz, Marco; Lenssen, Niklas; Felzen, Marco; Rossaint, Rolf; Tabuenca, Bernardo; Specht, Marcus; Skorning, Max

    2014-01-01

    Background: No systematic evaluation of smartphone/mobile apps for resuscitation training and real incident support is available to date. To provide medical, usability, and additional quality criteria for the development of apps, we conducted a mixed-methods sequential evaluation combining the persp

  4. Human factors in resuscitation: Lessons learned from simulator studies

    Directory of Open Access Journals (Sweden)

    Hunziker S

    2010-01-01

    Full Text Available Medical algorithms, technical skills, and repeated training are the classical cornerstones for successful cardiopulmonary resuscitation (CPR. Increasing evidence suggests that human factors, including team interaction, communication, and leadership, also influence the performance of CPR. Guidelines, however, do not yet include these human factors, partly because of the difficulties of their measurement in real-life cardiac arrest. Recently, clinical studies of cardiac arrest scenarios with high-fidelity video-assisted simulations have provided opportunities to better delineate the influence of human factors on resuscitation team performance. This review focuses on evidence from simulator studies that focus on human factors and their influence on the performance of resuscitation teams. Similar to studies in real patients, simulated cardiac arrest scenarios revealed many unnecessary interruptions of CPR as well as significant delays in defibrillation. These studies also showed that human factors play a major role in these shortcomings and that the medical performance depends on the quality of leadership and team-structuring. Moreover, simulated video-taped medical emergencies revealed that a substantial part of information transfer during communication is erroneous. Understanding the impact of human factors on the performance of a complex medical intervention like resuscitation requires detailed, second-by-second, analysis of factors involving the patient, resuscitative equipment such as the defibrillator, and all team members. Thus, high-fidelity simulator studies provide an important research method in this challenging field.

  5. Metronome Use for Coordination of Breaths and Cardiac Compressions Delivered by Minimally-Trained Caregivers During Two-Person CPR

    Science.gov (United States)

    Hurst, Victor, IV; West, Sarah; Austin, Paul; Branson, Richard; Beck, George

    2005-01-01

    Astronaut crew medical officers (CMO) aboard the International Space Station (ISS) receive 40 hours of medical training over 18 months before each mission, including two-person cardiopulmonary resuscitation (2CPR) as recommended by the American Heart Association (AHA). Recent studies have concluded that the use of metronomic tones improves the coordination of 2CPR by trained clinicians. 2CPR performance data for minimally-trained caregivers has been limited. The goal of this study was to determine whether use of a metronome by minimally-trained caregivers (CMO analogues) would improve 2CPR performance. 20 pairs of minimally-trained caregivers certified in 2CPR via AHA guidelines performed 2CPR for 4 minutes on an instrumented manikin using 3 interventions: 1) Standard 2CPR without a metronome [NONE], 2) Standard 2CPR plus a metronome for coordinating compression rate only [MET], 3) Standard 2CPR plus a metronome for coordinating both the compression rate and ventilation rate [BOTH]. Caregivers were evaluated for their ability to meet the AHA guideline of 32 breaths-240 compressions in 4 minutes. All (100%) caregivers using the BOTH intervention provided the required number of ventilation breaths as compared with the NONE caregivers (10%) and MET caregivers (0%). For compressions, 97.5% of the BOTH caregivers were not successful in meeting the AHA compression guideline; however, an average of 238 compressions of the desired 240 were completed. None of the caregivers were successful in meeting the compression guideline using the NONE and MET interventions. This study demonstrates that use of metronomic tones by minimally-trained caregivers for coordinating both compressions and breaths improves 2CPR performance. Meeting the breath guideline is important to minimize air entering the stomach, thus decreasing the likelihood of gastric aspiration. These results suggest that manifesting a metronome for the ISS may augment the performance of 2CPR on orbit and thus may

  6. The need to immobilise the cervical spine during cardiopulmonary resuscitation and electric shock administration in out-of-hospital cardiac arrest.

    Science.gov (United States)

    Desroziers, Milene; Mole, Sophie; Jost, Daniel; Tourtier, Jean-Pierre

    2016-06-13

    In cases of out-of hospital cardiac arrest (OHCA), falling to the ground can cause brain and neck trauma to the patient. We present a case of a man in his mid-60s who suffered from an OHCA resulting in a violent collapse. The patient received immediate cardiopulmonary resuscitation, but his spine was immobilised only after a large frontal haematoma was found. The resuscitation efforts resulted in return of spontaneous circulation and discharge from hospital. After this, doctors performed angioplasty, followed by a cardiopulmonary bypass. Later, CT scan examination reported a displaced and unstable fracture of the 6th vertebra without bone marrow involvement. The patient underwent a second operation. 40 days later, he was able to return home without sequela. This case shows the importance of analysing the circumstances of a fall, considering the possibility of two concomitant diagnoses and prioritising investigations and treatment.

  7. Laypersons may learn basic life support in 24min using a personal resuscitation manikin

    DEFF Research Database (Denmark)

    Isbye, Dan Lou; Rasmussen, Lars Simon; Lippert, Freddy Knudsen;

    2006-01-01

    BACKGROUND: Bystander basic life support (BLS) is an important part of cardiopulmonary resuscitation (CPR) and improves outcome after out-of-hospital cardiac arrest. However, the general population has poor BLS skills. Several training initiatives could be used to improve this situation and the c......BACKGROUND: Bystander basic life support (BLS) is an important part of cardiopulmonary resuscitation (CPR) and improves outcome after out-of-hospital cardiac arrest. However, the general population has poor BLS skills. Several training initiatives could be used to improve this situation...... assessed after 3 months, a 24 min DVD-based instruction plus subsequent self-training in BLS appears equally effective compared to a 6h BLS course and hence is more efficient. Udgivelsesdato: 2006-Jun...

  8. 小儿心肺复苏的临床特点及预后的影响因素%Clinical characteristics and the influence factors of prognosis of pediatric cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    王昕

    2015-01-01

    Objective:To analyze the clinical characteristics and the influence factors of prognosis of pediatric cardiopulmonary resuscitation.Methods:46 patients with pediatric cardiopulmonary resuscitation treatment were selected from May 2010 to May 2014.18 cases used cardiopulmonary resuscitation because of cardiac arrest;28 cases used cardiopulmonary resuscitation because of respiratory arrest.The clinical characteristics and prognosis of pediatric cardiopulmonary resuscitation were detailedly analyzed. Results:The cardiopulmonary resuscitation rate 42.9% of respiratory arrest children was higher than the cardiopulmonary resuscitation rate 16.7% of cardiac arrest children,and the difference was statistically significant(P<0.05).The children common diseases caused pediatric cardiopulmonary resuscitation were accidental injuries,infectious diseases and cardiovascular diseases and so on.Conclusion:More attention should be paid to the causes and clinical characteristics of pediatric cardiopulmonary resuscitation.Popularization of pediatric first-aid knowledge and doing a good job in the publicity and education work can effectively improve the rescue success rate of pediatric cardiopulmonary resuscitation and improve prognosis.%目的:分析小儿心肺复苏的临床特点及预后的影响因素。方法:2010年5月-2014年5月收治小儿心肺复苏治疗患者46例,其中因心跳停止采用心肺复苏18例,因呼吸停止采用心肺复苏28例,详细分析小儿心肺复苏的临床特点和预后。结果:呼吸停止患儿的心肺复苏率42.9%高于心跳停止患儿的心肺复苏率16.7%,差异具有统计学意义(P<0.05);引起小儿心肺复苏的患儿常见疾病有意外伤害、感染性疾病以及心血管疾病等。结论:应更加重视引起小儿心肺复苏的原因和临床特点,普及儿科急救的相关知识,做好宣传教育工作,有效提高小儿心肺复苏抢救成功率,改善预后。

  9. Factors influencing outcomes after cardiopulmonary resuscitation in emergency department%急诊科心搏骤停患者心肺复苏预后的影响因素

    Institute of Scientific and Technical Information of China (English)

    薛继可; 冷巧云; 高玉芝; 陈寿权; 李章平; 李惠萍; 黄唯佳; 程俊彦; 章杰

    2013-01-01

    Objective To assess the factors impacting outcomes of cardiopulmonary resuscitation (CPR) after cardiac arrest (CA) in department of emergency.Methods A CPR registry followed the Utstein template was carried out in Department of Emergency of The First Affiliated Hospital of Wenzhou Medical College from January 2005 through December 2011.The outcomes of CPR were compared among groups with various factors.The primary outcomes were rates to return of spontaneous circulation (ROSC),24-hour survival,survival at discharge and survival without neurological deficit at discharge.Univariate and multivariable logistic regression analysis were performed to evaluate factors associated with survival.Results A total of 725 patients with CPR attempts were enrolled for analysis.Of them,187 (25.8%) had ROSC,100 (13.8%) survived over 24 hours,48 (6.6%) survived to discharge,and 23 (3.2%) survived to discharge with favorable neurologic outcome.From a logistic regression analysis,the independent predictors of ROSC included traumatogenic CA,kind of cardiac rhythms observed at first monitoring,CPR duration and total adrenaline dose.The independent predictors of 24-hour survival included traumatogenic CA,cardiogentic CA,kind of cardiac rhythm found at first monitoring and CPR duration.Physical status before CA,cardiogenic CA,kind of cardiac rhythms appeared at first monitoring and CPR duration were independent predictors of survival at discharge and survival with neurologically intact function at discharge.Conclusions Cardiac fibrillation rhythms correctable with defibrillation,CPR duration ≤ 15 min and total adrenaline dose ≤ 5 mg were favorable predictors of ROSC,while traumatogenic CA was unfavorable.Cardiogenic CA,cardiac fibrillation rhythms rectifiable with defibrillation and CPR duration ≤ 15 min were favorable predictors of 24-hour survival,while traumatogenic CA was unfavorable.traumatogenic CA,cardiac dysrhythmia correctable,CPR duration ≤ 15 min were favorable

  10. Using multimedia tools and high-fidelity simulations to improve medical students' resuscitation performance: an observational study

    Science.gov (United States)

    Wang, Candice; Huang, Chin-Chou; Lin, Shing-Jong; Chen, Jaw-Wen

    2016-01-01

    Objectives The goal of our study was to shed light on educational methods to strengthen medical students' cardiopulmonary resuscitation (CPR) leadership and team skills in order to optimise CPR understanding and success using didactic videos and high-fidelity simulations. Design An observational study. Setting A tertiary medical centre in Northern Taiwan. Participants A total of 104 5–7th year medical students, including 72 men and 32 women. Interventions We provided the medical students with a 2-hour training session on advanced CPR. During each class, we divided the students into 1–2 groups; each group consisted of 4–6 team members. Medical student teams were trained by using either method A or B. Method A started with an instructional CPR video followed by a first CPR simulation. Method B started with a first CPR simulation followed by an instructional CPR video. All students then participated in a second CPR simulation. Outcome measures Student teams were assessed with checklist rating scores in leadership, teamwork and team member skills, global rating scores by an attending physician and video-recording evaluation by 2 independent individuals. Results The 104 medical students were divided into 22 teams. We trained 11 teams using method A and 11 using method B. Total second CPR simulation scores were significantly higher than first CPR simulation scores in leadership (p<0.001), teamwork (p<0.001) and team member skills (p<0.001). For methods A and B students' first CPR simulation scores were similar, but method A students' second CPR simulation scores were significantly higher than those of method B in leadership skills (p=0.034), specifically in the support subcategory (p=0.049). Conclusions Although both teaching strategies improved leadership, teamwork and team member performance, video exposure followed by CPR simulation further increased students' leadership skills compared with CPR simulation followed by video exposure. PMID:27678539

  11. Value of coma evaluating approaches in predicting prognosis of patients after cardiopulmonary resuscitation%不同昏迷评估方法判定心肺复苏成功患者预后的价值

    Institute of Scientific and Technical Information of China (English)

    张明; 钱俊英; 李涛; 解建; 徐拥庆; 姜志明

    2012-01-01

    目的 探讨昏迷的客观评估方法和主观评估方法判定心脏骤停后心肺复苏成功患者预后的价值.方法 选择心脏骤停后心肺复苏成功的昏迷患者39例,复苏后24h内行脑电双频指数(BIS)监测,同时进行格拉斯哥昏迷量表(GCS)评分和GCS-Pittsburgh评分,观察其6个月时的预后,并分析不同评估方法判定预后的价值.结果 6个月后,预后良好11例,预后不良28例.三种评估方法的预后不良组分值均明显低于预后良好组(P均<0.05);患者运动反应、对光反射、脑干反射及自主呼吸消失判断预后不良的敏感性均为100%,其中脑干反射的敏感性和特异性均较高;BIS监测判断预后不良的特异性、阳性预测值和准确性显著高于GCS-Pittsburgh评分(P<0.05).结论 三种昏迷评估方法均可判定心肺复苏后昏迷患者预后,但客观评估方法BIS监测对预后不良的判定价值优于主观评估方法.%Objective To determine the value of the objective bispectral index (BIS) and the subjective GCS and GCS-Pittsburgh score in evaluating the prognosis of comatose patients after cardiopulmonary resuscitation (CPR) because of cardiac arrest. Methods A total of 39 comatose patients after successful CPR because of cardiac arrest were included. BIS, CCS and GCS-Pittsburgh value were recorded within 24 hours after CPR, then to observe the prognosis for six months, analyze and evaluate the value of different approachs in predicting prognosis. Results After six months, 11 cases were in bad-prognosis group, 28 cases in good-prognosis group. The evaluation values of bad-prognosis group were lower than those of good-prognosis group ( P < 0.05 ). The sensitivity of vanish of motor reaction, light reflex, brainstem reflex and spontaneously breathing were 100% to predict bad-prognosis. The sensitivity and specificity of brainstem reflex were both high. The specificity, positive predictive and accuracy values of BIS were higher

  12. A comparison between over-the-head and lateral cardiopulmonary resuscitation with a single rescuer by bag-valve mask

    Directory of Open Access Journals (Sweden)

    Ebrahim Nasiri

    2014-01-01

    Full Text Available Context: mask fixation in the lateral position is difficult during CPR. Aim: the aim of this study is to compare the lateral CPR for the use of bag-valve mask by single paramedic rescuer as well as over-the-head CPR on the chest compression and ventilation on the manikin. Settings and Design: Mazandaran University of Medical Sciences. The design of this study was a randomized cross-over trial. Methods: participants learned a standardized theoretical introduction CPR according to the 2010 guidelines. The total number of chest compressions per two minutes was measured. Total number of correct and wrong ventilation per two minutes was evaluated. Statistical Analysis: we used Wilcoxon signed-rank test to analyze the non-normally distributed data in dependence groups A. P-value of more than 0.05 was considered to show statistical significance. Results: there were 100 participants (45 women and 55 men who participated in the study from September to March, 2011. The compression and ventilation rate in lateral CPR was lower than OTH CPR. Around 51% of participants had correct chest compression rate more than 90 beats per minute in lateral CPR and 65% of them had equal or more than ten correct ventilations per minute. Conclusions: in conclusion, this study confirmed that in a simulated CPR model over-the-head position CPR led to a better BLS than the lateral position CPR by a single paramedic student with a BVM device. We also concluded that by this new BVM fixation method on the face of the patients in the lateral position CPR can be a good alternative over-the-head mask fixation by a single trained rescuer.

  13. Optimal control applied to a thoraco-abdominal CPR model.

    Science.gov (United States)

    Jung, Eunok; Lenhart, Suzanne; Protopopescu, Vladimir; Babbs, Charles

    2008-06-01

    The techniques of optimal control are applied to a validated blood circulation model of cardiopulmonary resuscitation (CPR), consisting of a system of seven difference equations. In this system, the non-homogeneous forcing terms are chest and abdominal pressures acting as the 'controls'. We seek to maximize the blood flow, as measured by the pressure difference between the thoracic aorta and the right atrium. By applying optimal control methods, we characterize the optimal waveforms for external chest and abdominal compression during cardiac arrest and CPR in terms of the solutions of the circulation model and of the corresponding adjoint system. Numerical results are given for various scenarios. The optimal waveforms confirm the previously discovered positive effects of active decompression and interposed abdominal compression. These waveforms can be implemented with manual (Lifestick-like) and mechanical (vest-like) devices to achieve levels of blood flow substantially higher than those provided by standard CPR, a technique which, despite its long history, is far from optimal.

  14. Investigation on the update of 2005 Cardiopulmonary Resuscitation Guidelines in Chinese emergency medicine books%2005年心肺复苏指南在中国急诊医学书籍中内容更新的调查

    Institute of Scientific and Technical Information of China (English)

    卢章洪; 赵剡; 陈志桥; 王秋婷

    2011-01-01

    Objective To investigate if the update of cardiopulmonary resuscitation in Chinese Emergency medicine books can keep pace with the international cardiopulmonary resuscitation research.Methods To design the questionnaire according to the standard of 2005 American Heart Association CPR guidelines.To investigate and analyze the items of CPR in the emergency medicine books, which were published from March 2006 to December 2009 in China.Results This study investigated and analyzed 45 emergency medicine books from 23 publishers.The basic integrity of CPR in the books published in 2008 ~2009 (81.8% ) was better than that in 2006 ~2007 (34.8%).But the systemic integrity and errors were same between different years, there was no significant difference.The errors were almost existed in every parts of CPR, mainly in three areas: ①Still followed the 2000 CPR guidelines; ② Some special methods in China; ③It was inconsistency or ambiguous at the same point.The highest error rates are: volume of artificial ventilation (61.5%), check for response (50.0%),location of chest compressions (45.0%) and time of breath checking (43.5%).Conclusion There was great improvement of emergency medicine textbooks, but it still needs more improvement of details.It had failed to do timely and completely the update in the international CPR guidelines, and still had some outdated knowledge.%目的 探讨中国急诊医学书籍中关于心肺复苏术内容的更新程度能否跟上国际心肺复苏研究的步伐.方法 以2005年美国心脏协会心肺复苏术指南中的知识点为标准,自行设计调查表,对2006年3月至2009年12月期间中国出版的,针对专业医务人员的急诊医学书籍中心肺复苏术操作描述进行调查分析.结果 本次研究调查分析了自全国23个出版社的45本针对专业医务人员的急诊医学书籍.在心肺复苏术基本操作流程的完整性上,2008~2009年出版的书籍(81.8%) 高于2006~2007

  15. Rescuing the drowned: cardiopulmonary resuscitation and the origins of emergency medicine in the eighteenth century.

    Science.gov (United States)

    Marinozzi, Silvia; Bertazzoni, Giuliano; Gazzaniga, Valentina

    2011-08-01

    The concept of a medical emergency, i.e., a time when immediate action is required to stabilize and restore the vital functions, is absent in the tradition of ancient medicine, which seeks to cure the sick. The theoretical and conceptual development of a prompt medical assistance definitely owes much to the refinement of instruments and surgical techniques that were develop in the early modern age, allowing the extension of therapeutic action to "healthy" individuals who are suddenly life-threatened due to an accident or to some external events that affect their vital functions. But it is especially in the eighteenth century that the epistemic basis of medical emergency is structured, when the Enlightenment gave rise to the ethical and political imperative of public assistance that required the planning of first aid at multiple levels, and medicine developed the concept of life-saving treatment. In particular, eighteenth century medicine, studying systems to assure immediate relief to the victims of accidents-especially to the drowned-allowed the development of specific and methodological systems of resuscitation and emergency treatment.

  16. A good resuscitation model of non-transthoracic cardiopulmonary bypass in rats

    Institute of Scientific and Technical Information of China (English)

    AN Yong; XIAO Ying-bin; ZHONG Qian-jin

    2007-01-01

    Objective:To establish a good recoverable rat model of cardiopulmonary bypass (CPB) to lay the foundation for studying the pathophysiology of CPB.Methods:Twenty adult male Sprague-Dawley rats weighing 480 g um via the right jugular vein and further transferred by a miniaturized roller pump to a hollow fiber oxgenator and back to the rat via the left carotid artery. Priming consisted of 8 ml of homologous blood and 6 ml of colloid. The surface of the hollow fiber oxgenator was 0.075 m2. Rats were catheterized and brought in bypass for 120 min at a flow rate of 100-120 ml/kg/min. Oxygen flow/ perfusion flow was 0. 8 to 1. 0, the mean arterial pressure (MAP) kept in 60-80 mmHg. Blood gas analysis, lactate dehydrogenase (LDH), and survival rate were examined subsequently.Results: All CPB rats recovered from the operative process without incident and remained uneventful within one week. Normal cardiac function after successful weaning was confirmed by electrocardiography and blood pressure measurements. MAP remained stable. The results of blood gas analysis at different time points were within a normal range. No significant haemolysis could be detected in the given time frame under bypass condition by using LDH.Conclusions: The rat model of CPB can principally simulate the clinical setting of human CPB. The nontransthoracic model is easy to establish and is associated with excellent recovery. This well reproducible model may open the field for various studies on pathophysiological process of CPB and also of systemic ischemia-reperfusion injury in vivo.

  17. 开展院前心肺复苏培训的必要性及措施%Carry Out Pre-hospital Cardiopulmonary Resuscitation Training Necessity and Measures

    Institute of Scientific and Technical Information of China (English)

    宗毅; 刘风; 洪波; 张翠荣; 张姣

    2013-01-01

    目的:探讨开展院前心肺复苏(CPR)培训的必要性及措施。方法组织急救中心的急救人员了解院前急救的主要特点,并进行院前心肺复苏培训,培训包括理论培训及实践训练,理论知识的掌握可通过调查问卷形式进行考核。实践操作训练中急救小组人员进行团队合作,模拟现场急救,根据操作规范来进行评分统计,同时进行急救措施的总结。结果通过院前急救知识的培训后,急救的效率较之前未培训有所提升,在操作评分上平均达到(93.5±2.32),未进行急救培训时模拟评分为(70.26±1.22),对比统计差异有统计学意义。对参与急救的人员进行调查问询,其中有95%的急救人员认为科学全面的院前急救培训对自我技能及团队协作能力的提高有重要作用。结论对急救人员进行综合化、系统化的院前培训可以提高个人的技能,同时更好的和团队其他急救人员协作完成急救任务,提高急救的效率,从而减少患者的病死率,以便接受进一步的救治。%Objective To investigate the conduct of pre-hospital cardiopulmonary resuscitation (CPR) training Necessity and Measures. Methods Tissue emergency center prehospital emergency personnel to understand the main features, and conduct pre-hospital cardiopulmonary resuscitation training, training consists of theoretical training and practical training, theoretical knowledge mastered by the questionnaire form for assessment. Practical operation personnel training aid teams teamwork, analog-site ifrst aid, according to the operating speciifcations for scoring statistics, while a summary of ifrst aid measures. Results The knowledge of ifrst aid training, ifrst aid efifciency has improved compared to the previous untrained in the operation to achieve an average rating of (93.5 ± 2.32), ifrst aid training is not analog score was (70.26 ± 1.22), compared statistics the

  18. Low-dose tenecteplase during cardiopulmonary resuscitation due to massive pulmonary embolism: a case report and review of previously reported cases.

    Science.gov (United States)

    Hefer, David Václav Fred; Munir, Aman; Khouli, Hassan

    2007-10-01

    The case of a 29 year-old man who suffered a cardiac arrest due to a massive pulmonary embolism while he was undergoing surgical repair of a complex tibial plateau fracture is presented. After 70 min of unsuccessful cardiopulmonary resuscitation a bolus of 20 mg tenecteplase was given, with a return of spontaneous circulation 2 min after administration of the drug. Pulmonary embolism was subsequently demonstrated on a pulmonary angiogram. To our knowledge this is the first report to show that the use of a low dose of tenecteplase might be useful to achieve the return of spontaneous circulation in the resuscitation of patients with cardiac arrest secondary to massive pulmonary embolism. Previously reported cases are reviewed.

  19. 心肺复苏护理实习教学路径联合以案例为基础的学习法的效果%Effect of the Combined Cardiopulmonary Resuscitation Nursing Practice and Case-based Learn-ing Teaching Method

    Institute of Scientific and Technical Information of China (English)

    张红桥; 郭慧芳; 林冬梅; 钟华; 韩婷

    2015-01-01

    目的:探讨心肺复苏(cardiopulmonary resuscitation ,CPR)护理实习教学路径联合“以案例为基础的学习(case-based learning , CBL )”教学模式在临床教学中的应用效果。方法2012年,便利抽样法选取在大连医科大学附属第一医院三部急诊重症监护护病房实习的100名护理本科生为研究对象,按随机数字表法将其分为对照组(n=50)和观察组(n=50)。对照组护理本科生采用以授课为基础的学习(lecture-based learning ,LBL )教学法,观察组护理本科生采用护理实习教学路径联合CBL教学法。实习结束时比较两组学生CPR综合技能考核成绩,以及在完成CPR情景案例的演习中所消耗的时间;同时调查学生对教学方法的满意度。结果两组护理本科生,在医护协作、组织管理、护理文书等方面的差异均有统计学意义(P<00.5或 P<00.1)。观察组护理本科生CPR综合技能考核总成绩优于对照组,差异有统计学意义(P<00.1)。在情景案例的演习中,观察组护理本科生耗时明显缩短,与对照组比较,差异有统计学意义(t=34.6,P<00.5)。观察组学生对教学方法的满意率为96%。结论 CPR护理实习教学路径联合CBL教学法能有效提高学生的临床综合实践能力。%Objective To discuss the application effect of combining cardiopulmonary resuscitation(CPR) nursing practice and case-based learning(CBL) teaching method .Methods By convenience sampling ,100 students were selected and equally divided into control group and observation group .The control group received lecture-based learning teaching method ,while the observation group applied with CBL teaching method .The CPR practice assessment score ,time assumption during the CPR practice were compared between two groups ,and the satisfaction level was compared be-tween two groups .Results There were statistical significance

  20. Association of bystander cardiopulmonary resuscitation and survival according to ambulance response-times after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Rajan, Shahzleen; Wissenberg, Mads; Folke, Fredrik;

    2016-01-01

    chances decreased both for patients with bystander CPR and those without. However, the contrast between the survival chances of patients with vs. without bystander CPR increased over time: within 5 minutes, 30-day survival was 14.5% (95% CI: 12.8-16.4) vs. 6.3% (95% CI: 5.1-7.6), corresponding to 2.......3 times higher chances of survival associated with bystander CPR; within 10 minutes, 30-day survival chances were 6.7% (95% CI: 5.4-8.1) vs. 2.2% (95% CI: 1.5-3.1), corresponding to 3.0 times higher chances of 30-day survival associated with bystander CPR. The contrast in 30-day survival became...... statistically insignificant when response time exceeded 13 minutes (bystander CPR vs. no bystander CPR: 3.7% [95% CI: 2.2-5.4] vs. 1.5% [95% CI: 0.6-2.7]) but 30-day survival was still 2.5 times higher associated with bystander CPR. Based on the model and Danish OHCA Statistics, an additional of 233 patients...

  1. Training on cardiopulmonary resuscitation for mine rescue team members%对矿山救护队员心肺复苏技能培训的研究分析

    Institute of Scientific and Technical Information of China (English)

    赵小魁; 张斌; 王强; 杨万石

    2011-01-01

    Since 2005 regular training on cardiopulmonary resuscitation (CPR) has been held long-term.The experienced clinical physicians of the National Mine Emergency Aid Center (Coal General Hospital) are responsible for giving lectures and guiding practical exercises with manikins, based on the American Heart Association Guidelines for CPR and Emergency Cardiac. Care for more than 500 members of more than 60 mine rescue teams from 24 provinces, autonomous regions, and municipalities in China for 5 years. And then similar training at grassroots levels has been held with these persons who are to play a core role. Since 2006 3 sessions of National Mine Rescue Competition were held (2006, 2008, and 2010). The authors of this article participated in 3 Sections on CPR of 3 successive sessions of National Mine Rescue Competition (Sixth to Eighth). The results of the competitions showed that the numbers of general deduct marks in CPR in the Seventh and Eighth Competitions were both less than that in the Sixth Competition (both P<0.05) without significant difference between the results of the latter 2 sessions of competition (P>0.05). The practice showed that since most of the members of the mine rescue teams are from the minors who lack medical knowledge, systematic teaching is necessary, and it is effective to use the experience of one point to lead the whole area.%从2005年开始长期对矿山救护队员进行CPR的培训及训练.根据,国家矿山医疗救护中心(煤炭总医院)经验丰富的临床医师负责讲课,并指导用模拟人实际操作.5年来分批次直接培训全国24个省、市、自治区的重点60余支矿山救护队中核心成员500余名,再通过这些救护队核心成员进行基层的培训及演练.2006年起在全国矿山救援竞赛中进行CPR竞赛,本文作者参与第6~8届CPR竞赛的裁判工作.竞赛结果表明,第七和第八届竞赛中CPR操作扣分均显著低于第六届差异有统计学意义(P0.05).实践表

  2. The effects of Shenfu injection on the multiple-organ protection in patients after cardiopulmonary resuscitation%参附注射液对心肺复苏多脏器功能保护的研究

    Institute of Scientific and Technical Information of China (English)

    黄君龄; 孟婧; 袁颖; 薛明明; 杨伟强; 顾国嵘; 姚晨玲; 童朝阳; 沈洪

    2014-01-01

    目的 观察参附注射液对急诊心肺复苏术(cardiopulmonary resuscitation,CPR)后患者的脏器功能的保护作用及预后的影响.方法 采用前瞻性随机对照研究的方法,将2011年6月至2013年7月经复旦大学附属中山医院收治的124名急诊心肺复苏术患者,自主循环恢复超过24h,随机分为参附治疗组与常规治疗组,参附治疗组复苏成功后予以参附注射液以及急救治疗,常规治疗组给予除参附注射液之外的所有急救治疗.两组患者治疗至第14天,随访两组患者生存率、心肌钙蛋白(cardiac troponin,cTnT)、心房利纳肽(atrial natriuretic peptide,BNP)、血清丙氨酸氨基转移酶(alanine aminotransferase,ALT)、血清门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、肌酐(creatinine,Cr)、C反应蛋白(C reactive protein,CRP)水平,氧合指数(PaO2/FiO2)以及格拉斯评分.统计学方法采用单因素ANOVA方差分析检验组内的样本差异和组间差异,以P <0.05为差异有统计学意义.结果 (1) 124例急诊心肺复苏术患者,参附治疗组68例,常规治疗组56例,随访14 d后参附治疗组存活47例,常规治疗组存活32例.(2)与常规治疗组比较,参附治疗组患者的cTnT显著降低(P =0.023),BNP显著降低(P =0.001);ALT显著降低(P=0.010),AST显著降低(P =0.001),sCr显著降低(P =0.008);CRP组显著降低(P=0.001),参附治疗组氧合指数(PO2/FiO2)较常规治疗组显著升高(P=0.001),格拉斯评显著升高(P=0.001).结论 参附注射液可以减轻急诊心肺复苏术后患者重要脏器的缺血-再灌注损伤,保护心、脑、肺、肝、肾重要脏器的功能,可以改善急诊心肺复苏术后患者的预后.%Objective To investigate the efficacy of Shenfu injection for the protection of multipleorgan function in patients after cardiopulmonary resuscitation (CPR) and evaluate the prognosis.Methods A prospective randomized and controlled study was carried out from June 2011 through

  3. 急诊猝死流行病学特征及心肺复苏效果分析%Research of sudden death characteristics and clinical analysis of cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    占志刚

    2016-01-01

    Objective To investigate the effect of cardiopulmonary resuscitation in emergency treatment of sudden death.Methods The clinical data of 150 emergency death patients from January 2012 to December 2015 in People’s Hospital of Daxing District were retrospectively analyzed, epidemiological information including:gender, age, previous history of sudden death in patients with aura symptoms before sudden death, incentives, workplace, season occurrence and time characteristics of sudden death, and clinical effect of cardio-pulmonary resuscitation (CPR) was also analyzed.Results Among those patients, number of males was higher than that of females. The incidence of sudden death was higher in patients of following groups: between 60~79 years old, had history of cardiovascular disease, had premonitory symptom or with known risk factors; and it was higher in winter and spring than other seasons (P<0.05). As to the time distribution, 4~12 o’clock was the peak time of sudden death, following a slight increasing during 16~20 o’clock, and 0~4 o’clock was the time of lowest incidence. 142 patients had prehospital sudden death, 11 of them received CPR at the first time by witness at the scene, only 5 patients survived after CPR (3.33%, 5/150).Conclusion Emergency treatment of sudden death is usually given priority to middle-aged male-dominated, sudden cardiac death is the main reason. Cardiopulmonary resuscitation of the first responder on the spot combined with professional defibrillation and drug symptomatic treatment can improve the success rate of recovery of sudden death.%目的:分析急诊猝死流行病学特征并探讨心肺复苏对急诊猝死患者的急救效果。方法回顾性分析2012年1月~2015年12月于北京市大兴区人民医急诊科救治的150例急诊猝死病例的临床资料,从猝死患者的性别、年龄、既往史、猝死前先兆症状、诱因、猝死发生场所、猝死发生季节及时间等方面分析猝死的流行病

  4. Time to start of cardiopulmonary resuscitation and the effect of target temperature management at 33°C and 36°C

    DEFF Research Database (Denmark)

    Dankiewicz, Josef; Friberg, Hans; Bělohlávek, Jan;

    2016-01-01

    INTRODUCTION: The optimal temperature during targeted temperature management (TTM) for comatose patients resuscitated from out-of-hospital cardiac arrest is unknown. It has been hypothesized that patients with long no-flow times, for example those without bystander CPR would have the most to gain...... from temperature management at lower temperatures. METHODS: We analysed data from an international clinical trial randomizing cardiac arrest patients to targeted temperature management at 33°C and 36°C for an interaction between no-flow time and intervention group, with neurological function at six...... months after cardiac arrest as the primary outcome. A cerebral performance category (CPC) score of 1 or 2 was considered a good outcome. RESULTS: No-flow time (min) was associated with poor neurological outcome (OR 1.13, 95% confidence interval 1.06-1.20, p

  5. Cerbral protection effect of citicoline after successful cardiopulmonary resuscitation%胞磷胆碱对心肺复苏成功后脑保护作用分析

    Institute of Scientific and Technical Information of China (English)

    张惠娟; 张谨超

    2012-01-01

    Objective To study the effect of citicoline on prognosis of brain resuscitation after successful cardiopulmonary resuscitation(CPR).Methods All 422 patients with successful CPR from year 2007 to 2011 were divided into citicoline group (203 cases) and non-citicoline group (219 cases).Glasgow coma scale (GCS) score and clinic nerve function comprehensive score(NFCS) were analyzed and compared in citicoline group and non-citicoline group.Results Shortly after CPR,the scores of GCS and NFCS were not different between citicoline group and non-citicoline group [(6.4 ± 1.3) scores vs (6.3 ± 1.5) scores,(8.4 ± 1.4) scores vs (8.3 ± 1.9) scores,all P >0.05].7 days after CPR,the scores of GCS and NFCS were higher than those in 0 day after CPR in citicoline group [(12.0 ± 1.4) scores vs (6.4 ± 1.3) scores,(15.3 ± 2.0) scores vs (8.4 ± 1.4) scores] and non-citicoline group [(8.2 ± 1.5) scores vs (6.3 ± 1.5) scores,(11.8 ± 1.5) scores vs (8.3 ± 1.9) scores],and the scores of GCS and NFCS in citicoline group were higher than those in non-citicoline group [(12.0 ± 1.4) scores vs (8.2 ± 1.5)scores,(15.3 ± 2.0) scores vs (11.8 ± 1.5) scores] (all P < 0.05).Conclusions The nerve function status and quality of life in patients after successful CPR can be improved by citicoline.%目的 观察胞磷胆碱对心肺复苏术成功后患者脑复苏预后的影响.方法 以2007年2月至2011年6月我院422例心肺复苏成功患者为研究对象,按是否应用胞磷胆碱将患者分为2组,胞磷胆碱组203例,非胞磷胆碱组219例,分析并比较患者住院即刻及住院7d格拉斯哥昏迷量表(GCS)评分、临床神经功能综合(NFCS)评分.结果 心肺复苏后即刻,胞磷胆碱组和非胞磷胆碱组GCS评分、NFCS评分比较差异无统计学意义[(6.4±1.3)分比(6.3 ±1.5)分,(8.4±1.4)分比(8.3±1.9)分,均P>0 05];复苏第7天,胞磷胆碱组和非胞磷胆碱组GCS评分、NFCS评分均明显高于复苏即刻[胞磷胆碱组:(12.0±1

  6. Effect of bystander CPR initiation prior to the emergency call on ROSC and 30day survival-An evaluation of 548 emergency calls

    DEFF Research Database (Denmark)

    Viereck, Søren; Palsgaard Møller, Thea; Kjær Ersbøll, Annette;

    2016-01-01

    BACKGROUND: This study aimed at evaluating if time for initiation of bystander cardiopulmonary resuscitation (CPR) - prior to the emergency call (CPRprior) versus during the emergency call following dispatcher-assisted CPR (CPRduring) - was associated with return of spontaneous circulation (ROSC......) and 30-day survival. The secondary aim was to identify predictors of CPRprior. METHODS: This observational study evaluated out-of-hospital cardiac arrests (OHCA) occurring in the Capital Region of Denmark from 01.01.2013 to 31.12.2013. OHCAs were linked to emergency medical dispatch centre records...... and corresponding emergency calls were evaluated. Multivariable logistic regression analyses were applied to evaluate the association between time for initiation of bystander CPR, ROSC, and 30-day survival. Univariable logistic regression analyses were applied to identify predictors of CPRprior. RESULTS: The study...

  7. Effects of Blended Cardiopulmonary Resuscitation and Defibrillation E-learning on Nursing Students' Self-efficacy, Problem Solving, and Psychomotor Skills.

    Science.gov (United States)

    Park, Ju Young; Woo, Chung Hee; Yoo, Jae Yong

    2016-06-01

    This study was conducted to identify the educational effects of a blended e-learning program for graduating nursing students on self-efficacy, problem solving, and psychomotor skills for core basic nursing skills. A one-group pretest/posttest quasi-experimental design was used with 79 nursing students in Korea. The subjects took a conventional 2-week lecture-based practical course, together with spending an average of 60 minutes at least twice a week during 2 weeks on the self-guided e-learning content for basic cardiopulmonary resuscitation and defibrillation using Mosby's Nursing Skills database. Self- and examiner-reported data were collected between September and November 2014 and analyzed using descriptive statistics, paired t test, and Pearson correlation. The results showed that subjects who received blended e-learning education had improved problem-solving abilities (t = 2.654) and self-efficacy for nursing practice related to cardiopulmonary resuscitation and defibrillation (t = 3.426). There was also an 80% to 90% rate of excellent postintervention performance for the majority of psychomotor skills, but the location of chest compressions, compression rate per minute, artificial respiration, and verification of patient outcome still showed low levels of performance. In conclusion, blended E-learning, which allows self-directed repetitive learning, may be more effective in enhancing nursing competencies than conventional practice education.

  8. Correlation between Success Rates of Cardiopulmonary Cerebral Resuscitation and the Educational Level of the Team Leader; A Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Shahram Bolandparvaz

    2015-10-01

    Full Text Available Objectives: To determine the correlation between the success rates of the cardiopulmonary cerebral resuscitation (CPCR and the team’s leader education and skill level in Shiraz, southern Iran. Method: This cross-sectional study was conducted during a 6-month period from October 2007 to March 2008 in Nemazee hospital of Shiraz. We included all the patients who underwent CPCR due to cardiopulmonary arrest in emergency room of Nemazee hospital during the study period. We recorded the rates of return of spontaneous circulation (ROSC and discharge rate (DR of all the patients. The correlation between these two parameters and the team leader’s education and skill level was evaluated. Results: Overall we included total number 600 patients among whom there were 349 men (58.1% and 251(41.8% women with mean age of 58.9±42.6. We found that 270 (45.1% patients had ROSC, while 330 (54.9% patients died. Overall 18 (6.6% patients were discharged from hospital (3% of all participants. We found that the ROSC was significantly higher in those with specialist leader (anesthesiologist or pediatrician when compared to those in whom CPCR was conducted by technicians (55.2% vs. 30.7%; p=0.001. Conclusion: Conducting CPCR by persons with higher medical degrees resulted in higher rate of ROSC but not in more discharge rate. Inspite of the fact that the rate of ROSC following CPCR was closely analogous to that of developed countries, discharge rate was lower. This indicates that in our region, much more attention needs to be paid to post-resuscitation care and organizing training programs and to cover more resuscitation by CPCR team, conducted by the specialists.

  9. The predictive value of the 40 Hz auditory steady-state response in coma following cardiopulmonary resuscitation: a retrospective cohort study of 30 cases%40Hz听性稳态反应在心肺复苏后昏迷中的预测价值——30例回顾性队列研究

    Institute of Scientific and Technical Information of China (English)

    牟素花; 姬仲; 吴永明; 卢知娟; 王静新; 陈琼; 潘速跃

    2011-01-01

    Objective To investigate the predictive value of early prognosis of the 40 Hz auditory steady-state response (40 Hz ASSR) in patients with coma following cardiopulmonary resuscitation (CPR). Methods Thirty patients with coma following CPR admitted in the Neurological Intensive Care Unit (NICU) were examined with the 40 Hz ASSR and shortlatency somatosensory evoked potential (SLSEP), and both were graded. Using transferred out of NICU as the short-term outcome end point, the patients with coma following CPR were divided into a survival group (n =21) and a death group (n =9; including brain death). The correlation between the 40 Hz ASSR and SLSEP grading and prognosis was analyzed. Results The grades of the 40 Hz ASSR (r = 0. 722, P = 0.000) or SLSEP (r = 0. 430, P = 0.018) was significantly correlated with the short-term prognosis. The sensitivity, specificity and accuracy of the 40 Hz ASSR for predicting the short-term prognosis were 77. 8%, 100% and 93.3%, respectively; and those of SLSEP were 88. 9%, 61. 9% and 70. 0%, respectively. Conclusions The 40 Hz ASSR has a certain prognostic value in patients with coma following CPR. The higher the grade of the 40 Hz ASSR is, the greater the likelihood of the recent death.%目的 探讨40 Hz听性稳态反应(40 Hz auditory steady-state response,40 Hz ASSR)对心肺复苏(cardiopulmonary resuscitation,CPR)后昏迷患者早期预后的预测价值.方法 对神经重症监护病房(neurological intensive care unit,NICU)收治的30例CPR后昏迷患者进行40 Hz ASSR和短潜伏期体感诱发电位(short-latence somatosensory evoked potentials,SLSEP)检查,并对两者进行分级.以转出NICU时为近期预后评价终点,将CPR后昏迷患者分为存活组(n=21)和死亡组(包括脑死亡,n=9),分析40 Hz ASSR和SLSEP分级与预后的相关性.结果 40 Hz ASSR(r=0.722,P=0.000)和SLSEP(r=0.430,P=0.018)分级与近期预后显著相关.40 Hz ASSR预测近期预后的特异性为100%,敏感性为77.8%,准确性为93

  10. Clinical audit on documentation of anticipatory "Not for Resuscitation" orders in a tertiary australian teaching hospital

    Directory of Open Access Journals (Sweden)

    Naveen Sulakshan Salins

    2011-01-01

    Full Text Available Aim: The purpose of this clinical audit was to determine how accurately documentation of anticipatory Not for Resuscitation (NFR orders takes place in a major metropolitan teaching hospital of Australia. Materials and Methods: Retrospective hospital-based study. Independent case reviewers using a questionnaire designed to study NFR documentation reviewed documentation of NFR in 88 case records. Results: Prognosis was documented in only 40% of cases and palliative care was offered to two-third of patients with documented NFR. There was no documentation of the cardiopulmonary resuscitation (CPR process or outcomes of CPR in most of the cases. Only in less than 50% of cases studied there was documented evidence to suggest that the reason for NFR documentation was consistent with patient′s choices. Conclusion: Good discussion, unambiguous documentation and clinical supervision of NFR order ensure dignified and quality care to the dying.

  11. Development of a smart backboard system for real-time feedback during CPR chest compression on a soft back support surface.

    Science.gov (United States)

    Gohier, Francis; Dellimore, Kiran; Scheffer, Cornie

    2013-01-01

    The quality of cardiopulmonary resuscitation (CPR) is often inconsistent and frequently fails to meet recommended guidelines. One promising approach to address this problem is for clinicians to use an active feedback device during CPR. However, one major deficiency of existing feedback systems is that they fail to account for the displacement of the back support surface during chest compression (CC), which can be important when CPR is performed on a soft surface. In this study we present the development of a real-time CPR feedback system based on an algorithm which uses force and dual-accelerometer measurements to provide accurate estimation of the CC depth on a soft surface, without assuming full chest decompression. Based on adult CPR manikin tests it was found that the accuracy of the estimated CC depth for a dual accelerometer feedback system is significantly better (7.3% vs. 24.4%) than for a single accelerometer system on soft back support surfaces, in the absence or presence of a backboard. In conclusion, the algorithm used was found to be suitable for a real-time, dual accelerometer CPR feedback application since it yielded reasonable accuracy in terms of CC depth estimation, even when used on a soft back support surface.

  12. 心肺复苏循环恢复后淀粉酶改变与预后关系的研究%Prognosis meaning of the serum amylase change during cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    李玉范; 孟庆义

    2001-01-01

    目的探讨心肺复苏期间血清淀粉酶变化的预后意义。方法对42例进行心肺复苏并一度建立自主循环的心跳骤停患者的血清淀粉酶、血气分析指标和24h生存率进行观察。结果①血清淀粉酶>400 U/L组的24h生存率(16.7%)明显低于<400U/L组(70.8%,P=0.00055);②血清淀粉酶逐渐增高组的死亡率高于逐渐降低组(P=0.05450);③24h生存组的血清淀粉酶水平为431.3±229.5 U/L,低于死亡组(559.0±254.9 U/L),2组比较差异接近显著(t=1.865,P<0.1);④血清淀粉酶>400U/L组的pH值为7.014±0.228,明显低于<400 U/L组(pH 7.137±0.165),差异显著(t=2.031,P<0.05)。结论心肺复苏期间血清淀粉酶升高,尤其是逐渐增高者,提示预后不良。%Objective To explore the prognosis meaning of the change of the serum amylase during cardiopulmonary resuscitation (CPR).Methods Observe the changes of the serum amylase, blood gas analysis index and the 24 hours survival rate in 42 cardiac arrest patients who have been treated with CPR and once recovered autonomous circulation. Result ①The survival rate(16.7% )in the group whichserum amylase level > 400 U/L is much higher than that which serum amylase level < 400 U/L(70.8%, P = 0.00055) ;②The group which serum amylase level gradually rise has higher dead rate than that of serum amylase gradually dropped ( P = 0.0545) ;③The mean level of the serum amylase in 24 hour' s survival group is lower than that of the dead group, and the difference between the two group is nearly significant ( P < 0. 1); ④The pH value in the group with serum amylase > 400 U/L is 7.014 ± 0.228, which is lower than those with serum amylase <400 U/L(pH = 7.137 ± 0.167), the difference is very significant (P < 0.005). Conclusion The rise of the serum amylase during CPR indicates unfavorable prognosis.

  13. 影响急诊科心肺复苏效果的多因素分析%A Logistic regression analysis on the factors influencing effect of cardiopulmonary resuscitation in emergency department

    Institute of Scientific and Technical Information of China (English)

    张豪; 梁实; 陈清; 周文; 肖建鹏; 陈宏标

    2010-01-01

    Objective To look for the independent factors influencing the effect of cardiopulmonary resuscitation (CPR) in emergency department. Methods The data of patients involved in the study were retrieved from 72 network emergency hospitals in Shenzhen from September 2004 to January 2009. The data base was set up with EpiData software, according to questionnaires about cardiopulmonary arrest (CA)patients treated with CPR, and analyzed with SPSS 13.0 software. The binary Logistic regression was carried out with 8 factors which had emerged statistical significance through single factor analysis. Results A Logistic regression analysis on the factors influencing return of spontaneous circulation (ROSC) in emergency department showed the ventrical fibrillation [VF, odds ratio (OR) = 3. 071, P = 0. 000, 95% confidence interval (95%CI)=2. 019 - 4. 670] and pulseless electric activity (PEA, OR=1. 730, P=0. 036,95%CI= 1. 036- 2. 890) were protective factors compared with asystole; electric shock was a protective factor (OR=1. 574, P=0. 015, 95%CI=1. 093 - 2. 265); adrenaline ≤4 mg group had higher likelihood of obtaining ROSC compared with group receiving ≥ 5 mg of adrenaline (OR = 1.483, P= 0.037,95%CI=1.024-2.147); duration of CA before CPR was a risk factor (OR = 0.961, P = 0.000,95%CI=0. 946-0. 976). A Logistic regression analysis on the factors influencing survival to admission in emergency department showed the VF was a protective factor compared with asystole (OR = 2.013,P=0. 002, 95%CI= 1. 299- 3. 121); adrenine ≤4 mg group had higher likelihood of survival to admission compared with group ≥5 mg (OR=2. 289, P=0. 000, 95 %CI=1. 487 -3. 524); duration of CA before CPR was a risk factor (OR = 0. 951, P=0. 000, 95%CI = 0. 933 - 0. 969). Conclusion Rhythm of heart, the duration of CA, electric shock and accumulated adrenaline dosage were independent influencing factors for ROSC in emergency department. Rhythm of heart, the duration of CA and accumulated adrenaline

  14. [A brief history of resuscitation - the influence of previous experience on modern techniques and methods].

    Science.gov (United States)

    Kucmin, Tomasz; Płowaś-Goral, Małgorzata; Nogalski, Adam

    2015-02-01

    Cardiopulmonary resuscitation (CPR) is relatively novel branch of medical science, however first descriptions of mouth-to-mouth ventilation are to be found in the Bible and literature is full of descriptions of different resuscitation methods - from flagellation and ventilation with bellows through hanging the victims upside down and compressing the chest in order to stimulate ventilation to rectal fumigation with tobacco smoke. The modern history of CPR starts with Kouwenhoven et al. who in 1960 published a paper regarding heart massage through chest compressions. Shortly after that in 1961Peter Safar presented a paradigm promoting opening the airway, performing rescue breaths and chest compressions. First CPR guidelines were published in 1966. Since that time guidelines were modified and improved numerously by two leading world expert organizations ERC (European Resuscitation Council) and AHA (American Heart Association) and published in a new version every 5 years. Currently 2010 guidelines should be obliged. In this paper authors made an attempt to present history of development of resuscitation techniques and methods and assess the influence of previous lifesaving methods on nowadays technologies, equipment and guidelines which allow to help those women and men whose life is in danger due to sudden cardiac arrest.

  15. Analysis of professional prehospital emergency treatment effect on the success rate of cardiopulmonary resuscitation%分析专职化院前急救对心肺复苏成功率的影响

    Institute of Scientific and Technical Information of China (English)

    蒲亚军

    2015-01-01

    the two groups. Results The implementation of professional prehospital emergency observation group of CRI time was signiifcantly shorter than that of the control group, signiifcant difference has statistical signiifcance (P<0.05). Patients in the observation group through timely and effective emergency treatment of cardiac pulmonary resuscitation success rate of 17.2%(16cases), while the control group of patients with cardiopulmonary complex Su, the success rate was only 3.3%(3cases). The obvious differences between the two groups, statistical signiifcance (P<0.05). Conclusion The management of the pre hospital emergency treatment can effectively improve the efifciency of the ifrst aid, and increase the success rate of CPR.

  16. Cardiovascular implanted electronic devices in people towards the end of life, during cardiopulmonary resuscitation and after death: guidance from the Resuscitation Council (UK), British Cardiovascular Society and National Council for Palliative Care.

    Science.gov (United States)

    Pitcher, David; Soar, Jasmeet; Hogg, Karen; Linker, Nicholas; Chapman, Simon; Beattie, James M; Jones, Sue; George, Robert; McComb, Janet; Glancy, James; Patterson, Gordon; Turner, Sheila; Hampshire, Susan; Lockey, Andrew; Baker, Tracey; Mitchell, Sarah

    2016-06-01

    The Resuscitation Council (UK), the British Cardiovascular Society (including the British Heart Rhythm Society and the British Society for Heart Failure) and the National Council for Palliative Care recognise the importance of providing clear and consistent guidance on management of cardiovascular implanted electronic devices (CIEDs) towards the end of life, during cardiorespiratory arrest and after death. This document has been developed to provide guidance for the full range of healthcare professionals who may encounter people with CIEDs in the situations described and for healthcare managers and commissioners. The authors recognise that some patients and people close to patients may also wish to refer to this document. It is intended as an initial step to help to ensure that people who have CIEDs, or are considering implantation of one, receive explanation of and understand the practical implications and decisions that this entails; to promote a good standard of care and service provision for people in the UK with CIEDs in the circumstances described; to offer relevant ethical and legal guidance on this topic; to offer guidance on the delivery of services in relation to deactivation of CIEDs where appropriate; to offer guidance on whether any special measures are needed when a person with a CIED receives cardiopulmonary resuscitation; and to offer guidance on the actions needed when a person with a CIED dies.

  17. CPR in medical schools: learning by teaching BLS to sudden cardiac death survivors – a promising strategy for medical students?

    Directory of Open Access Journals (Sweden)

    Herkner Harald

    2006-04-01

    Full Text Available Abstract Background Cardiopulmonary resuscitation (CPR training is gaining more importance for medical students. There were many attempts to improve the basic life support (BLS skills in medical students, some being rather successful, some less. We developed a new problem based learning curriculum, where students had to teach CPR to cardiac arrest survivors in order to improve the knowledge about life support skills of trainers and trainees. Methods Medical students who enrolled in our curriculum had to pass a 2 semester problem based learning session about the principles of cardiac arrest, CPR, BLS and defibrillation (CPR-D. Then the students taught cardiac arrest survivors who were randomly chosen out of a cardiac arrest database of our emergency department. Both, the student and the Sudden Cardiac Death (SCD survivor were asked about their skills and knowledge via questionnaires immediately after the course. The questionnaires were then used to evaluate if this new teaching strategy is useful for learning CPR via a problem-based-learning course. The survey was grouped into three categories, namely "Use of AED", "CPR-D" and "Training". In addition, there was space for free answers where the participants could state their opinion in their own words, which provided some useful hints for upcoming programs. Results This new learning-by-teaching strategy was highly accepted by all participants, the students and the SCD survivors. Most SCD survivors would use their skills in case one of their relatives goes into cardiac arrest (96%. Furthermore, 86% of the trainees were able to deal with failures and/or disturbances by themselves. On the trainer's side, 96% of the students felt to be well prepared for the course and were considered to be competent by 96% of their trainees. Conclusion We could prove that learning by teaching CPR is possible and is highly accepted by the students. By offering a compelling appreciation of what CPR can achieve in using

  18. 亚低温治疗在脑复苏中的应用及影响预后因素分析%Mild hypothermia therapy for brain recovery after cardiopulmonary resuscitation and analysis of prognostic factors

    Institute of Scientific and Technical Information of China (English)

    王国兴; 谢苗荣; 刘凤奎; 王振洲

    2010-01-01

    Objective To explore the prognostic factors of mild hypothermia therapy in patients after cardiopulmonary resuscitation (CPR) and the prognostic value of the active electroencephalogram (AEEG).Methods Mild hypothermia therapy was applied in 42 patients after CRP whose circulation was stable on the basis of systemic treatment. Body temperature (jugular bulb temperature) was controlled at 31 - 34 ℃ for 3 - 6 days before rewarming. During treatment, routine examinations were made, and electroencephalogram was monitored and Hockday grade was estimated. Glasgow outcome scale (GOS) was use to evaluate the nervous system function of patients who survived for 3 months. Results There were varying degrees of difference between the good prognosis group (good recovery, moderate disability, n= 19) and the poor outcome group (severe disability, vegetative state, death, n=23) in the time of CPR after cardiac arrest (minutes: 4. 11±1.80 vs. 13.08±11.37), Glasgow coma scale (GCS) after the recovery (5.48±1.32 vs.4.13 ± 1.61), blood base excess (mmol/L: -10. 27±6.23 vs. -13. 18±7. 29) and lactate concentration (mmol/L: 6. 82±3. 12 vs. 8.47±4. 14, P<0. 05 or P<0. 01). There were significant differences between Hockday stage Ⅱ and Ⅲ in the rates of good prognosis in 37 patients who underwent the AEEG monitoring [85.7% (12/14) vs. 37.5% (3/8), P<0.05]. Conclusion The duration between CPR and cardiac arrest,GCS after resuscitation, blood base excess and lactate concentration can help determine the prognosis of patients after mild hypothermia therapy; electroencephalogram monitor is a helpful measure to determine the neurological outcome of patients after mild hypothermia therapy.%目的 探讨影响心肺复苏(CPR)术后亚低温治疗患者预后的因素及动态脑电波监测对预后的价值.方法 对42例循环稳定的CPR术后患者在全身治疗的基础上进行亚低温治疗,体温(颈静脉球温度)控制在31~34℃,维持3~6 d后复温.治疗

  19. Effectiveness of strengthened training in teaching of emergency cardiopulmonary resuscitation in department of emergency to medical students with different educational history%急诊科不同层次医学生心肺复苏再培训效果评价

    Institute of Scientific and Technical Information of China (English)

    刘英; 雷贤英; 胡迎春; 钟武

    2015-01-01

    目的:评价急诊科不同层次实习医学生接受心肺复苏再培训的效果。方法将急诊科接受过统一心肺复苏培训的324名不同层次的医学生分成研究组和对照组,研究组在进入急诊科实习时给予再次心肺复苏培训,对照组未接受再次培训,对比两组理论和操作考核成绩,团队合作意识、手法正确率等综合运用能力。结果接受心肺复苏再培训与未接受再培训的学生比较:理论、操作考核成绩均有统计学差异(P<0.05,P<0.01);综合运用能力:团队合作意识、手法正确率有统计学差异(P<0.01),不同学历层次医学生理论、操作考核及综合运用能力间无统计学差异(P>0.05)。结论急诊科入科时心肺复苏再培训针对性强,可更新和巩固理论及操作知识,提高综合运用能力,在理论、操作考核和综合实践中均优于未接受再培训组,且不受实习医学生学历层次影响,可提高心肺复苏培训效果,值得推广。%ObjectiveTo estimate the effectiveness of strengthened training in teaching of emergency cardiopulmonary resuscitation (CPR) to medical students with different educational history when they are practicing in department of emergency.MethodsAll students were trained for CPR, and then 324 students were randomly divided into experiment group and control group. The experiment group were given another time of training for CPR before they were practicing in department of emergency, and control group were given traditional training mode (study basic theory, watch of multimedia courseware and local functional training model). The scores of theory and practice examinations and the comprehensive ability were analyzed in two groups.Results The scores of theory and practice examinations in experiment group were higher than that in control group (P0.05).ConclusionsThe effectiveness of strengthened training in teaching of emergency

  20. Effect of video-based self-nstruction compared to traditional classroom instruction on the acquisition and retention of cardiopulmonary resuscitation skills for laypersons:a meta-analysis%视频自学与课堂教学对公众心肺复苏技能获得与保持效果的荟萃分析

    Institute of Scientific and Technical Information of China (English)

    李佳; 吴瑛; 肖倩; 岳鹏; 张澍

    2011-01-01

    Objective To compare the effect of video-based self-instruction (VSI) versus traditional classroom instruction (TCI) on the acquisition and retention of cardiopulmonary resuscitation skills for laypersons. Methods The randomized,controlled clinical trials on CPR instruction for laypersons were collected in the databases such as Cochrane Library, PubMed, and EMBASE. After critical appraisal and analysis of sensitivity and heterogeneity for the involved studies,a meta analysis was conducted to estimate the cumulative effect by RevMan 4.3 software. Results Ten randomized controlled trial (RCT) were involved in the study. Meta analysis showed that there was no significant difference in CPR performance immediately after training by VSI or TCI (OR=l.29,95% confidence interval ranged from 0.44 to 3.75,P>0.05). However,people 40 years old and over in VSI group showed better CPR performance than that of TCI group(OR=4.66,95% confidence interval ranged from 1.12 to 19.32, P0.05). Conclusions Older adults 40 years old and over tend to have better skills acquisition of CPR with VSI than that with TCI. Compared to TCI,VSI is better for short-term but not for long-term retention on CPR skills. It is suggested to further conduct multi-center randomized controlled trials to confirm the effect of VSI on long-term retention of CPR skills.%目的 评价视频自学(VSI)与传统课堂教学(TCI)对公众心肺复苏(CPR)技能获得与保持的效果.方法 采用荟萃分析(meta分析)方法,计算机检索Cochrane图书馆、PubMed、EMBASE等数据库,收集公众CPR培训的随机对照试验,进行文献质量评价后,应用RevMan 4.3软件进行敏感性和异质性分析,计算综合效应.结果 共纳入10篇随机对照试验研究.据meta分析结果显示,VSI组与TCI组CPR技能合格率差异无统计学意义[OR=1.29,95%CI(0.44,3.75),P>0.05].敏感性分析显示,研究对象年龄≥40岁者,VSI组CPR技能合格率明显优于TCI组[OR=4.66,95%CI(1

  1. Prognostic factors of cardiac arrest patients with cardiopulmonary resuscitation spontaneous circulation syn-drome%心脏骤停患者心肺复苏自主循环综合征预后相关因素分析

    Institute of Scientific and Technical Information of China (English)

    俞宁; 吕立文; 唐宇涛; 齐玉晶

    2016-01-01

    目的:探讨影响心脏骤停后心肺复苏自主循环综合征患者预后的相关因素,为临床上预后评估提供依据。方法收集2013-2015年入住我院急诊重症监护室成功心肺复苏自主循环200例,除去年龄不符(小于16岁)的,还有资料不完整的,最后纳入研究150例,对可能与预后相关的因素进行单因素分析和多因素分析,找出它们之间的相关性。结果单因素Logistic回归分析发现年龄,基础疾病史情况,性别,这三个因素对患者预后无统计学意义(P>0.05)。多因素Logistic 回归分析发现影响患者预后的因素有:心脏复苏开始的时间,持续时间,第4天的APACHEⅡ评分,以及复苏后有无肌肉阵挛,肌肉抽搐,有无脑干反应,有无室颤,室速等,这些因素对患者预后有统计学意义( P 0. 05 ) . Multivariate Logistic regression analysis showed that the influencing factors included CPR start time, duration, day 4 APACHEⅡscore, presence or absence of recovery after muscle clonus, muscle twitching, with or without brainstem response, chamber flutter, and ventricu-lar tachycardia (P<0. 05). Conclusion The prognostic factors of cardiopulmonary resuscitation spontaneous circu-lation include recovery start time, duration, day 4 APACHEⅡ score, presence or absence of myoclonic recovery, muscle twitching, with or without ventricular fibrillation, ventricular tachycardia, with or without stem, etc.

  2. 心肺复苏后血浆肾素活性与醛固酮分离现象的再研究%An analysis about the separation of plasma renin activity and aldosterone in patients with cardio-pulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    朱丽; 黄佳; 袁琦松; 周厚荣

    2016-01-01

    Objective To investigate the effect of separation of plasma renin activity and aldo⁃sterone on return of spontaneous circulation(ROSC)in patients with cardiopulmonary resuscitation (CPR). Method Thirty patients whose physical examinations were normal were randomly divided into group N; a total of 60 patients with sudden cardiac arrest who were treated with CPR were divided into two groups according to the effect of CPR, 28 patients with restoration of spontaneous circulation were group S, and 32 patients without restoration of spontaneous circulation were group U, at the Guizhou Province People's Hospital from January 2015 to December 2015. Peripheral venous blood of patients with CA 30 minites after CPR was collected, in order to test the plasma renin activity, aldosterone, serum potassium and sodium concentration and to compare each index between different groups. Results ①Compared to group N, plasma renin activity and aldosterone were obviously increased in group S and group U; and plasma renin activity and aldosterone in group U were higher than group S; the difference was statistically significant(P<0.05). ②The proportion of the separation of plasma renin activity and aldosterone in group S was lower than that in group U; the rate of ROSC in the group without separation of aldosterone was higher than the group with separation of aldosterone(2=4.63, P<0.05); and the level of serum potassium concentration in group with separation of aldosterone was higher than that in group with⁃out separation of aldosterone(P<0.01); the level of plasma sodium concentration in group without sepa⁃ration of aldosterone was lower than group with separation of aldosterone(P<0.01). Conclusion The phenomenon of the separation of renin activity and aldosterone exists in the patients who are treated with cardiopulmonary resuscitation, and the separation of plasma renin activity and aldosterone might induce hyponatremia and hyperkalemia, which is the disadvantage of

  3. 胞二磷胆碱提高心肺复苏效果和减轻心肌损伤的作用研究%The effects of CDP-Choline on the improvement of the successful rate of cardiopulmonary resuscitation and post-resuscitation cardiac function

    Institute of Scientific and Technical Information of China (English)

    黄煜; 何庆; 詹磊

    2013-01-01

    Objective To investigate the effects of CDP-Choline on the improvement of recovery of spontaneous circulation (ROSC) and protection against myocardial injury in cardiopulmonary resuscitation (CPR).Methods Sprague-Dawley (SD) rats were randomized into four groups:control group (n =5,no asphyxia),model group (n =10),adrenaline group (n =10) and CDP-Choline group (n =10).Cardiac arrest (CA) was induced by asphyxia,and then CPR was initiated.Drugs were administered at 5 minutes before CPR and at the initiation of CPR.Equal amount of normal saline was given in the control group and the model group.The hemodynamic parameters were monitored during CPR and after ROSC.After 2 hours,the myocardial tissue of the rats was harvested to assess the degree of ischemia/reperfusion (I/R) injury by measuring ATPase activity,superoxide dismutase (SOD) activity and malondialdehyde (MDA) content.Results Compared with the model group,the rate of ROSC was significantly elevated (90%,80% vs.20%,both P<0.01) in the CDP-Choline group and the adrenaline group,the time of achieving ROSC (s) was shorter (53 ± 10,55 ± 9 vs.95 ± 7,both P<0.01),and the heart rate (HR,bpm) and mean arterial pressure (MAP,mm Hg,1 mm Hg=0.133 kPa) at 2 hours after CPR were higher (HR:222.78 ±41.55,167.75 ± 11.76 vs.131.50 ±0.70; MAP:36.53 ±8.69,39.30 ±6.45 vs.30.19 ±5.15,all P<0.01).The cardiac function [the maximal rate of left ventricular pressure increase/decline (± dp/dt max)] in the CDP-Choline group was gradually stabilized and significantly higher than that in the model and the adrenaline groups.The cardiac function in the adrenaline group was higher than that of the model group,but it was in a tendency of lowering.Compared with the model group and the adrenaline group,the reduction of Na+-K+-ATPase (μmol· mg-1· h-1) and SOD (U/mg) activity were significantly increased in the CDP-Choline group (Na+-K+-ATPase:7.35 ± 0.20 vs.5.11 ± 0.69,4.70 ± 0.41; SOD activity:320.65 ± 47.25 vs.225

  4. Practice and enlightenment of cardio-pulmonary resuscitation emergency training%心肺复苏急救培训实践与启示

    Institute of Scientific and Technical Information of China (English)

    王海娟; 杨桂涛

    2015-01-01

    目的:以国际标准化心肺复苏课程为基础,探讨分层式心肺复苏急救培训的有效性和重要性。方法选取临床技能培训中心2013年6~7月参与培训的临床科室医务人员、医技科室医务人员和规范化培训医务人员共219名医生的培训资料,培训方式包括看视频、分组训练、集体讨论。比较培训前后的理论成绩和操作成绩。理论成绩的比较采用配对t检验;考试通过率的比较采用卡方检验。结果规范化培训医务人员、医技科室医务人员、临床科室医务人员培训前后的理论考核平均成绩得分分别为[(66.60±7.82)vs.(88.60±6.37);(61.60±7.44)vs.(86.90±5.80);(73.45±6.83)vs.(94.75±5.04)],均有统计学差异。规范化培训医务人员、医技科室医务人员、临床科室医务人员培训前后操作考核的通过率分别为[31.1%/85.2%;32.0%/90.7%;59.0%/96.4%],均有统计学差异。结论不同层次医务人员在心肺复苏培训前后理论与操作成绩均存在差异,分层式、有针对性的培训模式能有效提高不同层次医务人员的心肺复苏急救培训效果。%Objective Based on the international standard cardio-pulmonary resuscitation curriculum, the aim of the study is to investigate the effectiveness and importance of the layered cardio-pulmonary resuscitation emergency training. Method A total of 219 trainee including clinical medical personnel , auxiliary medical personnel and medical staff with standardized training were enrolled . Training included watching course video, team practice and class discussion, and the theoretical score and operation marks before and after layered cardio-pulmonary resuscitation training were compared. Theoretical score were compared by paired T-test, and operation pass ratio was determined byχ2 analy-sis. Results The pre- and post-training theoretical score of medical staff with standardized training, auxiliary

  5. Family Presence during Resuscitation: A Qualitative Analysis from a National Multicenter Randomized Clinical Trial.

    Directory of Open Access Journals (Sweden)

    Carla De Stefano

    Full Text Available The themes of qualitative assessments that characterize the experience of family members offered the choice of observing cardiopulmonary resuscitation (CPR of a loved one have not been formally identified.In the context of a multicenter randomized clinical trial offering family members the choice of observing CPR of a patient with sudden cardiac arrest, a qualitative analysis, with a sequential explanatory design, was conducted. The aim of the study was to understand family members' experience during CPR. All participants were interviewed by phone at home three months after cardiac arrest. Saturation was reached after analysis of 30 interviews of a randomly selected sample of 75 family members included in the trial. Four themes were identified: 1- choosing to be actively involved in the resuscitation; 2- communication between the relative and the emergency care team; 3- perception of the reality of the death, promoting acceptance of the loss; 4- experience and reactions of the relatives who did or did not witness the CPR, describing their feelings. Twelve sub-themes further defining these four themes were identified. Transferability of our findings should take into account the country-specific medical system.Family presence can help to ameliorate the pain of the death, through the feeling of having helped to support the patient during the passage from life to death and of having participated in this important moment. Our results showed the central role of communication between the family and the emergency care team in facilitating the acceptance of the reality of death.

  6. Protective and biogenesis effects of sodium hydrosulfide on brain mitochondria after cardiac arrest and resuscitation.

    Science.gov (United States)

    Pan, Hao; Xie, Xuemeng; Chen, Di; Zhang, Jincheng; Zhou, Yaguang; Yang, Guangtian

    2014-10-15

    Mitochondrial dysfunction plays a critical role in brain injury after cardiac arrest and cardiopulmonary resuscitation (CPR). Recent studies demonstrated that hydrogen sulfide (H2S) donor compounds preserve mitochondrial morphology and function during ischemia-reperfusion injury. In this study, we sought to explore the effects of sodium hydrosulfide (NaHS) on brain mitochondria 24h after cardiac arrest and resuscitation. Male Sprague-Dawley rats were subjected to 6min cardiac arrest and then resuscitated successfully. Rats received NaHS (0.5mg/kg) or vehicle (0.9% NaCl, 1.67ml/kg) 1min before the start of CPR intravenously, followed by a continuous infusion of NaHS (1.5mg/kg/h) or vehicle (5ml/kg/h) for 3h. Neurological deficit was evaluated 24h after resuscitation and then cortex was collected for assessments. As a result, we found that rats treated with NaHS revealed an improved neurological outcome and cortex mitochondrial morphology 24h after resuscitation. We also observed that NaHS therapy reduced intracellular reactive oxygen species generation and calcium overload, inhibited mitochondrial permeability transition pores, preserved mitochondrial membrane potential, elevated ATP level and ameliorated the cytochrome c abnormal distribution. Further studies indicated that NaHS administration increased mitochondrial biogenesis in cortex at the same time. Our findings suggested that administration of NaHS 1min prior CPR and followed by a continuous infusion ameliorated neurological dysfunction 24h after resuscitation, possibly through mitochondria preservation as well as by promoting mitochondrial biogenesis.

  7. Can mass education and a television campaign change the attitudes towards cardiopulmonary resuscitation in a rural community?

    DEFF Research Database (Denmark)

    Nielsen, Anne Møller; Isbye, Dan Lou; Lippert, Freddy Knudsen;

    2013-01-01

    Survival after out-of-hospital cardiac arrest (OHCA) is improved when bystanders provide Basic Life Support (BLS). However, bystander BLS does not occur frequently. The aim of this study was to assess the effects on attitudes regarding different aspects of resuscitation of a one-year targeted med...... campaign and widespread education in a rural Danish community. Specifically, we investigated if the proportion willing to provide BLS and deploy an automated external defibrillator (AED) increased....

  8. Survey of status quo of knowledge attitude practice of primary caregivers of patients with coronary disease on car-diopulmonary resuscitation%冠心病病人主要照顾者心肺复苏知信行现状调查

    Institute of Scientific and Technical Information of China (English)

    王中丽; 薛燕

    2015-01-01

    [目的]对冠心病病人主要照顾者心肺复苏(CPR)知识、态度、行为现状进行调查,为今后开展相关培训提供理论依据。[方法]采用方便抽样法选取太原市5家三级甲等医院心内科冠心病病人主要照顾者150人作为研究对象,采用自设问卷进行调查。[结果]主要照顾者CPR知识得分为9.73分±4.72分;CPR态度得分为23.03分±2.93分;CPR行为得分为28.24分±4.67分。CPR知识与态度、知识与行为、态度与行为之间呈正相关。[结论]主要照顾者CPR态度水平较高,知识、行为水平较低,应对冠心病病人主要照顾者知识、态度、行为进行全方位干预,以提高知信行整体水平,降低院外心脏骤停病人的致残率和死亡率。%Objective:To investigate the knowledge ,attitude and practice of the primary caregivers of patients with coronary heart disease (CHD) on cardiopulmonary resuscitation(CPR) ,so as to provide a theoretical basis for the future development of CRP .Methods:A total of 150 of primary main caregivers of patients with CHD were selected as the research objects by using the convenience sampling method in department of cardiology in five third grade A hospitals ,the self designed questionnaire was used to survey .Results:The CPR knowledge score of the primary caregivers was 9 .73 ± 4 .72 ,and the CPR attitude score was 23 .03 ± 2 .93 ,and the CPR practice score was 28 .24 ± 4 .67 .There was positively correlation between CPR knowledge and attitude ,knowl‐edge and behavior ,attitude and behavior .Conclusion:CPR attitude of primary caregivers was higher ,knowledge and practice level were lower ,comprehensive intervention should be carried out for KAP of CHD patients ,in or‐der to improve the overall level of KAP ,reduce the morbidity and mortality of cardiac arrest of patients out of hospital .

  9. 基层医师心肺复苏技能培训方法研究%The Research on Cardiopulmonary Resuscitation Training Methods for Primary Care Physicians

    Institute of Scientific and Technical Information of China (English)

    王长远; 孙长怡; 秦俭; 王晶

    2011-01-01

    Objective To study training effect of computer simulation step-by-step teaching cardiopulmonary resuscitation skills in the primary care physicians. Methods 27 primary care physicians were trained for cardiopulmonary resuscitation skills by the approach of brief-theory teaching, SimMan4000 comprehensive simulator, emergency care simulator, human patient simulator and video playback, content including chest compressions, intubation and malignant arrhythmia treatment etc. The difference between the before and after training were compared. The attitude of primary care physicians were investigated on the application of computer simulation step-by-step teaching. Results The results of chest compressions before and after training in primary care physicians were( 57.38 ± 8.42 )score vs ( 82.36 ± 9. 15 )score( P < 0.01 ), intubation was ( 61.75 ± 7.42 )scire vs ( 86.37 ± 8.04 )score( P < 0.01 )respectively, malignant arrhythmia treatment achievements were( 60.24 ± 6.54 )score vs ( 87.26 ± 5.49 )score( P < 0.01 ),96.2% of primary care physicians think the teaching methods can improve the learning ability and teamwork spirit. Conclusion The application of computer simulation step-by-step teaching can improve cardiopulmonary resuscitation skills, cultivating teamwork and emergency response ability of primary care physicians.%目的 探讨应用计算机模拟分步教学法对基层医师进行心肺复苏技能培训的效果.方法 应用简短理论授课、SimMan4000综合模拟人、急救模拟人、生理驱动高仿真电脑模拟人、录像回放等方法分步对27名基层医师进行心肺复苏技能培训,内容包括胸外按压、气管插管和恶性心律失常处理等,比较培训前后的成绩;调查基层医师对计算机模拟技术分步教学法的认可程度.结果 基层医师胸外按压培训前后的成绩分别为(57.38±8.42)分 vs (82.36±9.15)分,(P<0.01),气管插管的成绩分别为(61.75±7.42)分 vs (86.37±8.04)

  10. 尿激酶对家兔心肺复苏后脑神经细胞凋亡的影响%Influence of urokinase on nerve cell apoptosis after cardiopulmonary resuscitation in rabbits

    Institute of Scientific and Technical Information of China (English)

    郭晓东; 张巍; 郭静; 苏清明; 杨贵荣; 张杰; 孙鲲; 王立祥

    2015-01-01

    Objective To investigate the effect of urokinase on nerve cell apoptosis after cardiac arrest ( CA) and cardiopulmo-nary resuscitation(CPR)in rabbits.Methods 20 rabbits were randomly divided into experimental group and control group , 10 rabbits in each group .Potassium chloride injection combined with asphyxia method was conducted to establish the CA models .CPR and basic life-support were performed in experimental group .Based on above treatments , intervention with urokinase (20 000 U/kg) was con-ducted in experimental group .Neural apoptosis was identified by TUNEL and caspase-3 was detected by immunohistochemistry in order to prove the effect of urokinase on nerve cell apoptosis in rabbits 24 hours after CPR.Results Tunel and caspase-3 positive cells counts of cerebral cortex and hippocampus in experimental group were significantly less than those in control group , respectively .The comparisons were as follows(Tunel positive cells in cerebral cortex 29.22 ±7.86:37.20 ±7.04(t=-2.392,P=0.028), in hippo-campus 18.80 ±7.58:27.4 ±8.15(t=-2.442,P=0.025), Caspase-3 positive cells in cerebral cortex 22.1 ±9.93:33.1 ±12.64 (t=-2.165,P=0.044),in hippocampus 31.3 ±15.23 vs 46.8 ±16.73(t=-2.167,P=0.044);so thrombolytic therapy with u-rokinase can relieve nerve cell apoptosis obviously .Comparison of spontaneous circulation restoration time (s) 307.9 ±96.4:242.0 ± 71.0(t=-1.741, P=0.099), spontaneous breathing restoration time (min) 20.6 ±12.5:19.3 ±10.0 (t=-0.256, P=0.801), mean arterial pressure MAP (mmHg) 65.5 ±6.2:69.0 ±6.7 (t=1.217, P=0.239), there were no differences between the experi-mental group and control group .Conclusions Thrombolytic therapy with urokinase in CPR after CA can improve and lessen nervous lesion resulting from apoptosis in rabbits .%目的 探讨心搏骤停心肺复苏后溶栓药物尿激酶对脑神经细胞凋亡的影响. 方法 20只家兔按随机数字表法被分为溶栓组和常规复苏组,每组10只. 采用氯化钾

  11. The Effect of the Duration of Basic Life Support Training on the Learners’ Cardiopulmonary and Automated External Defibrillator Skills

    Directory of Open Access Journals (Sweden)

    Jin Hyuck Lee

    2016-01-01

    Full Text Available Background. Basic life support (BLS training with hands-on practice can improve performance during simulated cardiac arrest, although the optimal duration for BLS training is unknown. This study aimed to assess the effectiveness of various BLS training durations for acquiring cardiopulmonary resuscitation (CPR and automated external defibrillator (AED skills. Methods. We randomised 485 South Korean nonmedical college students into four levels of BLS training: level 1 (40 min, level 2 (80 min, level 3 (120 min, and level 4 (180 min. Before and after each level, the participants completed questionnaires regarding their willingness to perform CPR and use AEDs, and their psychomotor skills for CPR and AED use were assessed using a manikin with Skill-Reporter™ software. Results. There were no significant differences between levels 1 and 2, although levels 3 and 4 exhibited significant differences in the proportion of overall adequate chest compressions (p<0.001 and average chest compression depth (p=0.003. All levels exhibited a greater posttest willingness to perform CPR and use AEDs (all, p<0.001. Conclusions. Brief BLS training provided a moderate level of skill for performing CPR and using AEDs. However, high-quality skills for CPR required longer and hands-on training, particularly hands-on training with AEDs.

  12. A comparison of the outcome of CPR according to AHA 2005 ACLS and AHA 2010 ACLS guidelines in cardiac arrest: multicenter study.

    Science.gov (United States)

    Ocal, Oktay; Ozucelik, Dogac Niyazi; Avci, Akkan; Yazicioglu, Mustafa; Aydin, Yilmaz; Ayvaci, Baris Murat; Dogan, Halil; Aciksari, Kurtulus; Cukurova, Zafer

    2015-01-01

    The aim of this study was to evaluate whether there is a difference in the return of spontaneous circulation (ROSC) and survival with sequel-free recovery rates between the patients who underwent cardiopulmonary resuscitation (CPR) according to 2005 and 2010 guidelines. This study was conducted in the Bakırköy Dr. Sadi Konuk and Kartal Lütfi Kırdar Training and Research Hospital between dates of October 2010 and 28 February 2011 after approval of Ethics Committee. In the first months of the study, CPR was performed according to AHA 2005 ACLS guidelines (Group-1), while CPR was performed according to AHA 2010 ACLS guidelines after November 2010 (Group-2). Patients were assessed for neurological deficit with Cerebral Performance Categories Scale. Mean age was found as 69.01±13.05 (minimum: 21, maximum: 92) in 86 patients included. Of the 33 patients underwent CPR in the Group 1, ROSC was achieved in 51.5%; and 6.1% of these patients were discharged. Of the 53 patients underwent CPR in the Group 2, ROSC was achieved in 37.7%; and 9.4% of these patients were discharged. Although the number of living patients in Group 2 was higher than Group 1, the difference was not found statistically significant (5 versus 2), (P>0.05). But, neurological outcomes were found better with 2010 compared to 2005 guidelines (3/7 versus 0/2 good cerebral performance). It was found that the 2005 CPR guidelines practices in ED were more successful than the 2010 CPR guidelines practices in ROSC, but less successful in the rate of discharge from hospital and neurological sequel-free discharge rate.

  13. Effects of vasopressin and adrenaline on cerebral resuscitation in rats undergone cardiopulmonary resuscitation%血管加压素与肾上腺素对大鼠脑复苏效果的影响

    Institute of Scientific and Technical Information of China (English)

    杨伟伟; 彭鹏

    2011-01-01

    Objective To compare the effects of vasopressin and adrenaline on cerebral resuscitation in rats. Method Sixty male SD rats were used to set the animal model of cardiac arrest and were randomly (random number) divided into 4 groups (n = 15/group): sham operation group (sham-gro), negative control group (neg-gro), vasopressin group (vas-gro) and adrenaline group (adr-gro). Blood pressure was recorded, and brain tissue samples were obtained. Results There was no significant difference in the recovery rate between vas-gro and adr-gro 30 min after resuscitation (P <0.05). The mean blood pressure in vasgro was higher than that in adr-gro within 30 min (1,2, 5, 10, 20, 30 min) after restoration of spontaneous circulation. The measured MDA, SOD and GSH were significantly different (P < 0.05) between each two groups among vas-gro, sham-gro and adr-gro. Conclusions The recovery rate was similar between vasopressin group and adrenaline group during cardiopulmonary resuscitation in rats. However, vasopressin can to maintain the mean arterial pressure at a higher level after resuscitation, which can the increase the cerebral perfusion and reduce brain cell damage.%目的 比较血管加压素与肾上腺素对大鼠脑复苏效果的研究.方法 60只雄性SD大鼠建立心搏骤停模型,随机(随机数字法)分为4组(n=15/组):假手术组(sham operated group,shamgro)、阴性对照组(neg-gro)、血管加压素组(vas-gro)、肾上腺素组(adr-gro).分别记录血压变化,并取大鼠脑组织标本.结果 在复苏30 min后vas-gro与adr-gro复苏成功率差异无统计学意义(P>0.05);在自主循环恢复的30 min内(1,2,5,10,20,30 min)vas-gro的平均动脉压均高于adr-gro;测得MDA,SOD,GSH的量vas-gro,sham-gro,adr-gro互相之间差异有统计学意义(P<0.05).结论 血管加压素与肾上腺素在大鼠心肺复苏过程中成功率相近,但血管加压素能维持复苏后平均动脉压在较高水平,继而会更好的增加脑灌注,减轻脑细胞损伤.

  14. Telephone CPR Instructions in Emergency Dispatch Systems: Qualitative Survey of 911 Call Centers

    Directory of Open Access Journals (Sweden)

    John Sutter

    2015-10-01

    Full Text Available Introduction: Out-of-hospital cardiac arrest (OHCA is a leading cause of death. The 2010 American Heart Association Emergency Cardiovascular Care (ECC Guidelines recognize emergency dispatch as an integral component of emergency medical service response to OHCA and call for all dispatchers to be trained to provide telephone cardiopulmonary resuscitation (T-CPR pre-arrival instructions. To begin to measure and improve this critical intervention, this study describes a nationwide survey of public safety answering points (PSAPs focusing on the current practices and resources available to provide T-CPR to callers with the overall goal of improving survival from OHCA. Methods: We conducted this survey in 2010, identifying 5,686 PSAPs; 3,555 had valid e-mail addresses and were contacted. Each received a preliminary e-mail announcing the survey, an e-mail with a link to the survey, and up to three follow-up e-mails for non-responders. The survey contained 23 primary questions with sub-questions depending on the response selected. Results: Of the 5,686 identified PSAPs in the United States, 3,555 (63% received the survey, with 1,924/3,555 (54% responding. Nearly all were public agencies (n=1,888, 98%. Eight hundred seventy-eight (46% responding agencies reported that they provide no instructions for medical emergencies, and 273 (14% reported that they are unable to transfer callers to another facility to provide T-CPR. Of the 1,924 respondents, 975 (51% reported that they provide pre-arrival instructions for OHCA: 67 (3% provide compression-only CPR instructions, 699 (36% reported traditional CPR instructions (chest compressions with rescue breathing, 166 (9% reported some other instructions incorporating ventilations and compressions, and 92 (5% did not specify the type of instructions provided. A validation follow up showed no substantial difference in the provision of instructions for OHCA by non-responders to the survey. Conclusion: This is the

  15. Diagnosis and Treatment for a Cardio-Pulmonary Resuscitation (PCR) Patient with HELLP Syndrome (PRS) after Cesarean Section-The Discussion on Clinical Thinking of Post-Resuscitation Syndrome%HELLP综合征剖宫产术后发生心肺复苏后综合征一例分析——兼论复苏后综合征的临床思维

    Institute of Scientific and Technical Information of China (English)

    康红军; 赵妍; 胡新; 孟庆义

    2013-01-01

    目的 探讨复苏后综合征(post-resuscitation syndrome,PRS)的临床特点及诊治要点,以提高患者生存率并改善预后.方法 对我院收治的1例PRS的临床资料进行回顾性分析.结果 本例因停经30+4周,血压升高6周,上腹痛1d入院,诊断为宫内妊娠30+4周、重度子痫前期、HELLP综合征.急诊在全麻下行剖宫取胎术,术后患者因无尿、高钾血症等转入重症监护病房(ICU),予持续床旁连续性肾脏替代治疗(CRRT)中2次出现心室颤动(室颤),予心肺复苏(cardiopumonaryresuscitation,CPR)后恢复窦性心律.复苏后患者昏迷,予脑保护、地塞米松、多巴胺及补镁等治疗,3d后患者恢复意识,四肢肌力0级,予神经营养药物、针灸等治疗.ICU共治疗46d出院,随访3个月肌力完全恢复正常.结论 PRS治疗过程中重视脑保护并运用综合手段维持血流动力学的稳定,对于切实提高CPR效果及改善患者预后有重要意义.%Objective To discuss the clinical characteristics and the key points of diagnosis and therapy for post-resuscitation syndrome (PRS) so as to improve its survival rate and prognosis. Methods A retrospective analysis was performed on clinical data of a patient with PRS in our hospital. Results The patient was admitted for menolipsis for 30 +4 weeks, elevated blood pressure for 6 weeks and epigastric pain for 1 day, and was diagnosed as having the intrauterine pregnancy (30+4 weeks ) , severe pre-eclampsia and HELLP syndrome. The emergency cesarean section with general anesthesia was performed and the patient was transferred to ICU after operation due to anuria. During the process of continuous renal replacement therapy ( CRRT), the patient suffered a sudden onset of ventricular fibrillation for twice and sinus rhythm was recovered after cardiopulmonary resuscitation (CPR) , but the patient was still in a coma. Brain protection combined with treatment of dexamethasone, dopamine and magnesium were performed. The

  16. 应用新版心肺复苏及心血管急救指南评价医护人员胸外心脏按压质量%Quality of chest compression performed by medical staff as compared to the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

    Institute of Scientific and Technical Information of China (English)

    黄素芳; 严丽; 张凤玲; 邹灯秀

    2013-01-01

    Objective To evaluate the quality of chest compression performed by medical staff on a medical-training mannequin, to find out how medical staff conform to the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) , and to provide information for further CPR training program. Methods A total of 219 clinical staff participated in a training program on the 2010 American Heart Association Guidelines for CPR and ECC. Then the participants were asked to perform CPR on a medical-training mannequin for 2 min, and the quality of chest compression was evaluated by using the Lacrdal PC Skill Reporting System. Results The staff showed signs of fatigue at (57. 46 ± 29. 10)s and the rate of proper hand placement averaged 83. 35% ; mean compression rate was (130. 95 ± 23. 37)/min; 95. 63% performed compression at correct frequency; the rate of correct compression depth (at least 5 cm) averaged 14. 54% ; and rate of chest wall recoil was 78. 51 %. Conclusion Chest compression performed by medical staff fails to meet with the requirements of high-quality of chest compression. CPR training programs should especially focus on rescuer s hand placement, posture, compression depth, exertion, and compression rate, so as to improve training effect.%目的 对照了解临床医护人员实施心肺复苏时胸外心脏按压质量,为有效提高心肺复苏培训效果提供参考.方法 对219名临床医护人员按照实施理论知识与实践操作技能培训,利用高级复苏模型及计算机技能报告系统监测医护人员技能考核中的胸外心脏按压相关质量指标.结果 医护人员按压疲劳时间为(57.46±29.10)s,定位准确率为83.35%,平均按压心率为(130.95±23.37)次/min,按压频率正确率为95.63%,按压深度平均正确率为14.54%,胸壁回弹率为78.51%.结论 临床医护人员考核结果不能满足高质量胸外心脏按压的质量指标要求,进行心肺复

  17. [End-of-life care in emergency settings in the super-aged society: withholding CPR from frail elderly with severe ADL impairment].

    Science.gov (United States)

    Aita, Kaoruko

    2013-06-01

    Emergency and intensive care unit demographics have changed with the advent of the super-aged society in Japan. Japan has the highest population aging rate in the world. It is now predicted that an increasing number of people will die at higher age. The oldest old individuals show increasing frailty, with an excess vulnerability to stressors. It is believed that frail elderly would receive limited benefit from highly invasive emergency treatment and advanced intensive care which, on the contrary, could bring about harmful effects on frail elderly. So far a number of frail oldest-old nursing home residents with cardiopulmonary arrest have been taken by ambulance to emergency medical centers to receive cardio-pulmonary resuscitation in vain in Japan. Now is the time to stop the harmful ritual. Withholding CPR from frail elderly with severe ADL impairment would not constitute an act of ageism but the act of humanity based on medical evidence.

  18. Capacidades motoras envolvidas na habilidade psicomotora da técnica de ressuscitação cardiopulmonar: subsídios para o processo ensino-aprendizagem Capacidades motoras involucradas en la habilidad psicomotora de la técnica de resucitación cardiopulmonar: subsídios para el proceso ensenanza-aprendizaje Motor capacities involved in the psychomotor skills of the cardiopulmonary resuscitation: subsidies of the teaching-learning process

    Directory of Open Access Journals (Sweden)

    Ana Maria Kazue Miyadahira

    2001-12-01

    Full Text Available Trata-se de uma estudo bibliográfico sobre a identificação das capacidades motoras envolvidas na habilidade psicomotora da técnica de ressuscitação cardiopulmonar (RCP cuja finalidade é obter subsídios para o planejamento do processo ensino-aprendizagem desta habilidade. Verificou-se que as capacidades motoras envolvidas na habilidade psicomotora da técnica de RCP são predominantemente cognitivas e motoras, envolvendo 9 capacidades perceptivo-motoras e 8 capacidades de proficiência física. A técnica de RCP é uma habilidade psicomotora classificada como aberta, seriada e categorizada como uma habilidade fina e global e o processo de ensino-aprendizagem da técnica de RCP tem alto grau de complexidade.Se trata de un estudio bibliográfico sobre la identificación de las capacidades motoras involucradas en la habilidad psicomotora de la técnica de resucitación cardiopulmonar (RCP cuya finalidad fue obtener subsidios para la planificación del proceso ensenanza-aprendizaje de esta habilidad. Se verifico que las capacidades motoras involucradas en la habilidad psicomotora de la técnica de RCP son predominantemente cognitivas y motoras, involucrando 9 capacidades perceptivo-motoras y 8 capacidades de proficiencia física. La técnica de RCP es una habilidad psicomotora clasificada como abierta, seriada y categorizada como una habilidad fina y global y el proceso de ensenanza-aprendizaje de la técnica de RCP tiene alto grado de complejidad.It is a bibliographic study about the identification of the motor capacities involved in the psychomotor skills of the cardiopulmonary resuscitation (CPR which aims to obtain subsidies to the planning of the teaching-learning process of this skill. It was found that: the motor capacities involved in the psychomotor skill of the CPR technique are predominantly cognitive and motor, involving 9 perceptive-motor capacities and 8 physical proficiency capacities. The CPR technique is a psychomotor skill

  19. 影响心肺复苏成功率的相关因素分析%Analysis of the Relevant Factors Influencing the Success Rate of Cardiopulmonary Resuscitation

    Institute of Scientific and Technical Information of China (English)

    范再英; 黄艳娟; 周艳平

    2013-01-01

    [Objective] To analyze the relevant factors influencing the success rate of cardiopulmonary re-suscitation(CPR) ,and provide theoretical evidence for clinical intervention .[Methods] According to the suc-cess or not success of CPR ,122 patients receiving CPR treatment in our hospital from March 2007 to Oct . 2012 were divided into CPR success group(n=43) and CPR failure group(n=79) .The relevant factors influ-encing the success rate of CPR were analyzed .[Results] The percentages of patients(aged over or equal to 60 years old) with the history of cardiovascular disease ,disease onset outside the hospital ,bradyarrhythmias in CPR success group were significantly lower than those in CPR failure group ( P0 .05) .Multiple-factor logistic regression analysis showed that the types of pri-mary diseases ,the form of cardiac arrest were independent risk factors influencing the success rate of CPR ( P<0 .05) ,while the precursory symptom and naloxone were independent protective factors ( P < 0 .05) .[Conclusion]Observing the precursory symptom closely and taking emergency measures as soon as possible and applying naloxone actively are able to improve the success rate of CPR in patients .%[目的]分析影响心肺复苏(CPR)成功率的相关因素,为临床干预提供理论依据。[方法]2007年3月至2012年10月在本院接受CPR治疗的122例患者,根据CPR成功与否将上述患者分为复苏成功组(43例)与复苏失败组(79例),分析影响CPR成功率的相关因素。[结果]①复苏成功组年龄≥60岁、有心血管疾病史、院外发病、缓慢性心律失常患者的比例显著低于复苏失败组( P <0.05),合并先兆症状、胸外按压频率≥100次/分钟、使用人工气道、使用电除颤、递增法使用肾上腺素、使用胺碘酮、纳洛酮患者的比例显著高于复苏失败组( P<0.05),两组患者之间性别、发病时间、动脉血氧饱和度、瞳孔直径、阿托品相

  20. Application of extracorporeal membrane oxygenation to cardiopulmonary cerebral resuscitation%体外膜肺氧合在心肺脑复苏中的应用

    Institute of Scientific and Technical Information of China (English)

    蒋崇慧; 黄子通; 谢钢; 李斌飞; 宁晔; 吴美英; 郑伟华; 尹刚; 赵双彪

    2008-01-01

    Objective To investigate the effects and values of extracorporeal membrane oxygenation (EC-MO) used in patients after cardiac arrest. Method During five years period from June 2002 to June 2007,fifteen cases taken for cardiopulmonary resuscitation were treated by using ECMO in the emergency department and ICU. All the measures for disgnosis and treatment were observed to the guidelines for cardiopulmonary resuscitation and emergency cardiovasculat care set by the American Heart Association in 2005, and ECMO was applied in addition. The study was a self-comparison trial. The biomarkers including heart rate (HR), mean arterial pressure (MAP), central venous pressure( CVP) , arterial partial oxygen pressure (PaO2), arterial partial pressure of carbon dioxide ( PCQ2), oxygen saturation (SaO2), hydrogen power (PH), and concentration of lactic acid were taken and assayed before and 10 min, 1 h,6 h, 12 h, and 24 h after treatment. Differences between the results of measurements were analysed by t -test for matched pairs using SPSS version 10.0 software package. Neurological sequelae was also observed and described. Results Ten minutes after ECMO treatment, MAP rose dramatically (P 的标准诊治方案进行救治,同时行体外膜肺氧合(ECMO)治疗.采用治疗前后自身对照的方法,监测ECMO治疗前、ECMO治疗后10 min、1 h、6 h、12 h、24 h,患者的心率、平均动脉压、中心静脉压(eve);并抽取桡动脉血检测动脉血氧分压、二氧化碳分压、血氧饱和度、酸碱度、动脉血乳酸含量等指标;统计数据以((x)±s)表示,采用SPSS 10.0统计软件包进行t检验,以P<0.05为差异具有统计学意义;同时就患者的神经性后遗症进行了观察和描述.结果 平均动脉压在ECMO治疗后10min比ECMO治疗前明显升高(P<0.01),ECMO治疗后1 h比ECMO治疗后10 min有所升高(P<0.05);CVP在ECMO治疗后10 min比ECMO治疗前,ECMO治疗后1 h比ECMO治疗后10 min有所降低(P<0.05);经ECMO治疗后10

  1. A COMPARISON OF INTERNET-BASED LEARNING AND TRADITIONAL CLASSROOM LECTURE TO LEARN CPR FOR CONTINUING MEDICAL EDUCATION

    Directory of Open Access Journals (Sweden)

    Naser HEMMATI

    2013-01-01

    Full Text Available The purpose of this study was to compare the satisfaction and effectiveness of Internet-based learning (IBL and traditional classroom lecture (TCL for continuing medical education (CME programs by comparing final resuscitation exam results of physicians who received the newest cardiopulmonary resuscitation (CPR curriculum guidelines training either by traditional or by an Internet-based CME. A randomized two-group pretest-posttest quasi-experimental design was used. Postgraduate general physician trainees of Iran medical schools were participated. Two methods were compared for teaching the newest curriculum guidelines of the American Heart Association: lecture method in which the teacher follows a Power point presentation with linear layout, and with interactive self-assessment and Scenario-based learning, feedback, multimedia with linear and nonlinear layout with the same power point presentation as lecture in terms of text and photography. The data on final CPR exam grades, collected both groups trained physicians, were obtained for a total of 80 physicians in 2011. An independent sample t-test analysis indicated that participants in the IBL format reported significantly higher mean ratings for this format (62.5 ±2.32 than TCL format (54.6±2.18 (p=.001. There were no significant differences between the two groups in cognitive gains (p<0.05. well-designed IBL content can be effective or a supplement component to CME.

  2. Is there a place for CPR and sustained physiological support in brain-dead non-donors?

    Science.gov (United States)

    Brown, Stephen D

    2017-02-24

    This article addresses whether cardiopulmonary resuscitation (CPR) and sustained physiological support should ever be permitted in individuals who are diagnosed as brain dead and who had held previously expressed moral or religious objections to the currently accepted criteria for such a determination. It contrasts how requests for care would normally be treated in cases involving a brain-dead individual with previously expressed wishes to donate and a similarly diagnosed individual with previously expressed beliefs that did not conform to a brain-based conception of death. The paper first focuses narrowly on requests for CPR and then expands its scope to address extended physiological support. It describes how refusing the brain-dead non-donor's requests for either CPR or extended support would represent enduring harm to the antemortem or previously autonomous individual by negating their beliefs and self-identity. The paper subsequently discusses potential implications of policy that would allow greater accommodations to those with conscientious objections to currently accepted brain-based death criteria, such as for cost, insurance, higher brain formulations and bedside communication. The conclusion is that granting wider latitude to personal conceptions around the definition of death, rather than forcing a contested definition on those with valid moral and religious objections, would benefit both individuals and society.

  3. CPR Appliance:Applications and Prospects%心肺复苏器的应用及展望

    Institute of Scientific and Technical Information of China (English)

    郭凯; 张源波; 周荣斌

    2014-01-01

    心肺复苏器是有望替代传统人工胸外按压的器材,正逐步应用于现场急救和临床抢救工作当中。本文介绍了胸外按压泵机制的理念沿袭、不同心肺复苏器设计的理论依据和国内外常见心肺复苏器的使用方法及特点;同时对心肺复苏器的发展趋势和改进方向进行了展望。以期为心肺复苏器更有效地应用于临床抢救中提供有益借鉴和推广。%Cardiopulmonary resuscitation appliance is a promising substitution for traditional artificial compression and it is gradual y applied in the fields of first aid and salvage.This paper introduces the conception of pump mechanism of chest compression,the theoretical basis of design in various CPR appliance and application procedure as wel as characteristics of common CPR appliance at home and abroad.Besides,the paper shows future outlook in development tendency and improvement direction of the apparatus.Al this can be made use for reference and promotion of CPR appliance in the application of clinical emergency treatment.

  4. 心肺复苏成败原因的探讨%Discussion on the reason for success or failure of cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    丘佩青

    2012-01-01

    目的 探讨心肺复苏(CPR)成败原因,提高CPR的成功率.方法 对我院急诊科2006年12月~2011年11月有完整资料记录的396例心搏骤停(CA)患者(晚期肿瘤,慢性疾病终末期除外)的救治进行回顾性分析,对CPR开始时间,地点、电击除颤、气管插管,机械通气等数据进行统计和分析.结果 165例5 min内开始CPR,抢救成功86例,成功率为52.1%;85例5~10 min开始CPR,抢救成功29例,成功率为34.1%;其余140例10 min后开始CPR,抢救成功0例,说明5 min内CPR成功率明显高于5min后.院内CPR 140例,抢救成功80例,成功率为57.1%;院前CPR 256例,抢救成功35例,成功率为13.7%,说明院内CPR成功率明显高于院前CPR成功率;2 min内电陆除颤CPR成功率(54.2%)明显高于2 min后电陆除CPR成功率(34.0%);有气管插管CPR成功率(34.1%)明显高于无气管插管CPR成功率(13.0%);气管插管并接呼吸机CPR成功率为39.1%,明显高于未接呼吸机(包括气管插管和未气管插管的患者)CPR成功率(10.7%);差异均有高度统计学意义(均P<0.01).结论 尽早正确有效的CPR、电击除颤及熟练气管插管是CPR成功的关键,要提高CPR成功率必须加强专业急救队伍建设,建立完善急救网络, 院前急救与院内急救密切配合,普及全民急救知识,从而进一步提高CPR成功率.%Objective To probe into the keys of CPR and improve the success rate of CPR. Methods 396 patients (except the late-stage cancer, the end-stage chronic disease) with a complete record of cardiac arrest (CA) in the emergency department from December 2006 to November 2011 were retrospectively analyzed, including the analysis of the statistical data of the CPR start time, place, electric defibrillation, tracheal intubation, and mechanical ventilation. Results 165 cases begin to CPR within 5 minutes, 86 cases were successfully rescued and the success rate was 52.1%; 85 cases begin to CPR between 5 to 10

  5. The influence of different asphyxia time on the reproduction of multiply organ dysfunction model after cardiopulmonary resuscitation following cardiac arrest in rabbit%不同窒息时间对心搏骤停家兔心肺复苏后多器官功能障碍发生的影响

    Institute of Scientific and Technical Information of China (English)

    张东; 王育珊; 李南; 陈颖

    2011-01-01

    了可能性和可行性.%Objective To explore the effects of different asphyxia time on the reproduction of multiply organ dysfunction syndrome in rabbit after cardiopulmonary resuscitation (CPR-MODS) for cardiac arrest,in order to provide a method to reproduce an animal model of CPR-MODS for further research of cardiopulmonary resuscitation (CPR).Methods The rabbit cardiac arrest was caused by asphyxia as a result of clamping the trachea.Thirty rabbits were divided into 7-minute asphyxia group and 8-minute asphyxia group by means of random number table with 15 rabbits in each group.The rate of resumption of spontaneous circulation(ROSC),the mortality at different time points and the occurrence incidence of systemic inflammatory response syndrome (SIRS) of two groups were observed after CPR and the ROSC.The levels of serum tumor necrosis factor-a (TNF-a),myocardial MB-isoenzyme of creatine kinase (CK-MB),alanine aminotransferase (ALT),creatinine (Cr),glucose (Glu) and arterial partial pressure of oxygen (PaO2) before resuscitation and 12,24 and 48 hours after ROSC were measured simultaneously in the two groups.The incidence of CPR-MODS was calculated.Results The CPR time (seconds) in 7-minute asphyxia group was significantly shorter than that in 8-minute asphyxia group(147.60±22.09 vs.193.08±23.07,P<0.01).The ROSC rate of 7-minute asphyxia group and 8-minute asphyxia group was 100.00% and 86.67%,respectively,and there was no significant difference.The incidence of MODS in the rabbits surviving more than 24 hours after ROSC was 1 00% in both groups.The mortality at 6 hours after ROSC in 7-minute asphyxia group was remarkably lower than that of 8-minute asphyxia group(6.67% vs.46.67%,P<0.05).All the rabbits in 8-minute asphyxia group died at 48 hours.The incidence of SIRS after ROSC was 100% in both groups.Compared with that before asphyxiation,the 1evel of serum TNF-a(ng/L)as well as CK-MB(U/L) increased significantly at 12 hours after ROSC in both groups(TNF-a in 7-minute asphyxia group:100.71±20

  6. 参加 CPR 培训的心脏性猝死高危者家属对施救陌生人风险认知的质性研究%Risks of high-risk sudden cardiac arrest family members to rescue strangers after CPR training

    Institute of Scientific and Technical Information of China (English)

    薛雪; 王永利; 岳鹏

    2016-01-01

    目的:本研究旨在深入了解参与 CPR 培训的心脏性猝死(SCD)高危者家属对陌生人施救的风险。方法采用半结构式访谈,访谈参加 CPR 培训的 SCD 高危者家属11名,资料分析采用不断比较的方法。结果参与 CPR 培训的 SCD 高危者家属对陌生人施救的风险主要来自:自我能力不足、社会环境堪忧、效果不明确等方面。结论SCD 高危者家属是否会参与 CPR 施救取决于他们对风险的评估和认知。%Objective To investigate the risks of high-risk sudden cardiac death (SCD) family members to rescue strangers after cardiopulmonary resuscitation (CPR)training.Methods A total of 1 1 SCD family members had been semi-structured interviewed.Data was analyzed using constant-comparative method. Results The risks of high-risk SCD family members to rescue strangers included insufficient self-ability, unfavorable social environment and uncertain effects.Conclusions High-risk SCD family members′participation of CPR depends on their knowledge and evaluation of the risks.

  7. Awareness and knowledge of pediatric cardio- pulmonary resuscitation in the community of Al-Khobar city

    Directory of Open Access Journals (Sweden)

    Hatim K. Al-Turkistani

    2014-01-01

    Full Text Available Background: The history of resuscitation going back thousands of years has been reported in literature throughout history. This concept has undergone several decisive revolutionary changes particularly in pediatrics. Although the cardio-pulmonary resuscitation (CPR is relatively new in pediatrics, progress has been remarkable in the last a few decades. As it becomes more popular, especially under the influence of globalizing media, CPR also becomes a life requirement that is not restricted to health professionals. Materials and Methods: This was a cross-sectional community-based survey of 753 individuals of both sexes, visiting the first Pediatric Health Awareness Week held at Dammam University Hospital in April 2013. Data were collected by a personal face-to-face interview during which a short history was taken and a check list of sociodemographic data and questions related to infants′ CPR was completed. Statistical analysis was performed by using SPSS. Results: The study was carried out on 753 subjects (602 Saudis, 151 non-Saudis, 483 females, and 270 males. The mean age of participants was 33.3 ± 10.9 years. The postsecondary school level of education was 37.5% among females versus 21.9% among males. Of the participants, 80.8% of the females and 86.5% of males were totally unaware of CPR. The mean number of children among participants was 3.5 ± 2.5 children. There were 150 participants (19.9% with disabled children; 32% of them (6.4% of all participants were completely unaware of CPR despite having disabled children. Overall, 15.5% of all female participants had attended some CPR course (s compared with 6.1% of the males; 18.7% of the females had watched CPR program (s/video (s on TV or online compared to 11.1% of the males, and 59.4% of the females were willing and eager to participate in any CPR course compared with 29.3% of the males. The reasons for not wanting to attend CPR courses were as follows: 48.6% indicated that it was because

  8. (SERCA2a)Effects of Rhodioside on heart function in rats after cardiopulmonary resuscitation%红景天苷对心肺复苏后大鼠心脏功能的保护作用

    Institute of Scientific and Technical Information of China (English)

    邓节喜; 陈劲松; 王子敬; 郭寿贵; 赵蓓; 阮发晖; 窦燕; 林庚海; 吴轲

    2013-01-01

    目的 研究红景天苷对复苏后大鼠心脏功能的保护作用.方法 60只成年SD大鼠随机分为5组,每组12只:复苏前给药组、复苏即刻给药组、自主循环恢复(ROSC)时给药组、不给药组、假手术组.窒息法建立大鼠心肺复苏模型,按分组在不同时间点给予红景天苷注射液,自主循环恢复维持2 h后超声检查大鼠左心室功能.分离培养成年大鼠心肌细胞,给予红景天苷干预后检测钙调神经磷酸酶(CaN-Aβ)、肌浆网钙泵(SERCA2a)的表达.结果 与假手术组比较,模型各组左心室功能明显下降(P<0.05),红景天苷干预组细胞的CaN-Aβ表达下调,SERCA2a表达上调(P<0.05).结论 红景天苷可以保护复苏后大鼠的心脏功能,可能与调节CaN-Aβ、SERCA2a表达有关.%Objective To observe the protective effect of Rhodioside on heart function after cardiopulmonary resuscitation in rats. Methods 60 rats were randomized into 5 groups. Rat models of cardiopulmonary resuscitation were established. Rhodioside was administrated before or after resuscitation at different time. When return of spontaneous circulation sustained for 2 h, heart function was assessed by echocardiography. Cardiac myocytes of adult rats were isolated and cultured with or without Rhodioside, atorvastatin and irbesartan. RT - PCR and Western blot were used to evaluate the expression change of SERCA2a and CaN - Aβ. Results Echocardiography revealed that heart function in model groups was significantly lower than that in false surgery group. Further analysis demonstrated that when given Rhodioside before resuscitation, better improvement of heart function could be observed. RT - PCR and Western blot demonstrated that Rhodioside could down - regulate CaN - Aβ and up - regulate SERCA2a. Conclusion Rhodioside could improve heart function after resuscitation in rats possibly associated with the regulation of SERCA2a and CaN - Aβ.

  9. How to Improve Our Nosocomialsuccess Average of CPR%如何提高院内CPR成功率

    Institute of Scientific and Technical Information of China (English)

    李生浩

    2013-01-01

    Cardiopulmonary resuscitation,or CPR,had maken so many patients survive from sudden death,which experienced a lot of majorizations and changes during the latest decades.The newest standards of CPR were delivered by American Heart Association,or AHA,in 2010,and have heightened the survive rate so much.However, observing the developing history and the current situation of this technique,we can note that people are just training about CPR itself,yet it is not enough in the aspects of the team cooperation,the regularity of training,and the conscious initiative of medicallstaf .Success average of CPR can also be elevated a lot,immediately these ideas are accepted and learntcomprehensively.%心肺复苏术(CPR)无疑已经挽救了许多生命,历经数10年的优化和改进,2010年美国心脏协会(AHA)提出心肺复苏的新标准,进一步提高猝死患者的生存率,但从该技术的发展历程及现状来看,大多局限于对该技术本身的学习,然而对于团队协作、定期培训、医务人员的主观能动性等方面并未得到很好的推广,如果这些理念能得到广泛推广和认识,那么CPR成功率仍有提高的空间。

  10. 4种复苏方法对呼吸骤停猪肺通气的影响观察%Effect of four resuscitation methods on ventilation of pigs with respiratory arrest

    Institute of Scientific and Technical Information of China (English)

    刘亚华; 李秀满; 王立祥

    2012-01-01

    目的 观察胸外按压心肺复苏(C-CPR)、经膈肌下抬挤心肺复苏(D-CPR)、腹部按压心肺复苏(A-CPR)和腹部提压心肺复苏(L-CPR)4种复苏方法对呼吸骤停猪通气的影响.方法 健康家猪28只随机分为4组,经静脉推注琥珀胆碱建立猪呼吸骤停模型,于呼吸骤停即刻分别进行C-CPR、D-CPR、A-CPR和L-CPR.复苏2min后停止按压,给予呼吸机辅助呼吸直至实验猪恢复自主呼吸.测定并比较基础状态时和复苏时4种复苏方法产生的潮气量(VT),并计算分钟通气量(MV);比较各组心率(HR)和平均动脉压(MAP)水平及自主呼吸恢复时间.结果 基础状态下,4组间VT和MV之间差异无统计学意义(P>0.05).复苏2min时的VT和MV,D-CPR组高于C-CPR组,A-CPR组高于D- CPR组,L-CPR组高于A-CPR组,差异均有统计学意义(P<0.01).复苏2min时,L-CPR组HR恢复接近于基础值,A-CPR组HR维持在呼吸骤停即刻水平,C-CPR组和D-CPR组HR明显低于基础值(P<0.01);复苏2min后给予机械通气,复苏5min时各组HR均接近基础值.结论 在呼吸骤停猪模型中,L-CPR较其他3种CPR法能产生更大的VT和MV.%Objective To observe the effects of four cardiopulmonary resuscitation (CPR) methods on ventilation of pigs with respiratory arrest. The four CPR methods included chest compression CPR (C-CPR), compression under the diaphragm CPR (D-CPR), abdominal compression CPR (A-CPR), and abdominal wall lifting and compression CPR (L-CPR). Methods A total of 28 healthy domestic pigs were randomly divided into four groups. The pig respiratory arrest model was reproduced by intravenous injection of suxamethonium. Instantly after respiratory arrest, one of each CPR method was performed immediately on the respective groups of pigs. After 2 min of CPR, compression was stopped. The experimental pigs were given assisted respiration using a ventilator until autonomous respiration recovered. The tidal volume (VT) in basic status and that during

  11. Expression of Occludin protein and its influence on blood brain barrier after cardiopulmonary resuscitation in sudden cardiac arrest rats%大鼠心脏骤停心肺复苏后脑Occludin蛋白表达及其对血脑屏障的影响

    Institute of Scientific and Technical Information of China (English)

    张慧利; 罗序睿; 李爱连; 张洁

    2016-01-01

    Objective To investigate the expression of Occludin protein after cardiopulmonary resuscitation (CPR) in sudden cardiac arrest rats and its effect on blood brain barrier.Methods Totally 200 Sprague-Dawley male rats were randomly divided into control group (n =100) and CPR group (n =100).Only arteriovenous and endotracheal intubations were given in control group,without choking and CPR;sudden cardiac arrest model was established,then CPR was performed in CPR group.Fifty rats were sacrificed with decollation to collect the brain tissue 2,6,12,24 and 48 h after postoperative stable phase (10 min after operation) in control group and 2,6,12,24 and 48 h after return of spontaneous circulation (ROSC) in CPR group (n =10 at each time points);the Occludin expression in the brain tissue was measured by immunohistochemistry.Fifty rats were injected with 3 mg/kg Evans blue via caudal veins,then were sacrificed with decollation 2 h later to collect the brain tissue;the brain barrier permeability rates of Evans blue were measured by fluorescence spectrophotometer.Results The cell number of positive Occludin protein and Evans blue content in brain tissue were not significantly different between groups (P > 0.05).Along with time,the cell number of positive Occludin protein in brain tissue firstly decreased then increased in CPR group,being significantly lower than that in control group at all the time points [(68.2± 1.0)/high power field vs (86.8 ± 1.3)/high power field,(42.1 ± 1.6)/high power field vs (85.1 ±2.7)/high power field,(18.1 ± 1.1)/high power field vs (84.9 ±2.8)/high power field,(37.8 ± 0.7)/high power field vs (82.1 ± 3.1)/high power field,(61.2 ± 1.0)/high power field vs (83.8 ± 2.5)/high power field] (P < 0.05);along with time,the contents of Evans blue in brain tissue firstly increased then decreased in CPR group,being significantly higher than that in control group at all time points [(0.496 ± 0.042) μg/gvs (0.245 ±0.012) μg/g,(0.704±0.021)

  12. Effect of opening of neuronal mitochondrial permeability transition pore on respiratory function after cardiopulmonary resuscitation in rats%心肺复苏后大鼠脑线粒体通透性转换孔开放对线粒体呼吸功能的影响

    Institute of Scientific and Technical Information of China (English)

    马宇洁; 杨兴易; 林兆奋; 缪明永; 张雷; 宁波

    2008-01-01

    目的 研究大鼠心肺复苏(CPR)后神经细胞线粒体通透性转换孔(MPTP)开放对线粒体呼吸功能的影响,并探讨其可能机制.方法 建立窒息加冰KC1致大鼠心搏骤停(CA)/CPR动物模型,在自主循环恢复(ROSC)后3、6、12、24、48和72 h断头处死大鼠制备大脑皮质内线粒体匀浆.采用分光光度法测定线粒体MPTP的开放程度,用Clark氧电极法分析线粒体呼吸功能,并电镜下观察线粒体超微结构.结果 CA/CPR后大鼠神经细胞线粒体功能明显受损,线粒体呼吸Ⅲ态(R3)速率下降;ROSC后神经细胞MPTP持续处于开放状态,开放程度并不是瞬间增至最大,而是具有时间依赖性.具体表现为:ROSC后6h内神经细胞MPTP开放程度保持低水平,6 h以后开始迅速大量开放,12 h开放程度达到最大,24 h开放程度略有缩小,表明线粒体开始收缩.至48 h开放程度再次加大.72 h又明显缩小,但未达到正常水平(P均<0.05).虽然线粒体R3速率下降.但线粒体呼吸Ⅳ态(R4)速率升高,呼吸控制率(RCR)和磷/氧(P/O)比值明显下降;随着ROSC时间延长,RCR和P/O比值持续在低水平状态(P<0.05或P<0.01).透射电镜下观察细胞有明显损伤.相关分析表明,MPTP开放与RCR呈明显正相关(r=0.025,P<0.05).结论 CPR后MPTP开放是加重神经细胞能量代谢障碍的主要原因,在ROSC后早期即12 h以内如能及时应用抑制MPTP开放的策略,可能会使神经细胞的线粒体功能朝着良性方向发展.为神经功能的恢复赢得机会.%Objective To investigate the effect of opening of neuronal mitochondrial permeability transition pore (MPTP) on respiratory function after cardiopulmonary resuscitation (CPR) in rats and its possible mechanism.Methods Cardiac arrest (CA)/CPR rat model was reproduced by asphyxiation and ice-cold KCI followed resuscitation and restoration of spontaneous circulation (ROSC). The rats were sacrificed by decapitation at 3,6,12,24,48 and 72 hours

  13. Family Presence during Resuscitation: A Qualitative Analysis from a National Multicenter Randomized Clinical Trial

    Science.gov (United States)

    De Stefano, Carla; Normand, Domitille; Jabre, Patricia; Azoulay, Elie; Kentish-Barnes, Nancy; Lapostolle, Frederic; Baubet, Thierry; Reuter, Paul-Georges; Javaud, Nicolas; Borron, Stephen W.; Vicaut, Eric; Adnet, Frederic

    2016-01-01

    Background The themes of qualitative assessments that characterize the experience of family members offered the choice of observing cardiopulmonary resuscitation (CPR) of a loved one have not been formally identified. Methods and Findings In the context of a multicenter randomized clinical trial offering family members the choice of observing CPR of a patient with sudden cardiac arrest, a qualitative analysis, with a sequential explanatory design, was conducted. The aim of the study was to understand family members’ experience during CPR. All participants were interviewed by phone at home three months after cardiac arrest. Saturation was reached after analysis of 30 interviews of a randomly selected sample of 75 family members included in the trial. Four themes were identified: 1- choosing to be actively involved in the resuscitation; 2- communication between the relative and the emergency care team; 3- perception of the reality of the death, promoting acceptance of the loss; 4- experience and reactions of the relatives who did or did not witness the CPR, describing their feelings. Twelve sub-themes further defining these four themes were identified. Transferability of our findings should take into account the country-specific medical system. Conclusions Family presence can help to ameliorate the pain of the death, through the feeling of having helped to support the patient during the passage from life to death and of having participated in this important moment. Our results showed the central role of communication between the family and the emergency care team in facilitating the acceptance of the reality of death. PMID:27253993

  14. Programa de capacitação em ressuscitação cardiorrespiratória com uso do desfibrilador externo automático em uma universidade Programa de formación en reanimación cardiopulmonar con el uso del desfibrilador externo automático en una universidad Training program on cardiopulmonary resuscitation with the use of automated external defibrillator in a university

    Directory of Open Access Journals (Sweden)

    Ana Paula Boaventura

    2012-03-01

    .Early defibrillation in cardiopulmonary resuscitation (CPR receives increasing emphasis on its priority and rapidity. This is an experience report about the implementation of a training program in CPR using a defibrillator in a private university. The training program in basic CPR maneuvers was based on global guidelines, including a theorical course with practical demonstration of CPR maneuvers with the defibrillator, individual practical training and theoretical and practical assessments. About the performance of students in the practical assessment, the mean scores obtained by students in the first stage of the course was 26.4 points, while in the second stage the mean was 252.8 points; in the theoretical assessment the mean in the first stage was 3.06 points and in the second 9.0 points. The implementation of programs like this contribute to the effective acquisition of knowledge (theory and skill (pratice for the care of CPR victims.

  15. Studies on the partial pressure of end-tidal carbon dioxide and the coronary perfusion pressure during the cardiopulmonary resuscitation in dogs%心肺复苏期间犬潮气末二氧化碳分压与冠状动脉灌注压的研究

    Institute of Scientific and Technical Information of China (English)

    周哲人; 高路

    2014-01-01

    目的:以电击致犬心室颤动建立的心搏骤停动物模型为研究对象,研究在心肺复苏(CPR)模式下犬潮气末二氧化碳分压(PETCO2)和冠状动脉灌注压(CPP)的变化及相关性。方法选健康杂种犬36只随机分为三组:4 min胸外复苏组、4 min开胸复苏组、8 min开胸复苏组。每组12只犬,雌、雄各半,致颤前及复苏过程中对PETCO2及CPP进行监测。根据自主循环恢复(ROSC)情况,比较复苏成功和复苏失败犬的CPP和PETCO2。结果4 min 胸外心肺复苏(CCCPR)时CPP与PETCO2的Pearson相关系数为0.992,P<0.05,CPP与PETCO2呈线性正相关。4 min开胸心肺复苏(OCCPR)时CPP与PETCO2的Pearson相关系数为0.937,P<0.05,CPP与PETCO2呈线性正相关。8 min OCCPR时CPP与PETCO2的Pearson相关系数为0.952,P<0.05, CPP与PETCO2呈线性正相关。4 min胸外复苏组ROSC 8只(66.7%),4 min开胸复苏组ROSC 12只(100%),8 min开胸复苏组ROSC 7只(58.3%)。在按压复苏1、2、5、10、15、20 min时,自主循环恢复组与失败组的CPP和PETCO2分别比较,两组之间差异均有统计学意义(P<0.05)。结论心肺复苏期间CPP与PETCO2关系密切,呈线性正相关,因此可以用PETCO2参数评价心肺复苏的预后效果。%Objective To study the changes in and correlations between the partial pressure of end-tidal carbon dioxide (PETCO2) and the coronary perfusion pressure during cardio-pulmonary resuscitation (CPR) based on the cardiac arrest dog models of ventricular fibrillation by electric shock. Methods 36 healthy dogs were evenly randomized into 3 groups including 4 minutes close-chest CPR(CCCPR) group, 4 minutes open-chest CPR(OCCPR) group, and 8 minutes OCCPR group. There were 12 dogs in each group, half male and half female. In the process of CPR, all parameters about PETCO2 and CPP were recorded. Results In the 4 minutes CCCPR group, the correlation coefficient between

  16. 多次心肺复苏体外膜肺氧合支持后器官捐献供肾移植的临床疗效分析%Clinical outcomes of DCD renal transplantation after extracorporeal membrane oxygenation support with multiple cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    苏庆东; 董建辉; 李壮江; 孙煦勇; 曹嵩; 黄莹; 廖吉祥; 聂峰; 李海滨

    2016-01-01

    目的 比较多次心肺复苏后公民逝世后器官捐献(donation after citizen's death,DCD)供肾移植与无心肺复苏史DCD供肾移植的临床疗效.方法 回顾性分析了2012年7月至2014年12月完成的250例DCD供肾移植供、受者的临床资料.根据器官获取前是否发生多次心肺复苏(2次或2次以上)将其分为多次心肺复苏后DCD供肾移植组(观察组,17例)和无心肺复苏史供肾移植组(对照组,233例),多次心肺复苏供者均使用体外膜肺氧合(ECMO)技术支持.比较两组供者和受者的一般情况、受者术前血肌酐、术后不同时间点血肌酐水平、各种并发症的发生率及移植肾和受者的1年存活率.结果两组供者及受者一般情况、受者不同时间点血肌酐水平、住院时间相比较,差异均无统计学意义(P>0.05).观察组移植肾功能恢复延迟(DGF)发生率为17.6%(3/17),对照组DGF发生率为23.2%(54/233),差异无统计学意义(P>0.05).观察组术后急性排斥反应和肺部感染发生率均为11.8%;对照组分别为16.3%(38/233)及20.2%(47/233),两组间的差异均无统计学意义(P>0.05).Kaplan-Meier生存曲线结果显示,观察组受者和移植肾1年存活率均为94.1%,而对照组分别为92.7%和91.4%,但两组比较差异无统计学意义(P>0.05).结论 多次心肺复苏ECMO支持后DCD供肾移植近期临床效果与与无心肺复苏史DCD供肾移植相当.%Objective To compare the clinical outcomes of DCD renal transplantation from donors after extracorporeal membrane oxygenation (ECMO) support with multiple cardiopulmonary resuscitation (CPR) with donors showing no CPR history prior to organ procurement.Method A retrospective study was done on 17 cases of DCD renal transplantation from donors after (ECMO) support with multiple CPR (observation group) and 233 cases of DCD renal transplantation with no history of CPR (control group) from July 2012 to December 2014.Demographic and

  17. The Direction Function of Materialistic Dialectics for Cardiopulmonary Resuscitation in Prehospital Emergency%唯物辩证法在院前心肺复苏实践中的指导作用

    Institute of Scientific and Technical Information of China (English)

    郑进

    2011-01-01

    According to the viewpoint of materialistic dialectics , this paper analyzed some contradictory problem of Cardiopulmonary resuscitation in pre-hospital emergency, and proposed some ideas to resolve this problem too. It benefits for professional and nonprofessional rescuer in pre-hospital emergency care.%在院前心肺复苏实践中,我们会遇到很多矛盾的问题.本文从唯物辩证法的角度出发,分析了院前心肺复苏中一些比较棘手的问题,并为解决这些问题提出建议,对从事院前急救的医学专业人士以及非医学专业人士均具有一定的启发意义.

  18. Hands-on time during cardiopulmonary resuscitation is affected by the process of teambuilding: a prospective randomised simulator-based trial

    Directory of Open Access Journals (Sweden)

    Breuer Marc

    2009-02-01

    Full Text Available Abstract Background Cardiac arrests are handled by teams rather than by individual health-care workers. Recent investigations demonstrate that adherence to CPR guidelines can be less than optimal, that deviations from treatment algorithms are associated with lower survival rates, and that deficits in performance are associated with shortcomings in the process of team-building. The aim of this study was to explore and quantify the effects of ad-hoc team-building on the adherence to the algorithms of CPR among two types of physicians that play an important role as first responders during CPR: general practitioners and hospital physicians. Methods To unmask team-building this prospective randomised study compared the performance of preformed teams, i.e. teams that had undergone their process of team-building prior to the onset of a cardiac arrest, with that of teams that had to form ad-hoc during the cardiac arrest. 50 teams consisting of three general practitioners each and 50 teams consisting of three hospital physicians each, were randomised to two different versions of a simulated witnessed cardiac arrest: the arrest occurred either in the presence of only one physician while the remaining two physicians were summoned to help ("ad-hoc", or it occurred in the presence of all three physicians ("preformed". All scenarios were videotaped and performance was analysed post-hoc by two independent observers. Results Compared to preformed teams, ad-hoc forming teams had less hands-on time during the first 180 seconds of the arrest (93 ± 37 vs. 124 ± 33 sec, P Conclusion Hands-on time and time to defibrillation, two performance markers of CPR with a proven relevance for medical outcome, are negatively affected by shortcomings in the process of ad-hoc team-building and particularly deficits in leadership. Team-building has thus to be regarded as an additional task imposed on teams forming ad-hoc during CPR. All physicians should be aware that early

  19. DNR policies in North America: A procedural morass - resuscitation practices revisited

    Directory of Open Access Journals (Sweden)

    Puri V

    2006-01-01

    Full Text Available More than twenty-five years have elapsed since the first Do Not Resuscitate (DNR policies were proposed. A historical review of the application of DNR policies is provided with its rationale and perceived effects. A viewpoint is presented, that acceptance of implied consent for cardiopulmonary resuscitation (CPR in hospitalized patients was responsible for drawing up of DNR policies. Unfortunately, the principle of informed consent as related to CPR and DNR policies, has had unintended consequences. Practical results do not indicate that medical practices have become more humane. Abuses of the process go beyond matters of style and experience, in communicating with surrogate decision-makers. Instead of generating compassion and respect for the patient, policies may contribute to cynicism and lack of caring amongst physicians. Overly optimistic dependence on advance directives to reform medical practices, appears unjustified. The concept of futility to limit demands for non-beneficial care is examined. It is unlikely that physicians can routinely invoke futility, as an argument to limit treatments. A re-examination of DNR policies as a defense against technologic imperative is warranted.

  20. 血必净对大鼠心肺复苏后早期大脑皮质bcl-2及bax凋亡因子的影响%Effects of Xuebijing on cerebral cortex apoptosis factors bcl-2 and bax in rats at early stage after cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    刘海健; 张莉; 何喜欢

    2016-01-01

    ObjectiveTo observe the effects of different doses of Xuebijing on cerebral cortex apoptosis factors bcl-2 and bax in rats at early stage after cardiopulmonary resuscitation (CPR).Methods Thirty-two healthy SD rats aged 12 weeks were divided into four groups by using a random number table method (each,n = 8); all the rats were intubated through the opening of tracheotomy, and the blood pressure was measured through the left/right femoral artery catheter. Asphyxiation was applied to rats, resulting in cardiac arrest (CA), and then cardiopulmonary resuscitation (CPR) was carried out. After restoration of spontaneous circulation (ROSC), 0.9% normal saline 8 mL/kg, 0.9% normal saline 4 mL/kg + Xuebijing 4 mL/kg, 0.9% normal saline 2 mL/kg + Xuebijing 6 mL/kg and Xuebijing 8 mL/kg were given to model group, Xuebijing low dose group, middle dose group and high dose group respectively. The rat body weight, time of CA, CPR-ROSC time, ROSC ratio and the amounts of dopamine and 0.9% saline used in 24 hours were recorded. The positive protein expression levels of bcl-2 and bax in rat cerebral cortex and the ratio of bcl-2/bax was measured at 24 hours after ROSC.Results Compared with the model group, the amount of 0.9% normal saline (mL: 4.2±1.2, 2.6±1.0, 2.5±1.0 vs. 5.5±1.1,P < 0.05) and of dopamine used in 24 hours (μg: 1865±189, 1376±197, 1215±145 vs. 3526±141,P < 0.05), the levels of positive protein expression of bcl-2 (%: 33.4±4.3, 25.5±4.6, 26.1±4.2 vs. 38.5±5.1), and of bax at 24 hours after ROSC (%: 39.5±4.3, 32.8±3.8, 31.9±3.7 vs. 44.3±5.1) and the ratio of bcl-2/bax (0.87±0.16, 0.72±0.13, 0.71±0.14 vs. 0.89±0.11) was significantly decreased in low, middle and high dose groups (allP < 0.05). Compared with the low dose group, the amount of 0.9% normal saline and dopamine used in 24 hours, protein expression levels of bcl-2 and bax at 24 hours and the ratio of bcl-2/bax in middle dose and high dose groups were all lower than those in low dose group

  1. Fatores prognósticos de sobrevida pós-reanimação cardiorrespiratória cerebral em hospital geral In-hospital post-cardiopulmonary-cerebral resuscitation survival prognostic factors

    Directory of Open Access Journals (Sweden)

    André Mansur de Carvalho Guanaes Gomes

    2005-10-01

    Full Text Available OBJETIVO: Analisar as características clínicas e demográficas dos pacientes que receberam reanimação cardiorrespiratória e detectar fatores prognósticos de sobrevivência a curto e longo prazo. MÉTODOS: Analisamos, prospectivamente, 452 pacientes que receberam reanimação em hospitais gerais de Salvador. Utilizou-se análise uni, bivariada e estratificada nas associações entre as variáveis e a curva de sobrevida de Kaplan-Meier e a regressão de Cox para análise de nove anos de evolução. RESULTADOS: A idade variou de 14 a 93 anos, media de 54,11 anos; predominou o sexo masculino; metade dos pacientes tinha ao menos uma doença de base, enfermidade cardiovascular foi etiologia responsável em metade dos casos. Parada cardíaca foi testemunhada em 77% dos casos e em apenas 69% dos pacientes foi iniciada imediatamente a reanimação. O ritmo cardíaco inicial não foi diagnosticado em 59% dos pacientes. Assistolia foi o ritmo mais freqüente (42%, seguida de arritmia ventricular (35%. A sobrevida imediata foi de 24% e sobrevida à alta hospitalar de 5%. Foram identificados como fatores prognósticos em curto prazo: etiologia da parada; diagnóstico do ritmo cardíaco inicial; fibrilação ou taquicardia ventricular como mecanismo de parada; tempo estimado préreanimação menor ou igual a 5 minutos e, tempo de reanimação menor ou igual a 15 minutos. Os fatores prognósticos de sobrevivência em nove anos de evolução foram: não ter recebido epinefrina; ser reanimado em hospital privado e tempo de reanimação menor ou igual a 15 minutos. CONCLUSÃO: Os dados observados podem servir de subsídios para os profissionais de saúde decidir quando iniciar ou parar uma reanimação no ambiente hospitalar.OBJECTIVE: To assess clinical and demographic characteristics of patients who had cardiopulmonary resuscitation and identify short- and long-term survival prognostic factors. METHODS: Four hundred and fifty-two (452 resuscitated

  2. 心肺复苏后大鼠皮质区凋亡相关性微小RNA的表达变化%Expression changes in apoptosis-related microRNA in cerebral cortex after cardiopulmonary resuscitation in rat models of cardiac arrest induced by asphyxia

    Institute of Scientific and Technical Information of China (English)

    任妙丹; 何爱文; 陈寿权; 李章平; 乔江华; 李东芳; 李惠萍; 黄唯佳; 程俊彦

    2014-01-01

    Objective To observe the expression changes in apoptosis-related microRNA(miRNA) in cerebral cortex after cardiac arrest-cardiopulmonary resuscitation(CA-CPR)in rats and explore the factors that may affect the mechanism of CPR. Methods 24 clean male Sprague-Dawley(SD)rats were randomly divided into three groups,the normal control group,sham operation group and CA-CPR group(each n=8). The animal model of CA induced by asphyxia was established and CPR was performed. In the normal control group,no special management was performed. In the sham operation group,only abdominal cavity anesthesia,tracheotomy,vascular puncture and electrocardiogram(ECG)were performed without clamping the trachea and resuscitating. Normal feeding in normal control group and 24 hours after tracheotomy in sham operation group,at 24 hours after recovery of spontaneous circulation(ROSC)in CA-CPR group,cerebral cortex specimens were obtained for detection of the expression of miRNA by using real time fluorescence quantitative reverse transcription - polymerase chain reaction(RT-PCR). Flow cytometry(FCM)was used to detect the neurocyte apoptotic rate. Results Compared between normal control and sham operation groups,there were no significant differences in the expression of apoptosis-related miRNA and neurocyte apoptosis rate of cerebral cortex(both P>0.05). Compared with sham operation group,in CA-CPR group, 16 miRNA expressions were up-regulated,including Let-7c,miR-15a,miR-21,miR-24,miR-29,miR-29b, miR-34a, miR-103, miR-200a, miR-200b, miR-200c, miR-210, miR-326, miR-338-3p, miR-494 and miR-497,and there were 22 down-regulated,being Let-7a,Let-7b,Let-7d,Let-7e,miR-19a,miR-19b-1, miR-20a,miR-20b,miR-23a,miR-23b,miR-25,miR-98,miR-107,miR-122a,miR-125a,miR-125b, miR-145,miR-181a,miR-181c,miR-335,miR-384-5p and miR-422a. Eight miRNA had significant changes at 24 hours after ROSC,in which miR-15a,miR-21,miR-34a,miR-497 were up-regulated respectively for 6.831±2.625,8.122±3.442,5.349±2.010,6.590±3

  3. The new 2015 CPR guidelines change and progress%2015心肺复苏指南新变化与进展

    Institute of Scientific and Technical Information of China (English)

    金晓胜; 蔡文伟; 叶侃; 张盖

    2016-01-01

    mechanism more flexible.Con-firmed the single rescue operation sequence,sure the high quality of the BLS is the solid foundation of ACLS,and further stressed the importance of ACLS team.The purpose of this combined edition 2010 CPR Guidelines 2015 on the basis of new guidelines for comparative analysis,familiar with and master the new CPR guidelines change,so that medical staff better grasp CPR techniques,more scientific and effective res-cue cardiac arrest patients,improve Cardiopulmonary resuscitation success rate.

  4. The application of scene simulation in the training of cardiopulmonary cerebral resuscitation skills among emergency nurses%情景模拟在急诊护士心肺脑复苏技能培训中的应用

    Institute of Scientific and Technical Information of China (English)

    荣晓旭; 屠苏

    2013-01-01

    Objective:To discuss the application effect of scene simulation in the training of cardiopulmonary cerebral resuscitation skills among emergency nurses.Methods:Choose 57 emergency nurses as the targeted trainees.Carry out the training of clinical cardiopulmonary cerebral resuscitation skills through applying the integrated model of technology review (theory and classified technical exercises),establishment of the simulation scene,scene design,role assignment,scene simulation and summary.10 test the integrated abilities including theory,skills,and first aid ability of the targeted trainees before and after the training.Then compared the difference of the result,and send out the feedback questionnaire to analyze the evaluation of the teaching methods.Results:The result of the examination after the training remarkably improved comparing with the initial test scores.And all of the targeted trainees consider that the training is helpful,effective and of great practicality.Conclusion:The application of Scene simulation in the training of cardiopulmonary cerebral resuscitation skills among emergency nurses,not only enhanced the attraction of professional training,aroused the enthusiasm of emergency nurses in skill practice,but also strengthened their understanding and memory of the theory which,as a result,improves the sense of teamwork and comprehensive professional ability of the nursing staff,and turn out to be with very essential application value.%目的:探讨情景模拟在急诊护士心肺脑复苏技能培训中的效果.方法:选择57名急诊护士作为培训对象,采用技术要点复习(理论讲解与分项技术练习)、建立模拟现场、情景设计、角色分配、现场模拟与总结的综合模式,进行临床心肺脑复苏技能培训.培训前后,予以理论、技能、急救综合能力测试,比较两次成绩差异;并发放反馈调查问卷分析对教学方法的评价.结果:急诊护士培训后再次考核成绩

  5. 4 ℃盐水诱导的低温对猪心搏骤停复苏后肝脏的影响%Effects of hypothermia induced by 4 ℃ normal saline on liver in a swine model of cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    韩奕; 李春盛

    2010-01-01

    Objective To assess the effects of hypothermia induced by 4 ℃ normal saline (NS) on biochemical function, enzymology and morphology of liver in swine after the success of cardiopulmonary resuscitation (CPR) for cardiac arrest(CA). Method The swine were resuscitated with standard CPR 4 minutes after ventricular fibrillation(VF) ,and the survived swine were randomly(random number) divided into two groups. In hypothermia(LT) group (n = 5), swine were treated with continuous infusion of 4 ℃ NS at the speed of 1.33 mL/(kg·min) for 22 min, and then slow the speed to 10 mL/(kg·h) for 4 h. In normothermia (NT) group ( n= 5) swine were treated with the infusion of NS with room temperature instead of cryogenic NS at the same speed as the LT group. The hemodynamics and the changes of blood gas were monitored until 4 h after restoration of spontaneous circulation (ROSC), and blood samples were taken to detect serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) before VF and 10 min, 2 h and 4 h after ROSC. All swine were sacrificed 24 hours after ROSC, and their liver tissues were taken away for detecting Na+ -K + -ATP enzyme and Ca2+ -ATP enzyme as well as the histological changes under both light and electron microscopy. Results The heart rate, MAP, cardiac output(CO) and coronary perfusion pressure(CPP) of swine were stable in LT group ( P > 0.05). The AST, ALT and LDH increased in both groups but less in LT group. The hepatic ATP enzyme activity was much higher in LT group ( P < 0.05). Compared with the NT group, there were less cellularedema,necrosis or inflammatory cells infiltration, and better morphosis of mitochondria of livers found in swine of LT group. Conclusions The continuous administration of 4 ℃ NS after ROSC could quickly lower the core body temperature, and it could keep hemodynamics and oxygen metabolisms stable, protecting the biochemical function,enzymology and morphology of liver in swine

  6. Basic principles of the cardiopulmonary resuscitation——remain essentially the same despite all apparent changes%论心肺复苏的核心原理——万变不离其宗

    Institute of Scientific and Technical Information of China (English)

    孟庆义

    2011-01-01

    This paper expounds the basic principles of the cardiopulmonary resuscitation. The main points include the Venturi - effect in the mouth - to - mouth ventilation, the key points of chest compression analyzed with the Newton's laws of mechanics and law of energy conservation, and the development of electrical defibrillator with the Joule - Lenz law in the physics and principle of negation of negation in the philosophy. To master the basic principles of the cardiopulmonary resuscitation was the basis for studying and expanding the technique competence of cardiopulmonary resuscitation.%本文对心肺复苏(CPR)的一些核心原理进行了论述,主要内容有口对口人工呼吸与文丘里效应,用牛顿力学三大定律和能量守恒定律等原理解析胸部按压的操作要点,物理学的焦耳-楞次定律和哲学的否定之否定规律与体外电除颤技术的发展等;还提出掌握CPR的核心原理是发展和学习CPR技术的基础.

  7. Prognostic factors for death and survival with or without complications in cardiac arrest patients receiving CPR within 24 hours of anesthesia for emergency surgery

    Directory of Open Access Journals (Sweden)

    Siriphuwanun V

    2014-10-01

    Full Text Available Visith Siriphuwanun,1 Yodying Punjasawadwong,1 Worawut Lapisatepun,1 Somrat Charuluxananan,2 Ketchada Uerpairojkit2 1Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Purpose: To determine prognostic factors for death and survival with or without complications in cardiac arrest patients who received cardiopulmonary resuscitation (CPR within 24 hours of receiving anesthesia for emergency surgery. Patients and methods: A retrospective cohort study approved by the Maharaj Nakorn Chiang Mai University Hospital Ethical Committee. Data used were taken from records of 751 cardiac arrest patients who received their first CPR within 24 hours of anesthesia for emergency surgery between January 1, 2003 and October 31, 2011. The reviewed data included patient characteristics, surgical procedures, American Society of Anesthesiologist (ASA physical status classification, anesthesia information, the timing of cardiac arrest, CPR details, and outcomes at 24 hours after CPR. Univariate and polytomous logistic regression analyses were used to determine prognostic factors associated with the outcome variable. P-values of less than 0.05 were considered statistically significant. Results: The outcomes at 24 hours were death (638/751, 85.0%, survival with complications (73/751, 9.7%, and survival without complications (40/751, 5.3%. The prognostic factors associated with death were: age between 13–34 years (OR =3.08, 95% CI =1.03–9.19; ASA physical status three and higher (OR =6.60, 95% CI =2.17–20.13; precardiopulmonary comorbidity (OR =3.28, 95% CI =1.09–9.90; the condition of patients who were on mechanical ventilation prior to receiving anesthesia (OR =4.11, 95% CI =1.17–14.38; surgery in the upper abdominal site (OR =14.64, 95% CI =2.83–75.82; shock prior to cardiac arrest (OR =6.24, 95% CI =2.53–15

  8. Effects of hydrogen sulfide on the expressions of bax and bcl-2 in hippocampi of rats after cardiopulmonary resuscitation%硫化氢对大鼠心脏骤停后海马组织bax和bcl-2表达的影响

    Institute of Scientific and Technical Information of China (English)

    张自立; 蔺际; 廖晓星; 魏红艳; 李慧; 李欣; 刘荣; 胡春林; 戴刚

    2011-01-01

    目的 通过检测大鼠海马组织bcl-2和bax表达来探讨硫化氢(H2S)在心脏骤停(cardiac arrest, CA)后脑细胞凋亡中的作用.方法 雄性SD大鼠160只,初始选择108只随机均分为三组,建立CA/CPR模型.①第1组(36只):在自主循环恢复(ROSC)后予以NaHS干预;②第2组(36只),在自主循环恢复(ROSC)后予以羟胺干预;③第3组为常规复苏组(36只).上述三组根据观察终点又均分为1、3和7 d三个亚组,每个亚组再等分两组分别做相关凋亡的免疫组化和RT-PCR检测.结果 ①三组经历CPR大鼠死亡及备用鼠使用的差别无统计学意义(P>0.05);②在CPR后,三组之间大鼠血清H2S浓度变化的差异有统计学意义(F=189.917,P=0.000),在CPR后各时点上三组之间血清H2S浓度的差异均有统计学意义(P=0.000);③在CPR后,三组之间大鼠海马组织CA1区bax和bcl-2蛋白表达累积光密度变化的差异有统计学意义(P<0.05),在CPR后各时点上三组之间海马组织CA1区bax和bcl-2蛋白表达累积光密度的差异均有统计学意义(P<0.01);④在CPR后,三组之间大鼠海马组织bax和bcl-2 mRNA相对表达量变化的差异有统计学意义(P=0.000),在CPR后各时点上三组之间海马组织bax和bcl-2 mRNA相对表达量的差异有统计学意义(P<0.01).结论 在CPR后,H2S可能通过促进bcl-2和抑制bax表达来影响bcl-2/bax的平衡而参与神经细胞凋亡.%Objective To examine the expression of hax and bcl - 2 in the hippocampi of rats and investigate the effects of hydrogen sulfide ( H2S) on neurons apoptosis after cardiopulmonary resuscitation ( CPR). Methods There were 160 male SD rats, the 108 rats were initially selected and randomly divided into 3 groups equally. Model of cardiac arrest were induced by transcutaneous electrical epicardium stimulation and standard CPR were offered in all the subjects. After ROSC, the First group were given sodium bisulfide,the second group were given hydroxylamine, and the third

  9. Are chest compressions safe for the patient reconstructed with sternal plates? Evaluating the safety of cardiopulmonary resuscitation using a human cadaveric model

    Directory of Open Access Journals (Sweden)

    McKay Douglas R

    2010-08-01

    Full Text Available Abstract Background Plate and screw fixation is a recent addition to the sternal wound treatment armamentarium. Patients undergoing cardiac and major vascular surgery have a higher risk of postoperative arrest than other elective patients. Those who undergo sternotomy for either cardiac or major vascular procedures are at a higher risk of postoperative arrest. Sternal plate design allows quick access to the mediastinum facilitating open cardiac massage, but chest compressions are the mainstay of re-establishing cardiac output in the event of arrest. The response of sternal plates and the chest wall to compressions when plated has not been studied. The safety of performing this maneuver is unknown. This study intends to demonstrate compressions are safe after sternal plating. Methods We investigated the effect of chest compressions on the plated sternum using a human cadaveric model. Cadavers were plated, an arrest was simulated, and an experienced physician performed a simulated resuscitation. Intrathoracic pressure was monitored throughout to ensure the plates encountered an appropriate degree of force. The hardware and viscera were evaluated for failure and trauma respectively. Results No hardware failure or obvious visceral trauma was observed. Rib fractures beyond the boundaries of the plates were noted but the incidence was comparable to control and to the fracture incidence after resuscitation previously cited in the literature. Conclusions From this work we believe chest compressions are safe for the patient with sternal plates when proper plating technique is used. We advocate the use of this life-saving maneuver as part of an ACLS resuscitation in the event of an arrest for rapidly re-establishing circulation.

  10. 线粒体分裂抑制剂对心肺复苏后脑功能及神经元凋亡的影响%Effects of mitochondrial division inhibitor on neurological function and neuronal apoptosis in rats after cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    李毅; 王鹏; 林嘉莉; 黄子通

    2015-01-01

    Objective To investigate the effects of mitochondrial division inhibitor 1 (mdivi-1) in rats after cardiopulmonary resuscitation (CPR) and its mechanism.Methods Fifty Sprague-Dawley (SD) rats were randomly (random number table) divided into sham group (n =8),cardiac arrest (CA) model group (n =14),dimethyl sulfoxide post-treatment control group (DMSO group,n =14),and mdivi-1 post-treatment group (mdivi-1 group,n =14).Asphyxial CA was reproduced in animals,and they were resuscitated by CPR.In the mdivi-1 group or DMSO group,the animals were given mdivi-1 (1.2 mg/kg) or DMSO (0.1%) intravenously after restoration of spontaneous circulation (ROSC).The neurological functions were assessed using neurological deficit score (NDS) determined at 24,48 and 72 hours after CPR.The brain tissues were harvested at 72 hours after CPR.The histopathologic changes were assessed by hematoxylin and eosin (HE) staining,and the normal neuron was counted.The neuronal apoptosis was assessed with terminal dexynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining,and the expressions of cytochrome C (Cyt-C) protein in mitochondria and cytoplasm from hippocampus were determined by Western Blot.Results NDS in all experiment groups was gradually increased after CPR,and they were significantly lower than thoseo.f the sham group at 24,48,and 72 hours (51.5±3.7 vs.80.0±0.0,59.3±3.6 vs.80.0±0.0,66.7±2.6 vs.80.0±0.0,all P < 0.05).The number of normal pyramidal neurons in the hippocampal CA1 region was markedly reduced (cells/HP:4.4± 1.1 vs.23.1 ± 4.0,P < 0,05),the apoptotic index was significantly increased [(86.9 ± 6.9)% vs.(3.4 ± 0.8)%,P < 0.05],the expressions of Cyt-C in mitochondria were significantly decreased (A value:0.46±0.18 vs.1.00±0.00,P < 0.05),and the expressions of Cyt-C in cytoplasm were significantly up-regulated (A value:6.65±0.21 vs.1.00±0.00,P < 0.05).Compared with the CA group,NDS at 24 hours and 48 hours in mdivi-1 group was

  11. The risk factors and prognostic implication of acute pulmonary edema in resuscitated cardiac arrest patients

    Science.gov (United States)

    Kang, Dae-hyun; Kim, Joonghee; Rhee, Joong Eui; Kim, Taeyun; Kim, Kyuseok; Jo, You Hwan; Lee, Jin Hee; Lee, Jae Hyuk; Kim, Yu Jin; Hwang, Seung Sik

    2015-01-01

    Objective Pulmonary edema is frequently observed after a successful resuscitation in out-of-hospital cardiac arrest (OHCA) patients. Currently, its risk factors and prognostic implications are mostly unknown. Methods Adult OHCA patients with a presumed cardiac etiology who achieved sustained return of spontaneous circulation (ROSC) in emergency department were retrospectively analyzed. The patients were grouped according to the severity of consolidation on their initial chest X-ray (group I, no consolidation; group II, patchy consolidations; group III, consolidation involving an entire lobe; group IV, total white-out of any lung). The primary objective was to identify the risk factors of developing severe pulmonary edema (group III or IV). The secondary objective was to evaluate the association between long-term prognosis and the severity of pulmonary edema. Results One hundred and seven patients were included. Total duration of cardiopulmonary resuscitation (CPR) and initial pCO2 level were both independent predictors of developing severe pulmonary edema with their odds ratio (OR) being 1.02 (95% confidence interval [CI], 1.00 to 1.04; per 1 minute) and 1.04 (95% CI, 1.01 to 1.07; per 1 mmHg), respectively. The long term prognosis was significantly poor in patients with severe pulmonary edema with a OR for good outcome (6-month cerebral performance category 1 or 2) being 0.22 (95% CI, 0.06 to 0.79) in group III and 0.16 (95% CI, 0.04 to 0.63) in group IV compared to group I. Conclusion The duration of CPR and initial pCO2 level were both independent predictors for the development of severe pulmonary edema after resuscitation in emergency department. The severity of the pulmonary edema was significantly associated with long-term outcome. PMID:27752581

  12. Pulmonary embolism as a cause of cardiac arrest: Hypothermia in post-resuscitation period (cooling therapy

    Directory of Open Access Journals (Sweden)

    Niković Vuk

    2013-01-01

    Full Text Available Introduction. Pulmonary embolism as a possible cause of acute heart failure is a potentially fatal condition that can cause death in all age groups. Patients successfully resuscitated after cardiac arrest have a high risk of increased mortality and their poor long­term outcome is often associated with severe neurological complications. Case Outline. This is a case report of a 67­year­old man after a successful cardiopulmonary resuscitation (CPR which was followed by therapeutic hypothermia (TH. The patient visited the dermatological outpatients’ department with clinical presentation of pain and swelling of the right leg, shortness of breath and chest pain. During examination the patient lost consciousness, stopped breathing and had cardiac arrest. ECG was done which registered asystole. We began CPR. After 59 minutes of resuscitation return of heartbeat was achieved. The patient was transported to the Emergency Department. On admission, after computerized tomography (CT of the chest confirmed massive pulmonary embolism (PE, the patient was administered thrombolytic therapy with Metalyse (tenecteplase and anti­coagulation therapy (heparin. After stabilization, therapeutic hypothermia was applied. Combination of EMCOOLSpad on the chest and abdomen and cold Ringer lactate 500 ml at 4°C was flushed. Temperature was decreased to 33°C and kept stabile for 24 hours. After eight days the patient was conscious with a minimal neurological deficit. Conclusion. As shown in this case report, and according to the rich experience elsewhere, cooling therapy after out­of­hospital cardiac arrest and successful CRP may be useful in preventing neurological complications.

  13. Optimal Chest Compression Rate and Compression to Ventilation Ratio in Delivery Room Resuscitation: Evidence from Newborn Piglets and Neonatal Manikins

    Science.gov (United States)

    Solevåg, Anne Lee; Schmölzer, Georg M.

    2017-01-01

    Cardiopulmonary resuscitation (CPR) duration until return of spontaneous circulation (ROSC) influences survival and neurologic outcomes after delivery room (DR) CPR. High quality chest compressions (CC) improve cerebral and myocardial perfusion. Improved myocardial perfusion increases the likelihood of a faster ROSC. Thus, optimizing CC quality may improve outcomes both by preserving cerebral blood flow during CPR and by reducing the recovery time. CC quality is determined by rate, CC to ventilation (C:V) ratio, and applied force, which are influenced by the CC provider. Thus, provider performance should be taken into account. Neonatal resuscitation guidelines recommend a 3:1 C:V ratio. CCs should be delivered at a rate of 90/min synchronized with ventilations at a rate of 30/min to achieve a total of 120 events/min. Despite a lack of scientific evidence supporting this, the investigation of alternative CC interventions in human neonates is ethically challenging. Also, the infrequent occurrence of extensive CPR measures in the DR make randomized controlled trials difficult to perform. Thus, many biomechanical aspects of CC have been investigated in animal and manikin models. Despite mathematical and physiological rationales that higher rates and uninterrupted CC improve CPR hemodynamics, studies indicate that provider fatigue is more pronounced when CC are performed continuously compared to when a pause is inserted after every third CC as currently recommended. A higher rate (e.g., 120/min) is also more fatiguing, which affects CC quality. In post-transitional piglets with asphyxia-induced cardiac arrest, there was no benefit of performing continuous CC at a rate of 90/min. Not only rate but duty cycle, i.e., the duration of CC/total cycle time, is a known determinant of CC effectiveness. However, duty cycle cannot be controlled with manual CC. Mechanical/automated CC in neonatal CPR has not been explored, and feedback systems are under-investigated in this

  14. Beneficial effect of epinephrine infusion on cerebral and myocardial blood flows during CPR.

    Science.gov (United States)

    Koehler, R C; Michael, J R; Guerci, A D; Chandra, N; Schleien, C L; Dean, J M; Rogers, M C; Weisfeldt, M L; Traystman, R J

    1985-08-01

    It is hypothesized that epinephrine improves the ability to resuscitate the heart through a mechanism thought to be related to the increase in aortic pressure. Our results with epinephrine infusion during CPR are consistent with this hypothesis. Epinephrine selectively increased vascular resistance in noncerebral, noncoronary vascular beds, as indicated by a decrease in microsphere-determined blood flow in these areas. This increased vascular resistance raised aortic pressure during the chest compression phase and the relaxation phase of CPR. Because intracranial and right atrial pressures were only slightly higher with epinephrine, cerebral and myocardial perfusion pressures and blood flows were significantly improved. This beneficial effect (compared to no administration of a vasopressor) was more pronounced as CPR progressed beyond ten minutes. Enhanced cerebral and myocardial perfusion occurred with epinephrine when either the conventional or simultaneous compression and ventilation (SCV) mode of CPR was employed in dogs. Similar selective perfusion was sustained for 50 minutes of SCV-CPR with epinephrine, even when the onset of CPR was delayed five minutes. Regional brain blood flow differed in the delayed-CPR group in that cerebellum, brain stem, and thalamic regions initially had higher blood flows. In an infant animal model of CPR using conventional CPR in piglets, epinephrine also was found to increase cerebral and myocardial blood flows. These results show that administration of epinephrine benefits different age groups of different species with different modes of CPR; that benefits occur even with delayed onset of CPR which is associated with additional anoxia and acidosis; and that epinephrine administration is particularly effective in sustaining cerebral and coronary perfusion during prolonged CPR.

  15. A Portable Controller Design of Cardiopulmonary Resuscitation Artificial Person%一款便携式心肺复苏模拟人控制器的设计

    Institute of Scientific and Technical Information of China (English)

    孟祥顺

    2011-01-01

    介绍了基于AT89S51制作的心肺复苏模拟人控制电路,重点介绍了使用栅格尺和光电耦合器产生相对位移的方法,测量对模拟人进行人工呼吸和胸部按压时胸部起伏的幅度.电路中使用了ZLG7289组成的键盘和数码显示电路,使用了ISD4002语音电路,给出了程序流程图.%This paper introduces a novel control circuit of CPR simulator based on AT89S51. The relative displacement is generated by grid scale and opt. and elec. coupler. It is converted to amplitude of inhaling of the artificial person. Keyboard and digital display are based on ZLG7289 and the audio is based on ISD4002. A block diagram of the program is also presented in this article.

  16. Effect of different resuscitation strategies on post-resuscitation brain damage in a porcine model of prolonged cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    Gu Wei; Hou Xiaomin; Li Chunsheng

    2014-01-01

    Background The choice of a defibrillation or a cardiopulmonary resuscitation (CPR)-first strategy in the treatment of prolonged cardiac arrest (CA) is still controversial.The purpose of this study was to compare the effects of defibrillation or CPR administered first on neurological prognostic markers in a porcine model of prolonged CA.Methods After 8 minutes of untreated ventricular fibrillation (VF),24 inbred Chinese Wuzhishan minipigs were randomized to receive either defibrillation first (ID group,n=12) or chest compression first (IC group,n=12).In the ID group,a shock was delivered immediately.If defibrillation failed to attain restoration of spontaneous circulation (ROSC),manual chest compressions were rapidly initiated at a rate of 100 compressions/min and a compression-to-ventilation ratio of 30:2.If VF persisted after five cycles of CPR,a second defibrillation attempt was made.In the IC group,chest compressions were delivered first,followed by a shock.After successful ROSC,hemodynamic status and blood samples were obtained at 0.5,1,2,4,6,and 24 hours after ROSC.Porcine-specific neuron-specific enolase (NSE) and S100B were measured from sera using enzyme-linked immunosorbent assays.Porcine cerebral performance category scores were used to evaluate preliminary neurological function following 24 hours recovery.Surviving pigs were sacrificed at 24 hours after ROSC and brains were removed for electron microscopy analysis.Results The number of shocks,total defibrillation energy,and time to ROSC were significantly lower in the ID group compared with the IC group.Compared with the IC group,S100B expression was decreased at 2 and 4 hours after ROSC,and NSE expression decreased at 6 and 24 hours after ROSC in the ID group.Brain tissue analysis showed that injury was attenuated in the ID group compared with the IC group.There were no significant differences between 6 and 24 hours survival rates.Conclusion Defibrillation first may result in a shorter time to ROSC and

  17. 戊巴比妥钠和水合氯醛对窒息性心跳骤停大鼠心肺复苏后脑损伤的影响%Influence of pentobarbital and chloral hydrate on cerebral injury after cardiopulmonary resuscitation in a rat model of cardiac arrest induced by asphyxia

    Institute of Scientific and Technical Information of China (English)

    李章平; 陈寿权; 程俊彦; 章杰; 李惠萍; 黄唯佳; 王万铁

    2009-01-01

    Objective To investigate the influence of choral hydrate and pentobarbital on cerebral injury after cardiopulmonary resuscitation (CPR) in a rat model of cardiac arrest induced by asphyxia.Methods One hundred and sixty male 70-95 day old SD rats weighing 300-400 g were randomly divided into 2 anesthetic groups ( n = 80 each) : chloral hydrate group (CH) and pentobarbital group (PB).Each group was further divided into 2 subgroups ( n = 40 each) : control subgroup underwent no cardiac arrest and CPR subgroup.Anesthesia was induced with intraperitoneal (IP) 5% chloral hydrate 0.35 g/kg followed by intermittent IP 5% chloral hydrate 0.1 g/kg every hour in group CH and with IP 0.35% pentobarbital 35 mg/kg followed by intermittent IP 0.35% pentobarbital 10 mg/kg every hour in group PB.Left femoral vein and right carotid artery were cunnulated for drug and fluid administration and BP monitoring.The animals were tracheostomized and mechanically ventilated.Cardiac arrest was induced by occlusion of tracheal tube and verified by disappearance of pulse wave on BP tracing and asystole/ventricular fibrillation/systolic BP 60 mm Hg lasting for more than 10 min were used as criteria for recovery of spontaneous circulation (ROSC).Eight animals were decapitated and their brains were immediately removed at 0.5,3,6,9 and 24 h (T1-5) after BOSC respectively.2% Evans blue 2 ml/kg was injected Ⅳ 15 min before each time point.Brain water content (wet weight dry weight/wet weight × 100% ) and Evan's brain content in the brain tissue were determined.Results The two groups were comparable with respect to body weight,amount of adrenaline given,duration of precordial cardiac massage and BOSC time.The brain water content and Evan's blue content in the brain tissue were significantly increased after ROSC in beth groups.The cerebral water content was significantly higher after BOSC in group CH than in group PB.There was no significant difference in Evan's blue content in the brain tissue

  18. Training and Confidence Level of Junior Anaesthetists in CPR- Experience in A Developing Country

    Directory of Open Access Journals (Sweden)

    Desalu Ibironke

    2008-01-01

    There is low confidence among junior anaesthetists in Nigeria in performance of CPR, poor knowledge of ECG interpretation of cardiac arrest rhythm and little practice in defibrillation. The establishment of a Resuscitation council would ensure adequate and frequent training which would improve knowledge, boost confidence and result in better patient care.

  19. Application of laryngeal mask during cardiopulmonary resuscitation%喉罩在急诊心肺复苏中的临床应用

    Institute of Scientific and Technical Information of China (English)

    任玉琴; 顾言; 陈建荣

    2015-01-01

    目的:探讨喉罩(LMA)在急诊心肺复苏(CPR)中的临床应用价值.方法:选择120例心跳呼吸骤停进行CPR的患者,随机分为LMA组和气管插管组.观察2组患者气道有效开放时间、收缩压变化、经皮血氧饱和度(SpO2)上升时间、瞳孔回缩时间的变化.结果:LMA组开放气道时间[(20.2±6.7)s]少于气管插管组r(76.5±29.4)s],差异有统计学意义(P<0.01);LMA组o.5h、2h收缩压[(79.7±8.6)mmHg,(118.9±16.4) mmHg)]高于气管插管组[(61.2±7.9)mmHg,(96.3±9.7)mmHg)],差异有统计学意义(P<0.01);LMA组Sp02上升时间[(2.4±0.7)min]少于气管插管组[(4.5±1.2) min],差异有统计学意义(P<0.01);LMA组瞳孔回缩时间[(7.4±1.9)min]少于气管插管组[(9.8±3.4) min],差异有统计学意义(P<0.05).结论:在CPR中,LMA用于早期开放气道,其操作较气管插管更为简单、快捷,可有效地纠正低氧血症.

  20. 成人心肺复苏后缺血缺氧性脑病的临床与影像学分析%Clinical and imaging features of adult anoxic-ischemic encephalopathy after cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    李艺; 杨晓苏; 肖波; 杨欢; 贺健安; 肖岚; 舒怡; 龙学颖; 廖伟华

    2012-01-01

    Objective To explore the clinical and imaging features of anoxic-ischemic encephalopathy (AIE) patients after cardiopulmonary resuscitation.Methods A total of 28 qualified AIE patients during the last decade from Xiangya Hospital,Central South University were recruited and analyzed retrospectively.Results The symptoms of status epilepticus,acute posthypoxic myoclonus,Lance-Adams syndrome,subarachnoid hemorrhage and cognitive deficits were observed.The abnormal findings of magnetic resonance imaging (MRI) or computed tomography (CT),involving neocortex,basal ganglia and paraventricular white matter,were also recorded.During the early phase of disease,swollen cortex was present on MRI/CT.However,encephalatrophy appeared during the late phase.The more severe symptoms were observed,the more foci were present on MRI/CT.Conclusion The etiologies of AIE patients are heterogeneous after cardiopulmonary resuscitation. The clinical symptoms and imaging studies are of prognostic significance.%目的 研究心肺复苏后缺血缺氧性脑病的临床与影像学表现.方法 回顾性分析2002年1月至2011年10月中南大学湘雅医院收治的28例成人心肺复苏后缺血缺氧性脑病患者的临床及影像学资料.结果 患者可出现继发性癫痫持续状态、急性症状性肌阵挛、Lance-Adams综合征、脑血管意外等多种临床表现;46.43%(13例/28例)的患者为植物生存状态.CT和MRI影像学检查发现患者早期(发病后1周)多表现为脑回肿胀,并存在弥散性脑损害;同时可合并脑出血,脑梗死,蛛网膜下腔出血等;在疾病晚期(发病后3个月)影像学检查表现为脑萎缩和(或)脑积水.病情越重的患者头部MRI成像异常表现越明显.当MRI显示3个或3个以上不同脑区受累时,GCS评分显示其意识状态显著差于受累部位少或影像学检查正常的患者.结论 引起心肺复苏后缺血缺氧性脑病的病因不一,其临床表现和MRI等影像学检查对本

  1. Out-of-Hospital Perimortem Cesarean Section as Resuscitative Hysterotomy in Maternal Posttraumatic Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Francesca Gatti

    2014-01-01

    Full Text Available The optimal treatment of a severe hemodynamic instability from shock to cardiac arrest in late term pregnant women is subject to ongoing studies. However, there is an increasing evidence that early “separation” between the mother and the foetus may increase the restoration of the hemodynamic status and, in the cardiac arrest setting, it may raise the likelihood of a return of spontaneous circulation (ROSC in the mother. This treatment, called Perimortem Cesarean Section (PMCS, is now termed as Resuscitative Hysterotomy (RH to better address the issue of an early Cesarean section (C-section. This strategy is in contrast with the traditional treatment of cardiac arrest characterized by the maintenance of cardiopulmonary resuscitation (CPR maneuvers without any emergent surgical intervention. We report the case of a prehospital perimortem delivery by Caesarean (C section of a foetus at 36 weeks of gestation after the mother’s traumatic cardiac arrest. Despite the negative outcome of the mother, the choice of performing a RH seems to represent up to date the most appropriate intervention to improve the outcome in both mother and foetus.

  2. Simulation in resuscitation training.

    Science.gov (United States)

    Perkins, Gavin D

    2007-05-01

    The quality of education, CPR guidelines and the chain of survival all contribute to patient outcome following cardiac arrest. Increasing concerns about patient safety have focused attention on the methods used to train and prepare doctors for clinical practice. Reductions in clinical exposure at both undergraduate and postgraduate level have been implicated in junior doctors inability to recognise and manage critically ill patients. Simulation is used as a central training tool in contemporary advanced life support teaching. Simulation provides a learning opportunity for controlled clinical practice without putting patients or others at risk. This review examines the history and rationale for simulation training in resuscitation and provides some background to the learning theories that underpin it. The role of task trainers, high and low fidelity patient simulators and computer assisted simulation as teaching tools are discussed.

  3. Decision to resuscitate or not in patients with chronic diseases

    DEFF Research Database (Denmark)

    Saltbæk, Lena; Tvedegaard, Erling

    2012-01-01

    Do-not-resuscitate (DNR) decisions are frequently made without informing the patients. We attempt to determine whether patients and physicians wish to discuss the DNR decision, who they think, should be the final decision maker and whether they agree on the indication for cardiopulmonary resuscit...

  4. Ressuscitação cardiopulmonar com a utilização do desfibrilador externo semi-automático: avaliação do processo ensino-aprendizagem Resucitador cardiopulmonar con utilización del disfibrilador externo semiautomático: evaluación del proceso enseñanza-aprendizaje Cardiopulmonary resuscitation with semi-automated external defibrillator: assessment of the teaching-learning process

    Directory of Open Access Journals (Sweden)

    Ana Maria Kazue Miyadahira

    2008-09-01

    that, for every minute delayed on defibrillating a heart arrest patient, survival chances decrease by 10%, and that the same chances of survival are 98% effective when it is employed within 30 seconds. While attending a heart arrest patient, it is crucial that the use of external semi-automated defibrillator (AED is included in the training. The purpose of the present study is to compare Psychomotor Ability and the Theoretical Knowledge of lay people on cardiopulmonary resuscitation (CPR using AED, before and after training. This sample was composed of 40 administrative workers of a public institution that were trained on CPR technique using EAD, as an experiment. The significantly higher scores in the assessment instrument items of Psychomotor Ability and Theoretical Knowledge, after training, indicates that the participants have presented improvements in their performances.

  5. 高血压性灌注对心肺复苏成功后肺的影响%Effects of hypertensive perfusion on lung after successful cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    宿志宇; 李春盛

    2010-01-01

    目的 猪心肺复苏成功后,用去甲肾上腺素诱导高血压性灌注,研究其埘血清TNF-α和IL-6、肺组织Na~+-K~+-ATP酶以及肺组织形态学的影响.方法 10只家猪窒颤4 min,给予标准心肺复苏,复苏成功后分两绀:(1)高血压组(n=5)立即给予去甲肾上腺素,使平均动脉压维持在室颤前血压的130%4 h;(2)正常血压组(n=5)给予适量的去甲肾上腺素,维持平均动脉压为室颤前水平4h.监测血流动力学指标;分别在室颤前、复苏成功后10 min,2 h,4 h取血,检测血清TNF-α和IL-6;复苏成功后24 h取肺组织,检测Na~+-K~+-ATP酶,并行普通病理和超微结构检测.用配对t检验对数据进行统计学分析.结果 高血压组除影响血压和心率外,对其他血流动力学指标影响较小,能够减少TNF-α和IL-6的释放(P<0.01),增强肺泡细胞膜Na~+-K~+-ATP酶的活性,减少肺泡表面活性物质的消耗.结论 去甲肾上腺素诱导的高血压性灌注能够减少炎症因子的释放,增强肺泡细胞ATP酶的活性,对肺脏具有重要的保护作用.%Objective To investigate the effect of hypertensive perfusion which induced by norepinephrine on the TNF-α and IL-6 in serum and the activity of Na~+-K~+-ATPase in lung tissue and to observe the morphology of lung tissue. Method Ten domestic pigs were suffered from ventricular fibrillation for 4 minutes and applied cardiopulmonary resuscitation. The pigs they were divided into two groups. Hypertensive perfusion group( n = 5) :the mean arterial pressure, which induced by norepinephrine was maintained as 130% as baseline for 4 hours; nor-real perfusion group( n = 5) : the mean arterial pressure was maintained as baseline for 4 hours, too. Hemodynamic parameters was observed, blood samples were extracted to detect the TNF-α and IL-6 in serum at the time of baseline, 10 min, 2 h and 4 h after successful resuscitation. The expression of Na~+ -K~+ -ATPase in lung tissue and the change of ultrastmeture and

  6. 3D 动漫心肺复苏教育游戏的设计与实现%Design and realization of CPR educational games with 3D animation

    Institute of Scientific and Technical Information of China (English)

    周静; 江智霞; 楼婷; 胡汝均; 李玉

    2016-01-01

    As a hotspot in research on the development of information society,educational games are gradually promoting the reform of higher education.Taking the case of cardiopulmonary resuscitation (CPR)games for example,the paper introduces the design ideas,elements and structure of CPR educational games with 3D animation in order to provide some helpful advice for researchers of medical educational games.%教育游戏作为信息社会发展研究的一个热点,逐步推动了高等教育的改革。文章以心肺复苏为游戏案例,介绍了3D 动漫心肺复苏教育游戏设计的思路以及元素设计和构建,以期对医学教育游戏研究者有所借鉴与助益。

  7. Efficacy and safety of early rapid infusion of icy normal saline in patients after cardiopulmonary resuscitation%心肺复苏后早期注射冰盐水的有效性和安全性临床评价

    Institute of Scientific and Technical Information of China (English)

    李宏飞; 李颖; 何万民; 王助衡

    2014-01-01

    Objective To assess the feasibility,safety,and effectiveness of early rapid icy normal saline infusion to attain mild hypothermia in cardiac arrest patients. Methods A single-center prospective randomized controlled trial was conducted. From March 2011 to October 2013,patients who had recovery of spontaneous circulation (ROSC)after cardiopulmonary resuscitation (CPR)in Beijing Daxing District People's Hospital were randomly divided into two groups. In icy normal saline group,patients received a rapid infusion of 1 000 mL of 4 ℃ normal saline intravenously to attain a mild hypothermia. In the control group,the patients were treated with ice bag on head,and axillary temperature was monitored. For all patients,rectal temperature was measured and recorded immediately and 1 hour later . The occurrence of pulmonary edema on initial chest X-ray at 6 hours ,occurrence of tremor within 48 hours,ventricular fibrillation recurring within 48 hours,and consciousness or death within 14 days were recorded. Results A total of 45 patients were enrolled,including 23 patients in icy normal saline group and 22 in control group. The patients in icy normal saline group had a rectal temperature descended from(36.7±0.9)℃to(34.9±0.7)℃1 hour later,while the patients in control group had a rectal temperature risen from(36.5±1.0)℃to(37.9±0.9)℃1 hour later. There was significant difference in rectal temperature between two groups (t=2.228,P=0.031). The number of patients who successfully awaken within 14 days in ice normal saline group was significantly larger than that in control group (13 cases vs. 7 cases,χ²=65.710,P=0.021). There was no statistical difference in the occurrence of acute pulmonary edema (4 cases vs . 6 cases),tremor (2 cases vs . 0 case),ventricular fibrillation recurrence (4 cases vs. 5 cases)and death within 14 days (11 cases vs. 12 cases,all P>0.05). Conclusions The study shows that early rapid i.v. infusion of 4℃normal saline is feasible,safe and

  8. Application of Positron Emission TomographyintheDetection of Myocardial Metabolism inPigVentricularFibrillation and Asphyxiation Cardiac Arrest ModelsafterResuscitation

    Institute of Scientific and Technical Information of China (English)

    WUCaiJun; LIChunSheng; ZHANGYi; YANGJun

    2014-01-01

    ObjectiveTo study the application of positron emission tomography (PET) in detection of myocardial metabolism in pig ventricular fibrillation and asphyxiation cardiac arrest models after resuscitation. MethodsThirty-two healthyminiature pigs were randomized into aventricular fibrillation cardiac arrest (VFCA) group (n=16) and an asphyxiation cardiac arrest (ACA)group (n=16). Cardiac arrest (CA) was induced byprogrammed electric stimulationorendotracheal tube clamping followed by cardiopulmonary resuscitation (CPR) anddefibrillation. At four hours and 24 h afterspontaneous circulation was achieved, myocardial metabolism was assessed by PET.18F-FDG myocardial uptake in PET was analyzed and the maximum standardized uptake value (SUVmax) was measured. ResultsSpontaneous circulation was 100% and 62.5% in VFCA group and ACA group, respectively.PET demonstrated that the myocardial metabolism injuries was more severe and widespread after ACA than after VFCA. The SUVmax was higher in VFCA group than in ACA group (P<0.01).In VFCA group,SUVmaxat 24h after spontaneous circulation increased to the level of baseline. ConclusionACA causes more severe cardiac metabolism injuries than VFCA. Myocardial dysfunction is associated with less successful resuscitation. Myocardial stunning does occur with VFCA but not with ACA.

  9. 手掌腋下平移法定位胸外按压部位在心肺复苏中的应用研究%Application of Chest Compression Site Positioning by Palm Armpit Translation Method in Cardiopulmonary Resuscitation

    Institute of Scientific and Technical Information of China (English)

    谢芬高; 褚昀赟; 马华丰; 文航华; 曹俊; 张希洲

    2016-01-01

    workers,with significant differences between them (t’ = 5. 24,P ﹤ 0. 001). The time needed to position compression site by palm armpit translation method and traditional method was(2. 5 ± 0. 3)s and(21. 2 ± 2. 6)s respectively,with significant differences between them(t = - 282. 40,P ﹤ 0. 001). (AY - 1 / 2HW) / SL was(0. 38 ± 0. 03),and DX-NIL/ SL was(0. 37 ± 0. 01);they have no significant difference( t= - 1. 61,P = 0. 11 ) . Conclusion Chest compression site positioning by palm armpit translation method is simple, convenient,feasible,fast and accurate,saving more time for cardiopulmonary resuscitation.%目的:探讨一种心肺复苏胸外按压的定位方法———手掌腋下平移法的实用性和可行性。方法采用随机数字表法选取2014年10月10—19日在三峡大学人民医院急诊心电图室行心电图检查的患者30例为模拟心肺复苏被抢救者(模拟者)。同期选取急诊科医生或护士50例为心肺复苏抢救者(抢救者)。抢救者分别采用手掌腋下平移法和传统方法对同一模拟者进行定位。手掌腋下平移法为五指自然并拢,拇指朝向患者头侧并紧贴腋窝顶部,立即平移手掌,相当于沿两侧腋窝顶部连线移动使掌跟停在胸部正中线上。传统方法参照《2010年美国心脏协会心肺复苏及心血管急救指南》及《2015年美国心脏协会心肺复苏及心血管急救指南》定位。收集模拟者的年龄、身高、体质量、整个胸骨长度(SL)、两侧腋窝顶部连线与前正中线交点到胸骨下切迹的距离(AY)、两侧乳头连线(INL)与前正中线交点到胸骨下切迹的距离(DX-INL),收集抢救者的性别、年龄、身高、体质量、右手五指自然并拢时手掌的宽度(HW)以及抢救者采用手掌腋下平移法和传统方法准确找到定位点所需要的时间及定位点距胸骨下切迹的距离与 SL的比值,即(AY -1/2HW)/ SL、DX - INL/ SL

  10. Effect of β-adrenergic receptor blockers on cardiopulmonary resuscitation in the rats of myocardial infarction model%β受体阻滞剂对心肌梗死大鼠心肺复苏的影响

    Institute of Scientific and Technical Information of China (English)

    赵晓静; 彭卓; 王丽娜; 刘健; 高艳霞; 任云霞; 李丽君

    2011-01-01

    目的 观察β受体阻滞剂慢性作用对心肌梗死大鼠心肺复苏的影响.方法 采用气管插管,结扎冠脉前降支制作急性心肌梗死(简称心梗)模型,随机分为假手术组(n=45)、心梗未喂药组(n=45)、心梗喂药组[美托洛尔20 mg/(kg·d),n=45].窒息法制作大鼠心肺复苏模型.心脏停跳后给予肾上腺素,三组各分为低、中、高剂量三个亚组(肾上腺素0.02、0.04、0.06 mg/kg),同时胸外按压及呼吸机辅助呼吸.结果 ①自主循环恢复率和心电活动恢复率:心梗未喂药组与假手术组比较,低、高剂量组明显下降(P=5.06×10-5,P=0.033),中剂量组差异无统计学意义(P=0.054).心梗喂药组与心梗未喂药组比较,中剂量组降低(P=0.022),而高剂量组增高(P=0.043).心梗喂药组组内比较,高剂量组较中剂量组明显提高(P=0.0006).②肾上腺素用量:同组内低、中、高剂量亚组间比较差异有统计学意义(P0.05).③自主循环恢复时间:各亚组间比较差异无统计学意义(P>0.05).结论 β受体阻滞剂慢性作用影响心肌梗死大鼠的心肺复苏,增加肾上腺素剂量有可能提高自主循环恢复率.%Objective To study the effect of β -blockers on cardiopulmonary resuscitation in the rats of myocardial infarction model. Methods Male Sprague - Dawley rats were randomly divided in three groups: the pseudo -operation group( n =45), the myocardial infarction group without metoprolol (n= 45 ), the myocardial infarction group with metoprolol( n= 45 ) [20 mg/( kg · d) ].The left coronary artery was ligated near its origin to establish the acute myocardial infarction model. Asphyxial cardiac arrest was induced by clamping the endotracheal tube four weeks later. Each group was divided into three sub -groups according to epinephrine doses used in cardiopulmonary resuscitation: low dose group(0.02 mg/kg), medium dose group ( 0.04 mg/kg), high dose group ( 0.06 mg/kg). Results ① Return of spontaneous circulation

  11. Prediction of Recovery from Coma After CPR

    Science.gov (United States)

    ... PATIENTS AND THEIR FAMILIES PREDICTION OF RECOVERY FROM COMA AFTER CPR This summary will provide you with ... tests that help doctors predict poor recovery from coma after CPR. In this case, poor recovery means ...

  12. Outcome of Prolonged Ventricular Fibrillation and CPR in a Rat Model of Chronic Ischemic Left Ventricular Dysfunction

    Directory of Open Access Journals (Sweden)

    Xiangshao Fang

    2013-01-01

    Full Text Available Patients with chronic left ventricular (LV dysfunction are assumed to have a lower chance of successful CPR and lower likelihood of ultimate survival. However, these assumptions have rarely been documented. Therefore, we investigated the outcome of prolonged ventricular fibrillation (VF and CPR in a rat model of chronic LV dysfunction. Sprague-Dawley rats were randomized to (1 chronic LV dysfunction: animals underwent left coronary artery ligation; and (2 sham control. Echocardiography was used to measure cardiac performance before surgery and 4 weeks after surgery. Four weeks after surgical intervention, 8 min of VF was induced and defibrillation was delivered after 8 min of CPR. LV dilation and low ejection fraction were observed 4 weeks after coronary ligation. With optimal chest compressions, coronary perfusion pressure values during CPR were well maintained and indistinguishable between groups. There were no differences in resuscitability and numbers of shock required for successful resuscitation between groups. Despite the significantly decreased cardiac index in LV dysfunction animals before induction of VF, no differences in cardiac index were observed between groups following resuscitation, which was associated with the insignificant difference in postresuscitation survival. In conclusion, the outcomes of CPR were not compromised by the preexisting chronic LV dysfunction.

  13. Autonomous CaMKII Activity as a Drug Target for Histological and Functional Neuroprotection after Resuscitation from Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Guiying Deng

    2017-01-01

    Full Text Available The Ca2+/calmodulin-dependent protein kinase II (CaMKII is a major mediator of physiological glutamate signaling, but its role in pathological glutamate signaling (excitotoxicity remains less clear, with indications for both neuro-toxic and neuro-protective functions. Here, the role of CaMKII in ischemic injury is assessed utilizing our mouse model of cardiac arrest and cardiopulmonary resuscitation (CA/CPR. CaMKII inhibition (with tatCN21 or tatCN19o at clinically relevant time points (30 min after resuscitation greatly reduces neuronal injury. Importantly, CaMKII inhibition also works in combination with mild hypothermia, the current standard of care. The relevant drug target is specifically Ca2+-independent “autonomous” CaMKII activity generated by T286 autophosphorylation, as indicated by substantial reduction in injury in autonomy-incompetent T286A mutant mice. In addition to reducing cell death, tatCN19o also protects the surviving neurons from functional plasticity impairments and prevents behavioral learning deficits, even at extremely low doses (0.01 mg/kg, further highlighting the clinical potential of our findings.

  14. Autonomous CaMKII Activity as a Drug Target for Histological and Functional Neuroprotection after Resuscitation from Cardiac Arrest.

    Science.gov (United States)

    Deng, Guiying; Orfila, James E; Dietz, Robert M; Moreno-Garcia, Myriam; Rodgers, Krista M; Coultrap, Steve J; Quillinan, Nidia; Traystman, Richard J; Bayer, K Ulrich; Herson, Paco S

    2017-01-31

    The Ca(2+)/calmodulin-dependent protein kinase II (CaMKII) is a major mediator of physiological glutamate signaling, but its role in pathological glutamate signaling (excitotoxicity) remains less clear, with indications for both neuro-toxic and neuro-protective functions. Here, the role of CaMKII in ischemic injury is assessed utilizing our mouse model of cardiac arrest and cardiopulmonary resuscitation (CA/CPR). CaMKII inhibition (with tatCN21 or tatCN19o) at clinically relevant time points (30 min after resuscitation) greatly reduces neuronal injury. Importantly, CaMKII inhibition also works in combination with mild hypothermia, the current standard of care. The relevant drug target is specifically Ca(2+)-independent "autonomous" CaMKII activity generated by T286 autophosphorylation, as indicated by substantial reduction in injury in autonomy-incompetent T286A mutant mice. In addition to reducing cell death, tatCN19o also protects the surviving neurons from functional plasticity impairments and prevents behavioral learning deficits, even at extremely low doses (0.01 mg/kg), further highlighting the clinical potential of our findings.

  15. [Advanced resuscitation of adults

    DEFF Research Database (Denmark)

    Lippert, F.K.; Lauritsen, T.L.; Torp-Pedersen, C.

    2008-01-01

    International and European Resuscitation Council (ERC) Guidelines for Resuscitation 2005 implicate major changes in resuscitation, including new universal treatment algorithms. This brief summary of Guidelines 2005 for advanced resuscitation of adult cardiac arrest victims is based upon the ERC...

  16. Design of the RINSE Trial: The Rapid Infusion of cold Normal Saline by paramedics during CPR

    Directory of Open Access Journals (Sweden)

    Jacobs Ian

    2011-10-01

    Full Text Available Abstract Background The International Liaison Committee on Resuscitation (ILCOR now recommends therapeutic hypothermia (TH (33°C for 12-24 hours as soon as possible for patients who remain comatose after resuscitation from shockable rhythm in out-of-hospital cardiac arrest and that it be considered for non shockable rhythms. The optimal timing of TH is still uncertain. Laboratory data have suggested that there is significantly decreased neurological injury if cooling is initiated during CPR. In addition, peri-arrest cooling may increase the rate of successful defibrillation. This study aims to determine whether paramedic cooling during CPR improves outcome compared standard treatment in patients who are being resuscitated from out-of-hospital cardiac arrest. Methods/Design This paper describes the methodology for a definitive multi-centre, randomised, controlled trial of paramedic cooling during CPR compared with standard treatment. Paramedic cooling during CPR will be achieved using a rapid infusion of large volume (20-40 mL/kg to a maximum of 2 litres ice-cold (4°C normal saline. The primary outcome measure is survival at hospital discharge. Secondary outcome measures are rates of return of spontaneous circulation, rate of survival to hospital admission, temperature on arrival at hospital, and 12 month quality of life of survivors. Discussion This trial will test the effect of the administration of ice cold saline during CPR on survival outcomes. If this simple treatment is found to improve outcomes, it will have generalisability to prehospital services globally. Trial Registration ClinicalTrials.gov: NCT01172678

  17. Amiodarone supplants lidocaine in ACLS and CPR protocols.

    Science.gov (United States)

    Mizzi, Anna; Tran, Thanh; Mangar, Devanand; Camporesi, Enrico M

    2011-09-01

    Amiodarone is an antiarrhythmic medication used to treat and prevent certain types of serious, life-threatening ventricular arrhythmias. Amiodarone gained slow acceptance outside the specialized field of cardiac antiarrhythmic surgery because the side-effects are significant. Recent adoption of amiodarone in the ACLS (Advanced Cardiac Life Support) protocol has somewhat popularized this class of antiarrhythmics. Its use is slowly expanding in the acute medicine setting of anesthetics. This article summarizes the use of Amiodarone by anesthesiologists in the operating room and during cardiopulmonary resuscitation.

  18. Increased susceptibility to cardiovascular effects of dihydrocapcaicin in resuscitated rats. Cardiovascular effects of dihydrocapsaicin

    DEFF Research Database (Denmark)

    Fosgerau, Keld; Ristagno, Giuseppe; Jayatissa, Magdalena Niepsuj;

    2010-01-01

    Survivors of a cardiac arrest often have persistent cardiovascular derangements following cardiopulmonary resuscitation including decreased cardiac output, arrhythmias and morphological myocardial damage. These cardiovascular derangements may lead to an increased susceptibility towards the extern...

  19. 胺碘酮联合磷酸肌酸钠对心肺复苏后心肌的保护作用%Protective effects of amiodarone combined with creatine phosphate sodium on myocardium after cardiopulmonary resuscitation in rabbits

    Institute of Scientific and Technical Information of China (English)

    王芳; 周雨; 许铁

    2013-01-01

    目的 研究胺碘酮联合磷酸肌酸钠对兔心肺复苏(CPR)后心肌的保护作用.方法 用窒息法制作CPR模型.选取健康日本长耳大白兔40只,随机分为A组(假手术组)、B组(生理盐水组)、C组(胺碘酮组)、D组(磷酸肌酸钠组)、E组(胺碘酮联合磷酸肌酸钠组),每组8只,动态监测HR、MAP及血浆CK、CK-MB含量.复苏后6 h处死兔,光镜下观察心肌组织病理学变化.结果 B组、C组、D组和E组兔的HR、MAP比较差异无统计学意义(P>0.05).与A组比较,CPR后B组、C组、D组和E组兔血浆CK、CK-MB含量均增高,差异有统计学意义(P 0.05). Compared with group A, the levels of plasma CK, CK - MB were significantly higher in group B, group C, group D and group E after CPR (P 0.05). In group B, group C, group D and group E, the levels of plasma CK, CK - MB increased gradually after CPR( P < 0. 05 ). Correlation analysis showed that there was significantly postitive relation between the levels of plasma CK, CK - MB and the time after CPR in group B, group C, group D and group E (P < 0. 05 ) . Results of pathology showed that myocardial injury were more seriously in group B than in group C and group D, and myocardial injury were more seriously in group C and group D than in group E. Conclusion Treatment with amiodarone, creatine phosphate sodium, amiodarone combined with creatine phosphate sodium can alleviate myocardial injury after CPR in rabbits, the protective effects of amiodarone combined with creatine phosphate sodium were the best.

  20. Defibrillator charging before rhythm analysis significantly reduces hands-off time during resuscitation

    DEFF Research Database (Denmark)

    Hansen, L. K.; Folkestad, L.; Brabrand, M.

    2013-01-01

    BACKGROUND: Our objective was to reduce hands-off time during cardiopulmonary resuscitation as increased hands-off time leads to higher mortality. METHODS: The European Resuscitation Council (ERC) 2005 and ERC 2010 guidelines were compared with an alternative sequence (ALT). Pulseless ventricular...

  1. Learn CPR You Can Do It!

    Science.gov (United States)

    ... free mobile training apps for the iPhone and Android Phones. Get the iPhone App Here - Get the Android App Here STANDARD CPR FOR ADULTS - CPR in ... Take the videos wherever you go free. FREE ANDROID APP - Free training app for Android equipped phones. ...

  2. Successful prolonged resuscitation involving the use of tenecteplase without neurological sequelae.

    Science.gov (United States)

    Archan, Sylvia; Prause, Gerhard; Kügler, Bernhard; Gumpert, Rainer; Giacomini, Giorgio

    2008-11-01

    Prehospital cardiac arrest is associated with a very poor prognosis. We report a case of complete neurological recovery after prolonged resuscitation involving the use of tenecteplase in a patient with undifferentiated cardiac arrest with a return of spontaneous circulation after 1 hour of resuscitation, where basic life support was commenced immediately by a bystanding family member. Factors associated with an increased chance of survival from out-of-hospital cardiac arrest are discussed as well as the role of thrombolytics in cardiopulmonary resuscitation.

  3. Ethics and medico legal aspects of "Not for Resuscitation"

    Directory of Open Access Journals (Sweden)

    Naveen Sulakshan Salins

    2010-01-01

    Full Text Available Not for resuscitation in India still remains an abstract concept with no clear guidelines or legal frame work. Cardiopulmonary resuscitation is a complex medical intervention which is often used inappropriately in hospitalized patients and usually guided by medical decision making rather than patient-directed choices. Patient autonomy still remains a weak concept and relatives are expected to make this big decision in a short time and at a time of great emotional distress. This article outlines concepts around ethics and medico legal aspects of not for resuscitation, especially in Indian setting.

  4. Assessment of the Quality of Basic and Expanded Resuscitative Measures in a Multifield Hospital (Simulation Course

    Directory of Open Access Journals (Sweden)

    A. N. Kuzovlev

    2016-01-01

    Full Text Available The survival of patients after the sudden circulatory arrest (SCA depends not only on immediate onset of resuscitative measures, but also on their quality.The purpose of the study. The purpose is to assess the compliance of basic and expanded resuscitative measures carried out by healthcare providers in hospitals with modern national and international guidelines within the frames of a stimulation course.Materials and Methods. The research was perfomed in a multifield hospital in Moscow, in 2016. It consisted of two phases. During the first phase, within the frames of a simulation course, providers' skills in the cardiopul monary resuscitation (CPR and chest compression (CC technique mastership were evaluated. During the second stage, their skills in expanded CPR and ability to work as a part of resuscitation teams were assessed. During the simulation, all team activities were recorded (both audio and video; CC parameters were also registered using a CC pressure control sensor (hereinafter referred to as a sensor and audiovisual tips. The European Resuscitation Council Guidelines for Resuscitation 2015 were used as reference criteria. The analysis was performed using the ZOLL RescueNet Code Review® software. A statistical analysis was performed using the Statistica 7.0 software (MannWhitney Utest. The data were presented as a mean, median ± 25—75 percentiles (25—75 IQR, minimum and maximum values. The difference was considered significant at P<0.05.Results. Test results of most healthcare providers were unsatisfactory when the CPR was performed without sensors and audiovisual tips: the percentage of target CCs was not more than 10% in 72% of providers (n=18. When the CPR was performed with sensors and audiovisual tips regulating the CC quality, the percentage of target CCs was 65.7%. i.e. it was significantly higher than that during the CPR without the sensor and the tips (P=0.0000. While only one provider was able to perform

  5. Emergency nurses' current practices and understanding of family presence during CPR.

    LENUS (Irish Health Repository)

    Madden, Eilis

    2012-02-03

    PURPOSE: To examine emergency nurses\\' current practices and understanding of family presence during CPR in the emergency department, Cork University Hospital, Republic of Ireland. METHOD: A quantitative descriptive design was used in the study. A questionnaire developed by ENA was distributed to emergency nurses working in a level I trauma emergency department at Cork University Hospital. The total sample number was 90, including all emergency nurses with at least 6 months\\' emergency nursing experience. RESULTS: Emergency nurses often took families to the bedside during resuscitation efforts (58.9%) or would do so if the opportunity arose (17.8%). A high percentage (74.4%) of respondents would prefer a written policy allowing the option of family presence during CPR. The most significant barrier to family witnessed resuscitation (FWR) was conflicts occurring within the emergency team. The most significant facilitator to FWR was a greater understanding of health care professionals on the benefits of FWR to patients and families, indicating the need for educational development. CONCLUSION: The findings of the study and previously published studies indicate the need for development of written polices and guidelines on the practice to meet the needs of patients, families, and staff by providing consistent, safe, and caring practices for all involved in the resuscitation process. Recommendations of the study include the development of a written policy and an educational programme on the safe implementation and practices of FWR.

  6. 2010年美国心脏协会儿童心肺复苏指南更新的解读%Highlights of 2010 American Heart Association guidelines changes for pediatric cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    钱素云; 高恒淼

    2012-01-01

    2010年10月,美国心脏协会新的儿童基础和高级生命支持指南发布.新指南由众多专家历经3年,对大量心肺复苏文献复习和讨论达成一致意见后完成.与2005版儿童基础和高级生命支持指南相比,新指南对一些关键问题作了重要更新,包括基础生命支持步骤由A-B-C改为C-A-B、高质量胸外按压、除颤及自动除颤器在婴儿中的使用、复苏过程中药物的使用、先天性心脏病患儿的复苏、复苏后处理及对心源性猝死的评估.本文对其重要更新及依据作一简要介绍.%In Oct 2010,American Heart Association (AHA) released new guidelines for pediatric basic life support and pediatric advanced life support.The new AHA guidelines are based on an extensive review of thousands of resuscitation studies by experts who reached a consensus over a 3-year period.Compared with the 2005 AHA guidelines for pediatric basic and advanced life support,the new guidelines made major changes on some key issues,including the change of basic life sequence from A-B-C to C-A-B,high-quality chest compression,defibrillation and the use of automated external defibrillator in infants,medications during resuscitation,resuscitation of children with congenital heart disease,post-resuscitation management and evaluation of sudden cardiac death victims.This paper summarized the substantial changes and the reasons to change.

  7. Outcome after resuscitation beyond 30 minutes in drowned children with cardiac arrest and hypothermia : Dutch nationwide retrospective cohort study

    NARCIS (Netherlands)

    Kieboom, J. K.; Verkade, H. J.; Burgerhof, J. G.; Bierens, J. J.; van Rheenen, P. F.; Kneyber, M. C.; Albers, M. J.

    2015-01-01

    OBJECTIVES To evaluate the outcome of drowned children with cardiac arrest and hypothermia, and to determine distinct criteria for termination of cardiopulmonary resuscitation in drowned children with hypothermia and absence of spontaneous circulation. DESIGN Nationwide retrospective cohort study. S

  8. [Resuscitation in acute poisonings based on 2005 and 2010 Resuscitation Guideline].

    Science.gov (United States)

    Macheta, Alicja; Pach, Janusz; Andres, Janusz

    2011-01-01

    Acute poisonings in USA are a leading cause of cardiac arrest, especially in youngsters. Primary survey and cardiopulmonary resuscitation for poisoning is based on ABCDE procedure. One of the most common manifestation of acute poisoning is coma. An open airway should be ensured. Endotracheal intubation should be performed by an experienced person. The mouth-to mouth method of artificial respiration can be applied ultimately. In case of cyanide, hydrogen sulfide, organophosphates and corrosives poisonings a special caution is needed and pocket mask or self-inflating bag with a face mask should be rather used. A quick poison identification and a contact with regional poison information centre regarding patient management are crucial. Different procedures include prolonged cardiopulmonary resuscitation.

  9. What is the true definition of a "Do-Not-Resuscitate" order? A Japanese perspective

    Directory of Open Access Journals (Sweden)

    Hiraoka E

    2016-06-01

    Full Text Available Eiji Hiraoka,1 Yosuke Homma,2 Yasuhiro Norisue,3 Takaki Naito,1 Yuko Kataoka,1 Osamu Hamada,1 Yo Den,1 Osamu Takahashi,4 Shigeki Fujitani3 1Department of Internal Medicine, 2Department of Emergency Medicine, 3Department of Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan; 4Department of Internal Medicine, St Luke’s International Hospital, Tokyo, Japan Background: Japan has no official guidelines for do-not-resuscitate (DNR orders. Therefore, we investigated the effect of DNR orders on physician decision making in relation to performing noncardiopulmonary resuscitation (CPR and CPR procedures.Methods: A case-scenario-based questionnaire that included a case of advanced cancer, a case of advanced dementia, and a case of nonadvanced heart failure was administered to physicians. The questions determined whether physicians would perform different non-CPR procedures and CPR procedures in the presence or absence of DNR orders. The number of non-CPR procedures each physician would perform and the number of physicians who would perform each non-CPR and CPR procedure in the absence and presence of DNR ocrders were compared. Physicians from three Japanese municipal acute care hospitals participated.Results: We analyzed 111 of 161 (69% questionnaires. Physicians would perform significantly fewer non-CPR procedures in the presence of DNR orders than in the absence of DNR orders for all three case scenarios (median [interquartile range] percentages: Case 1: 72% [45%–90%] vs 100% [90%–100%]; Case 2: 55% [36%–72%] vs 91% [63%–100%]; Case 3: 78% [55%–88%] vs 100% [88%–100%]. Fewer physicians would perform non-CPR and CPR procedures in the presence of DNR orders than in the absence of DNR orders. However, considerable numbers of physicians would perform electric shock treatment for ventricular fibrillation in the presence of DNR orders (Case 1: 26%; Case 2: 16%; Case 3: 20%.Conclusion: DNR orders affect physician

  10. Exploration on the Teaching Methods of Cardiopul-monary Resuscitation in Tourism Health Care Course for ;Secondary Vocational Tourism Major%中职旅游专业旅游保健课程心肺复苏教学方法的探讨

    Institute of Scientific and Technical Information of China (English)

    胡文

    2015-01-01

    Tourism health care is an emerging major of secondary vocational schools to expand the space of education and tally with social needs in recent years. As a medical related professional discipline, tourism health major reflects its social value, medical value and humanistic value, so it is a professional course that is practical and close to people's life. This paper mainly introduces the main teaching methods of cardiopulmonary resuscitation in tourism health care course for secondary vocational tourism ma-jor, explores and illustrates the possible problems in teaching.%旅游保健专业是近年来中职学校为了拓展办学空间,顺应社会需要而开设的新兴专业。作为医学相关类的专业学科,旅游保健专业体现了它的社会价值、医疗价值与人文价值,是一门非常实用的、贴近人们生活的专业课程。本文主要介绍了中职学校旅游专业旅游保健课程中心肺复苏术的主要教学方法,探讨了教学中可能存在的问题并举例说明。

  11. Mastery of first-aid knowledge and cardiopulmonary resuscitation skills among the public:analysis of 536 citizens undergoing training%536名公众急救知识及心肺复苏技能培训掌握情况比较

    Institute of Scientific and Technical Information of China (English)

    蒋晓红; 李晓锋; 叶泽兵; 田军章

    2013-01-01

    Objective To explore the effects of mastering of the first-aid knowledge and skills among the public. Methods The two-day training was conducted by six instructors certified by the American Heart Association (AHA) for 536 citizens, all non-medical majoring or professional, 148 college students, 234 subway staff members, and 154 community people, 357 males and 179 females, aged 18~53, 265 with bachelor degree or above, 166 with junior college degree, 105 with degree of senior middle school graduate or undergraduate, and 178 with the experience of being spectator. The training contents included first-aid knowledge (stroke, cardiac arrest, drowning, poisoning, heat stroke, and trauma) and adult single cardiopulmonary resuscitation skills. The teaching method included slide projecting, videos as well as the instructors’demonstration with dummy man. Then examination was conducted with 100 points as full mark and 80 points as eligible mark. Results The eligible rates in first-aid knowledge of the trainees with bachelor degree or above, junior college degree, and senior middle school graduate degree or lower were 73.96%, 71.69%, and 65.06% respectively, without significant differences between any 2 groups ( χ 2=1.51, P>0.05). The eligible rates in adult single cardiopulmonary resuscitation of these 3 groups were 67.55%, 65.06%, and 61.90% respectively, without significant differences between any 2 groups (χ2=1.10, P>0.05). The eligible rates in first-aid knowledge and adult single cardiopulmonary resuscitation of the trainees with experience as being first witness were 84.83%and 84.843% respectively, both significantly higher than those of the trainees without the experience as being spectator (64.53%and 56.15%respectively,χ2=30.01, P<0.05;χ2=47.30, P<0.050). Conclusion The effects of training in first-aid knowledge and cardiopulmonary resuscitation are not related to the educational level of the citizens being trained, but related to their emergency awareness.%目

  12. 心肺复苏中机械通气时机选择对急诊心博骤停患者预后的影响%Effects of mechanical ventilation timing during cardiopulmonary resuscitation on the prognosis of patients with cardiac arrest inemergency

    Institute of Scientific and Technical Information of China (English)

    付乐章

    2013-01-01

    目的探讨心肺复苏的机械通气时机选择对急诊心博骤停患者预后影响。方法选取在本院接受心博骤停自动循环恢复机械通气的50例患者为研究对象,按照机械通气的时间分为早期上机组24例,以及晚期上机组26例,统计两组患者的年龄、性别、心博骤停心率类型以及心博骤停的原因,同时统计两组患者心肺复苏成功效率、心博骤停24 h、有无角膜性反射、有无瞳孔反射、疼痛躲避反应、运动反应、出院时神经功能分类以及治愈出院率。对两组患者的各项指标进行相应比较。结果两组患者的年龄、性别、心博骤停心率类型以及心博骤停原因,两者差异无统计学意义( P>0.05);两组患者的心肺复苏率、24 h角膜反射(+)、24 h瞳孔反射(+)、24 h疼痛躲避反应(+)、24 h运动反应(+)以及其出院时神经功能分类等,其指标差异有统计学意义,早期上机组明显优于晚期上机组( P<0.05);两组患者成活出院率(45.5%∶40.0%)之间差异无统计学意义( P>0.05),其总成活出院率为33.41%。结论对心博骤停的患者应及早给予机械通气呼吸支持,从而促进患者心脏的恢复,以提高心博骤停疾病患者的治疗效果,提高心博骤停患者心肺复苏的成功率,并且对其神经功能的预后进行改善。%Objective To investigate the effects of mechanical ventilation timing during cardiopulmonary re-suscitation on the prognosis of patients with cardiac arrest in emergency .Methods 50 patients with cardiac arrest , receiving automatic cycle recovery of mechanical ventilation were divided into early treated group (24 cases) and later treated group (26 cases) according to the time of mechanical ventilation .Age ,gender ,type of heart rate ,etiological factor of cardiac arrest ,achievement ratio of cardiopulmonary resuscitation and corneal

  13. Trauma resuscitation time.

    NARCIS (Netherlands)

    Olden, G.D.J. van; Vugt, A.B. van; Biert, J.; Goris, R.J.A.

    2003-01-01

    Documenting the timing and organisation of trauma resuscitation can be utilised to assess performance standards, and to ensure a high quality of trauma resuscitation procedures. Since there is no European literature available on trauma resuscitation time (TRT) in the emergency room, the aim of this

  14. Constitutive disease resistance requires EDS1 in the Arabidopsis mutants cpr1 and cpr6 and is partially EDS1-dependent in cpr5.

    Science.gov (United States)

    Clarke, J D; Aarts, N; Feys, B J; Dong, X; Parker, J E

    2001-05-01

    The systemic acquired resistance (SAR) response in Arabidopsis is characterized by the accumulation of salicylic acid (SA), expression of the pathogenesis-related (PR) genes, and enhanced resistance to virulent bacterial and oomycete pathogens. The cpr (constitutive expressor of PR genes) mutants express all three SAR phenotypes. In addition, cpr5 and cpr6 induce expression of PDF1.2, a defense-related gene associated with activation of the jasmonate/ethylene-mediated resistance pathways. cpr5 also forms spontaneous lesions. In contrast, the eds1 (enhanced disease susceptibility) mutation abolishes race-specific resistance conferred by a major subclass of resistance (R) gene products in response to avirulent pathogens. eds1 plants also exhibit increased susceptibility to virulent pathogens. Epistasis experiments were designed to explore the relationship between the cpr- and EDS1-mediated resistance pathways. We found that a null eds1 mutation suppresses the disease resistance phenotypes of both cpr1 and cpr6. In contrast, eds1 only partially suppresses resistance in cpr5, leading us to conclude that cpr5 expresses both EDS1-dependent and EDS1-independent components of plant disease resistance. Although eds1 does not prevent lesion formation on cpr5 leaves, it alters their appearance and reduces their spread. This phenotypic difference is associated with increased pathogen colonization of cpr5 eds1 plants compared to cpr5. The data allow us to place EDS1 as a necessary downstream component of cpr1- and cpr6-mediated responses, but suggest a more complex relationship between EDS1 and cpr5 in plant defense.

  15. O custo direto do programa de treinamento em ressuscitação cardiopulmonar em um hospital universitário El costo directo del programa de entrenamiento em resucitación cardiopulmonar en un hospital universitário The direct cost of the cardiopulmonary resuscitation training program in a university hospital

    Directory of Open Access Journals (Sweden)

    Nadia Nasser Follador

    2007-03-01

    resuscitation for technicians and assistant nurses of the Intensive Care and Semi-Intensive Care units at the University of São Paulo's Hospital Universitário (HU-USP, and at checking the direct costs of the main activities in the process. This is an exploratory research, a retrospective, documental survey, using the case study model. The results showed that the total direct cost of the cardiopulmonary resuscitation training program was 9,081.44 reals. The direct cost with personnel represented 96.74%, and with material 3.26%. In the training planning sub-process, most of the direct cost was represented by the instructor-assisting nurse, with 5,451.60 reals (62.04%. The direct costs related to the material that was used were also higher in the training program sub-process, 188.80 reals (63.73%. The total cost per trainee was 206.40 reals.

  16. Imaging anatomical study of abdominal aorta terminal blocking in vitro assisting in standard cardiopulmonary resuscitation%体外腹主动脉末端阻断辅助标准心肺复苏的影像解剖研究

    Institute of Scientific and Technical Information of China (English)

    钟涛; 张旻海; 菅洪健; 武钢

    2015-01-01

    Objective To supply imaging anatomical basis for abdominal aorta blocking assisting in standard cardiopulmonary resuscitation to improve coronary perfusion pressure. Methods CT images of 75 patients, 41 males and 34 females, were collected. The bellybutton was used as the landmark, and indexes as follows were measured:①The vertebral level of the bellybutton midpoint; ②The relationship between abdominal aorta termination and bellybutton midpoint;③The relationship among the vertical tracks of abdominal artery, lumbar vertebrae,and inferior vena cava. Results The markers for the end of abdominal artery,lumbar vertebrae and navel roughly overlapped at the human median line:①The navel midpoint was located between 40.31 mm above and 32.82 mm below the inferior border of L4;②The end of the abdominal artery was located between 35 mm above and 35 mm below the bellybutton midpoint; ③The end of abdominal artery was located slightly to the left of the lumbar spine, and inferior vena cava was located to right of the lumbar spine at the transverse section of the body at the level of the end of the abdominal artery. Conclusions According to the imaging study, navel can be adopted as the landmark for blocking in vitro the end of the abdominal aorta, assisting in the standard cardiopulmonary resuscitation. It could improve the hemodynamic indexes, ensure blood supply of the critical organs such as brain and heart, and improve coronary perfusion pressure with high success rate.%目的:为体外腹主动脉末端阻断辅助标准心肺复苏(CPR)提供影像解剖学基础。方法75名患者的CT影像解剖图中,以脐为标志点,主要观测:①脐中点水平面对应椎体的位置;②腹主动脉末端与脐中点的关系;③腹主动脉下段、下腔静脉下段与腰椎的相对位置关系。结果腹主动脉末端、腰椎与脐标志点基本重叠于人体正中线位置:①脐中点位于腰4椎体下缘以上40.31mm,以下32.82 mm

  17. [Prehospital cardiac resuscitation in Queretaro, Mexico. Report of 3 cases. Importance of an integral emergency medical care system].

    Science.gov (United States)

    Fraga-Sastrías, Juan Manuel; Aguilera-Campos, Andrea; Barinagarrementería-Aldatz, Fernando; Ortíz-Mondragón, Claudio; Asensio-Lafuente, Enrique

    2014-01-01

    In Mexico, out-of-hospital cardiac arrest is a health problem that represents 33,000 to 150,000 or more deaths per year. The few existent reports show mortality as high as 100% in contrast to some international reports that show higher survival rates. In Queretaro, during the last 5 years there were no successful resuscitation cases. However, in 2012 some patients were reported to have return of spontaneous circulation. We report in this article 3 cases with return of spontaneous circulation and pulse at arrival to the hospital. Two of the patients were discharged alive, one of them with poor cerebral performance category. Community cardiopulmonary resuscitation, early defibrillation and better emergency medical system response times, are related with survival. This poorly explored health problem in Queretaro could be increased with quality and good public education, bystander assisted cardiopulmonary resuscitation, police involvement in cardiopulmonary resuscitation and defibrillation, public access defibrillation programs and measurement of indicators and feedback for better results.

  18. Temperature Management After Cardiac Arrest: An Advisory Statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.

    Science.gov (United States)

    Donnino, Michael W; Andersen, Lars W; Berg, Katherine M; Reynolds, Joshua C; Nolan, Jerry P; Morley, Peter T; Lang, Eddy; Cocchi, Michael N; Xanthos, Theodoros; Callaway, Clifton W; Soar, Jasmeet

    2016-01-01

    For more than a decade, mild induced hypothermia (32 °C-34 °C) has been standard of care for patients remaining comatose after resuscitation from out-of-hospital cardiac arrest with an initial shockable rhythm, and this has been extrapolated to survivors of cardiac arrest with initially nonshockable rhythms and to patients with in-hospital cardiac arrest. Two randomized trials published in 2002 reported a survival and neurological benefit with mild induced hypothermia. One recent randomized trial reported similar outcomes in patients treated with targeted temperature management at either 33 °C or 36 °C. In response to these new data, the International Liaison Committee on Resuscitation Advanced Life Support Task Force performed a systematic review to evaluate 3 key questions: (1) Should mild induced hypothermia (or some form of targeted temperature management) be used in comatose post-cardiac arrest patients? (2) If used, what is the ideal timing of the intervention? (3) If used, what is the ideal duration of the intervention? The task force used Grading of Recommendations Assessment, Development and Evaluation methodology to assess and summarize the evidence and to provide a consensus on science statement and treatment recommendations. The task force recommends targeted temperature management for adults with out-of-hospital cardiac arrest with an initial shockable rhythm at a constant temperature between 32 °C and 36 °C for at least 24 hours. Similar suggestions are made for out-of-hospital cardiac arrest with a nonshockable rhythm and in-hospital cardiac arrest. The task force recommends against prehospital cooling with rapid infusion of large volumes of cold intravenous fluid. Additional and specific recommendations are provided in the document.

  19. Selection, Training, and Utilization of Navy Recruit Training Command Officers.

    Science.gov (United States)

    1980-05-01

    Severe Weather Extremes of Heat and Cold Cardiopulmonary Resuscitation (CPR) Orientation The Heimlich Maneuver Common Recruit Injuries and Complaints...TOPIC 7. DIVISION OFFICER EMERGENCY PROCEDURES Severe Weather Extremes of Hot and Cold Cardiopulmonary Resuscitation (CPR) Orientation The Heimlich ... Maneuver Common Recruit Injuries/Complaints Medical Plan Fire Epidemic Incidents Which May Result in Extensive News Coverage Psychiatric Disorders Suicide

  20. Improved neurologically intact survival with the use of an automated, load-distributing band chest compression device for cardiac arrest presenting to the emergency department

    OpenAIRE

    2012-01-01

    Introduction It has been unclear if mechanical cardiopulmonary resuscitation (CPR) is a viable alternative to manual CPR. We aimed to compare resuscitation outcomes before and after switching from manual CPR to load-distributing band (LDB) CPR in a multi-center emergency department (ED) trial. Methods We conducted a phased, prospective cohort evaluation with intention-to-treat analysis of adults with non-traumatic cardiac arrest. At these two urban EDs, systems were changed from manual CPR to...

  1. Is peer tutoring beneficial in the context of school resuscitation training?

    Science.gov (United States)

    Lester, C; Donnelly, P; Weston, C

    1997-09-01

    First year pupils at a Cardiff comprehensive school were trained in cardiopulmonary resuscitation, 106 by the teacher only and 137 by the teacher assisted by older pupils (peer tutoring). Scores in a multiple choice theory test and in practical skill assessment showed no significant difference between instruction methods, but boys taught by the teacher assisted by older pupils expressed less willingness to resuscitate in an emergency than girls instructed by either method (P novice trainees (P < 0.025).

  2. Hypovolemic shock resuscitation.

    Science.gov (United States)

    Kobayashi, Leslie; Costantini, Todd W; Coimbra, Raul

    2012-12-01

    Several changes in the way patients with hemorrhagic shock are resuscitated have occurred over the past decades, including permissive hypotension, minimal crystalloid resuscitation, earlier blood transfusion, and higher plasma and platelet-to-red cell ratios. Hemostatic adjuncts, such as tranexamic acid and prothrombin complex, and the use of new methods of assessing coagulopathy are also being incorporated into resuscitation of the bleeding patient. These ideas have been incorporated by many trauma centers into institutional massive transfusion protocols, and adoption of these protocols has resulted in improvements in mortality and morbidity. This article discusses each of these new resuscitation strategies and the evidence supporting their use.

  3. Analysis of the Capability Portfolio Review (CPR)

    Science.gov (United States)

    2014-06-01

    with affordability. The CPR process is a critical element in restoring the balance to the Army and the equipping/fielding strategies (AUSA, 2010).The...potential opportunities to allocate resources in order to optimize the balance between operational capability and financial efficiency. There are 3 types...simple color- scorecard summaries of how options rate on a number of juxtaposed criteria, such as measures of capabilities, risks, upside potential, and

  4. Vascular access in resuscitation: is there a role for the intraosseous route?

    Science.gov (United States)

    Anson, Jonathan A

    2014-04-01

    Intraosseous vascular access is a time-tested procedure which has been incorporated into the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation. Intravenous access is often difficult to achieve in shock patients, and central line placement can be time consuming. Intraosseous vascular access, however, can be achieved quickly with minimal disruption of chest compressions. Newer insertion devices are easy to use, making the intraosseous route an attractive alternative for venous access during a resuscitation event. It is critical that anesthesiologists, who are often at the forefront of patient resuscitation, understand how to properly use this potentially life-saving procedure.

  5. Teamwork during resuscitation.

    Science.gov (United States)

    Weinstock, Peter; Halamek, Louis P

    2008-08-01

    Effective resuscitation requires the integration of several cognitive, technical, and behavioral skills. Because resuscitation is performed by teams of health care professionals, these individuals must be able to work together in a coordinated and efficient manner, making teamwork a critical skill for care of patients in distress. Despite the importance of teamwork in health care, little consensus exists as to what it is, how it can most effectively be learned, and how it should be assessed. This article reviews current knowledge on the measurement, training, and importance of teamwork in pediatric resuscitation.

  6. Application of the Hand-washing Tips in the CPR nursing operation%"洗手口诀"在心肺复苏护理操作中的应用

    Institute of Scientific and Technical Information of China (English)

    李东雅; 何诗雯; 陈偶英

    2015-01-01

    Objective To explore the application effect of the Hand-washing Tips in the CPR nursing opera-tion. Methods The students of 2012 nursing class 1 ( control group) adopted traditional cardiopulmonary resuscitation ( CPR) nursing operation teaching method, while the students of 2012 nursing class 2 ( observation group) adopted the Hand-washing Tips based on the traditional methods. Then at the semester test, the hand washing status before and after CPR operation of the two groups of students , which included the number of correct order, omission, correct method were compared. Results The number of the students with hand washing site omission before the operation in observation group were apparently higher than those of control group ( P<0. 05 ) . The number of correct order, correct method of observation group were significantly higher than those of control group, the differences between the two groups were sta-tistically significant ( P<0. 01; P<0. 05 ); the number of the students with hand washing site omission after the opera-tion in observation group was apparently lower than that of control group ( P<0. 05 ) . Conclusion The application of the Hand-washing Tips in the CPR nursing operation can cover Seven Hand-washing Actions essentials, improve hand washing quality and future clinical health education levels of students and improve the hand-washing compliance rate of nurses, patients and attendants.%目的 探讨"洗手口诀"在心肺复苏护理操作中的应用效果. 方法 2012级专科1班(对照组)采用常规心肺复苏护理操作教学方法,2012级专科2班(观察组)在常规心肺复苏护理操作教学方法基础上,加用"洗手口诀",比较两组学生期末考试心肺复苏操作前后的洗手环节情况,包括顺序正确数、部位遗漏数、方法正确数. 结果 观察组心肺复苏操作前洗手部位遗漏人数低于对照组( P<0. 05 );观察组心肺复苏操作后洗手顺序正确人数、洗手方法正确人数均

  7. ABC of Resuscitation

    CERN Document Server

    Colquhoun, Michael

    2003-01-01

    This guide has concise and practical information on all aspects of resuscitation. New guidelines are just one of the changes to the 5th edition of this book as many of the chapters have been completely rewritten.

  8. Gastric rupture after Heimlich maneuver and cardiopulmonary resuscitation.

    Science.gov (United States)

    Tung, P H; Law, S; Chu, K M; Law, W L; Wong, J

    2001-01-01

    Choking is a common emergency problem. The Heimlich maneuver is unquestionably effective in relieving airway obstruction. Serious and life-threatening complications may arise, however, if the maneuver is applied incorrectly. Two cases of gastric rupture after Heimlich maneuver are reported. Lay public, paramedics and the medical professionals should be educated with the correct technique of Heimlich maneuver and its potential complications. All patients receiving Heimlich maneuver should be examined by an experienced physician.

  9. Theoretical knowledge of nurses working in non-hospital urgent and emergency care units concerning cardiopulmonary arrest and resuscitation Conocimiento teórico de los enfermeros sobre parada cardiorrespiratoria y resucitación cardiopulmonar en unidades no hospitalarias de atención de urgencia y emergencia Conhecimento teórico dos enfermeiros sobre parada e ressuscitação cardiopulmonar, em unidades não hospitalares de atendimento à urgência e emergência

    Directory of Open Access Journals (Sweden)

    Angélica Olivetto de Almeida

    2011-04-01

    Full Text Available Non-Hospital Urgent and Emergency Care Units were created to deliver care to patients in chronic or acute situations and to coordinate the flow of urgent care. This descriptive study analyzed the theoretical knowledge of nurses working in these units concerning cardiopulmonary arrest and resuscitation. A questionnaire was applied to 73 nurses from 16 units in seven cities in the region of Campinas, SP, Brazil. The respondents displayed some gaps in their knowledge such as how to detect Cardiopulmonary Arrest (CPA, the ability to list the sequence of basic life support, and how to determine the appropriate compression to ventilation ratio (>60%. They also did not know: the immediate procedures to take after CPA detection (>70%; the rhythm pattern present in a CPA (>80%; and they only partially identified (100% the medication used in cardiopulmonary resuscitation. The average score on a scale from zero to ten was 5.2 (± 1.4. The nurses presented partial knowledge of the guidelines available in the literature.Las Unidades no hospitalarias de Atención de Urgencia y Emergencia fueron creadas para atender pacientes con cuadros agudos o crónicos agudos y ordenar los flujos de urgencia. El objetivo de este estudio fue analizar el conocimiento teórico de los enfermeros de esas unidades sobre parada cardiorrespiratoria y resucitación cardiopulmonar. Se trata de un estudio descriptivo, cuyos datos fueron obtenidos aplicando un cuestionario a 73 enfermeros de 16 unidades, de siete municipios de la Región Metropolitana de Campinas. Se observó que los entrevistados presentaron vacíos de conocimiento sobre como detectar: la parada cardiorrespiratoria, la secuencia del soporte básico de vida y la relación ventilación/compresión (>60%; desconocen las conductas que deben adoptadas inmediatamente después de la detección (> 70% y los estándares de ritmos presentes en la parada cardíaca (> 80%; y identificaron parcialmente (100% los f

  10. Qualidade das anotações de enfermagem relacionadas à ressuscitação cardiopulmonar comparadas ao modelo Utstein Calidad de las anotaciones de enfermería relacionadas a la resucitación cardiopulmonar comparadas con el modelo Utstein Quality of nursing records related to cardiopulmonary resuscitation compared to the Utstein model

    Directory of Open Access Journals (Sweden)

    Ana Paula Fernandes

    2010-01-01

    los eventos (16%, drogas utilizadas (50% y profesionales envueltos en la RPC (88%. CONCLUSIONES: Las anotaciones fueron escasas y, frecuentemente, no realizadas. La utilización del modelo Utstein favorece la anotación secuencial de los eventos, evitando la pérdida de datos.OBJECTIVE: To assess the quality of nursing records related to cardiopulmonary resuscitation, comparing them to the validated Utstein protocol, in a university hospital. METHODS: Retrospective, exploratory and descriptive study, with quantitative approach, performed by means of consultation records of patients that suffered cardiorespiratory arrest (CRA followed by death. The data collection was carried out in the period of May 1st to June 30th, in 2009. RESULTS: Of the 144 medical records surveyed, 74 were dismissed for not having any recorded information on the items to be studied and, 70 constituted the study sample. In these there were no entries on: the immediate cause of CRA (92%; the interventions seeking to recover the cardiorespiratoy arrest (RCA (71%; on the initial rate of CRA (59%; on the time of events (16%; on drugs used (50%; and, on the professionals involved in RCA (88%. CONCLUSIONS: The notes were scarce and often not realized. The use of the Utstein model favors the annotation sequence of events, avoiding data loss.

  11. [Guidelines for uniform reporting of data from out-of-hospital and in-hospital cardiac arrest and resuscitation in the pediatric population: the pediatria utstein-style].

    Science.gov (United States)

    Tormo Calandín, C; Manrique Martínez, I

    2002-06-01

    Children who require cardiopulmonary resuscitation present high mortality and morbidity. The few studies that have been published on this subject use different terminology and methodology in data collection, which makes comparisons, evaluation of efficacy, and the performance of meta-analyses, etc. difficult. Consequently, standardized data collection both in clinical studies on cardiorespiratory arrest and in cardiopulmonary resuscitation in the pediatric age group are required. The Spanish Group of Pediatric Cardiopulmonary Resuscitation emphasizes that recommendations must be simple and easy to understand. The first step in the elaboration of guidelines on data collection is to develop uniform definitions (glossary of terms). The second step comprises the so-called time intervals that include time periods between two events. To describe the intervals of cardiorespiratory arrest different clocks are used: the patient's watch, that of the ambulance, the interval between call and response, etc.Thirdly, a series of clinical results are gathered to determine whether the efforts of cardiopulmonary resuscitation have a positive effect on the patient, the patient's family and society. With the information gathered a registry of data that includes the patient's personal details, general data of the cardiopulmonary resuscitation, treatment, times of performance and definitive patient outcome is made.

  12. Proposta educacional virtual sobre atendimento da ressuscitação cardiopulmonar no recém-nascido Propuesta educativa virtual para la atención de la reanimación cardiopulmonar en el recién nacido Virtual educational proposal in cardiopulmonary resuscitation for the neonate care

    Directory of Open Access Journals (Sweden)

    Gilciane Ribeiro Gonçalves

    2010-06-01

    - Fundamentos de anatomía y fisiología cardiaca del recién nacido; Módulo 2 - Factores de riesgo para la ocurrencia de paro cardiorrespiratorio en el recién nacido; Módulo 3 - Planeamiento de los cuidados de enfermería; Módulo 4 - Medicamentos utilizados en el paro cardiorrespiratorio del recién nacido, y Módulo 5 - Atención del paro cardiorrespiratorio en el recién nacido. Este estudio puede contribuir a la innovación en la enseñanza de la enfermería a partir de una propuesta educativa virtual referida a un tema de alta relevancia como lo es la atención de la resucitación cardiopulmonar del recién nacido.The purpose of this study was to develop an educational proposal using virtual multimedia resources, to innovate, stimulate and diversify areas of communication and interaction, facilitating nurses' autonomous and reflexive process of teaching and learning. This is an applied research, following the cyclical and interactive phases of designing, planning, developing and implementing. The educational proposal was developed on the TelEduc platform, using specific tools for content organization and communication between students and administrator. The teaching modules were on the following themes: Module 1 - Fundamentals of the heart anatomy and physiology in newborns; Module 2 - Risk factors for the occurrence of cardiorespiratory arrest in newborns; Module 3 - Planning nursing care; Module 4 - Medications used in cardiopulmonary arrests in newborns; and Module 5 - Cardiorespiratory arrest care in newborns. This study may contribute to innovating teaching in nursing from a virtual educational proposal on the important issue of newborn cardiopulmonary resuscitation care.

  13. Cardiac Arrest: Obstetric CPR/ACLS.

    Science.gov (United States)

    Cobb, Benjamin; Lipman, Steven

    2017-01-10

    In contrast with other high-resource countries, maternal mortality has seen an increase in the United States. Caring for pregnant women in cardiac arrest may prove uniquely challenging given the rarity of the event coupled by the physiological changes of pregnancy. Optimization of resuscitative efforts warrants special attention as described in the 2015 American Heart Association's "Scientific Statement on Maternal Cardiac Arrest." Current recommendations address a variety of topics ranging from the basic components of chest compressions and airway management to some of the logistical complexities and operational challenges involved in maternal cardiac arrest.

  14. Haemostatic resuscitation in trauma

    DEFF Research Database (Denmark)

    Stensballe, Jakob; Ostrowski, Sisse Rye; Johansson, Par I.

    2016-01-01

    PURPOSE OF REVIEW: To discuss the recent developments in and evolvement of next generation haemostatic resuscitation in bleeding trauma. RECENT FINDINGS: Mortality from major trauma is a worldwide problem, and massive haemorrhage remains a major cause of potentially preventable deaths. Development...... of coagulopathy further increases trauma mortality emphasizing that coagulopathy is a key target in the phase of bleeding. The pathophysiology of coagulopathy in trauma reflects at least three distinct mechanisms that may be present isolated or coexist: acute traumatic coagulopathy, coagulopathy associated...... with the lethal triad, and consumptive coagulopathy. The concepts of 'damage control surgery' and 'damage control resuscitation' have been developed to ensure early control of bleeding and coagulopathy to improve outcome in bleeding trauma. Haemostatic resuscitation aims at controlling coagulopathy and consists...

  15. PyCPR - a python-based implementation of the Conjugate Peak Refinement (CPR) algorithm for finding transition state structures.

    Science.gov (United States)

    Gisdon, Florian J; Culka, Martin; Ullmann, G Matthias

    2016-10-01

    Conjugate peak refinement (CPR) is a powerful and robust method to search transition states on a molecular potential energy surface. Nevertheless, the method was to the best of our knowledge so far only implemented in CHARMM. In this paper, we present PyCPR, a new Python-based implementation of the CPR algorithm within the pDynamo framework. We provide a detailed description of the theory underlying our implementation and discuss the different parts of the implementation. The method is applied to two different problems. First, we illustrate the method by analyzing the gauche to anti-periplanar transition of butane using a semiempirical QM method. Second, we reanalyze the mechanism of a glycyl-radical enzyme, namely of 4-hydroxyphenylacetate decarboxylase (HPD) using QM/MM calculations. In the end, we suggest a strategy how to use our implementation of the CPR algorithm. The integration of PyCPR into the framework pDynamo allows the combination of CPR with the large variety of methods implemented in pDynamo. PyCPR can be used in combination with quantum mechanical and molecular mechanical methods (and hybrid methods) implemented directly in pDynamo, but also in combination with external programs such as ORCA using pDynamo as interface. PyCPR is distributed as free, open source software and can be downloaded from http://www.bisb.uni-bayreuth.de/index.php?page=downloads . Graphical Abstract PyCPR is a search tool for finding saddle points on the potential energy landscape of a molecular system.

  16. Estudo preliminar das relações entre duração da parada cardiorrespiratória e suas consequências nas vítimas de trauma Preliminary study of the relationship between the cardiopulmonary arrest time and its consequences in patients who underwent trauma

    Directory of Open Access Journals (Sweden)

    Andréia Bertelli

    1999-06-01

    Full Text Available Foi proposta desta pesquisa obter subsídios para iniciar ou manter manobras de reanimação cardiopulmonar (RCP especificamente em vítimas de trauma. A duração da parada e reanimação cardiopulmonar de sobreviventes foi descrita, assim como, o desempenho cerebral e mortalidade dessas vítimas 24, 48 e 72 horas após tais eventos terem ocorrido. Com os resultados dessa caracterização estudou-se a relação entre tempo de parada e reanimação cardiorrespiratória, e, mortalidade. Os dados foram obtidos em plantões no Pronto Socorro do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Grande parte das vítimas (93,4% apresentaram trauma grave e a principal "causa mortis" foi trauma crânio-encefálico. A sobrevivência ao período de 72 horas foi de 10%. A avaliação de 72 horas, das vítimas sobreviventes a parada cardiorrespiratória (PCR de causa traumática mostrou mau desempenho cerebral dessas vítimas no período. A sobrevida após o primeiro episódio de PCR relacionou-se mais consistentemente com o tempo de PCR das vítimas de trauma do que o tempo de RCP. O tempo de PCR The proposal of this research was to obtain parameters to start or maintain cardiopulmonary resuscitation (CPR in victims of trauma. The duration of the cardiac arrest and the CPR of the survivors was described, as well as the cerebral performance and the mortality of these victims 24, 48 and 72 hours after these events had happened. With the results of this caracterization the relation between duration of cardiac arrest time, CPR and mortality were described. Data for this report were coleted in Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo emergency departament. A big amount of the victims (93, 4% presents severe trauma and main cause of death was brain injury. Survival at 72 hours after CPR was 10%. The assessment, during the 72 hour period, of the survivors from cardiac arrest of traumatic cause has

  17. Kunstigt åndedraet udgør fortsat en del af basal genoplivning

    DEFF Research Database (Denmark)

    Krarup, Niels Henrik; Løfgren, Bo

    2009-01-01

    Bystander cardiopulmonary resuscitation (CPR) consisting of mouth-to-mouth ventilation and chest compressions improves survival from cardiac arrest. Bystanders perform CPR only in a minority of cardiac arrests. To improve the number of bystanders initiating CPR, the American Heart Association...

  18. Technique for chest compressions in adult CPR

    Directory of Open Access Journals (Sweden)

    Rajab Taufiek K

    2011-12-01

    Full Text Available Abstract Chest compressions have saved the lives of countless patients in cardiac arrest as they generate a small but critical amount of blood flow to the heart and brain. This is achieved by direct cardiac massage as well as a thoracic pump mechanism. In order to optimize blood flow excellent chest compression technique is critical. Thus, the quality of the delivered chest compressions is a pivotal determinant of successful resuscitation. If a patient is found unresponsive without a definite pulse or normal breathing then the responder should assume that this patient is in cardiac arrest, activate the emergency response system and immediately start chest compressions. Contra-indications to starting chest compressions include a valid Do Not Attempt Resuscitation Order. Optimal technique for adult chest compressions includes positioning the patient supine, and pushing hard and fast over the center of the chest with the outstretched arms perpendicular to the patient's chest. The rate should be at least 100 compressions per minute and any interruptions should be minimized to achieve a minimum of 60 actually delivered compressions per minute. Aggressive rotation of compressors prevents decline of chest compression quality due to fatigue. Chest compressions are terminated following return of spontaneous circulation. Unconscious patients with normal breathing are placed in the recovery position. If there is no return of spontaneous circulation, then the decision to terminate chest compressions is based on the clinical judgment that the patient's cardiac arrest is unresponsive to treatment. Finally, it is important that family and patients' loved ones who witness chest compressions be treated with consideration and sensitivity.

  19. Fluid resuscitation in trauma

    Directory of Open Access Journals (Sweden)

    Rudra A

    2006-01-01

    Full Text Available Appropriate fluid replacement is an essential component of trauma fluid resuscitation. Once hemorrhage is controlled, restoration of normovolemia is a priority. In the presence of uncontrolled haemorrhage, aggressive fluid management may be harmful. The crystalloid-colloid debate continues but existing clinical practice is more likely to reflect local biases rather than evidence based medicine. Colloids vary substantially in their pharmacology and pharmacokinetics,and the experimental finding based on one colloid cannot be extrapolated reliably to another. In the initial stages of trauma resuscitation the precise fluid used is probably not important as long as an appropriate volume is given. Later, when the microcirculation is ′leaky′, there may be some advantages to high or medium weight colloids such as hydroxyethyl starch. Hypertonic saline solutions may have some benefit in patients with head injuries. A number of hemoglobin solutions are under development, but one of the most promising of these has been withdrawn recently. It is highly likely that at least one of these solutions will eventually become routine therapy for trauma patient resuscitation. In the meantime, contrary to traditional teaching, recent data suggest that restrictive strategy of red cell transfusion may improve outcome in some critically ill patients.

  20. Methylene Blue for Vasoplegia When on Cardiopulmonary Bypass During Double-Lung Transplantation.

    Science.gov (United States)

    Carley, Michelle; Schaff, Jacob; Lai, Terrance; Poppers, Jeremy

    2015-10-15

    Vasoplegia syndrome, characterized by hypotension refractory to fluid resuscitation or high-dose vasopressors, low systemic vascular resistance, and normal-to-increased cardiac index, is associated with increased morbidity and mortality after cardiothoracic surgery. Methylene blue inhibits inducible nitric oxide synthase and guanylyl cyclase, and has been used to treat vasoplegia during cardiopulmonary bypass. However, because methylene blue is associated with increased pulmonary vascular resistance, its use in patients undergoing lung transplantion has been limited. Herein, we report the use of methylene blue to treat refractory vasoplegia during cardiopulmonary bypass in a patient undergoing double-lung transplantation.

  1. Clinical Implication of Cough CPR in Cardiac Cath Lab

    Directory of Open Access Journals (Sweden)

    Monish S Rau

    2013-02-01

    Full Text Available A 60 year-old-male with inferoposterior ST-elevation myocardial infarction (STEMI was shifted to cardiac cath lab for primary percutaneous coronary intervention (PCI. Coronary angiography revealed right coronary artery (RCA dominance with complete occlusion of the RCA in mid vessel. During angioplasty, the patient developed reperfusion induced Bezold Jarisch Reflex (BJR with profound bradycardia along with decrease in systolic pressure. The patient was asked to cough. The use of cough-CPR maintained the consciousness as the patient was getting syncopal. This report focuses on BJR and cough-CPR specific to interventional cardiology practice within the catheterization laboratory. Awareness of the fact that BJR may develop due to successful restoration of flow which can be managed with cough CPR, atropine and fluids can avoid the administration of vasoconstrictors.

  2. Prehospital fluid resuscitation in trauma

    NARCIS (Netherlands)

    Raum, M. R.; Waydhas, C.

    2009-01-01

    The indications for and type and amount of fluid resuscitation for trauma patients in the field remains highly controversial. There is unanimity, however, that trauma victims may suffer from acute blood loss. In addition to stopping the bleeding fluid resuscitation is the second mainstay in shock th

  3. Recurrence of Ventricular Fibrillation after Successful Conversion, May be Associated with Immediate Post-Shock Chest Compressions: A Case Report

    OpenAIRE

    Shiyovich, Arthur; Gerovich, Alexander; Katz, Amos

    2013-01-01

    Aims: Since 2005, cardiopulmonary resuscitation (CPR) guidelines advise immediately resuming CPR after a defibrillation shock to minimize CPR interruption. During resuscitation, the incidence of ventricular fibrillation (VF) recurrence is as high as 79%. The aim of this report is to present a case of VF recurrence induced by chest compressions (CCs) following successful defibrillation of VF and to discuss the possible mechanisms that could be linked to this observation. Case Presentation: A 5...

  4. Successful resuscitation from two cardiac arrests in a female patient with critical aortic stenosis, severe mitral regurgitation and coronary artery disease

    Directory of Open Access Journals (Sweden)

    Mijušković Dragan

    2012-01-01

    Full Text Available Introduction. The incidence of sudden cardiac death in patients with severe symptomatic aortic stenosis is up to 34% and resuscitation is described as highly unsuccessful. Case report. A 72-year-old female patient with severe aortic stenosis combined with severe mitral regurgitation and three-vessel coronary artery disease was successfully resuscitated following two in-hospital cardiac arrests. The first cardiac arrest occurred immediately after intraarterial injection of low osmolar iodinated agent during coronary angiography. Angiography revealed 90% occlusion of the proximal left main coronary artery and circumflex branch. The second arrest followed induction of anesthesia. Following successful open-chest resuscitation, aortic valve replacement, mitral valvuloplasty and three-vessel aortocoronary bypass were performed. Postoperative pericardial tamponade required surgical revision. The patient recovered completely. Conclusion. Decision to start resuscitation may be justified in selected patients with critical aortic stenosis, even though cardiopulmonary resuscitation in such cases is generally considered futile.

  5. Effect of gasps to hemodynamics during cardiopulmonary resuscitation in a porcine model of prolonged cardiac arrest%叹息样呼吸与猪心肺复苏过程中血流动力学变化的研究

    Institute of Scientific and Technical Information of China (English)

    王烁; 武军元; 季宪飞; 李春盛

    2011-01-01

    Objective Gasp was defined as a pathology respiration during cardiac arrest. This study was to investigate its effect on hemodynamics during CPR. Method Twelve domestic pigs, weighening (30 ± 1) kg,were anaesthetized. After tracheal intubation and mechanical ventilation, continuous respiratory variables were recorded. An artery catheter was inserted for reference blood samples and measuring aortic artery pressure (AOP).Right atrial pressure (RAP) and cardiac output (CO) were detected by Swan-Ganz catheter. Ventricular fibrillation (VF) was induced by programmed electrical stimulation instruments. After 4 minutes untreated VF, standard 30:2 CPR was done for 12 minutes and the parameters were recorded. Results pH, PaCO2 and lactic acid increased and PaO2 decreased progressively during CPR, whereas PaO2 was up to 50mmHg during the whole protocol. Gasps were observed in 10 animals, but weaken gradually; the left 2 animals with no gasp did not restore of spontaneous circulation (ROSC). Standard CPR could produce passive ventilation more than dead space (VD), but its tidal volume decreased gradually, which led to the percentage of rescue ventilation increased progressively. Positive correlations were found between CO, coronary perfusion pressure (CPP) and minute ventilation of gasps (MVg) (r was 0.736 and 0.721 respectively, both P <0.01); negative correlation were found between RAP and MVg (r= -0. 744, P < 0.01). Conclusions Standard CPR could maintain 12 minutes oxygenation of body; compressions could produce enough passive ventilation more than VD; gasps were benefit to ROSC by increasing CO, CPP and decreasing RAP.%目的 研究CPR的病理生理过程,探讨叹息样呼吸对CPR过程中血流动力学的影响.方法 12头北京长白猪,体质量(30±1)kg,麻醉后气管插管,机械通气,连续记录实时呼吸参数.股动脉置管测量主动脉压(AOP),并抽取动脉血;肺动脉漂浮导管置测最右心房压(RAP)及心输出

  6. Hydroxyethyl starch for resuscitation

    DEFF Research Database (Denmark)

    Haase, Nicolai; Perner, Anders

    2013-01-01

    PURPOSE OF REVIEW: Resuscitation with hydroxyethyl starch (HES) is controversial. In this review, we will present the current evidence for the use of HES solutions including data from recent high-quality randomized clinical trials. RECENT FINDINGS: Meta-analyses of HES vs. control fluids show clear...... and surgical patients cannot adequately assess safety issues and do not show clear benefit with the use of HES. There is currently no firm evidence that tetrastarch has better safety profile than the former HES solutions. SUMMARY: There is no evidence for an overall beneficial effect of HES in any subgroup...... of critically ill patients, but there are clear signs of harm. As safer alternatives exist, we recommend that HES is no longer used in critically ill patients....

  7. Resuscitation og abdominalkirurgiske aspekter ved damage control-kirurgi

    DEFF Research Database (Denmark)

    Hillingsø, Jens G; Svendsen, Lars Bo; Johansson, Pär I

    2011-01-01

    vicious cycle". Due to this a new resuscitation practice has been defined; damage control resuscitation, consisting of hypotensive resuscitation (restricted use of crystalloids), haemostatic resuscitation (balanced use of blood components) in combination with surgical haemostatic procedures (damage...

  8. The Responses of Tissues from the Brain, Heart, Kidney, and Liver to Resuscitation following Prolonged Cardiac Arrest by Examining Mitochondrial Respiration in Rats

    Directory of Open Access Journals (Sweden)

    Junhwan Kim

    2016-01-01

    Full Text Available Cardiac arrest induces whole-body ischemia, which causes damage to multiple organs. Understanding how each organ responds to ischemia/reperfusion is important to develop better resuscitation strategies. Because direct measurement of organ function is not practicable in most animal models, we attempt to use mitochondrial respiration to test efficacy of resuscitation on the brain, heart, kidney, and liver following prolonged cardiac arrest. Male Sprague-Dawley rats are subjected to asphyxia-induced cardiac arrest for 30 min or 45 min, or 30 min cardiac arrest followed by 60 min cardiopulmonary bypass resuscitation. Mitochondria are isolated from brain, heart, kidney, and liver tissues and examined for respiration activity. Following cardiac arrest, a time-dependent decrease in state-3 respiration is observed in mitochondria from all four tissues. Following 60 min resuscitation, the respiration activity of brain mitochondria varies greatly in different animals. The activity after resuscitation remains the same in heart mitochondria and significantly increases in kidney and liver mitochondria. The result shows that inhibition of state-3 respiration is a good marker to evaluate the efficacy of resuscitation for each organ. The resulting state-3 respiration of brain and heart mitochondria following resuscitation reenforces the need for developing better strategies to resuscitate these critical organs following prolonged cardiac arrest.

  9. The Responses of Tissues from the Brain, Heart, Kidney, and Liver to Resuscitation following Prolonged Cardiac Arrest by Examining Mitochondrial Respiration in Rats.

    Science.gov (United States)

    Kim, Junhwan; Villarroel, José Paul Perales; Zhang, Wei; Yin, Tai; Shinozaki, Koichiro; Hong, Angela; Lampe, Joshua W; Becker, Lance B

    2016-01-01

    Cardiac arrest induces whole-body ischemia, which causes damage to multiple organs. Understanding how each organ responds to ischemia/reperfusion is important to develop better resuscitation strategies. Because direct measurement of organ function is not practicable in most animal models, we attempt to use mitochondrial respiration to test efficacy of resuscitation on the brain, heart, kidney, and liver following prolonged cardiac arrest. Male Sprague-Dawley rats are subjected to asphyxia-induced cardiac arrest for 30 min or 45 min, or 30 min cardiac arrest followed by 60 min cardiopulmonary bypass resuscitation. Mitochondria are isolated from brain, heart, kidney, and liver tissues and examined for respiration activity. Following cardiac arrest, a time-dependent decrease in state-3 respiration is observed in mitochondria from all four tissues. Following 60 min resuscitation, the respiration activity of brain mitochondria varies greatly in different animals. The activity after resuscitation remains the same in heart mitochondria and significantly increases in kidney and liver mitochondria. The result shows that inhibition of state-3 respiration is a good marker to evaluate the efficacy of resuscitation for each organ. The resulting state-3 respiration of brain and heart mitochondria following resuscitation reenforces the need for developing better strategies to resuscitate these critical organs following prolonged cardiac arrest.

  10. Performing CPR on a commercial diver inside the diving bell

    Directory of Open Access Journals (Sweden)

    Sourabh Bhutani

    2015-01-01

    Full Text Available CPR in a diving bell is difficult. It is taught by diving companies and training institutes but has not been subjected to the tenets of evidence based medicine. The diving bell lacks space as well as a flat hard surface to lay the patient on and therefore conventional methods of administering CPR are not possible. The diver is hung from a pulley tied to the diver's harness, and the bell flooded with water to reduce pooling of blood. Airway is established using a cervical collar to hyperextend the neck and inserting an appropriate oropharyngeal airway. Cardiac compressions are administered by the bellman using his head or the knee while holding the patient with his arms from behind. The bell can be recovered to surface only when spontaneous breathing and circulation have started. Diving bell offers a unique environment for management of unconscious casualties. Even though the method is at variance with the conventional method of administering CPR, it is the only method possible inside the bell. It is important that the method be scrutinized and refined so as to be more effective and efficacious inside the bell.

  11. 血必净注射液对复苏后大鼠细胞因子和p38丝裂素活化蛋白激酶通路的影响%Effect of Xuebijing injection(血必净注射液)on cytokine and p38 mitogen activated protein kinase pathway in rats after cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    李海峰; 于亚欣; 姜晓明; 刘永茂; 刘晓亮; 孙明莉

    2010-01-01

    目的 探讨窒息致心搏骤停(CA)心肺复苏(CPR)后大鼠心、脑组织中肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)和p38丝裂素活化蛋白激酶(p38MAPK)的变化及血必净注射液的影响.方法 采用呼气末夹闭气管窒息法建立大鼠CA模型后进行CPR.将50只健康Wistar大鼠随机分为对照组、模型组及小、中、大剂量血必净治疗组(血必净注射液浓度分别为5.0、7.5、15.0 ml/kg)5组.复苏24 h后处死大鼠,取心、脑组织标本,电镜下观察心、脑组织的病理改变;采用酶联免疫吸附法(ELISA)检测心、脑组织中TNF-α、IL-1β和p38MAPK含量.结果 组织病理观察显示,心、脑细胞超微结构出现损伤性改变,以模型组最重,大剂量血必净组最轻.模型组心、脑组织中TNF-α、IL-1β和p38MAPK含量较对照组明显升高(均P<0.01);血必净治疗组心、脑TNF-α、IL-1β、p38MAPK含量较模型组明显下降,其中大剂量组较小剂量组下降更明显(均P<0.05).结论 CA复苏后大鼠心、脑组织内TNF-α、IL-1β和p38MAPK含量增多;血必净注射液可明显调节心、脑组织中的TNF-α、IL-1β和p38MAPK含量,而且存在明显量-效关系,从而缓解CA大鼠复苏中缺氧及再灌注后炎症因子所带来的损伤.

  12. A systematic review of intensive cardiopulmonary management after spinal cord injury.

    Science.gov (United States)

    Casha, Steven; Christie, Sean

    2011-08-01

    Intensive cardiopulmonary management is frequently undertaken in patients with spinal cord injury (SCI), particularly due to the occurrence of neurogenic shock and ventilatory insufficiency and in an attempt to reduce secondary injury. We undertook a systematic review of the literature to examine the evidence that intensive care management improves outcome after SCI and to attempt to define key parameters for cardiopulmonary support/resuscitation. We review the literature in five areas: management of SCI patients in specialized centers, risk in SCI patients of cardiopulmonary complications, parameters for blood pressure and oxygenation/ventilation support following SCI, risk factors for cardiopulmonary insufficiency requiring ICU care after SCI, and preventative strategies to reduce the risks of cardiopulmonary complications in SCI patients. The literature supports that, in light of the significant incidence of cardiorespiratory complications, SCI patients should be managed in a monitored special care unit. There is weak evidence supporting the maintenance of MAP >85 mmHg for a period extending up to 1 week following SCI.

  13. Cardiopulmonary bypass in pregnancy

    Directory of Open Access Journals (Sweden)

    Mukul Chandra Kapoor

    2014-01-01

    Full Text Available Cardiac surgery carried out on cardiopulmonary bypass (CPB in a pregnant woman is associated with poor neonatal outcomes although maternal outcomes are similar to cardiac surgery in non-pregnant women. Most adverse maternal and fetal outcomes from cardiac surgery during pregnancy are attributed to effects of CPB. The CPB is associated with utero-placental hypoperfusion due to a number of factors, which may translate into low fetal cardiac output, hypoxia and even death. Better maternal and fetal outcomes may be achieved by early pre-operative optimization of maternal cardiovascular status, use of perioperative fetal monitoring, optimization of CPB, delivery of a viable fetus before the operation and scheduling cardiac surgery on an elective basis during the second trimester.

  14. Right turn resuscitation: frequently asked questions.

    Science.gov (United States)

    Tai, N R M; Russell, R

    2011-09-01

    In this article the process of operating room resuscitation - commonly known as Right Turn Resuscitation (RTR) when conducted in the medical treatment facility at Camp Bastion - is described. The place of RTR within the concepts of damage control resuscitation and surgery is discussed along with activation criteria and protocols. The medical leadership, team roles, advantages and disadvantages are reviewed. Finally, studies describing the impact of RTR and operating room resuscitation are briefly described.

  15. 心肺复苏后血清S100蛋白早水平对生存出院的预测价值%Value of early levels of serum S100 protein to predict survival discharge after successful cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    李海玲; 缪文丽; 任红贤; 林慧艳; 顾晓峰

    2008-01-01

    目的 探讨心肺复苏(CPR)后血清S100蛋白(S100)水平变化对患者生存出院的预测价值.方法 选择25例经CPR自主循环恢复(ROSC)后收入ICU的患者,将CPR成功后生存患者分为生存组12例,院内病死患者为死亡组13例.所有患者均在ROSC后2、12、24、48h分别采取静脉血,采用电化学发光免疫法检测S100;同时收集人ICU后24h内临床资料,计算各时间段急性生理学与慢性健康状况Ⅱ、Ⅲ评分(APACHEⅡ、Ⅲ)及存活概率(PS).结果 ①死亡组APACHEⅡ、Ⅲ评分明显高于生存组(P<0.01),PS、GCS评分明显低于生存组(P<0.05),开始通气时间、ROSC时间比生存组明显长(P<0.05);②生存组在2、12、48h S100水平明显低于死亡组(P<0.01);③S100的ROC曲线下面积(AUC)为0.903(P=0.001).以S100水平0.165μg/L作为诊断界点(cutoff 值),ROSC后2h S100对CPR后生存出院的阳性预测值为100%、阴性预测值73%(P=0.002),12h分别为100%和76.47%(P=0.001);预测院内死亡ROSC后2h灵敏度93.3%、特异度61.5%(P=0.001);12h分别为93.3%和58.3%(P=0.001).结论 心肺复苏后早期血清S100水平对评估患者生存出院的预测具有重要临床意义.

  16. International review on the use of information for the regulation of health and social care, April 2014

    LENUS (Irish Health Repository)

    McCaul, Conán

    2009-10-01

    Multiple interventions have been tested in models of cardiopulmonary resuscitation (CPR) to optimize drug use, chest compressions, and ventilation. None has studied the effects of positive end-expiratory pressure (PEEP) on outcome. We hypothesized that because PEEP can reverse pulmonary atelectasis, lower pulmonary vascular resistance, and potentially improve cardiac output, its use during CPR would increase survival.

  17. The crystal structure of the Hsp90 co-chaperone Cpr7 from Saccharomyces cerevisiae.

    Science.gov (United States)

    Qiu, Yu; Ge, Qiangqiang; Wang, Mingxing; Lv, Hui; Ebrahimi, Mohammad; Niu, Liwen; Teng, Maikun; Li, Xu

    2017-02-09

    The versatility of Hsp90 can be attributed to the variety of co-chaperone proteins that modulate the role of Hsp90 in many cellular processes. As a co-chaperone of Hsp90, Cpr7 is essential for accelerating the cell growth in an Hsp90-containing trimeric complex. Here, we report the crystal structure of Cpr7 at a resolution of 1.8Å. It consists of an N-terminal PPI domain and a C-terminal TPR domain, and exhibits a U-shape conformation. Our studies revealed the aggregation state of Cpr7 in solution and the interaction properties between Cpr7 and the MEEVD sequence from the C-terminus of Hsp90. In addition, the structure and sequence analysis between Cpr7 and homologues revealed the structure basis both for the function differences between Cpr6 and Cpr7 and the functional complements between Cns1 and Cpr7. Our studies facilitate the understanding of Cpr7 and provide decent insights into the molecular mechanisms of the Hsp90 co-chaperone pathway.

  18. Bioinformatics analysis for structure and function ofCPR ofPlasmodium falciparum

    Institute of Scientific and Technical Information of China (English)

    ZhigangFan; Lingmin Zhang; GuogangYan; QiangWu; XiufengGan; Saifeng Zhong; GuifenLin

    2011-01-01

    Objective:To analyse the structure and function ofNADPH-cytochrome p450 reductase(CYPOR orCPR) fromPlasmodium falciparum (Pf), and to predict its’ drug target and vaccine target. Methods: The structure, function, drug target and vaccine target ofCPR fromPlasmodium falciparum were analyzed and predicted by bioinformatics methods.Results:PfCPR, which was olderCPR, had close relationship with theCPR from otherPlasmodium species, but it was distant from its hosts, such asHomo sapiens andAnopheles.PfCPR was located in the cellular nucleus ofPlasmodium falciparum.335aa-352aa and591aa -608aa were inserted the interior side of the nuclear membrane, while151aa-265aa was located in the nucleolus organizer regions.PfCPR had40 function sites and44 protein-protein binding sites in amino acid sequence. The teriary structure of 1aa-700aa was forcep-shaped with wings.15 segments ofPfCPR had no homology withHomo sapien CPR and most were exposed on the surface of the protein. These segments had25 protein-protein binding sites. While13other segments all possessed function sites. Conclusions: The evolution or genesis ofPlasmodium falciparum is earlier than those ofHomo sapiens. PfCPR is a possible resistance site of antimalarial drug and may involve immune evasion, which is associated with parasite of sporozoite in hepatocytes.PfCPR is unsuitable as vaccine target, but it has at least 13 ideal drug targets.

  19. Application of Calibrated Peer Review (CPR) Writing Assignments to Enhance Experiments with an Environmental Chemistry Focus

    Science.gov (United States)

    Margerum, Lawrence D.; Gulsrud, Maren; Manlapez, Ronald; Rebong, Rachelle; Love, Austin

    2007-01-01

    The browser-based software program, Calibrated Peer Review (CPR) developed by the Molecular Science Project enables instructors to create structured writing assignments in which students learn by writing and reading for content. Though the CPR project covers only one experiment in general chemistry, it might provide lab instructors with a method…

  20. Early Management and Fluid Resuscitation

    Directory of Open Access Journals (Sweden)

    Kaya Yorgancı

    2011-07-01

    Full Text Available Initial management of severely burned patient is similar with a trauma victim. Determination of airway patency, evaluation of respiration and circulation, early recognition of concomitant trauma has vital importance in burn patients. In the early phase, mortality mainly depends on missed or un-treated severe injuries or pathologies, but not burn injury itself.In patients that have TBSA greater than 15 %, fluid resuscitation should be started. In the first 24 hours, crystalloid solutions should be preferred. .Several formulas can guide fluid resuscitation; however the amount of fluid that is given to the patient should be individualized according to the patient’s need. (Journal of the Turkish Society Intensive Care 2011; 9 Suppl: 7-10

  1. Resuscitating the Baby after Shoulder Dystocia

    Directory of Open Access Journals (Sweden)

    Savas Menticoglou

    2016-01-01

    Full Text Available Background. To propose hypovolemic shock as a possible explanation for the failure to resuscitate some babies after shoulder dystocia and to suggest a change in clinical practice. Case Presentation. Two cases are presented in which severe shoulder dystocia was resolved within five minutes. Both babies were born without a heartbeat. Despite standard resuscitation by expert neonatologists, no heartbeat was obtained until volume resuscitation was started, at 25 minutes in the first case and 11 minutes in the second. After volume resuscitation circulation was restored, there was profound brain damage and the babies died. Conclusion. Unsuspected hypovolemic shock may explain some cases of failed resuscitation after shoulder dystocia. This may require a change in clinical practice. Rather than immediately clamping the cord after the baby is delivered, it is proposed that (1 the obstetrician delay cord clamping to allow autotransfusion of the baby from the placenta and (2 the neonatal resuscitators give volume much sooner.

  2. CPR evolution of kilometer-scale craters on the lunar mare

    Science.gov (United States)

    King, Isabel; Fassett, Caleb; Thomson, Bradley J.; Minton, David A.; Watters, Wesley A.

    2016-10-01

    This study analyzes the 12.6-cm radar signature of kilometer-scale craters using data from the Mini-RF instrument on the Lunar Reconnaissance Orbiter. We examine the circular polarization ratio (CPR), which is sensitive to rockiness and surface roughness at the decimeter scale, to determine if there is a relationship between CPR signature and age for craters on the lunar mare. The craters come from an existing dataset of >13,000 craters ranging 800 m to 5 km in diameter that have previously determined degradation states based on their topography. The locations of craters in the original data set were manually co-registered to Mini-RF level 2 observations from the PDS, and for each crater, radial CPR profiles were extracted. In total, there were 5,142 unique craters with Mini-RF observations; 914 craters had repeat measurements that were used to assess uncertainties in CPR profiles. To characterize the time evolution of CPR, the craters were analyzed by finding the median profiles for groups of craters sorted by age and diameter. The highest CPR values are found in the interiors of the craters, and for craters ≤2 km, the freshest craters have the highest CPR values. In the ejecta, fresh craters exhibit the highest CPR, and this decreases with time until an equilibrium is reached. As expected from theory, larger craters' profiles evolve less quickly, with only minor changes in CPR inside their rim and a slower decrease of CPR in their ejecta. In conjunction with other datasets like topography, optical maturity, and rockiness, these data are important for constraining models of regolith evolution and crater degradation on the Moon.

  3. [Studies of emergency cardiopulmonary bypass (ECPB) for cardiopulmonary-cerebral resuscitation; (1) Introduction of a portable-percutaneous ECPB system].

    Science.gov (United States)

    Ashimura, K; Kano, T; Hashiguchi, A; Sadanaga, M; Sakamoto, M; Morioka, T

    1992-06-01

    The authors have developed an ECPB system, which can be applied quickly, safely and easily under an emergency condition requiring cardiac massage and artificial ventilation. Fundamentally, the ECPB system consists of 3 parts; a portable ECPB apparatus, a pair of percutaneous cannulae and a short circuit connecting an oxygenator with the cannulae. The ECPB apparatus is assembled with commercially available components (i.e., a centrifugal pump, a battery pack, a temperature controller, a compact membrane oxygenator with a heat exchanger, etc) and they are placed on a mobile cart. The circuit is primed with 300 ml of lactated Ringer solution. The priming can be done within 15 minutes via a reservoir. It is also possible to keep the primed circuit to be ready for emergency use at least for a week. The cannulae are placed intravascularly through the femoral artery and vein by using the Seldinger's percutaneous method. In an emergency situation, the arterial and venous cannulations are carried out separately on the both inguinal regions to save time. The tip of the venous cannula is adjusted to be placed near the right atrium under fluoroscopy. Initiation of ECPB via the femoro-femoral V-A cannulae assures instant and stable supply of oxygenated blood to all of the vital organs. At the present time, nothing is more important than a quick supply of oxygenated blood to the brain to ameliorate the post-ischemic brain damage.

  4. Extracorporeal membrane oxygenation support in post-traumatic cardiopulmonary failure

    Science.gov (United States)

    Lin, Chun-Yu; Tsai, Feng-Chun; Lee, Hsiu-An; Tseng, Yuan-His

    2017-01-01

    Abstract Patients with multiple traumas associated with cardiopulmonary failure have a high mortality rate; however, such patients can be temporarily stabilized using extracorporeal membrane oxygenation (ECMO), providing a bridge to rescue therapy. Using a retrospective study design, we aimed to clarify the prognostic factors of post-traumatic ECMO support. From March 2006 to July 2016, 43 adult patients (mean age, 37.3 ± 15.2 years; 7 females [16.3%]) underwent ECMO because of post-traumatic cardiopulmonary failure. Pre-ECMO demographics, peri-ECMO events, and post-ECMO recoveries were compared between survivors and nonsurvivors. The most common traumatic insult was traffic collision (n = 30, 69.8%), and involved injury areas included the chest (n = 33, 76.7%), head (n = 14, 32.6%), abdomen (n = 21, 48.8%), and fractures (n = 21, 48.8%). Fifteen patients (34.9%) underwent cardiopulmonary resuscitation and 22 (51.2%) received rescue interventions before ECMO deployment. The mean time interval between trauma and ECMO was 90.6 ± 130.1 hours, and the mode of support was venovenous in 26 patients (60.5%). A total of 26 patients (60.5%) were weaned off of ECMO and 22 (51.6%) survived to discharge, with an overall mean support time of 162.9 ± 182.7 hours. A multivariate regression analysis identified 2 significant predictors for in-hospital mortality: an injury severity score (ISS) >30 (odds ratio [OR], 9.48; 95% confidence interval [CI], 1.04–18.47; P = 0.042), and the requirement of renal replacement therapy (RRT) during ECMO (OR, 8.64; 95% CI, 1.73–26.09; P = 0.020). These two factors were also significant for the 1-year survival (ISS >30: 12.5%; ISS ≤30, 48.1%, P = 0.001) (RRT required, 15.0%; RRT not required, 52.2%, P = 0.006). Using ECMO in selected traumatized patients with cardiopulmonary failure can be a salvage therapy. Prompt intervention before shock-impaired systemic organ perfusion and acute

  5. Implementing Calibrated Peer Review (CPR) in a Large-lecture Science Course

    Science.gov (United States)

    Ward, A. S.; Bettis, E. A., III; Russell, J. E.; Van Horne, S.; Sipola, M.; Rocheford, M. K.; Colombo, M. R.

    2014-12-01

    Assessing writing assignments and providing students the opportunity to meaningfully revise the assignments are challenging for instructors of large enrollment science classes. We included two individual writing assignments and peer assessments as part of course assessment for a large Introduction to Environmental Science course. In order to facilitate the assessment, Calibrated Peer Review (CPR), a web-based application developed by UCLA that enables frequent writing assignments in any discipline and with any class size, was adopted. The CPR assignment process involved four steps: submitting a writing assignment, calibrating each student's review skills, reviewing peers' writing, and assessing one's own writing assignment (self-assessment). A rubric was provided to guide students through each writing assignment and the same rubric was used in calibration, review, and self-assessment scoring. Once the instructors uploaded the writing prompts, rubrics, sample writings and answer keys into the CPR system, the CPR software fully directed all student activity (writing assignment submission, calibrations, reviews, and self-assessment). Students were able to view their results within the CPR program, including their self-calibration scores, reviewing scores, peers' ratings and feedback, total earned scores, and self-assessment scores. Surveys independently administered at the conclusion of the CPR assignments indicated that sixty to seventy-five percent of the students perceived that CPR was helpful in their learning, improved their writing and evaluation skills, and that the process of reviewing other students' essays and their own essays was more helpful than the comments received from peers. These survey results are in agreement with the well-established educational research literature that shows the benefits of peer review and peer assessment to student learning. Our experience with CPR in a large enrollment science course indicates that thoughtful planning of the

  6. Coexpression of CPR from various origins enhances biotransformation activity of human CYPs in S. pombe.

    Science.gov (United States)

    Neunzig, Ina; Widjaja, Maria; Peters, Frank T; Maurer, Hans H; Hehn, Alain; Bourgaud, Frédéric; Bureik, Matthias

    2013-08-01

    Cytochrome P450 enzymes (CYPs or P450s) are the most important enzymes involved in the phase I metabolism of drugs (and other xenobiotics) in humans, and the corresponding drug metabolites are needed as reference substances for their structural confirmation and for pharmacological or toxicological characterization. We have previously shown that biotechnological synthesis of such metabolites is feasible by whole-cell biotransformation with human CYPs recombinantly expressed in the fission yeast Schizosaccharomyces pombe. It was the aim of this study to compare the activity of seven human microsomal CYPs (CYP2C9, CYP2D6, CYP3A4, CYP3A5, CYP3A7, CYP17, and CYP21) upon coexpression with NADPH-cytochrome P450 oxidoreductases (CPRs) from various origins, namely, human CPR (hCPR) and its homologues from fission yeast (ccr1) and the bishop's weed Ammi majus (AmCPR), respectively. For this purpose, 28 recombinant strains were needed, with five of them having been constructed previously and 23 strains being newly constructed. Bioconversion experiments showed that coexpression of a CPR does not only influence the reaction rate but, in some cases, also exerts an influence on the metabolite pattern. For CYP3A enzymes, coexpression of hCPR yielded the best results, while for another two, hCPR was equally helpful as ccr1 (both CYP17 and CYP21) or AmCPR (CYP17 only), respectively. Interestingly, CYP2D6 displayed its highest activity when coexpressed with ccr1 and CYP2C9 with AmCPR. These results corroborate the view of CPR as a well-suited bio-brick in synthetic biology for the construction of artificial enzyme complexes.

  7. The Iranian physicians attitude toward the do not resuscitate order

    Directory of Open Access Journals (Sweden)

    Fallahi M

    2016-06-01

    comprehensive training to various groups, including patients, doctors, nurses, administrators, and policy makers of the health system. Keywords: cardiopulmonary resuscitation, physicians, attitude

  8. Rural Hospital Preparedness for Neonatal Resuscitation

    Science.gov (United States)

    Jukkala, Angela; Henly, Susan J.; Lindeke, Linda

    2008-01-01

    Context: Neonatal resuscitation is a critical component of perinatal services in all settings. Purpose: To systematically describe preparedness of rural hospitals for neonatal resuscitation, and to determine whether delivery volume and level of perinatal care were associated with overall preparedness or its indicators. Methods: We developed the…

  9. Arabidopsis CPR5 independently regulates seed germination and postgermination arrest of development through LOX pathway and ABA signaling.

    Directory of Open Access Journals (Sweden)

    Guilan Gao

    Full Text Available The phytohormone abscisic acid (ABA and the lipoxygenases (LOXs pathway play important roles in seed germination and seedling growth and development. Here, we reported on the functional characterization of Arabidopsis CPR5 in the ABA signaling and LOX pathways. The cpr5 mutant was hypersensitive to ABA in the seed germination, cotyledon greening and root growth, whereas transgenic plants overexpressing CPR5 were insensitive. Genetic analysis demonstrated that CPR5 gene may be located downstream of the ABI1 in the ABA signaling pathway. However, the cpr5 mutant showed an ABA independent drought-resistant phenotype. It was also found that the cpr5 mutant was hypersensitive to NDGA and NDGA treatment aggravated the ABA-induced delay in the seed germination and cotyledon greening. Taken together, these results suggest that the CPR5 plays a regulatory role in the regulation of seed germination and early seedling growth through ABA and LOX pathways independently.

  10. Cooling strategies and transport theories for brain hypothermia resuscitation

    Institute of Scientific and Technical Information of China (English)

    LIU Jing

    2007-01-01

    The brain is one of the most important organs in a biological body whose normal function depends heavily on an uninterrupted delivery of oxygen.Unlike skeletal muscles that can survive for hours without oxygen,neuron cells in the brain are easily subjected to an irreversible damage within minutes from the onset of oxygen deficiency.With the interruption of cardiopulmonary circulation in many cardiac surgical procedures or accidental events leading to cerebral circulation arrest,an imbalance between energy production and consumption will occur which causes a rapid depletion of oxygen due to the interrupted blood-flow to the brain.Meanwhile,the cooling function of the blood flow on the hot tissue will be stopped,while metabolic heat generation in the tissues still keeps running for awhile.Under such adverse situations,the potential for cerebral protection through hypothermia has been intensively investigated in clinics by lowering brain temperature to restrain the cerebral oxygen demands.The reason can be attributed to the decreased metabolic requirements of the cold brain tissues,which allows a longer duration for the brain to endure reduced oxygen delivery.It is now clear that hypothermia would serve as the principal way for neurologic protection in a wide variety of emergency medicines,especially in cerebral damage,anoxia,circulatory arrest,respiratory occlusion,etc.However,although brain cooling has been found uniquely significant in clinical practices,the serious lack of knowledge on the mechanisms involved prevents its further advancement in brain resuscitation.Compared with the expanded trials in clinics,only very limited efforts were made to probe the engineering issues involved,which turns out to be a major obstacle for the successful operation of brain hypothermia resuscitation.From the viewpoint of biothermal medical engineering,the major theories and strategies for administering brain cooling can generally be classified into three categories:heat transfer

  11. Enalapril protects against myocardial ischemia/reperfusion injury in a swine model of cardiac arrest and resuscitation

    Science.gov (United States)

    Wang, Guoxing; Zhang, Qian; Yuan, Wei; Wu, Junyuan; Li, Chunsheng

    2016-01-01

    There is strong evidence to suggest that angiotensin-converting enzyme inhibitors (ACEIs) protect against local myocardial ischemia/reperfusion (I/R) injury. This study was designed to explore whether ACEIs exert cardioprotective effects in a swine model of cardiac arrest (CA) and resuscitation. Male pigs were randomly assigned to three groups: sham-operated group, saline treatment group and enalapril treatment group. Thirty minutes after drug infusion, the animals in the saline and enalapril groups were subjected to ventricular fibrillation (8 min) followed by cardiopulmonary resuscitation (up to 30 min). Cardiac function was monitored, and myocardial tissue and blood were collected for analysis. Enalapril pre-treatment did not improve cardiac function or the 6-h survival rate after CA and resuscitation; however, this intervention ameliorated myocardial ultrastructural damage, reduced the level of plasma cardiac troponin I and decreased myocardial apoptosis. Plasma angiotensin (Ang) II and Ang-(1–7) levels were enhanced in the model of CA and resuscitation. Enalapril reduced the plasma Ang II level at 4 and 6 h after the return of spontaneous circulation whereas enalapril did not affect the plasma Ang-(1–7) level. Enalapril pre-treatment decreased the myocardial mRNA and protein expression of angiotensin-converting enzyme (ACE). Enalapril treatment also reduced the myocardial ACE/ACE2 ratio, both at the mRNA and the protein level. Enalapril pre-treatment did not affect the upregulation of ACE2, Ang II type 1 receptor (AT1R) and MAS after CA and resuscitation. Taken together, these findings suggest that enalapril protects against ischemic injury through the attenuation of the ACE/Ang II/AT1R axis after CA and resuscitation in pigs. These results suggest the potential therapeutic value of ACEIs in patients with CA. PMID:27633002

  12. A cyclophilin A CPR1 overexpression enhances stress acquisition in Saccharomyces cerevisiae.

    Science.gov (United States)

    Kim, Il-Sup; Kim, Hyun-Young; Shin, Sun-Young; Kim, Young-Saeng; Lee, Dong Hee; Park, Kyung Moc; Yoon, Ho-Sung

    2010-06-01

    Cyclophilins are conserved cis-trans peptidyl-prolyl isomerase that are implicated in protein folding and function as molecular chaperones. We found the expression of cyclophilin A, Cpr1, changes in response to exposure to yeast Saccharomyces cerevisiae to abiotic stress conditions. The effect of Cpr1 overexpression in stress responses was therefore examined. The CPR1 gene was cloned to the yeast expression vector pVTU260 under regulation of an endogenous alcohol dehydrogenase (ADH) promoter. The overexpression of Cpr1 drastically increased cell viability of yeast in the presence of stress inducers, such as cadmium, cobalt, copper, hydrogen peroxide, tert-butyl hydroperoxide (t-BOOH), and sodium dodecyl sulfate (SDS). The Cpr1 expression also enhanced the cell rescue program resulting in a variety of antioxidant enzymes including thioredoxin system (particularly, thioredoxin peroxidase), metabolic enzymes (glucose-6-phosphate dehydrogenase and glyceraldehyde-3-phosphate dehydrogenase), and molecular chaperones (Hsp104, Hsp90, Hsp60 and Hsp42). Thus, our study illustrates the importance of Cpr1 as a molecular chaperone that improves cellular stress responses through collaborative relationships with other proteins when yeast cells are exposed to adverse conditions, and it also premises the improvement of yeast strains.

  13. Role of the community matron in advance care planning and 'do not attempt CPR' decision-making: a qualitative study.

    Science.gov (United States)

    Kazmierski, Mandy; King, Nigel

    2015-01-01

    The community matron (CM) is often the key worker caring for patients with chronic, life-limiting, long-term conditions, but these patients are not always recognised as palliative cases. This study explored the experiences of CMs with regard to advance care planning (ACP) and 'do not attempt cardiopulmonary resuscitation' (DNACPR) decision-making to understand whether or not they felt adequately prepared for this aspect of their role, and why. Qualitative data were generated from six CMs using a broad interpretive phenomenological approach. Face-to-face recorded interviews were analysed using template analysis. The study found that although participants faced complex ethical situations around ACP and DNACPR almost on a daily basis, none had received any formal training despite the emphasis on training in national and local guidelines. Participants often struggled to get their patients accepted on to the Gold Standards Framework. The research found variability and complexity of cases to be the main barriers to clear identification of the palliative phase.

  14. CPR1000全厂断电事故瞬态特性分析%Transient Analyses of Station Blackout Accident for CPR1000

    Institute of Scientific and Technical Information of China (English)

    张亚培; 田文喜; 秋穗正; 苏光辉

    2011-01-01

    The primary loop of CPR1000 nuclear power plant was modeled using RELAP5/MOD3. 4 code, and the transient thermal hydraulic characteristics were analyzed under the condition of station blackout accident (SBO). The calculation results by RELAP5 code were compared with those of THEMIS code, and the results by RELAP5 code were consistent with those of THEMIS code. The results show that the RELAP5 model can accurately simulate the transient thermal hydraulic characteristics of CPR1000 under the condition of SBO.%用RELAP5/MOD3.4程序对CPR1000压水堆一回路系统进行整体建模,分析全厂断电事故下一回路主要参数的瞬态热工水力特性,并将RELAP5模型计算结果与THEMIS程序的计算结果进行对比,二者符合得较好.计算结果表明:该模型可较准确地模拟CPR1000在事故下的热工水力特性.

  15. Multiple dimensions of cardiopulmonary dyspnea

    Institute of Scientific and Technical Information of China (English)

    HAN Jiang-na; XIONG Chang-ming; YAO Wei; FANG Qiu-hong; ZHU Yuan-jue; CHENG Xian-sheng; Karel P Van de Woestijne

    2011-01-01

    Background The current theory of dyspnea perception presumes a multidimensional conception of dyspnea.However,its validity in patients with cardiopulmonary dyspnea has not been investigated.Methods A respiratory symptom checklist incorporating spontaneously reported descriptors of sensory experiences of breathing discomfort,affective aspects,and behavioral items was administered to 396 patients with asthma,chronic obstructive pulmonary disease (COPD),diffuse parenchymal lung disease,pulmonary vascular disease,chronic heart failure,and medically unexplained dyspnea.Symptom factors measuring different qualitative components of dyspnea were derived by a principal component analysis.The separation of patient groups was achieved by a variance analysis on symptom factors.Results Seven factors appeared to measure three dimensions of dyspnea:sensory (difficulty breathing and phase of respiration,depth and frequency of breathing,urge to breathe,wheeze),affective (chest tightness,anxiety),and behavioral (refraining from physical activity) dimensions.Difficulty breathing and phase of respiration occurred more often in COPD,followed by asthma (R2=0.12).Urge to breathe was unique for patients with medically unexplained dyspnea (R2=0.12).Wheeze occurred most frequently in asthma,followed by COPD and heart failure (R2=0.17).Chest tightness was specifically linked to medically unexplained dyspnea and asthma (R2=0.04).Anxiety characterized medically unexplained dyspnea (R2=0.08).Refraining from physical activity appeared more often in heart failure,pulmonary vascular disease,and COPD (R2=0.15).Conclusions Three dimensions with seven qualitative components of dyspnea appeared in cardiopulmonary disease and the components under each dimension allowed separation of different patient groups.These findings may serve as a validation on the multiple dimensions of cardiopulmonary dyspnea.

  16. History of cardiopulmonary bypass (CPB).

    Science.gov (United States)

    Hessel, Eugene A

    2015-06-01

    The development of cardiopulmonary bypass (CPB), thereby permitting open-heart surgery, is one of the most important advances in medicine in the 20th century. Many currently practicing cardiac anesthesiologists, cardiac surgeons, and perfusionists are unaware of how recently it came into use (60 years) and how much the practice of CPB has changed during its short existence. In this paper, the development of CPB and the many changes and progress that has taken place over this brief period of time, making it a remarkably safe endeavor, are reviewed. The many as yet unresolved questions are also identified, which sets the stage for the other papers in this issue of this journal.

  17. [Records of in-hospital cardiopulmonary resuscitation: applicability of a tool].

    Science.gov (United States)

    Boaventura, Ana Paula; Araújo, Izilda Esmenia Muglia

    2006-09-01

    Records of cardiac arrest are not usually made, or are incomplete, and should contain more information. This study aimed at applying a tool developed to record in-hospital cardiac arrest. The tool was previously validated by experts, and then applied by registered nurses in six wards. Fifty-four cases of in-hospital cardiac arrest were recorded, and over 90% positive answers, relative to evaluation criteria, were obtained. In the analysis of entry per data set, the average was higher than 70%. It was concluded that the tool supplied the needs of cardiac arrest recording for this hospital.

  18. THE LEVEL OF TRAINING OF PROFESSIONAL NURSING FRONT CARDIOPULMONARY RESUSCITATION IN THE EMERGENCY ROOM

    Directory of Open Access Journals (Sweden)

    Jéssica de Lyra Sousa

    2011-06-01

    Full Text Available O sucesso do atendimento a uma vítima de PCR é determinado pelo reconhecimento precoce da ausência dos sinais vitais e da pronta instituição do suporte básico e avançado de vida. Objetivo:. identificar a conduta e a capacitação do profissional de enfermagem frente uma reanimação cardiorrespiratória na emergência. Metodologia:. Pesquisa de campo, descritiva com abordagem quantitativa. Aplicou-se questionários contendo dez perguntas objetivas  sobre RCP a enfermeiros que atuam no setor de emergência do hospital municipal Souza Aguiar, sendo quantificados os erros e acertos obtidos em cada questão e os dados foram analisados por teste estatístico. Resultados:. A capacitação dos profissionais de enfermagem na atuação em uma reanimação cardiopulmonar é insatisfatória, sendo que somente 40,7% tiveram um percentual geral de acertos. Conclusão:. Programas de educação continuada são fundamentais para que a equipe de enfermagem possa manter-se atualizada em relação a novos conhecimentos e protocolos.Descritores: Parada cardíaca, Ressuscitação Cardiopulmonar, Enfermagem em Emergência.

  19. A SOF Damage Control Resuscitation Cocktail

    Science.gov (United States)

    2015-05-01

    resuscitation (DCR) cocktail for use by SOF’s that is capable of improving survival from polytrauma in austere settings. The cocktail components...components are tested in a combat-relevant swine polytrauma model of hemorrhagic shock with traumatic brain injury, free internal bleeding from an aortic...from polytrauma in austere settings. The cocktail components include Hextend for volume resuscitation and tissue perfusion, fibrinogen concentrate

  20. The Mathematics of Morality for Neonatal Resuscitation

    OpenAIRE

    Meadow, William; Lagatta, Joanne; Andrews, Bree; Lantos, John

    2012-01-01

    We have discussed in this chapter ethical issues surrounding the resuscitation of infants who are at great risk to die or survive with significant morbidity. We have introduced data regarding three separate aspects of the morality of resuscitation for these infants – money, outcomes, and prediction. We have demonstrated that there are no credible financial arguments against NICU care for infants born at the border of viability – rather, the NICU is a bargain in terms of dollars devoted to inf...

  1. Acute mesenteric ischemia after cardio-pulmonary bypass surgery

    Institute of Scientific and Technical Information of China (English)

    Bassam Abboud; Ronald Daher; Joe Boujaoude

    2008-01-01

    Acute mesenteric ischemia (AMI) is a highly-lethal surgical emergency.Several pathophysiologic events (arterial obstruction,venous thrombosis and diffuse vasospasm) lead to a sudden decrease in mesenteric blood flow.Ischemia/reperfusion syndrome of the intestine is responsible for systemic abnormalities,leading to multi-organ failure and death.Early diagnosis is difficult because the clinical presentation is subtle,and the biological and radiological diagnostic tools lack sensitivity and specificity.Therapeutic options vary from conservative resuscitation,medical treatment,endovascular techniques and surgical resection and revascularization.A high index of suspicion is required for diagnosis,and prompt treatment is the only hope of reducing the mortality rate.Studies are in progress to provide more accurate diagnostic tools for early diagnosis.AMI can complicate the post-operative course of patients following cardio-pulmonary bypass (CPB).Several factors contribute to the systemic hypo-perfusion state,which is the most frequent pathophysiologic event.In this particular setting,the clinical presentation of AMI can be misleading,while the laboratory and radiological diagnostic tests often produce inconclusive results.The management strategies are controversial,but early treatment is critical for saving lives.Based on the experience of our team,we consider prompt exploratory laparotomy,irrespective of the results of the diagnostic tests,is the only way to provide objective assessment and adequate treatment,leading to dramatic reduction in the mortality rate.

  2. Cardiopulmonary helminths in foxes from the Pyrenees.

    Science.gov (United States)

    Garrido-Castañé, Ignasi; Ortuño, Anna; Marco, Ignasi; Castellà, Joaquim

    2015-12-01

    The present survey was carried out to investigate the prevalence of cardiopulmonary helminths in red foxes in Pyrenees area and to evaluate the role of foxes in the eco-epidemiology of these nematodes. Hearts and entire respiratory tracts were obtained from 87 foxes from Vall d'Aran region, Pyrenees, Catalonia, north-eastern Spain. The cardiopulmonary tracts were dissected, flushed and examined for nematodes using sedimented flushing water. Of the 87 examined foxes, 53 (61%) were positive for cardiopulmonary helminths. The identified nematodes were Crenosoma vulpis (44.8%), Eucoleus aerophilus (29.9%) and Angiostrongylus vasorum (3.4%). Statistical differences were observed only on comparing age and C.vulpis prevalence, with young foxes being more infected than adults. The high prevalence of cardiopulmonary nematodes suggested that red foxes may play an important role in their transmission and maintenance in the studied area.

  3. Resuscitation og abdominalkirurgiske aspekter ved damage control-kirurgi

    DEFF Research Database (Denmark)

    Hillingsø, Jens G; Svendsen, Lars Bo; Johansson, Pär I

    2011-01-01

    In multitrauma patients continuous bleeding is one of the major killers. Coagulation defects have been shown to be a primary event and to occur very early in multitrauma patients (acute traumatic coagulopathy). It is enhanced by acidosis, hypothermia and further coagulation disorders in the "bloody...... vicious cycle". Due to this a new resuscitation practice has been defined; damage control resuscitation, consisting of hypotensive resuscitation (restricted use of crystalloids), haemostatic resuscitation (balanced use of blood components) in combination with surgical haemostatic procedures (damage...

  4. Drugs during delivery room resuscitation--what, when and why?

    Science.gov (United States)

    Kapadia, Vishal S; Wyckoff, Myra H

    2013-12-01

    Although seldom needed, the short list of medications used for delivery room resuscitation of the newborn includes epinephrine and volume expanders. Naloxone, sodium bicarbonate and the use of other vasopressors are no longer considered helpful during acute resuscitation and are more often administered in the post-resuscitative period under special circumstances. This review examines the existing literature for the two commonly used medications in neonatal resuscitation and identifies the many knowledge gaps requiring further research.

  5. An unanticipated cardiac arrest and unusual post-resuscitation psycho-behavioural phenomena/near death experience in a patient with pregnancy induced hypertension and twin pregnancy undergoing elective lower segment caesarean section

    Directory of Open Access Journals (Sweden)

    Mridul M Panditrao

    2010-01-01

    Full Text Available A case report of a primigravida, who was admitted with severe pregnancy induced hypertension (BP 160/122 mmHg and twin pregnancy, is presented here. Antihypertensive therapy was initiated. Elective LSCS under general anaesthesia was planned. After the birth of both the babies, intramyometrial injections of Carboprost and Pitocin were administered. Immediately, she suffered cardiac arrest. Cardio pulmonary resucitation (CPR was started and within 3 minutes, she was successfully resuscitated. The patient initially showed peculiar psychological changes and with passage of time, certain psycho-behavioural patterns emerged which could be attributed to near death experiences, as described in this case report.

  6. An unanticipated cardiac arrest and unusual post-resuscitation psycho-behavioural phenomena/near death experience in a patient with pregnancy induced hypertension and twin pregnancy undergoing elective lower segment caesarean section.

    Science.gov (United States)

    Panditrao, Mridul M; Singh, Chanchal; Panditrao, Minnu M

    2010-09-01

    A case report of a primigravida, who was admitted with severe pregnancy induced hypertension (BP 160/122 mmHg) and twin pregnancy, is presented here. Antihypertensive therapy was initiated. Elective LSCS under general anaesthesia was planned. After the birth of both the babies, intramyometrial injections of Carboprost and Pitocin were administered. Immediately, she suffered cardiac arrest. Cardio pulmonary resucitation (CPR) was started and within 3 minutes, she was successfully resuscitated. The patient initially showed peculiar psychological changes and with passage of time, certain psycho-behavioural patterns emerged which could be attributed to near death experiences, as described in this case report.

  7. Damage control resuscitation for massive hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Osaree Akaraborworn

    2014-01-01

    Hemorrhage is the second most common cause of death among trauma patients and almost half of the deaths occur within 24 hours after arrival.Damage control resuscitation is a new paradigm for patients with massive bleeding.It consists of permissive hypotension,hemostatic resuscitation and transfusion strategies,and damage control surgery.Permissive hypotension seems to have better results before the bleeding is controlled.The strategy of fluid resuscitation is minimizing crystalloid infusion and increasing early transfusion with a high ratio of fresh frozen plasma to packed red cells.Damage control surgery is done when the patient's condition is unfit for definitive surgery.Hemorrhage and contamination control with temporary abdominal closure is performed before transferring the patients to intensive care unit and the operating room for a permanent laparotomy.

  8. Video recording trauma resuscitations: an effective teaching technique.

    Science.gov (United States)

    Hoyt, D B; Shackford, S R; Fridland, P H; Mackersie, R C; Hansbrough, J F; Wachtel, T L; Fortune, J B

    1988-04-01

    Since the initial hour after injury is the most crucial time for trauma patients, resuscitation technique is of vital importance. Standardized courses for first-hour management (ATLAS) have been widely accepted. A teaching format based upon video recording of every resuscitation has been developed. Tapes are reviewed by the staff and by the individuals involved in a particular resuscitation. In a weekly resuscitation review conference, actual footage is presented to the trauma team members, specific aspects of a resuscitation are critiqued, and supplemental didactic information is presented. Legal problems have been avoided by making the review and conference a part of the quality assurance process. Patient anonymity is preserved by positioning the video camera at the foot of the resuscitation bed. Tapes are erased after each conference. Video recording allows analysis of: 1) priorities during the resuscitation; 2) cognitive integration of the workup by the team leader; 3) physical integration of the workup by the team leader; 4) team member adherence to assigned responsibilities, resuscitation time, errors or breaks in technique; and 5) behavior change over time. In 3 1/2 years, more than 2,500 resuscitations have been recorded. Over a 3-month period, average resuscitation time to definitive care decreased for age- and injury severity-matched patient groups cared for by one team. Resuscitations have become more efficient and adherence to assigned responsibilities better. Weekly review of resuscitation contributes to improved technique and trauma care.

  9. Ethyl Pyruvate Provides Therapeutic Benefits to Resuscitation Fluids

    Science.gov (United States)

    2009-02-01

    described in previous studies [40]. Animals without resuscitation were characterized by uremia, metabolic acidosis and hyperglycemia. Both resuscitation...AnGap) and negative base excess of extracellular fluid (BEecf). Resuscitation with Hextend alone or with ethyl pyruvate improved metabolic acidosis , anion...gap and BEecf . These effects on metabolic acidosis did not correlate with changes in bicarbonate, gases (total and partial CO2), or

  10. Tribolium castaneum RR-1 cuticular protein TcCPR4 is required for formation of pore canals in rigid cuticle.

    Directory of Open Access Journals (Sweden)

    Mi Young Noh

    2015-02-01

    Full Text Available Insect cuticle is composed mainly of structural proteins and the polysaccharide chitin. The CPR family is the largest family of cuticle proteins (CPs, which can be further divided into three subgroups based on the presence of one of the three presumptive chitin-binding sequence motifs denoted as Rebers-Riddiford (R&R consensus sequence motifs RR-1, RR-2 and RR-3. The TcCPR27 protein containing the RR-2 motif is one of the most abundant CPs present both in the horizontal laminae and in vertical pore canals in the procuticle of rigid cuticle found in the elytron of the red flour beetle, Tribolium castaneum. Depletion of TcCPR27 by RNA interference (RNAi causes both unorganized laminae and pore canals, resulting in malformation and weakening of the elytron. In this study, we investigated the function(s of another CP, TcCPR4, which contains the RR-1 motif and is easily extractable from elytra after RNAi to deplete the level of TcCPR27. Transcript levels of the TcCPR4 gene are dramatically increased in 3 d-old pupae when adult cuticle synthesis begins. Immunohistochemical studies revealed that TcCPR4 protein is present in the rigid cuticles of the dorsal elytron, ventral abdomen and leg but not in the flexible cuticles of the hindwing and dorsal abdomen of adult T. castaneum. Immunogold labeling and transmission electron microscopic analyses revealed that TcCPR4 is predominantly localized in pore canals and regions around the apical plasma membrane protrusions into the procuticle of rigid adult cuticles. RNAi for TcCPR4 resulted in an abnormal shape of the pore canals with amorphous pore canal fibers (PCFs in their lumen. These results support the hypothesis that TcCPR4 is required for achieving proper morphology of the vertical pore canals and PCFs that contribute to the assembly of a cuticle that is both lightweight and rigid.

  11. Correlation of Serum CPR to Plasma Glucose Ratio with Various Indices of Insulin Secretion and Diseases Duration in Type 2 Diabetes

    OpenAIRE

    2013-01-01

    Evaluating insulin secretion ability and sensitivity is essential to establish an appropriate treatment for patients with type 2 diabetes. The serum C-peptide response (CPR) level is used to evaluate the quantity of endogenous insulin secretion. However, the serum CPR level alone cannot indicate insulin-secretion ability or insulin sensitivity, because plasma glucose levels influence endogenous insulin secretion and vice versa.The CPR index, a ratio of serum CPR level to plasma glucose concen...

  12. Early Fluid Resuscitation and High Volume Hemofiltration Decrease Septic Shock Progression in Swine.

    Science.gov (United States)

    Zhao, Ping; Zheng, Ruiqiang; Xue, Lu; Zhang, Min; Wu, Xiaoyan

    2015-01-01

    This study aimed to assess the effects of early fluid resuscitation (EFR) combined with high volume hemofiltration (HVHF) on the cardiopulmonary function and removal of inflammatory mediators in a septic shock swine model. Eighteen swine were randomized into three groups: control (n = 6) (extracorporeal circulating blood only), continuous renal replacement therapy (CRRT) (n = 6; ultrafiltration volume = 25 mL/Kg/h), and HVHF (n = 6; ultrafiltration volume = 85 mL/Kg/h). The septic shock model was established by intravenous infusion of lipopolysaccharides (50 µg/kg/h). Hemodynamic parameters (arterial pressure, heart rate, cardiac output, stroke volume variability, left ventricular contractility, systemic vascular resistance, and central venous pressure), vasoactive drug parameters (dose and time of norepinephrine and hourly fluid intake), pulmonary function (partial oxygen pressure and vascular permeability), and cytokines (interleukin-6 and interleukin-10) were observed. Treatment resulted in significant changes at 4-6 h. HVHF was beneficial, as shown by the dose of vasoactive drugs, fluid intake volume, left ventricular contractility index, and partial oxygen pressure. Both CRRT and HVHF groups showed improved removal of inflammatory mediators compared with controls. In conclusion, EFR combined with HVHF improved septic shock in this swine model. The combination decreased shock progression, reduced the need for vasoactive drugs, and alleviated the damage to cardiopulmonary functions.

  13. Neurologisches Outcome nach CPR bei schockresistentem Kammerflimmern unter Gabe von Sedacoron(R

    Directory of Open Access Journals (Sweden)

    Müller R

    2003-01-01

    Full Text Available Bei einer protrahierten CPR mit schockresistentem Kammerflimmern kann unter Gabe von Sedacoron(R ein zufriedenstellender internistischer Zustand erreicht werden. Neurologisch bleiben nach 6 Wochen geringe Defizite des Kurzzeitgedächtnisses. Der Autor regt mit dieser Kasuistik eine Fortsetzung der ARREST- und der ALIVE-Studie an, wobei das neurologische Outcome Beachtung finden sollte.

  14. Does use of the CPREzy involve more work than CPR without feedback?

    NARCIS (Netherlands)

    Berkom, P.F. van; Noordergraaf, G.J.; Scheffer, G.J.; Noordergraaf, A.

    2008-01-01

    AIM: Feedback during CPR may facilitate quality in chest compressions, but has also been associated with caregiver complaints such as stiff wrists, the need for more force and increased fatigue. This concern about extra work is, when using the CPREzy with its own spring-loaded surface, particularly

  15. Brain metabolism in patients with vegetative state after post-resuscitated hypoxic-ischemic brain injury: statistical parametric mapping analysis of F-18 fluorodeoxyglucose positron emission tomography

    Institute of Scientific and Technical Information of China (English)

    Yong Wook Kim; Hyoung Seop Kim; Young-Sil An

    2013-01-01

    Background Hypoxic-ischemic brain injury (HIBI) after cardiopulmonary resuscitation is one of the most devastating neurological conditions that causing the impaired consciousness.However,there were few studies investigated the changes of brain metabolism in patients with vegetative state (VS) after post-resuscitated HIBI.This study aimed to analyze the change of overall brain metabolism and elucidated the brain area correlated with the level of consciousness (LOC) in patients with VS after post-resuscitated HIBI.Methods We consecutively enrolled 17 patients with VS after HIBI,who experienced cardiopulmonary resuscitation.Overall brain metabolism was measured by F-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET) and we compared regional brain metabolic patterns from t7 patients with those from 15 normal controls using voxel-by-voxel based statistical parametric mapping analysis.Additionally,we correlated the LOC measured by the JFK-coma recovery scale-revised of each patient with brain metabolism by covariance analysis.Results Compared with normal controls,the patients with VS after post-resuscitated HIBI revealed significantly decreased brain metabolism in bilateral precuneus,bilateral posterior cingulate gyrus,bilateral middle frontal gyri,bilateral superior parietal gyri,bilateral middle occipital gyri,bilateral precentral gyri (PFEw correctecd <0.0001),and increased brain metabolism in bilateral insula,bilateral cerebella,and the brainstem (PFEw correctecd <0.0001).In covariance analysis,the LOC was significantly correlated with brain metabolism in bilateral fusiform and superior temporal gyri (P uncorrected <0.005).Conclusions Our study demonstrated that the precuneus,the posterior cingulate area and the frontoparietal cortex,which is a component of neural correlate for consciousness,may be relevant structure for impaired consciousness in patient with VS after post-resuscitated HIBI.In post-resuscitated HIBI,measurement of brain

  16. 急诊心肺复苏后自主循环恢复患者临床特征的研究%Study on the clinical characteristics of the CPR patients with the return of spontaneous circulation in the emergency department

    Institute of Scientific and Technical Information of China (English)

    贺蕾; 钱远宇; 孟庆义

    2011-01-01

    目的:探讨急诊心肺复苏后自主循环恢复患者的临床特征.方法:对232例急诊心肺复苏后自主循环恢复患者的临床特征进行回顾性分析,主要内容包括年龄、性别、既往病史、首发症状、来诊方式、就诊时间和临床诊断等.结果:①本组232自主循环恢复患者中,有184例(79.3%)很快在急诊抢救区域死亡,收住ICU或CCU的只有48例(20.7%);②在住院患者中,有28例(58.3%,28/48)出院存活,其中遗留神经功能缺损的有9例(32.1%,9/28);⑧由意外事故所致的出院存活率为38.5%(5/13),高于心血管系统疾病(12.5%,7/56)、神经系统疾病(7.7%,4/52)、消化系统疾病(613%,1/16)、创伤组(8.9%,4,45)和消耗性疾病晚期(0,0/9),且差异均有统计学意义(P<0.05).④心血管疾病复苏患者完全康复的比例为100.0%(7/7),高于神经系统疾病组(0,0/4)、呼吸系统疾病(66.7%,4/6),且差异均有统计学意义(P<0.05).结论:急诊心肺复苏后自主循环恢复的患者完全康复出院的比例还比较低,由心血管疾病、意外事故和创伤造成的心脏停搏患者,预后相对较好.%Objective: To investigate the clinical characteristics of the patients with the return of spontaneous circulation (ROSC) after cardiopulmonary resuscitation (CPR) in the emergency department.Methods: The data included the age, gender, past history, symptom, time to visit hospital, and clinical diagnosis were collected and analyzed in the 232 cases with the ROSC after CPR in the emergency department.Results: ①Among the 232 ROSC patients, 184 (79.3%) cases were died later and the other (20.7%, 48/232) were charged into the ICU or CCU.②In those 48 hospitalized patients, only 28 cases (58.3%, 28/48) were discharged with 9 (32.1%, 9/28) patients with the mild to moderate neurological deficit.③The higher discharged rate was found in the electrical accident, drowning and suicide patients 38.5% (5/13), which higher than that of the

  17. Decarbonylated cyclophilin A Cpr1 protein protects Saccharomyces cerevisiae KNU5377Y when exposed to stress induced by menadione.

    Science.gov (United States)

    Kim, Il-Sup; Jin, Ingnyol; Yoon, Ho-Sung

    2011-01-01

    Cyclophilins are conserved cis-trans peptidyl-prolyl isomerase that are implicated in protein folding and function as molecular chaperones. The accumulation of Cpr1 protein to menadione in Saccharomyces cerevisiae KNU5377Y suggests a possibility that this protein may participate in the mechanism of stress tolerance. Stress response of S. cerevisiae KNU5377Y cpr1Δ mutant strain was investigated in the presence of menadione (MD). The growth ability of the strain was confirmed in an oxidant-supplemented medium, and a relationship was established between diminishing levels of cell rescue enzymes and MD sensitivity. The results demonstrate the significant effect of CPR1 disruption in the cellular growth rate, cell viability and morphology, and redox state in the presence of MD and suggest the possible role of Cpr1p in acquiring sensitivity to MD and its physiological role in cellular stress tolerance. The in vivo importance of Cpr1p for antioxidant-mediated reactive oxygen species (ROS) neutralization and chaperone-mediated protein folding was confirmed by analyzing the expression changes of a variety of cell rescue proteins in a CPR1-disrupted strain. The cpr1Δ to the exogenous MD showed reduced expression level of antioxidant enzymes, molecular chaperones, and metabolic enzymes such as nicotinamide adenine dinucleotide phosphate (NADPH)- or adenosine triphosphate (ATP)-generating systems. More importantly, it was shown that cpr1Δ mutant caused imbalance in the cellular redox homeostasis and increased ROS levels in the cytosol as well as mitochondria and elevated iron concentrations. As a result of excess ROS production, the cpr1Δ mutant provoked an increase in oxidative damage and a reduction in antioxidant activity and free radical scavenger ability. However, there was no difference in the stress responses between the wild-type and the cpr1Δ mutant strains derived from S. cerevisiae BY4741 as a control strain under the same stress. Unlike BY4741, KNU5377Y Cpr1

  18. Comparative Effectiveness of Emergency Resuscitative Thoracotomy versus Closed Chest Compressions among Patients with Critical Blunt Trauma: A Nationwide Cohort Study in Japan.

    Directory of Open Access Journals (Sweden)

    Kodai Suzuki

    Full Text Available Although emergency resuscitative thoracotomy is performed as a salvage maneuver for critical blunt trauma patients, evidence supporting superior effectiveness of emergency resuscitative thoracotomy compared to conventional closed-chest compressions remains insufficient. The objective of this study was to investigate whether emergency resuscitative thoracotomy at the emergency department or in the operating room was associated with favourable outcomes after blunt trauma and to compare its effectiveness with that of closed-chest compressions.This was a retrospective nationwide cohort study. Data were obtained from the Japan Trauma Data Bank for the period between 2004 and 2012. The primary and secondary outcomes were patient survival rates 24 h and 28 d after emergency department arrival. Statistical analyses were performed using multivariable generalized mixed-effects regression analysis. We adjusted for the effects of different hospitals by introducing random intercepts in regression analysis to account for the differential quality of emergency resuscitative thoracotomy at hospitals where patients in cardiac arrest were treated. Sensitivity analyses were performed using propensity score matching.In total, 1,377 consecutive, critical blunt trauma patients who received cardiopulmonary resuscitation in the emergency department or operating room were included in the study. Of these patients, 484 (35.1% underwent emergency resuscitative thoracotomy and 893 (64.9% received closed-chest compressions. Compared to closed-chest compressions, emergency resuscitative thoracotomy was associated with lower survival rate 24 h after emergency department arrival (4.5% vs. 17.5%, respectively, P < 0.001 and 28 d after arrival (1.2% vs. 6.0%, respectively, P < 0.001. Multivariable generalized mixed-effects regression analysis with and without a propensity score-matched dataset revealed that the odds ratio for an unfavorable survival rate after 24 h was lower for

  19. Successful Management of a Patient with Refractory Ventricular Fibrillation (VF) due to Acute Myocardial Infarction (AMI) and Lung Injury by Transition from Percutaneous Cardiopulmonary Support (PCPS) to Veno-Venous Extracorporeal Membrane Oxygenation (ECMO).

    Science.gov (United States)

    Sato, Atsushi; Isoda, Kikuo; Gatate, Yodo; Akita, Koji; Daida, Hiroyuki

    2016-01-01

    A 69-year-old man was admitted to our hospital with cardiopulmonary arrest. Percutaneous cardio-pulmonary support (PCPS) using the right femoral artery and vein was initiated, because ventricular fibrillation continued. Although we succeeded in defibrillation after percutaneous coronary intervention (PCI), a chest radiograph indicated a pneumothorax in the right lung and a pulmonic contusion in the left lung caused by cardiopulmonary resuscitation. Two days after PCI, partial pressure of arterial oxygen (PaO2) from the right radial artery suddenly decreased, and his cardiac function showed improvement on an echocardiogram. To avoid additional brain damage, we converted the treatment to veno-venous extracorporeal membrane oxygenation by changing the blood returning site of PCPS from the right femoral artery to the right jugular vein. Thereafter, the patient's PaO2 level gradually improved.

  20. Persisting effect of community approaches to resuscitation

    DEFF Research Database (Denmark)

    Nielsen, Anne Møller; Isbye, Dan Lou; Lippert, Freddy Knudsen

    2014-01-01

    BACKGROUND: On the Danish island of Bornholm an intervention was carried out during 2008-2010 aiming at increasing out-of-hospital cardiac arrest (OHCA) survival. The intervention included mass media focus on resuscitation and widespread educational activities. The aim of this study was to compar...

  1. [Basic and advanced resuscitation of children

    DEFF Research Database (Denmark)

    Lauritsen, T.L.; Jensen, Tim; Greisen, G.

    2008-01-01

    The ERC Guidelines 2005 regarding the resuscitation of children and neonates recommend changes in treatment algorithms. Cardiac arrest in children is most often caused or worsened by hypoxic conditions. On confirmation of cardiac arrest in a child, treatment is initiated with 5 ventilations and c...

  2. Balanced crystalloids for septic shock resuscitation

    Science.gov (United States)

    Corrêa, Thiago Domingos; Cavalcanti, Alexandre Biasi; de Assunção, Murillo Santucci Cesar

    2016-01-01

    Timely fluid administration is crucial to maintain tissue perfusion in septic shock patients. However, the question concerning which fluid should be used for septic shock resuscitation remains a matter of debate. A growing body of evidence suggests that the type, amount and timing of fluid administration during the course of sepsis may affect patient outcomes. Crystalloids have been recommended as the first-line fluids for septic shock resuscitation. Nevertheless, given the inconclusive nature of the available literature, no definitive recommendations about the most appropriate crystalloid solution can be made. Resuscitation of septic and non-septic critically ill patients with unbalanced crystalloids, mainly 0.9% saline, has been associated with a higher incidence of acid-base balance and electrolyte disorders and might be associated with a higher incidence of acute kidney injury. This can result in greater demand for renal replacement therapy and increased mortality. Balanced crystalloids have been proposed as an alternative to unbalanced solutions in order to mitigate their detrimental effects. Nevertheless, the safety and effectiveness of balanced crystalloids for septic shock resuscitation need to be further addressed in a well-designed, multicenter, pragmatic, randomized controlled trial. PMID:28099643

  3. Combat Damage Control Resuscitation: Today and Tomorrow

    Science.gov (United States)

    2010-04-01

    blood components to optimize hemostasis, the concept of permissive hypotension is used to decrease the bleeding from uncontrolled bleeding points, the...physiologic deterioration. The future of damage control resuscitation will most likely involve the refinement and customization of blood components for the

  4. Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial

    OpenAIRE

    Perkins, Gavin D; Lall, Ranjit; Quinn, Tom; Deakin, Charles D; Cooke, Matthew W; Horton, Jessica; Lamb, Sarah E; Slowther, Anne-Marie; Woollard, Malcolm; Carson, Andy; Smyth, Mike; Whitfield, Richard; Williams, Amanda; Pocock, Helen; Black, John J. M.

    2015-01-01

    BACKGROUND: Mechanical chest compression devices have the potential to help maintain high-quality cardiopulmonary resuscitation (CPR), but despite their increasing use, little evidence exists for their effectiveness. We aimed to study whether the introduction of LUCAS-2 mechanical CPR into front-line emergency response vehicles would improve survival from out-of-hospital cardiac arrest. METHODS: The pre-hospital randomised assessment of a mechanical compression device in cardiac...

  5. 21 CFR 868.6175 - Cardiopulmonary emergency cart.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary emergency cart. 868.6175 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Miscellaneous § 868.6175 Cardiopulmonary emergency cart. (a) Identification. A cardiopulmonary emergency cart is a device intended to store and...

  6. Predictors of cardio pulmonary resuscitation outcome in postoperative cardiac children

    Directory of Open Access Journals (Sweden)

    Bana Agha Nasser

    2016-10-01

    Conclusion: Higher heart rate, lower core body temperature, lower O2 saturation, and higher lactic acid measured 6 hours before arrest are possible predictors of poorer outcome and mortality following CPR in postoperative cardiac children.

  7. Prediction of poor outcome within the first 3 days of postanoxic coma.

    NARCIS (Netherlands)

    Zandbergen, E.G.; Hijdra, A.; Koelman, J.H.; Hart, A.A.M.; Vos, P.E.; Verbeek, M.M.; Haan, R.J. de

    2006-01-01

    OBJECTIVE: To determine the optimal timing of somatosensory evoked potential (SSEP) recordings and the additional value of clinical and biochemical variables for the prediction of poor outcome in patients who remain comatose after cardiopulmonary resuscitation (CPR). METHODS: A prospective cohort st

  8. Postanoxic coma: prognosis after therapeutic hypothermia

    NARCIS (Netherlands)

    Bouwes, A.

    2012-01-01

    Postanoxic coma, also known as anoxic-ischemic coma, is a state of unconsciousness caused by global anoxia of the brain. The most common cause is primary cardiac arrest followed by successful cardiopulmonary resuscitation (CPR). Other causes include primary respiratory arrest, near-drowning, strangu

  9. Prognosis of coma after therapeutic hypothermia: a prospective cohort study.

    NARCIS (Netherlands)

    Bouwes, A.; Binnekade, J.M.; Kuiper, M.A.; Bosch, F.H.; Zandstra, D.F.; Toornvliet, A.C.; Biemond, H.S.; Kors, B.M.; Koelman, J.H.; Verbeek, M.M.; Weinstein, H.C.; Hijdra, A.; Horn, J.

    2012-01-01

    OBJECTIVE: This study was designed to establish the reliability of neurologic examination, neuron-specific enolase (NSE), and median nerve somatosensory-evoked potentials (SEPs) to predict poor outcome in patients treated with mild hypothermia after cardiopulmonary resuscitation (CPR). METHODS: This

  10. Regions of High Out-Of-Hospital Cardiac Arrest Incidence and Low Bystander CPR Rates in Victoria, Australia

    Science.gov (United States)

    Straney, Lahn D.; Bray, Janet E.; Beck, Ben; Finn, Judith; Bernard, Stephen; Dyson, Kylie; Lijovic, Marijana; Smith, Karen

    2015-01-01

    Background Out-of-hospital cardiac arrest (OHCA) remains a major public health issue and research has shown that large regional variation in outcomes exists. Of the interventions associated with survival, the provision of bystander CPR is one of the most important modifiable factors. The aim of this study is to identify census areas with high incidence of OHCA and low rates of bystander CPR in Victoria, Australia Methods We conducted an observational study using prospectively collected population-based OHCA data from the state of Victoria in Australia. Using ArcGIS (ArcMap 10.0), we linked the location of the arrest using the dispatch coordinates (longitude and latitude) to Victorian Local Government Areas (LGAs). We used Bayesian hierarchical models with random effects on each LGA to provide shrunken estimates of the rates of bystander CPR and the incidence rates. Results Over the study period there were 31,019 adult OHCA attended, of which 21,436 (69.1%) cases were of presumed cardiac etiology. Significant variation in the incidence of OHCA among LGAs was observed. There was a 3 fold difference in the incidence rate between the lowest and highest LGAs, ranging from 38.5 to 115.1 cases per 100,000 person-years. The overall rate of bystander CPR for bystander witnessed OHCAs was 62.4%, with the rate increasing from 56.4% in 2008–2010 to 68.6% in 2010–2013. There was a 25.1% absolute difference in bystander CPR rates between the highest and lowest LGAs. Conclusion Significant regional variation in OHCA incidence and bystander CPR rates exists throughout Victoria. Regions with high incidence and low bystander CPR participation can be identified and would make suitable targets for interventions to improve CPR participation rates. PMID:26447844

  11. Regions of High Out-Of-Hospital Cardiac Arrest Incidence and Low Bystander CPR Rates in Victoria, Australia.

    Directory of Open Access Journals (Sweden)

    Lahn D Straney

    Full Text Available Out-of-hospital cardiac arrest (OHCA remains a major public health issue and research has shown that large regional variation in outcomes exists. Of the interventions associated with survival, the provision of bystander CPR is one of the most important modifiable factors. The aim of this study is to identify census areas with high incidence of OHCA and low rates of bystander CPR in Victoria, Australia.We conducted an observational study using prospectively collected population-based OHCA data from the state of Victoria in Australia. Using ArcGIS (ArcMap 10.0, we linked the location of the arrest using the dispatch coordinates (longitude and latitude to Victorian Local Government Areas (LGAs. We used Bayesian hierarchical models with random effects on each LGA to provide shrunken estimates of the rates of bystander CPR and the incidence rates.Over the study period there were 31,019 adult OHCA attended, of which 21,436 (69.1% cases were of presumed cardiac etiology. Significant variation in the incidence of OHCA among LGAs was observed. There was a 3 fold difference in the incidence rate between the lowest and highest LGAs, ranging from 38.5 to 115.1 cases per 100,000 person-years. The overall rate of bystander CPR for bystander witnessed OHCAs was 62.4%, with the rate increasing from 56.4% in 2008-2010 to 68.6% in 2010-2013. There was a 25.1% absolute difference in bystander CPR rates between the highest and lowest LGAs.Significant regional variation in OHCA incidence and bystander CPR rates exists throughout Victoria. Regions with high incidence and low bystander CPR participation can be identified and would make suitable targets for interventions to improve CPR participation rates.

  12. Decarbonylated cyclophilin A Cpr1 protein protects Saccharomyces cerevisiae KNU5377Y when exposed to stress induced by menadione

    OpenAIRE

    Kim, Il-Sup; Jin, Ingnyol; Yoon, Ho-Sung

    2010-01-01

    Cyclophilins are conserved cis–trans peptidyl-prolyl isomerase that are implicated in protein folding and function as molecular chaperones. The accumulation of Cpr1 protein to menadione in Saccharomyces cerevisiae KNU5377Y suggests a possibility that this protein may participate in the mechanism of stress tolerance. Stress response of S. cerevisiae KNU5377Y cpr1Δ mutant strain was investigated in the presence of menadione (MD). The growth ability of the strain was confirmed in an oxidant-supp...

  13. Extensive gene amplification and concerted evolution within the CPR family of cuticular proteins in mosquitoes.

    Science.gov (United States)

    Cornman, R Scott; Willis, Judith H

    2008-06-01

    Annotation of the Anopheles gambiae genome has revealed a large increase in the number of genes encoding cuticular proteins with the Rebers and Riddiford Consensus (the CPR gene family) relative to Drosophila melanogaster. This increase reflects an expansion of the RR-2 group of CPR genes, particularly the amplification of sets of highly similar paralogs. Patterns of nucleotide variation indicate that extensive concerted evolution is occurring within these clusters. The pattern of concerted evolution is complex, however, as sequence similarity within clusters is uncorrelated with gene order and orientation, and no comparable clusters occur within similarly compact arrays of the RR-1 group in mosquitoes or in either group in D. melanogaster. The dearth of pseudogenes suggests that sequence clusters are maintained by selection for high gene-copy number, perhaps due to selection for high expression rates. This hypothesis is consistent with the apparently parallel evolution of compact gene architectures within sequence clusters relative to single-copy genes. We show that RR-2 proteins from sequence-cluster genes have complex repeats and extreme amino-acid compositions relative to single-copy CPR proteins in An. gambiae, and that the amino-acid composition of the N-terminal and C-terminal sequence flanking the chitin-binding consensus region evolves in a correlated fashion.

  14. Leadership and Teamwork in Trauma and Resuscitation

    OpenAIRE

    Michael Menchine; Elizabeth Burner; Sanjay Arora; Kenji Inaba; Demetrios Demetriades; Bertrand Yersin

    2016-01-01

    I ntroduction: Leadership skills are described by the American College of Surgeons’ ATLS course as necessary to provide care for patients during resuscitations. However, leadership is a complex concept, and the tools used to assess the quality of leadership are poorly described, inadequately validated, and infrequently used. Despite its importance, dedicated leadership education is rarely part of physician training programs. The goals of this investigation were the following: 1. D...

  15. Physiological consequences : Cardiopulmonary, vestibular, and sensory aspects

    NARCIS (Netherlands)

    Welsch, H.; Albery, W.; Banks, R.D.; Bles, W.

    2000-01-01

    Discussing the physiological consequences of enhanced fighter manoeuvrability (EFM), aspects of cardiopulmonary reactions will be seen during high G manoeuvres, especially the combination of negative G-load followed by high G-onset manoeuvres ("push-pull"). The aircraft's capability to reach high al

  16. Arabidopsis CPR5 is a senescence-regulatory gene with pleiotropic functions as predicted by the evolutionary theory of senescence.

    Science.gov (United States)

    Jing, Hai-Chun; Anderson, Lisa; Sturre, Marcel J G; Hille, Jacques; Dijkwel, Paul P

    2007-01-01

    Evolutionary theories of senescence predict that genes with pleiotropic functions are important for senescence regulation. In plants there is no direct molecular genetic test for the existence of such senescence-regulatory genes. Arabidopsis cpr5 mutants exhibit multiple phenotypes including hypersensitivity to various signalling molecules, constitutive expression of pathogen-related genes, abnormal trichome development, spontaneous lesion formation, and accelerated leaf senescence. These indicate that CPR5 is a beneficial gene which controls multiple facets of the Arabidopsis life cycle. Ectopic expression of CPR5 restored all the mutant phenotypes. However, in transgenic plants with increased CPR5 transcripts, accelerated leaf senescence was observed in detached leaves and at late development around 50 d after germination, as illustrated by the earlier onset of senescence-associated physiological and molecular markers. Thus, CPR5 has early-life beneficial effects by repressing cell death and insuring normal plant development, but late-life deleterious effects by promoting developmental senescence. As such, CPR5 appears to function as a typical senescence-regulatory gene as predicted by the evolutionary theories of senescence.

  17. Analysis of Secondary Emergency Passive Heat Sink's Ability to Relieve Accident of CPR1000%CPR1000二次侧非能动应急热阱设计与事故缓解能力分析

    Institute of Scientific and Technical Information of China (English)

    王明军; 张亚培; 田文喜; 苏光辉; 秋穗正

    2012-01-01

    The transient thermal hydraulic characteristics of CPR1000 were analyzed using RELAP5/MOD3. 4 to verify the capability of the adopting air-cooled heat exchanger's emergency passive heat sink (EPHS) for accident mitigation under the condition of feed-water line break (FLB). The calculation results show that the EPHS of CPR1000 can supply the water to steam generator immediately and remove the core residual heat after the FLB successfully. Therefore, it demonstrates that the design of the EPHS of CPR1000 is successful.%在主给水管道破裂事故下,利用RELAP5/MOD3.4程序对CPR1000压水堆一回路热工水力参数瞬态特性进行分析计算,验证采用空冷换热器的CPR1000二次侧非能动应急热阱对事故的缓解能力.计算结果表明:CPR1000在发生主给水管道破裂事故后,二次侧非能动应急热阱完全可及时向蒸汽发生器补水,同时导出堆芯余热,保证反应堆处于安全状态,从而验证了CPR1000二次侧非能动应急热阱的设计是成功的.

  18. The Research of Safety DCS for CPR1000 Nuclear Power Plant%CPR1000核电厂安全级DCS研究

    Institute of Scientific and Technical Information of China (English)

    魏海峰

    2012-01-01

    目前在建CPR1000核电厂(红沿河、宁德、阳江、防城港等)仪控系统采用日本三菱电机和北京广利核联队提供的数字化仪控系统DCS,其中安全级DCS采用日本三菱电机的MLETAC系统,非安全级DCS采用和利时的HOLLAIS-N系统.安全级DCS系统设计遵循单一故障、多样性、独立性、冗余性等原则,本文将对安全级DCS进行介绍.

  19. INDIKASI DAN KETERAMPILAN RESUSITASI JANTUNG PARU (RJP

    Directory of Open Access Journals (Sweden)

    Kaliammah Ganthikumar

    2016-05-01

    Full Text Available Cardiopulmonary resuscitation (CPR is a livesaving technique which is very useful in many emergencies, such as heart attack or near drowning, in which someone’s breathing or heartbeat has stopped.The American Heart Association recommends that everyone - doesn’t have experience or medical personnel can start CPR with chest compression. Chest compression can help to save someone’s life eventhough you doesn’t have knowledge. Its better then doing nothing. CPR can delivery enough oxygen to brain and vital organ till definitive medication is given to restore normal heart rthym. The supply of oxygen to brain is distupted for eight to te minutes can cause death.CPR for a cardiac arrest I starting from circulation then breathing then airway( C-B-A Keyword:Technique CPR, CPR for cardiac arrest

  20. Pyruvate-Enhanced Resuscitation for Hemorrhagic Shock and Hindlimb Ischemia

    Science.gov (United States)

    2015-06-06

    Pyruvate-Enhanced Resuscitation for Hemorrhagic Shock and Hindlimb Ischemia The overall goals of this investigation were to test the ability of...Final Report: Pyruvate-Enhanced Resuscitation for Hemorrhagic Shock and Hindlimb Ischemia Report Title The overall goals of this investigation were to...during ischemia -reperfusion injury and cause cellular damage which likely contributes to myocardial contractile dysfunction. ROS oxidize and

  1. Emergent cardiopulmonary bypass during pectus excavatum repair

    Directory of Open Access Journals (Sweden)

    Ryan Craner

    2013-01-01

    Full Text Available Pectus excavatum is a chest wall deformity that produces significant cardiopulmonary disability and is typically seen in younger patients. Minimally invasive repair of pectus excavatum or Nuss procedure has become a widely accepted technique for adult and pediatric patients. Although it is carried out through a thoracoscopic approach, the procedure is associated with a number of potential intraoperative and post-operative complications. We present a case of cardiac perforation requiring emergent cardiopulmonary bypass in a 29-year-old male with Marfan syndrome and previous mitral valve repair undergoing a Nuss procedure for pectus excavatum. This case illustrates the importance of vigilance and preparation by the surgeons, anesthesia providers as well as the institution to be prepared with resources to handle the possible complications. This includes available cardiac surgical backup, perfusionist support and adequate blood product availability.

  2. Multimodality imaging for resuscitated sudden cardiac death.

    Science.gov (United States)

    Chen, Yingming Amy; Deva, Djeven; Kirpalani, Anish; Prabhudesai, Vikram; Marcuzzi, Danny W; Graham, John J; Verma, Subodh; Jimenez-Juan, Laura; Yan, Andrew T

    2015-01-01

    We present a case that elegantly illustrates the utility of two novel noninvasive imaging techniques, computed tomography (CT) coronary angiography and cardiac MRI, in the diagnosis and management of a 27-year-old man with exertion-induced cardiac arrest caused by an anomalous right coronary artery. CT coronary angiography with 3D reformatting delineated the interarterial course of an anomalous right coronary artery compressed between the aorta and pulmonary artery, whereas cardiac MRI showed a small myocardial infarction in the right coronary artery territory not detected on echocardiography. This case highlights the value of novel multimodality imaging techniques in the risk stratification and management of patients with resuscitated cardiac arrest.

  3. [Clinical relevance of cardiopulmonary reflexes in anesthesiology].

    Science.gov (United States)

    Guerri-Guttenberg, R A; Siaba-Serrate, F; Cacheiro, F J

    2013-10-01

    The baroreflex, chemoreflex, pulmonary reflexes, Bezold-Jarisch and Bainbridge reflexes and their interaction with local mechanisms, are a demonstration of the richness of cardiovascular responses that occur in human beings. As well as these, the anesthesiologist must contend with other variables that interact by attenuating or accentuating cardiopulmonary reflexes such as, anesthetic drugs, surgical manipulation, and patient positioning. In the present article we review these reflexes and their clinical relevance in anesthesiology.

  4. Hypertonic saline solution resuscitation in hemorrhagic shock dogs

    Institute of Scientific and Technical Information of China (English)

    蔡秀军; 黄迪宇; 牟一平; 彭淑牖

    2002-01-01

    To find out the optimal concentration, infusion rate and dosage of saline for resuscitation. Methods: Forty-five dogs were used to establish hypovolemic shock models. The dogs were resuscitated with saline of different concentrations and different dosages under different infusion rates, and the resuscitation results were compared. Results: The best concentration was 7.5%, the best rate of infusion 20 ml/min (a volume equivalent to 15% of the shed blood) and the best dosage 5.71 ml/kg. The method was effective for resuscitation, the mean arterial pressure (MAP) could be elevated to 89% of the baseline, and this MAP could be kept for more than one hour. Conclusions: Using 7.5% sodium chloride solution equivalent to 15% of the shed blood at an infusion rate of 20 ml/min can achieve a best resuscitation result.

  5. Adaptive hepatic and intestinal alterations in mice after deletion of NADPH-cytochrome P450 Oxidoreductase (Cpr) in hepatocytes.

    Science.gov (United States)

    Cheng, Xingguo; Gu, Jun; Klaassen, Curtis D

    2014-11-01

    Cytochrome P450 enzymes (P450) play an important role in first-pass metabolism in both the intestine and liver. NADPH-cytochrome P450 oxidoreductase (Cpr) is an essential electron transfer protein required for microsomal P450 activity. Mice with conditional knockout of Cpr in hepatocytes develop normally and survive even with complete loss of liver microsomal P450 activity. Our current studies were performed to determine whether alternative drug-metabolizing pathways increase in an attempt to maintain whole-body homeostasis. In addition to the liver, Cpr is mainly expressed in tissues such as lung, kidney, and gastrointestinal tract. In livers of H-Cpr-null mice, there is a marked increase in mRNA expression of phase I enzymes (Aldh1a1, 1a7, 3a2; Ces1b2, 2a6, and 2a12), antioxidant enzymes (Ho-1, Nqo1, and epoxide hydrolase), phase II enzymes (Ugt1a9; Gsta1/2, m3, m4, m6, t1, and t3; and Sult1a1 and 1d1), and drug transporters (Oatp1a4, Oct3, Mate1, Mdr1a, and Mrp3 and 4). In addition, glucuronide-conjugated bilirubin concentrations are doubled in serum of H-Cpr-null mice. Both constitutive androstane receptor (CAR) and nuclear factor erythroid 2-related factor 2 (Nrf2) protein in nuclei are higher in the livers of H-Cpr-null mice, indicating that CAR and Nrf2 are activated. In the small intestine of H-Cpr-null mice, mRNA expression of Cyp3a11 and Mdr1a, two genes critical for intestinal first-pass metabolism, are markedly up-regulated. In addition, nutrient (Pept1) and cholesterol (Npc1l1) transporters are induced in the small intestine of H-Cpr-null mice. In conclusion, in H-Cpr-null mice, adaptive regulation of alternative detoxification genes in liver and small intestine appear to partially compensate for the loss of microsomal P450 function in liver.

  6. CPR1000主控室可居留性设计改进

    Institute of Scientific and Technical Information of China (English)

    赵海; 刘晓爽

    2010-01-01

    文章参照RG1.196及NUREG—0800对主控室可居留性的要求,通过对CPR1000主控室可居留性系统的分析研究,针对其可居留区域范围过大、微正压无法平稳维持、应急通风系统不独立等问题,提出改进方案,确保在事故工况下主控室的可居留性。

  7. The effect of computer-based resuscitation simulation on nursing students' performance, self-efficacy, post-code stress, and satisfaction.

    Science.gov (United States)

    Roh, Young Sook; Kim, Sang Suk

    2014-01-01

    Computer-based simulation has intuitive appeal to both educators and learners with the flexibility of time, place, immediate feedback, and self-paced and consistent curriculum. The purpose of this study was to assess the effects of computer-based simulation on nursing students' performance, self-efficacy, post-code stress, and satisfaction between computer-based simulation plus instructor-led cardiopulmonary resuscitation training group and instructor-led resuscitation training-only group. This study was a nonequivalent control group posttest-only design. There were 213 second year nursing students randomly assigned to one of two groups: 109 nursing students with computer-based simulation or 104 with control group. Overall nursing students' performance score was higher in the computer-based simulation group than in the control group but reached no statistical significance (t = 1.086, p = .283). There were no significant differences in resuscitation-specific self-efficacy, post-code stress, and satisfaction between the two groups. Computer-based simulation combined with hands-on practice did not affect in nursing students' performance, self-efficacy, post-code stress, and satisfaction in nursing students. Further study must be conducted to inform instructional design and help integrate computer-based simulation and rigorous scoring rubrics.

  8. Rabbit model of uncontrolled hemorrhagic shock and hypotensive resuscitation

    Directory of Open Access Journals (Sweden)

    J.B. Rezende-Neto

    2010-12-01

    Full Text Available Clinically relevant animal models capable of simulating traumatic hemorrhagic shock are needed. We developed a hemorrhagic shock model with male New Zealand rabbits (2200-2800 g, 60-70 days old that simulates the pre-hospital and acute care of a penetrating trauma victim in an urban scenario using current resuscitation strategies. A laparotomy was performed to reproduce tissue trauma and an aortic injury was created using a standardized single puncture to the left side of the infrarenal aorta to induce hemorrhagic shock similar to a penetrating mechanism. A 15-min interval was used to simulate the arrival of pre-hospital care. Fluid resuscitation was then applied using two regimens: normotensive resuscitation to achieve baseline mean arterial blood pressure (MAP, 10 animals and hypotensive resuscitation at 60% of baseline MAP (10 animals. Another 10 animals were sham operated. The total time of the experiment was 85 min, reproducing scene, transport and emergency room times. Intra-abdominal blood loss was significantly greater in animals that underwent normotensive resuscitation compared to hypotensive resuscitation (17.1 ± 2.0 vs 8.0 ± 1.5 mL/kg. Antithrombin levels decreased significantly in normotensive resuscitated animals compared to baseline (102 ± 2.0 vs 59 ± 4.1%, sham (95 ± 2.8 vs 59 ± 4.1%, and hypotensive resuscitated animals (98 ± 7.8 vs 59 ± 4.1%. Evidence of re-bleeding was also noted in the normotensive resuscitation group. A hypotensive resuscitation regimen resulted in decreased blood loss in a clinically relevant small animal model capable of reproducing hemorrhagic shock caused by a penetrating mechanism.

  9. A marked increase in gastric fluid volume during cardiopulmonary bypass

    OpenAIRE

    2011-01-01

    Major physiological stress occurs during cardiac surgery with cardiopulmonary bypass. This is related to hypothermia and artificial organ perfusion. Thus, serious gastrointestinal complications, particularly upper gastrointestinal bleeding, sometimes follow cardiac surgery. We have compared the antisecretory effects of a preanesthetic H2 antagonist (roxatidine, cardiopulmonary bypass-H2 group, n = 15) and a proton pump inhibitor (rabeprazole, cardiopulmonary bypass-PPI group, n = 15) in patie...

  10. Effect of hypertensive reperfusion on the changes between cerebral oxygen delivery and uptake after cardiac arrest and resuscitation in dogs

    Institute of Scientific and Technical Information of China (English)

    杜权; 马永达; 葛衡江; 刘怀琼; 李阳

    2004-01-01

    Objective: To study the changes between cerebral oxygen (O2) delivery and uptake in dogs resuscitated under normotension or hypertension for 4 h. Methods: The model of ventricular fibrillation of 8 min in 12 dogs was made,followed by open cardiopulmonary resuscitation, reperfnsion with normal or high mean arterial pressure (MAP), and controlled ventilation to 4 h. Animals were randomly assigned into Group NT (normotensive reperfusion, n = 6) and Group HT(hypertensive reperfusion, n = 6). Cerebral arteriovenous (sagittal sinus) O2 content difference (Ca-ssO2) and venous(sagittal sinus) PO2(PssO2) were determined before cardiac arrest (CA) and 30, 60, 120, and 240 min after CA. Results: In Group NT, Ca-ssO2 was lower at 30 min ( P < 0.05) but higher at 240 min ( P < 0.01 ) after CA than that before CA. In Group HT, Ca-ssO2 was not significantly different from that in Group NT before CA but was lower than that in Group NT at 30 min after CA ( P < 0.01 ). Ca-ssO2 was not significantly different in Group NT and HT thereafter. In both groups,PssO2 was both higher at 30 min after reperfnsion ( P < 0.01 ) and at 240 min after reperfnsion lower ( P < 0.05) than those before CA .At 30 min after reperfusion, PssO2 was higher (P<0.01) in Group HT than that in Group NT, with insignificant difference between two groups. Conclusion: Cerebral O2 delivery and uptake are mismatched after CA and resuscitation. Hypertensive reperfusion improves oxygen delivery to the brain early after CA.

  11. CPR - infant

    Science.gov (United States)

    ... he or she eats. Do not allow an infant to crawl around while eating or drinking from a bottle. Never tie pacifiers, jewelry, chains, bracelets, or anything else around an infant's neck or wrists. Alternative Names Rescue breathing and ...

  12. A Randomized Controlled Study of Manikin Simulator Fidelity on Neonatal Resuscitation Program Learning Outcomes

    Science.gov (United States)

    Curran, Vernon; Fleet, Lisa; White, Susan; Bessell, Clare; Deshpandey, Akhil; Drover, Anne; Hayward, Mark; Valcour, James

    2015-01-01

    The neonatal resuscitation program (NRP) has been developed to educate physicians and other health care providers about newborn resuscitation and has been shown to improve neonatal resuscitation skills. Simulation-based training is recommended as an effective modality for instructing neonatal resuscitation and both low and high-fidelity manikin…

  13. Resuscitation at the limits of viability--an Irish perspective.

    LENUS (Irish Health Repository)

    Khan, R A

    2012-02-01

    BACKGROUND: Advances in neonatal care continue to lower the limit of viability. Decision making in this grey zone remains a challenging process. OBJECTIVE: To explore the opinions of healthcare providers on resuscitation and outcome in the less than 28-week preterm newborn. DESIGN\\/METHODS: An anonymous postal questionnaire was sent to health care providers working in maternity units in the Republic of Ireland. Questions related to neonatal management of the extreme preterm infant, and estimated survival and long-term outcome. RESULTS: The response rate was 55% (74% obstetricians and 70% neonatologists). Less than 1% would advocate resuscitation at 22 weeks, 10% of health care providers advocate resuscitation at 23 weeks gestation, 80% of all health care providers would resuscitate at 24 weeks gestation. 20% of all health care providers would advocate cessation of resuscitation efforts on 22-25 weeks gestation at 5 min of age. 65% of Neonatologists and 54% trainees in Paediatrics would cease resuscitation at 10 min of age. Obstetricians were more pessimistic about survival and long term outcome in newborns delivered between 23 and 27 weeks when compared with neonatologists. This difference was also observed in trainees in paediatrics and obstetrics. CONCLUSION: Neonatologists, trainees in paediatrics and neonatal nurses are generally more optimistic about outcome than their counterparts in obstetrical care and this is reflected in a greater willingness to provide resuscitation efforts at the limits of viability.

  14. Which Form of Medical Training is the Best in Improving Interns’ knowledge Related to Advanced Cardiac Life Support Drugs Pharmacology? An Educational Analytical Intervention Study Between Electronic Learning and Lecture-Based Education

    Science.gov (United States)

    Khoshbaten, Manouchehr; Soleimanpour, Hassan; Ala, Alireza; Shams Vahdati, Samad; Ebrahimian, Kimia; Safari, Saeid; Golzari, Samad EJ; Salek Ranjbarzadeh, Fariba; Mehdizadeh Esfanjani, Robab

    2014-01-01

    Background: Conventional educational systems seem to be improper throughout the cardiopulmonary resuscitation (CPR) teaching process. The most common causes of failed resuscitation are unfamiliarity with cardiopulmonary resuscitation algorithms, poor performance of leader of the CPR team and lack of skilled personnel, coordination among members during resuscitation, and responsibility of staff. Objectives: Electronic learning, as a new educational method is controversial issue in medical education for improving physicians’ practical knowledge and it is inevitable that further research on its effectiveness should be done. Materials and Methods: The present study is a prospective, pre- and post-educational, cross-sectional research, in which 84 interns were randomly divided into two groups. pre- and post- educational interventions that took place in the Department of Emergency Medicine, interns were evaluated by 21 multiple choice questions related to American Heart Association guidelineson cardiopulmonary resuscitation drugs. Questions were assessed in terms of routes for CPR drugs administration, CPR drug dosage forms, clinical judgment and appropriate CPR drug administration, and the alternative drugs in emergency situations. Data were analyzed by generalized estimating equations regression models and P < 0.05 was considered statistically significant. Results: Evaluating the effectiveness of both educational methods revealed that the mean answering score for 21 questions before education was 7.5 ± 2.6 and no significant difference was observed in groups (P = 0.55). However, after education, the average scores significantly increased to 11.0 ± 3.9 (P < 0.001). Electronic learning method was not associated with considerable increase in the knowledge of interns in this group compared with the lecture-based group (P = 0.49). Conclusions: No significant differences were observed between electronic learning and lecture-based education in improving interns

  15. Leadership and Teamwork in Trauma and Resuscitation

    Science.gov (United States)

    Ford, Kelsey; Menchine, Michael; Burner, Elizabeth; Arora, Sanjay; Inaba, Kenji; Demetriades, Demetrios; Yersin, Bertrand

    2016-01-01

    Introduction Leadership skills are described by the American College of Surgeons’ Advanced Trauma Life Support (ATLS) course as necessary to provide care for patients during resuscitations. However, leadership is a complex concept, and the tools used to assess the quality of leadership are poorly described, inadequately validated, and infrequently used. Despite its importance, dedicated leadership education is rarely part of physician training programs. The goals of this investigation were the following: 1. Describe how leadership and leadership style affect patient care; 2. Describe how effective leadership is measured; and 3. Describe how to train future physician leaders. Methods We searched the PubMed database using the keywords “leadership” and then either “trauma” or “resuscitation” as title search terms, and an expert in emergency medicine and trauma then identified prospective observational and randomized controlled studies measuring leadership and teamwork quality. Study results were categorized as follows: 1) how leadership affects patient care; 2) which tools are available to measure leadership; and 3) methods to train physicians to become better leaders. Results We included 16 relevant studies in this review. Overall, these studies showed that strong leadership improves processes of care in trauma resuscitation including speed and completion of the primary and secondary surveys. The optimal style and structure of leadership are influenced by patient characteristics and team composition. Directive leadership is most effective when Injury Severity Score (ISS) is high or teams are inexperienced, while empowering leadership is most effective when ISS is low or teams more experienced. Many scales were employed to measure leadership. The Leader Behavior Description Questionnaire (LBDQ) was the only scale used in more than one study. Seven studies described methods for training leaders. Leadership training programs included didactic teaching

  16. Leadership and Teamwork in Trauma and Resuscitation

    Directory of Open Access Journals (Sweden)

    Michael Menchine

    2016-09-01

    Full Text Available Introduction: Leadership skills are described by the American College of Surgeons’ Advanced Trauma Life Support (ATLS course as necessary to provide care for patients during resuscitations. However, leadership is a complex concept, and the tools used to assess the quality of leadership are poorly described, inadequately validated, and infrequently used. Despite its importance, dedicated leadership education is rarely part of physician training programs. The goals of this investigation were the following: 1. Describe how leadership and leadership style affect patient care; 2. Describe how effective leadership is measured; and 3. Describe how to train future physician leaders.  Methods: We searched the PubMed database using the keywords “leadership” and then either “trauma” or “resuscitation” as title search terms, and an expert in emergency medicine and trauma then identified prospective observational and randomized controlled studies measuring leadership and teamwork quality. Study results were categorized as follows: 1 how leadership affects patient care; 2 which tools are available to measure leadership; and 3 methods to train physicians to become better leaders. Results: We included 16 relevant studies in this review. Overall, these studies showed that strong leadership improves processes of care in trauma resuscitation including speed and completion of the primary and secondary surveys. The optimal style and structure of leadership are influenced by patient characteristics and team composition. Directive leadership is most effective when Injury Severity Score (ISS is high or teams are inexperienced, while empowering leadership is most effective when ISS is low or teams more experienced. Many scales were employed to measure leadership. The Leader Behavior Description Questionnaire (LBDQ was the only scale used in more than one study. Seven studies described methods for training leaders. Leadership training programs

  17. Availability and Utilization of Cardiac Resuscitation Centers

    Directory of Open Access Journals (Sweden)

    Bryn E. Mumma

    2014-11-01

    Full Text Available Introduction: The American Heart Association (AHA recommends regionalized care following out-of-hospital cardiac arrest (OHCA at cardiac resuscitation centers (CRCs. Key level 1 CRC criteria include 24/7 percutaneous coronary intervention (PCI capability, therapeutic hypothermia capability, and annual volume of ≥40 patients resuscitated from OHCA. Our objective was to characterize the availability and utilization of resources relevant to post-cardiac arrest care, including level 1 CRCs in California. Methods: We combined data from the AHA, the California Office of Statewide Health Planning and Development (OSHPD, and surveys to identify CRCs. We surveyed emergency department directors and nurse managers at all 24/7 PCI centers identified by the AHA to determine their post-OHCA care capabilities. The survey included questions regarding therapeutic hypothermia use and specialist availability and was pilot-tested prior to distribution. Cases of OHCA were identified in the 2011 OSHPD Patient Discharge Database using a “present on admission” diagnosis of cardiac arrest (ICD-9-CM code 427.5. We defined key level 1 CRC criteria as 24/7 PCI capability, therapeutic hypothermia, and annual volume ≥40 patients admitted with a “present on admission” diagnosis of cardiac arrest. Our primary outcome was the proportion of hospitals meeting these criteria. Descriptive statistics and 95% CI are presented. Results: Of the 333 acute care hospitals in California, 31 (9.3%, 95% CI 6.4-13% met level 1 CRC criteria. These hospitals treated 25% (1937/7780; 95% CI 24-26% of all admitted OHCA patients in California in 2011. Of the 125 hospitals identified as 24/7 PCI centers by the AHA, 54 (43%, 95% CI 34-52% admitted ≥40 patients following OHCA in 2011. Seventy (56%, 95% CI 47-65% responded to the survey; 69/70 (99%, 95% CI 92-100% reported having a therapeutic hypothermia protocol in effect by 2011. Five percent of admitted OHCA patients (402/7780; 95% CI

  18. History of neonatal resuscitation - part 3: endotracheal intubation.

    Science.gov (United States)

    Obladen, Michael

    2009-01-01

    Endotracheal intubation to resuscitate neonates was used by Scheel in 1798. A century before endotracheal anesthesia was developed, inventive obstetricians constructed devices for endotracheal intubation of infants and mastered their insertion, localization, and airtight sealing. Fell's laryngoscope, Magill's intubation forceps and tissue-friendly materials were significant contributions of the 20th century to endotracheal intubation of the newborn. The striking absence of scientific studies on the most efficient resuscitation techniques for neonates can be explained by the difficulty to adjust for the personal skills of the resuscitator.

  19. Asymptomatic cardiopulmonary changes caused by adenoid hypertrophy.

    Science.gov (United States)

    Abdel-Aziz, Mosaad

    2011-07-01

    Adenoid hypertrophy is the most common cause of pediatric upper airway obstruction, and it can lead to cardiopulmonary complications such as pulmonary hypertension, cor pulmonale, and even heart failure. The aim of this study was to detect the asymptomatic cardiopulmonary changes that could happen in children with adenoid hypertrophy.Eighty children with adenoid hypertrophy were included in this study. Chest x-ray was used to assess the cardiothoracic ratio, whereas echocardiography was used for measuring the pulmonary arterial pressures, right ventricular diastolic filling parameters, and right ventricular end-diastolic diameters. All patients underwent adenoidectomy with or without tonsillectomy, and they were subjected again to echocardiographic assessment 6 months after the operation. No patient showed an increase in the cardiothoracic ratio on x-ray. Preoperative echocardiography showed an increase in pulmonary artery pressure (22.7 [SD, 3.8] mm Hg), a decrease in right ventricular diastolic filling parameters (E/A = 1.03 [SD, 0.17]), and an increase in right ventricular end-diastolic diameters (1.89 [SD, 0.19] cm). Postoperatively, pulmonary artery pressure decreased to 17.2 [SD, 2.1] mm Hg, right ventricular diastolic filling (E/A) increased to 1.25 [SD, 0.11], and right ventricular end-diastolic diameters decreased to 1.68 [SD, 0.12] cm. The comparison between preoperative and postoperative results for each individual parameter was statistically significant. Clinically asymptomatic cardiopulmonary changes due to adenoid hypertrophy are not rare. Early diagnosis and treatment of upper airway obstruction can prevent these serious complications. Echocardiographic examination should be recommended for these patients as a part of preoperative preparation to avoid anesthetic complications.

  20. 21 CFR 870.4240 - Cardiopulmonary bypass heat exchanger.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass heat exchanger. 870.4240... bypass heat exchanger. (a) Identification. A cardiopulmonary bypass heat exchanger is a device, consisting of a heat exchange system used in extracorporeal circulation to warm or cool the blood...

  1. Incidence and outcomes of out-of-hospital cardiac arrest in the eastern part of Yamaguchi prefecture.

    Science.gov (United States)

    Shiraki, Teruo; Osawa, Kazuhiro; Suzuki, Hideyuki; Yoshida, Masatoki; Takahashi, Natsuki; Takeuchi, Kazufumi; Tanakaya, Machiko; Kohno, Kunihisa; Saito, Daiji

    2009-07-01

    The aim of the present study was to evaluate the factors related to poor prognosis of out-of-hospital cardiac arrest patients in one local area of Japan. From May 1, 2002 to April 30, 2008, a total of 442 patients with cardiopulmonary arrest were transferred for resuscitation to the National Hospital Organization, Iwakuni Clinical Center. Of 325 patients with cardiopulmonary arrest of cardiac etiology, 126 patients were witnessed by a bystander. However, only 37 received bystander cardiopulmonary resuscitation, 13 had shockable cardiac rhythm, 3 survived 1 month, and 2 had a good neurological discharge. Multivariate analysis of overall cardiac arrest showed that 1-month survival and neurologically favorable discharge were associated with bystander cardiopulmonary resuscitation (P=0.049 and 0.013) and initial shockable cardiac rhythm (P=0.001 and 0.007). In this region, the survival rate for patients with cardiopulmonary arrest was lower than that reported in other areas, probably because fewer patients received bystander CPR or had shockable cardiac rhythm. This may result from CPR being less popularized in this region than in other areas, suggesting that raising the awareness of CPR would improve the survival rate.

  2. Planktonic foraminiferal biogeography in the Indian sector of the Southern Ocean: Contribution from CPR data

    Science.gov (United States)

    Meilland, Julie; Fabri-Ruiz, Salomé; Koubbi, Philippe; Monaco, Claire Lo; Cotte, Cédric; Hosie, Graham W.; Sanchez, Sophie; Howa, Hélène

    2016-04-01

    Within the framework of the Scientific Committee on Antarctic Research (SCAR) Southern Ocean-Continuous Plankton Recorder (SO-CPR) Survey, the oceanic regions around Crozet and Kerguelen Islands were investigated in February-March 2013. Living planktonic Foraminifera (LPF) were collected in the upper mixed layer with a CPR along a 2160 nautical mile sea transect that crossed main hydrological fronts in the Indian sector of the Southern Ocean. In the SO-CPR database, mean total abundances of Foraminifera occurring during late austral summer are highly variable at an inter-annual scale, from 10 to 250 ind.m-3, representing 10-40% of the total zooplankton abundance, respectively. In the Southern Ocean, major inter-annual changes in zooplankton community structure were already reported. In this study, we describe the large scale distributional pattern of individual planktonic foraminiferal species living in near-surface waters of the Indian sector of the Southern Ocean, and we attempt to explain why major spatial variability in relative species abundances occurs during a late austral summer. In February-March 2013, LPF total abundances recorded between 42.86°S and 56.42°S ranged from 0 to a maximum of 258 ind.m-3. In the Open Ocean Zone, the LPF community was composed of four major species (Globigerinita uvula, Neogloboquadrina pachyderma, Neogloboquadrina incompta, Globigerina bulloides). Generally, LPF total abundances are supposed to mirror primary production induced by hydrological fronts or induced by topography near Crozet and Kerguelen Islands. However, during late austral summer 2013, high foraminiferal abundances in the upper mixed layer did not always match the pattern of near-surface primary production (high Chl-a concentration areas delineated from satellite imagery). Low LPF standing stocks in late austral summer in the Southern Ocean contrasted with the presence of high densities of heavily silicified diatoms. This suggests that the late bloom

  3. The Stop-Only-While-Shocking algorithm reduces hands-off time by 17% during cardiopulmonary resuscitation

    DEFF Research Database (Denmark)

    Hansen, Lars Koch; Mohammed, Anna; Pedersen, Magnus;

    2016-01-01

    into using the Stop-Only-While-Shocking (SOWS) algorithm or the ERC2010 algorithm. In SOWS, chest compressions were only interrupted for a post-charging rhythm analysis and immediate shock delivery. A Resusci Anne HLR-D manikin and a LIFEPACK 20 defibrillator were used. The manikin recorded time and chest...... compressions. RESULTS: Sample size was calculated with an α of 0.05 and 80% power showed that we should test four scenarios with each algorithm. Twenty-nine physicians participated in 11 scenarios. Hands-off time was significantly reduced 17% using the SOWS algorithm compared with ERC2010 [22.1% (SD 2.3) hands...

  4. Endothelial Dysfunction in Resuscitated Cardiac Arrest (ENDO-RCA)

    DEFF Research Database (Denmark)

    Meyer, Anna Sina P; Ostrowski, Sisse R; Kjaergaard, Jesper;

    2016-01-01

    BACKGROUND: Morbidity and mortality following initial survival of cardiac arrest remain high despite great efforts to improve resuscitation techniques and post-resuscitation care, in part due to the ischemia-reperfusion injury secondary to the restoration of the blood circulation. Patients...... resuscitated from cardiac arrest display evidence of endothelial injury and coagulopathy (hypocoagulability, hyperfibrinolysis), which in associated with poor outcome. Recent randomized controlled trials have revealed that treatment with infusion of prostacyclin reduces endothelial damage after major surgery...... and AMI. Thus, a study is pertinent to investigate if prostacyclin infusion as a therapeutic intervention reduces endothelial damage without compromising, or even improving, the hemostatic competence in resuscitated cardiac arrest patients. Post-cardiac arrest patients frequently have a need...

  5. Prognosis of hospital survivors after salvage from cardiopulmonary bypass with centrifugal cardiac assist.

    Science.gov (United States)

    Curtis, J J; Walls, J T; Schmaltz, R A; Boley, T; Landreneau, R; Nawarawong, W

    1990-01-01

    Since October 1986, 6 hospital survivors who were salvaged from cardiopulmonary bypass (CPB) with the Sarns centrifugal pump were observed. Centrifugal assist was employed only after failure to wean with usual resuscitative measures, including multiple high dose inotropes and intraaortic balloon pumping. There were five men and one woman, 46-59 years of age (mean 61 years). All patients had undergone coronary artery bypass grafting, with two patients having had concomitant left ventricular aneurysmectomy and two aortic valve replacement. Five patients had left ventricular assist only and one had biventricular assist. Duration of assist ranged from 26 to 72 hr (mean 48 hr). Complications were ubiquitous, and the resultant prolonged hospitalization was resource intensive. All hospital survivors remain alive and are in New York Heart Association functional Class II, with an average follow-up of 24 months, (6-41 months). Compared with preoperative values, current left ventricular function is improved in 2 patients, has deteriorated in 3, and is unchanged in 1. Thus, the Sarns centrifugal pump will allow salvage of some patients who otherwise are not weanable from CPB. Survivors can expect a reasonable functional capacity as reflected by this experience.

  6. Assessing Exercise Limitation Using Cardiopulmonary Exercise Testing

    Directory of Open Access Journals (Sweden)

    Michael K. Stickland

    2012-01-01

    Full Text Available The cardiopulmonary exercise test (CPET is an important physiological investigation that can aid clinicians in their evaluation of exercise intolerance and dyspnea. Maximal oxygen consumption (V˙O2max is the gold-standard measure of aerobic fitness and is determined by the variables that define oxygen delivery in the Fick equation (V˙O2 = cardiac output × arterial-venous O2 content difference. In healthy subjects, of the variables involved in oxygen delivery, it is the limitations of the cardiovascular system that are most responsible for limiting exercise, as ventilation and gas exchange are sufficient to maintain arterial O2 content up to peak exercise. Patients with lung disease can develop a pulmonary limitation to exercise which can contribute to exercise intolerance and dyspnea. In these patients, ventilation may be insufficient for metabolic demand, as demonstrated by an inadequate breathing reserve, expiratory flow limitation, dynamic hyperinflation, and/or retention of arterial CO2. Lung disease patients can also develop gas exchange impairments with exercise as demonstrated by an increased alveolar-to-arterial O2 pressure difference. CPET testing data, when combined with other clinical/investigation studies, can provide the clinician with an objective method to evaluate cardiopulmonary physiology and determination of exercise intolerance.

  7. Arabidopsis CPR5 is a senescence-regulatory gene with pleiotropic functions as predicted by the evolutionary theory of senescence

    NARCIS (Netherlands)

    Jing, Hai-Chun; Anderson, Lisa; Sturre, Marcel J. G.; Hille, Jacques; Dijkwel, Paul P.

    2007-01-01

    Arabidopsis CPR5 is a senescence-regulatory gene with pleiotropic functions as predicted by the evolutionary theory of senescence Hai-Chun Jing1,2, Lisa Anderson3, Marcel J.G. Sturre1, Jacques Hille1 and Paul P. Dijkwel1,* 1Molecular Biology of Plants, Groningen Biomolecular Sciences and Biotechnolo

  8. The Campylobacter jejuni CprRS two-component regulatory system regulates aspects of the cell envelope

    Science.gov (United States)

    As a leading cause of foodborne bacterial gastroenteritis, Campylobacter jejuni is a significant human pathogen. C. jejuni lives commensally in the gastrointestinal tract of animals, but tolerates variable environments during transit to a susceptible host. A two-component regulatory system, CprRS, w...

  9. Evaluation of pediatric CPR course on knowledge of pediatric residents--before and after ACLS course.

    Science.gov (United States)

    Soltani, Alireza Ebrahim; Khan, Zahid Hussain; Arbabi, Shahriar; Hossini, Babak; Nahvi, Hedaiatollah; Agamohammadi, Asghar

    2009-02-01

    An evaluation was conducted on the knowledge gained by pediatric residents on CPR, before and after a PALS (Pediatric Advanced Cardiac Life Support) course. Following an examination of all pediatric residents at Tehran University of Medical Sciences, they were divided into two groups: non-trained (Group 1) and a group scheduled to undergone training (Group 2). A course on ACLS was conducted. Examination were performed before and after the ACLS course. The mean of the examination prior to the course in Group 1 and 2 was low, reflecting no significant differences between the Groups. Examination after the ACLS course showed a statistically significant improvement in Group 2 (P ACLS course and enhanced after the course.

  10. Molecular population genetics of the NADPH cytochrome P450 reductase (CPR) gene in Anopheles minimus.

    Science.gov (United States)

    Srivastava, Hemlata; Huong, Ngo Thi; Arunyawat, Uraiwan; Das, Aparup

    2014-08-01

    Development of insecticide resistance (IR) in mosquito vectors is a primary huddle to malaria control program. Since IR has genetic basis, and genes constantly evolve with response to environment for adaptation to organisms, it is important to know evolutionary pattern of genes conferring IR in malaria vectors. The mosquito Anopheles minimus is a major malaria vector of the Southeast (SE) Asia and India and is susceptible to all insecticides, and thus of interest to know if natural selection has shaped variations in the gene conferring IR. If not, the DNA fragment of such a gene could be used to infer population structure and demography of this species of malaria vector. We have therefore sequenced a ~569 bp DNA segment of the NADPH cytochrome P450 reductase (CPR) gene (widely known to confer IR) in 123 individuals of An. minimus collected in 10 different locations (eight Indian, one Thai and one Vietnamese). Two Indian population samples were completely mono-morphic in the CPR gene. In general, low genetic diversity was found with no evidence of natural selection in this gene. The data were therefore analyzed to infer population structure and demography of this species. The 10 populations could be genetically differentiated into four different groups; the samples from Thailand and Vietnam contained high nucleotide diversity. All the 10 populations conform to demographic equilibrium model with signature of past population expansion in four populations. The results in general indicate that the An. minimus mosquitoes sampled in the two SE Asian localities contain several genetic characteristics of being parts of the ancestral population.

  11. DCS Cabinet Power Loss Analysis for CPR 1000 Nuclear Power Plant%CPR1000核电厂DCS机柜失电分析

    Institute of Scientific and Technical Information of China (English)

    周亮; 赵岩峰; 孙永滨

    2014-01-01

    The DCS overall structure of CRP1000 nuclear power plant was introduced . Based on the RPC ,the signal interface character and signal processing mechanism on the key root were analyzed .By the power loss analyzing of RPC ,the RPC loss power may lead reactor trip signal from anticipated transient without scram (ATWS) system .The results indicate that it is necessary to search DCS cabinet power loss analysis .Optimi‐zing and assigning the main waterflow signals can avoid trigger reactor trip signal by mistake .The DCS cabinet power loss analysis can optimize the I&C (instrumentation and control) design and increase the nuclear plant’s reliability .%介绍了CPR1000核电厂数字化控制系统(DCS)的总体结构,以反应堆保护机柜(RPC)为基础,分析RPC的信号接口特性和信号关键路径节点的信号处理机制。结合RPC Ⅳ保护通道失电造成未能停堆的预期瞬变(ATWS)系统误发停堆信号的原因进行分析及优化,结果表明:对DCS机柜失电分析的研究是必要的,通过对RPC Ⅳ的给水流量信息进行优化和合理分配,可避免误发停堆信号。失电分析可优化仪控的设计,提高核电厂的可靠性。

  12. 21 CFR 870.4210 - Cardiopulmonary bypass vascular catheter, cannula, or tubing.

    Science.gov (United States)

    2010-04-01

    ... Devices § 870.4210 Cardiopulmonary bypass vascular catheter, cannula, or tubing. (a) Identification. A cardiopulmonary bypass vascular catheter, cannula, or tubing is a device used in cardiopulmonary surgery to... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass vascular catheter,...

  13. Clinical experience and skills of physicians in hospital cardiac arrest teams in Denmark: a nationwide study

    Science.gov (United States)

    Lauridsen, Kasper G; Schmidt, Anders S; Caap, Philip; Aagaard, Rasmus; Løfgren, Bo

    2017-01-01

    Background The quality of in-hospital resuscitation is poor and may be affected by the clinical experience and cardiopulmonary resuscitation (CPR) training. This study aimed to investigate the clinical experience, self-perceived skills, CPR training and knowledge of the guidelines on when to abandon resuscitation among physicians of cardiac arrest teams. Methods We performed a nationwide cross-sectional study in Denmark. Telephone interviews were conducted with physicians in the cardiac arrest teams in public somatic hospitals using a structured questionnaire. Results In total, 93 physicians (53% male) from 45 hospitals participated in the study. Median age was 34 (interquartile range: 30–39) years. Respondents were medical students working as locum physicians (5%), physicians in training (79%) and consultants (16%), and the median postgraduate clinical experience was 48 (19–87) months. Most respondents (92%) felt confident in treating a cardiac arrest, while fewer respondents felt confident in performing intubation (41%) and focused cardiac ultrasound (39%) during cardiac arrest. Median time since last CPR training was 4 (2–10) months, and 48% had attended a European Resuscitation Council (ERC) Advanced Life Support course. The majority (84%) felt confident in terminating resuscitation; however, only 9% were able to state the ERC guidelines on when to abandon resuscitation. Conclusion Physicians of Danish cardiac arrest teams are often inexperienced and do not feel competent performing important clinical skills during resuscitation. Less than half have attended an ERC Advanced Life Support course, and only very few physicians know the ERC guidelines on when to abandon resuscitation.

  14. Associates of Cardiopulmonary Arrest in the Perihemodialytic Period

    Directory of Open Access Journals (Sweden)

    Jennifer E. Flythe

    2014-01-01

    Full Text Available Cardiopulmonary arrest during and proximate to hemodialysis is rare but highly fatal. Studies have examined peridialytic sudden cardiac event risk factors, but no study has considered associates of cardiopulmonary arrests (fatal and nonfatal events including cardiac and respiratory causes. This study was designed to elucidate patient and procedural factors associated with peridialytic cardiopulmonary arrest. Data for this case-control study were taken from the hemodialysis population at Fresenius Medical Care, North America. 924 in-center cardiopulmonary events (cases and 75,538 controls were identified. Cases and controls were 1 : 5 matched on age, sex, race, and diabetes. Predictors of cardiopulmonary arrest were considered for logistic model inclusion. Missed treatments due to hospitalization, lower body mass, coronary artery disease, heart failure, lower albumin and hemoglobin, lower dialysate potassium, higher serum calcium, greater erythropoietin stimulating agent dose, and normalized protein catabolic rate (J-shaped were associated with peridialytic cardiopulmonary arrest. Of these, lower albumin, hemoglobin, and body mass index; higher erythropoietin stimulating agent dose; and greater missed sessions had the strongest associations with outcome. Patient health markers and procedural factors are associated with peridialytic cardiopulmonary arrest. In addition to optimizing nutritional status, it may be prudent to limit exposure to low dialysate potassium (<2 K bath and to use the lowest effective erythropoietin stimulating agent dose.

  15. Strategies for cardiopulmonary exercise testing of pectus excavatum patients

    Directory of Open Access Journals (Sweden)

    Moh H. Malek

    2008-01-01

    Full Text Available The purpose of this paper is to provide strategies for cardiopulmonary exercise testing of pectus excavatum patients. Currently, there are no standardized methods for assessing cardiovascular and pulmonary responses in this population; therefore, making comparisons across studies is difficult if not impossible. These strategies are intended for physicians, pulmonary technicians, exercise physiologists, and other healthcare professionals who conduct cardiopulmonary exercise testing on pectus excavatum patients. By using the strategies outlined in this report, comparisons across studies can be made, and the effects of pectus excavatum on cardiopulmonary function can be assessed with greater detail.

  16. A marked increase in gastric fluid volume during cardiopulmonary bypass

    Science.gov (United States)

    Hirota, Kazuyoshi; Kudo, Mihoko; Hashimoto, Hiroshi; Kushikata, Tetsuya

    2011-01-01

    Major physiological stress occurs during cardiac surgery with cardiopulmonary bypass. This is related to hypothermia and artificial organ perfusion. Thus, serious gastrointestinal complications, particularly upper gastrointestinal bleeding, sometimes follow cardiac surgery. We have compared the antisecretory effects of a preanesthetic H2 antagonist (roxatidine, cardiopulmonary bypass-H2 group, n = 15) and a proton pump inhibitor (rabeprazole, cardiopulmonary bypass-PPI group, n = 15) in patients undergoing cardiac surgery with cardiopulmonary bypass, and also compared in patients undergoing a off-pump coronary artery bypass graft surgery (off-pump cardiopulmonary bypass-H2 group, n = 15). Gastric pH (5.14 ± 0.61) and gastric fluid volume (13.2 ± 2.4 mL) at the end of surgery in off-pump cardiopulmonary bypass-H2 groups was significantly lower and higher than those in both cardiopulmonary bypass-H2 (6.25 ± 0.54, 51.3 ± 8.0 mL) and cardiopulmonary bypass-PPI (7.29 ± 0.13, 63.5 ± 14.8 mL) groups, respectively although those variables did not differ between groups after the induction of anesthesia. Plasma gastrin (142 ± 7 pg/mL) at the end of surgery and maximal blood lactate levels (1.50 ± 0.61 mM) in off-pump cardiopulmonary bypass-H2 group were also significantly lower than those in both cardiopulmonary bypass-H2 (455 ± 96 pg/mL, 3.97 ± 0.80 mM) and cardiopulmonary bypass-PPI (525 ± 27 pg/mL, 3.15 ± 0.44 mM) groups, respectively. In addition, there was a significant correlation between gastric fluid volume and maximal blood lactate (r = 0.596). In conclusion, cardiopulmonary bypass may cause an increase in gastric fluid volume which neither H2 antagonist nor PPI suppresses. A significant correlation between gastric fluid volume and maximal blood lactate suggests that gastric fluid volume may predict degree of gastrointestinal tract hypoperfusion. PMID:21765601

  17. Transient Diabetes Insipidus Following Cardiopulmonary Bypass.

    Science.gov (United States)

    Ekim, Meral; Ekim, Hasan; Yilmaz, Yunus Keser; Bolat, Ali

    2015-04-01

    Diabetes insipidus (DI) results from inadequate output of Antidiuretic Hormone (ADH) from the pituitary gland (central DI) or the inability of the kidney tubules to respond to ADH (nephrogenic DI). ADH is an octapeptide produced in the supraoptic and paraventricular nuclei of the hypothalamus and stored in the posterior lobe of the pituitary gland. Cardiopulmonary Bypass (CPB) has been shown to cause a six-fold increased circulating ADH levels 12 hours after surgery. However, in some cases, ADH release may be transiently suppressed due to cardioplegia (cardiac standstill) or CPB leading to DI. We present the postoperative course of a 60-year-old man who developed transient DI after CPB. He was successfully treated by applying nasal desmopressin therapy. Relevant biochemical parameters should be monitored closely in patients who produce excessive urine after open heart surgery.

  18. Rationale, design, and implementation protocol of an electronic health record integrated clinical prediction rule (iCPR randomized trial in primary care

    Directory of Open Access Journals (Sweden)

    Wisnivesky Juan

    2011-09-01

    Full Text Available Abstract Background Clinical prediction rules (CPRs represent well-validated but underutilized evidence-based medicine tools at the point-of-care. To date, an inability to integrate these rules into an electronic health record (EHR has been a major limitation and we are not aware of a study demonstrating the use of CPR's in an ambulatory EHR setting. The integrated clinical prediction rule (iCPR trial integrates two CPR's in an EHR and assesses both the usability and the effect on evidence-based practice in the primary care setting. Methods A multi-disciplinary design team was assembled to develop a prototype iCPR for validated streptococcal pharyngitis and bacterial pneumonia CPRs. The iCPR tool was built as an active Clinical Decision Support (CDS tool that can be triggered by user action during typical workflow. Using the EHR CDS toolkit, the iCPR risk score calculator was linked to tailored ordered sets, documentation, and patient instructions. The team subsequently conducted two levels of 'real world' usability testing with eight providers per group. Usability data were used to refine and create a production tool. Participating primary care providers (n = 149 were randomized and intervention providers were trained in the use of the new iCPR tool. Rates of iCPR tool triggering in the intervention and control (simulated groups are monitored and subsequent use of the various components of the iCPR tool among intervention encounters is also tracked. The primary outcome is the difference in antibiotic prescribing rates (strep and pneumonia iCPR's encounters and chest x-rays (pneumonia iCPR only between intervention and control providers. Discussion Using iterative usability testing and development paired with provider training, the iCPR CDS tool leverages user-centered design principles to overcome pervasive underutilization of EBM and support evidence-based practice at the point-of-care. The ongoing trial will determine if this collaborative

  19. Experience with an emergency resuscitation system.

    Science.gov (United States)

    Raithel, S C; Swartz, M T; Braun, P R; Dake, S B; Taub, J O; Zambie, M A; Miller, L W; Deligonul, U; McBride, L R; Pennington, D G

    1989-01-01

    The need for a portable extracorporeal support system that can be rapidly initiated for various types of cardiopulmonary failure is well known. The authors report on a system consisting of 3/8 inch tubing, a Sci-Med membrane oxygenator, Omnitherm heat exchanger, Biomedicus or Sarns centrifugal pump, portable battery, and oxygen tanks. The system is mounted on a cart for easy mobility and can be primed in 5-10 min. USCI, DLP, or Axiom cannulas can be inserted femorally. Over 30 months, 29 patients, aged 19-78 years, underwent extracorporeal membrane oxygenation (ECMO) support for cardiac arrest during catheterization (10 patients), shock secondary to acute myocardial infarction (MI) (10 patients), elective percutaneous transluminal coronary angioplasty (PTCA) support (four patients), postcardiotomy failure (four patients), and exposure hypothermia (one patient). Adequate support was achieved in all but one patient. Device flows ranged from 0.2 to 6.0 l/min. There were six survivors (elective PTCA support, three patients; cardiac arrest during catheterization, three patients). Complications included bleeding (15 patients), deep venous thrombosis (three patients), and pump failure (one patient). A portable ECMO system has been developed that allows rapid institution of circulatory support.

  20. Fatores que afetam a ventilação com o reanimador manual autoinflável: uma revisão sistemática Factors affecting manual resuscitator use: a systematic review

    Directory of Open Access Journals (Sweden)

    Pricila Mara N. de Oliveira

    2011-12-01

    a device that provides positive pressure ventilation. Surveys conducted to assess the adequacy of manual resuscitators to American Society for Testing and Materials standards show that several factors affect manual ventilation. However, results are conflicting. The aim of this study was to verify evidence of factors that influence pediatric/adult pulmonary ventilation with manual resuscitator by a systematic review. DATA SOURCE: Original articles indexed in Medline, Lilacs and SciELO published from January 1986 to March 2011. The key-words used were: "manual resuscitator", "manual ventilation", "positive pressure ventilation" in Portuguese and English, as well as "bag-valve". DATA SYNTHESIS: 45 articles were selected, most of them experimental. The studies compared manual resuscitator brands and models, and analyzed the physical characteristics of professionals. The effectiveness of ventilation with manual resuscitator depends on the brand, model and functional characteristics of the equipment. Ventilation also varies with the education, training and experience of the professional who handles the equipment. Other factors that can influence effectiveness are the manual resuscitator compression form, the use of a pressure relief valve and the flow of oxygen provided to the manual resuscitator. CONCLUSIONS: The variability of ventilatory parameters during manual resuscitation does not allow a standardization of the technique, being harmful to cardiopulmonary resuscitation. Although most manual resuscitator seem to follow international standards, the equipment must be evaluated in the clinical settings. There are few studies about pediatric and neonatal manual resuscitator models.

  1. Spatial variation in nitrogen dioxide concentrations and cardiopulmonary hospital admissions

    NARCIS (Netherlands)

    Dijkema, Marieke B A; van Strien, Robert T; van der Zee, Saskia C; Mallant, Sanne F; Fischer, Paul; Hoek, Gerard; Brunekreef, Bert; Gehring, Ulrike

    2016-01-01

    BACKGROUND: Air pollution episodes are associated with increased cardiopulmonary hospital admissions. Cohort studies showed associations of spatial variation in traffic-related air pollution with respiratory and cardiovascular mortality. Much less is known in particular about associations with cardi

  2. Improved Design of CPR1000 Nuclear Power Plant Reactor Protection and Control System%CPR1000核电站反应堆保护及控制系统的设计改进

    Institute of Scientific and Technical Information of China (English)

    乐可佳

    2016-01-01

    Ningde nuclear power plant is the most advanced CPR1000 digital nuclear power plant in China. It is the first nuclear power plant after the Fukushima nuclear accident. Reactor protection and control system during the production and construction of a significant design improvements, it is worth learning from other nuclear power plants.%宁德核电站是我国最先进的CPR1000数字化核电站,是福岛核事故后正式商运的第一台核电站。反应堆保护及控制系统在生产建设期间进行了重大的设计改进,值得其他核电站借鉴。

  3. Design of a Functional Training Prototype for Neonatal Resuscitation

    Directory of Open Access Journals (Sweden)

    Sivaramakrishnan Rajaraman

    2014-11-01

    Full Text Available Birth Asphyxia is considered to be one of the leading causes of neonatal mortality around the world. Asphyxiated neonates require skilled resuscitation to survive the neonatal period. The project aims to train health professionals in a basic newborn care using a prototype with an ultimate objective to have one person at every delivery trained in neonatal resuscitation. This prototype will be a user-friendly device with which one can get trained in performing neonatal resuscitation in resource-limited settings. The prototype consists of a Force Sensing Resistor (FSR that measures the pressure applied and is interfaced with Arduino® which controls the Liquid Crystal Display (LCD and Light Emitting Diode (LED indication for pressure and compression counts. With the increase in population and absence of proper medical care, the need for neonatal resuscitation program is not well addressed. The proposed work aims at offering a promising solution for training health care individuals on resuscitating newborn babies under low resource settings.

  4. Current Neonatal Resuscitation Practices among Paediatricians in Gujarat, India

    Directory of Open Access Journals (Sweden)

    Satvik C. Bansal

    2014-01-01

    Full Text Available Aim. We assessed neonatal resuscitation practices among paediatricians in Gujarat. Methods. Cross-sectional survey of 23 questions based on guidelines of Neonatal Resuscitation Program (NRP and Navjaat Shishu Suraksha Karyakram (NSSK was conducted using web-based tool. Questionnaire was developed and consensually validated by three neonatologists. Results. Total of 142 (21.2% of 669 paediatricians of Gujarat, India, whose e-mail addresses were available, attempted the survey and, from them, 126 were eligible. Of these, 74 (58.7% were trained in neonatal resuscitation. Neonatal Intensive Care Unit with mechanical ventilation facilities was available for 54% of respondents. Eighty-eight (69.8% reported correct knowledge and practice regarding effective bag and mask ventilation (BMV and chest compressions. Knowledge and practice about continuous positive airway pressure use in delivery room were reported in 18.3% and 30.2% reported use of room air for BMV during resuscitation. Suctioning oral cavity before delivery in meconium stained liquor was reported by 27.8% and 38.1% cut the cord after a minute of birth. Paediatricians with NRP training used appropriate method of tracheal suction in cases of nonvigorous newborns than those who were not trained. Conclusions. Contemporary knowledge about neonatal resuscitative practices in paediatricians is lacking and requires improvement. Web-based tools provided low response in this survey.

  5. Institutional property rights structure, common pool resource (CPR), tragedy of the urban commons: A Review

    Science.gov (United States)

    Ling, G.; Ho, C. S.; Ali, H. M.

    2014-02-01

    There have been a plethora of researches on the significance of public open space (POS) in contributing to societies' sustainability. However, by virtue of identified maladaptive policy-based-property rights structure, such a shared good becomes vulnerable to tragedy of the urban commons (overexploitation) that subsequently leads to burgeoning number of mismanaged POS e.g., degraded and unkempt urban public spaces. By scrutinising the literatures within property rights domain and commons resources, an objective is highlighted in this paper which is to insightfully discourse institutional property rights structure pertaining to the mechanism, roles and interrelationship between property-rights regimes, bundle of property rights and resource domains; types of goods on how they act upon and tie in the POS with the social quandary. In summary, urban POS tragedy can potentially be triggered by the institutional structure especially if the ownership is left under open-access resource regime and ill-defined property rights which both successively constitute the natures of Common Pool Resource (CPR) within the commons, POS. Therefore, this paper sparks an idea to policy makers that property rights structure is a determinant in sustainably governing the POS in which adaptive assignment of property regimes and property rights are impelled.

  6. Aseismic safety analysis of a prestressed concrete containment vessel for CPR1000 nuclear power plant

    Science.gov (United States)

    Yi, Ping; Wang, Qingkang; Kong, Xianjing

    2017-01-01

    The containment vessel of a nuclear power plant is the last barrier to prevent nuclear reactor radiation. Aseismic safety analysis is the key to appropriate containment vessel design. A prestressed concrete containment vessel (PCCV) model with a semi-infinite elastic foundation and practical arrangement of tendons has been established to analyze the aseismic ability of the CPR1000 PCCV structure under seismic loads and internal pressure. A method to model the prestressing tendon and its interaction with concrete was proposed and the axial force of the prestressing tendons showed that the simulation was reasonable and accurate. The numerical results show that for the concrete structure, the location of the cylinder wall bottom around the equipment hatch and near the ring beam are critical locations with large principal stress. The concrete cracks occurred at the bottom of the PCCV cylinder wall under the peak earthquake motion of 0.50 g, however the PCCV was still basically in an elastic state. Furthermore, the concrete cracks occurred around the equipment hatch under the design internal pressure of 0.4MPa, but the steel liner was still in the elastic stage and its leak-proof function soundness was verified. The results provide the basis for analysis and design of containment vessels.

  7. Optimizing Chest Compression to Rescue Ventilation Ratios During One-Rescuer CPR by Professionals and Lay Persons: Children are Not Just Little Adults

    OpenAIRE

    Babbs, Charles F.; Nadkarni, Vinay

    2003-01-01

    Objective: To estimate the optimum ratio of chest compressions to ventilations for onerescuer CPR that maximizes systemic oxygen delivery in children. Method: Equations describing oxygen delivery and blood flow during CPR as functions of the number of compressions and the number of ventilations delivered over time were adapted from the former work of Babbs and Kern. These equations were solved explicitly as a function of body weight, using scaling algorithms based upon principles of developme...

  8. A knockout strain of CPR1 induced during fermentation of Saccharomyces cerevisiae KNU5377 is susceptible to various types of stress.

    Science.gov (United States)

    Kim, Il-Sup; Yun, Hae-Sun; Park, In-Su; Sohn, Ho-Yong; Iwahashi, Hitoshi; Jin, Ing-Nyol

    2006-10-01

    To investigate the tolerance factor of Saccharomyces cerevisiae KNU5377 against various types of environmental stress during fermentation, we identified the protein that is upregulated at high temperatures. The highly upregulated protein was high-score-matched as a cytoplasmic peptidyl-prolyl cis-trans isomerase, cyclophilin (Cpr1p), by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF). We constructed a CPR1-deleted KNU5377 strain (KNU5377Y cpr1Delta) to determine the roles of the protein under fermentative or stress condition. The growth of the S. cerevisiae KNU5377Y cpr1Delta strain was completely inhibited under the following conditions: heat (40 degrees C), hydrogen peroxide (20-30 mM), menadione (0.3 mM), ethanol (16%), sulfuric acid (5 mm), and lactic acid (0.4-0.8%). However, the wild-type and cpr1Delta mutant of S. cerevisiae BY4741 as a positive control did not show differences in sensitivity to stress. It is interesting to note that the wild-type KNU5377Y and KNU5377Y cpr1Delta mutant showed high sensitivity against various stresses, particularly, acid stress such as in the presence of sulfuric and lactic acid. Although the alcohol fermentation rate of the KNU5377Y cpr1Delta mutant markedly decreased with an increase in temperature up to 40 degrees C, we observed no decrease in that of the wild-type strain under the same conditions. These results suggest that CPR1 contributes to the stress tolerance of KNU5377 against various types of environmental stress caused during fermentation, thus leading to the physiological role of maintaining an alcohol fermentation yield, even at high temperatures such as 40 degrees C.

  9. Blood Transfusion Strategies for Hemostatic Resuscitation in Massive Trauma.

    Science.gov (United States)

    McGrath, Caroline

    2016-03-01

    Massive transfusion practices were transformed during the 1970s without solid evidence supporting the use of component therapy. A manual literature search was performed for all references to the lethal triad, acute or early coagulopathy of trauma, fresh whole blood, and component transfusion therapy in massive trauma, and damage control resuscitation. Data from recent wars suggest traditional component therapy causes a nonhemostatic resuscitation worsening the propagation of the lethal triad hastening death. These same studies also indicate the advantage of fresh whole blood over component therapy even when administered in a 1:1:1 replacement ratio.

  10. History of neonatal resuscitation. Part 2: oxygen and other drugs.

    Science.gov (United States)

    Obladen, Michael

    2009-01-01

    Oxygen was used in neonatal resuscitation from 1780, within 5 years of its detection. It rapidly gained general acceptance and infiltrated delivery rooms and, a century later, neonatal special care units. After 217 years without scientific evidence, the use of oxygen for neonatal resuscitation has recently been questioned. Continuous distending airway pressure for oxygen administration was available at the beginning of the 20th century, but was not widely accepted. Alkali and analeptic drugs gained widespread but short-lived use after the Second World War.

  11. The Cardiopulmonary effect of passive movement

    Directory of Open Access Journals (Sweden)

    L. Loram

    2002-02-01

    Full Text Available Eleven articles were reviewed on the cardiopulmonary effects of passive movements. These included two articles on theneurological effects of passive movements. Of the eleven articles, four were considered to have level II evidence in accordance with Sackett’s rules of evidence. There was little consensus regarding the rate or duration of passive movements. There were some suggestions that upper limb movement produces a greater ventilatory response than lower limb movement. There was a statistically significant increase (p< 0.05 in minute ventilation when the movement was done at a rate of 40 repetitions per minute or more, but this change may not be clinically significant. Passive movements were not detrimental to neurosurgical patients with a normal or slightly elevated intracranial pressure, although the values of the intracranial pressure were not stated.  The studies were limited in that eight of the eleven had small sample sizes and most studies were conducted using normal subjects. Further studies with higher levels of evidence need to be  conducted to verify any results reported to date in the literature. Studies that are relevant to clinical practice also need to be conducted in populations such as sedated intensive care patients.

  12. Cardiopulmonary Exercise Test: Background, Applicability and Interpretation

    Science.gov (United States)

    Herdy, Artur Haddad; Ritt, Luiz Eduardo Fonteles; Stein, Ricardo; de Araújo, Claudio Gil Soares; Milani, Mauricio; Meneghelo, Romeu Sérgio; Ferraz, Almir Sérgio; Hossri, Carlos; de Almeida, Antonio Eduardo Monteiro; Fernandes-Silva, Miguel Morita; Serra, Salvador Manoel

    2016-01-01

    Cardiopulmonary exercise test (CPET) has been gaining importance as a method of functional assessment in Brazil and worldwide. In its most frequent applications, CPET consists in applying a gradually increasing intensity exercise until exhaustion or until the appearance of limiting symptoms and/or signs. The following parameters are measured: ventilation; oxygen consumption (VO2); carbon dioxide production (VCO2); and the other variables of conventional exercise testing. In addition, in specific situations, pulse oximetry and flow-volume loops during and after exertion are measured. The CPET provides joint data analysis that allows complete assessment of the cardiovascular, respiratory, muscular and metabolic systems during exertion, being considered gold standard for cardiorespiratory functional assessment.1-6 The CPET allows defining mechanisms related to low functional capacity that can cause symptoms, such as dyspnea, and correlate them with changes in the cardiovascular, pulmonary and skeletal muscle systems. Furthermore, it can be used to provide the prognostic assessment of patients with heart or lung diseases, and in the preoperative period, in addition to aiding in a more careful exercise prescription to healthy subjects, athletes and patients with heart or lung diseases. Similarly to CPET clinical use, its research also increases, with the publication of several scientific contributions from Brazilian researchers in high-impact journals. Therefore, this study aimed at providing a comprehensive review on the applicability of CPET to different clinical situations, in addition to serving as a practical guide for the interpretation of that test. PMID:27982272

  13. Postoperative abdominal complications after cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Dong Guohua

    2012-10-01

    Full Text Available Abstract Background To summarize the diagnostic and therapeutic experiences on the patients who suffered abdominal complications after cardiovascular surgery with cardiopulmonary bypass(CPB. Methods A total of 2349 consecutive patients submitted to cardiovascular surgery with CPB in our hospital from Jan 2004 to Dec 2010 were involved. The clinical data of any abdominal complication, including its incidence, characters, relative risks, diagnostic measures, medical or surgical management and mortality, was retrospectively analyzed. Results Of all the patients, 33(1.4% developed abdominal complications postoperatively, including 11(33.3% cases of paralytic ileus, 9(27.3% of gastrointestinal haemorrhage, 2(6.1% of gastroduodenal ulcer perforation, 2(6.1% of acute calculus cholecystitis, 3(9.1% of acute acalculus cholecystitis, 4(12.1% of hepatic dysfunction and 2(6.1% of ischemia bowel diseases. Of the 33 patients, 26 (78.8% accepted medical treatment and 7 (21.2% underwent subsequent surgical intervention. There were 5(15.2% deaths in this series, which was significantly higher than the overall mortality (2.7%. Positive history of peptic ulcer, advanced ages, bad heart function, preoperative IABP support, prolonged CPB time, low cardiac output and prolonged mechanical ventilation are the risk factors of abdominal complications. Conclusions Abdominal complications after cardiovascular surgery with CPB have a low incidence but a higher mortality. Early detection and prompt appropriate intervention are essential for the outcome of the patients.

  14. Cardiopulmonary exercise testing (CPET) in pulmonary emphysema.

    Science.gov (United States)

    Paoletti, Patrizia; De Filippis, Francesca; Fraioli, Francesco; Cinquanta, Alessandra; Valli, Gabriele; Laveneziana, Pierantonio; Vaccaro, Francesco; Martolini, Dario; Palange, Paolo

    2011-12-15

    In patients affected by chronic obstructive pulmonary disease (COPD), cardiopulmonary response to exercise was never related to the severity of emphysema (E) measured by high resolution computed tomography (HRCT). Sixteen patients (age=65±8 yrs; FEV(1)=54±18%pred; RV=160±28%pred) with moderate to severe E (quantified by lung HRCT as % voxels cycle-ergometer to exhaustion. Oxygen uptake (V˙(O2)), carbon dioxide output (V˙(CO2)), ventilation (V˙(E)), tidal volume (V(T)), and end-tidal P(CO2) (PET(CO2)) derived variables were measured breath-by-breath. The % of E correlated with: (1) the ratio V(Tpeak) (r=0.74; p=0.001); (2) the V˙(E)/V˙(CO2) slope (r=-0.77; p=0.0004); (3) PET(CO2) values at peak exercise (r=0.80; p=0.0001). Also, the %E was strongly predicted by the following exercise equation: %E(EST) = 58.1 + 11.9 × ΔV˙(E)/V˙(CO2) (r=0.94; p1 is typically observed in severe E patients; furthermore, the V˙(E)/V˙(CO2) slope and the PET(CO2peak) values decrease and increase respectively as more as the emphysema is severe.

  15. Resuscitative Hyperkalemia in Noncrush Trauma: A Prospective, Observational Study

    Science.gov (United States)

    2006-12-01

    Hemostatic,” or “damage-control,” resuscitation, in which definitive surgical repair is deferred in preference to earlier establishment of he- mostatic...addition, their population consisted of patients who were trans- ported to hospitals with hemodialysis capabilities; the true incidence of

  16. Three different CPR management models for riverine nitrogen polluters in Sweden

    Energy Technology Data Exchange (ETDEWEB)

    Arheimer, B.

    1997-12-31

    Sweden has failed in the environmental goal of reducing the nitrogen transport to the Baltic Sea by 50 per cent in ten years, mainly because of the large amounts of nitrogen still leaching from arable land. The riverine nitrogen problem can be formulated in terms of a CPR problem, as the property rights of the river water are undefined and it is possible to free-ride in the maintenance of the resource by polluting it for personal aim. Swedish water management at present is dominated by a command-and-control policy. However, to master the situation, various propositions of changed institutional arrangements for better management of water resources have been presented recently. This chapter describes and discusses three models that have been proposed for water management in the Swedish environmental policy debate: the community model, the negotiation model and the market model. To be economically efficient and ecologically sustainable, all of these models must be in accordance with local environmental, socio-economic and cultural conditions. According to the analysis, the proposed management models have about the same institutional requirements, although the sensitivity to various requirements may differ among the models. In the chapter it is argued that new policy implementation in Sweden should include regional water administration boards, where monitoring and problem analysis are kept within single catchments. Problem solution should be decentralized so that sub basins are managed according to the model most in accordance with local conditions. As long as the various requests for model success are met, different management models may be used in different parts of the same watershed. This may be possible since the overwhelming need of institutional arrangements is about the same for the three proposed management models and, consequently, they do not exclude each other 42 refs, 3 figs, 1 tab

  17. Pulmonary fat embolism--a prospective study within the forensic autopsy collective of the Republic of Iceland.

    Science.gov (United States)

    Voisard, Matthias X; Schweitzer, Wolf; Jackowski, Christian

    2013-01-01

    In the last century, studies established the origin of pulmonary fat embolism (PFE) and identified mechanical trauma as main source for PFE. This prospective study focused on determining a possible influence of cardiopulmonary resuscitation (CPR), in the context of an aging population, on the occurrence of PFE. Lung tissue samples from 256 bodies were examined using the twin-edged knife technique without preliminary fixation but after staining with Sudan III. PFE grading was determined according to Falzi and performed at a 10× magnification. For statistical analysis, bodies were grouped by age, gender, and putrefaction and categorized following whether they had experienced trauma, CPR, the combination of both, or no mechanical impact. There was a significant correlation of trauma, CPR, and the combination of both to PFE but no noticeable influence of gender or putrefaction. An age over 70 years promotes a PFE due to resuscitation.

  18. Oxygen resuscitation and oxidative-stress biomarkers in premature infants

    Directory of Open Access Journals (Sweden)

    Kumar VH

    2014-05-01

    Full Text Available Vasanth HS Kumar,1 Vivien Carrion,1 Karen A Wynn,1 Lori Nielsen,1 Anne Marie Reynolds,1 Rita M Ryan2 1Department of Pediatrics, The Women and Children's Hospital of Buffalo, Buffalo, NY, 2Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA Background: Resuscitation of premature infants with 100% O2 may initiate significant oxidant stress during development, predisposing them to bronchopulmonary dysplasia. In the study reported here, we examined the effects of three different oxygen concentrations at resuscitation on oxygen saturations (SpO2 and oxidant stress in premature infants. Study design: Infants <32 weeks gestational age were randomized to 21%, 40%, or 100% O2 and resuscitated as per 2005 neonatal resuscitation guidelines. Oxygen groups and SpO2 were unmasked at 10 minutes of age and FiO2 adjusted to maintain an SpO2 of 85%–95% for the next 20 minutes. Blood was collected at 24 hours, 1 week, and 4 weeks for measurement of the oxidative-stress markers, such as a reduced glutathione (GSH to oxidized glutathione (GSSG ratio (GSH/GSSG, nitrotyrosine levels, and 8-hydroxydeoxyguanosine (8-OHdG levels. The study was stopped at 30% enrollment following publication of the 2010 neonatal resuscitation guidelines. Results: We enrolled 18 patients during the study period. SpO2 increased over time (P<0.0001; however, this increase was not different among the three oxygen groups in the first 10 minutes after birth. FiO2 was significantly higher in the 100% O2 group, despite weaning (P<0.02 to maintain target saturations at 30 minutes of age. The GSH/GSSG ratio was significantly lower in the 100% O2 group at 24 hours than in the other groups (P<0.01. Plasma nitrotyrosine was significantly higher in the 40% and 100% O2 groups over time (P<0.01. Levels of 8-OHdG were significantly higher at 4 weeks compared with at 24 hours, independent of the oxygen group (P<0.0001. Conclusion: In this study, we defined the natural

  19. Managing the Inflammatory Response after Cardiopulmonary Bypass : Review of the Studies in Animal Models

    NARCIS (Netherlands)

    Liguori, Gabriel Romero; Kanas, Alexandre Fligelman; Moreira, Luiz Felipe Pinho

    2014-01-01

    OBJECTIVE: To review studies performed in animal models that evaluated therapeutic interventions to inflammatory response and microcirculatory changes after cardiopulmonary bypass. METHODS: It was used the search strategy ("Cardiopulmonary Bypass" (MeSH)) and ("Microcirculation" (MeSH) or "Inflammat

  20. Gravity and Development of Cardiopulmonary Reflex

    Science.gov (United States)

    Nagaoka, Shunji; Eno, Yuko; Ohira, Yoshinobu

    Cardio-pulmonary reflex, which our cardiac activity is synchronized to the respiration by autonomic nervous system regulation, is called as "respiratory sinus arrhythmia" and commonly found in adult. The physiological function of the espiratory sinus arrhythmia is considered to maximize the gas exchange during respiration cycle. This respiration induced heart rate variability (RHRV) is only found in mammals and avian showing a remarkable postnatal development, whereas no RHRV in aquatic species such as fish or amphibian. To elucidate our hypothesis that gravity exposure may plays a key role in the postnatal development of RHRV as well as its evolutional origin in these ground animals, we have studied effects of hypergravity (2G) on the postnatal development of RHRV using rat. Pregnant Wister rats were kept in centrifugal cages system for 38 days from 6th days of pregnant mother to have neonates until 23 days old. Electrocardiograph was recorded from the neonates in 2 to 23 days old in 2G group with simultaneous control (1G) group. The RHRV analysis was performed by calculating a component of Fourier power spectral coincide with the respiration frequency. In both groups, averaged resting heart rate gradually increase from 2 to 23 days old. When comparing the heart rate between the two groups, the 2G group indicated significantly lower (240± 8 bpm) than 1G control (326±21 bpm, p¡0.001) in 2 days old, where as no significance in 23 days old. The RHRV of 2 days old neonates in both groups indicated very small magnitude but significantly lower in 2G group than 1G control (p¡0.01). The RHRV gradually increase during the first 2 weeks and then rapid increased to reached 45 fold of magnitude in 1G control, whereas 69 fold in 2G group. The results strongly suggested that the postnatal innervation from respiration to cardiovascular centers was gravity dependent.

  1. Hantavirus cardiopulmonary syndrome successfully treated with high-volume hemofiltration

    Science.gov (United States)

    Bugedo, Guillermo; Florez, Jorge; Ferres, Marcela; Roessler, Eric; Bruhn, Alejandro

    2016-01-01

    Hantavirus cardiopulmonary syndrome has a high mortality rate, and early connection to extracorporeal membrane oxygenation has been suggested to improve outcomes. We report the case of a patient with demonstrated Hantavirus cardiopulmonary syndrome and refractory shock who fulfilled the criteria for extracorporeal membrane oxygenation and responded successfully to high volume continuous hemofiltration. The implementation of high volume continuous hemofiltration along with protective ventilation reversed the shock within a few hours and may have prompted recovery. In patients with Hantavirus cardiopulmonary syndrome, a short course of high volume continuous hemofiltration may help differentiate patients who can be treated with conventional intensive care unit management from those who will require more complex therapies, such as extracorporeal membrane oxygenation. PMID:27410413

  2. Three-dimensional Steady State Thermal-hydraulic Analysis of Secondary Side for CPR1000 Steam Generator%CPR1000蒸汽发生器二次侧三维稳态热工水力分析

    Institute of Scientific and Technical Information of China (English)

    莫少嘉; 盛朝阳; 任红兵; 秦加明; 左超平

    2015-01-01

    A three‐dimensional steady state analysis software GENEPI was used to do the thermal‐hydraulic analysis of tube bundle region for secondary side of CPR1000 steam generator .The porous medium model and local pressure‐drop model were used in GENEPI to represent the tubes and pressure‐drop of the complex geometry .The flow and temperature fields of the tube bundle in secondary side were analyzed and the high‐est steam quality in the tube bundle is 0.3 .The kinetic energy of typical tubes was acquired by a computer code as the input for the flow‐induced vibration analysis .The result shows that the flow‐induced vibration in heat transfer tubes is acceptable .At the same time ,the flow and temperature fields near the tube sheet were analyzed and the fouling deposit region was predicted based on such a model and working condition .The result can be used as the input for the design of draining pipe .The calculation results verify the rationality for the design of the CPR1000 steam generator secondary side tube bundle region .%采用三维稳态分析软件GENEPI ,对CPR1000蒸汽发生器二次侧管束区进行了热工水力计算,利用多孔介质及局部阻力系数来表征传热管及各几何部件的复杂结构和压降影响,得到了二次侧管束区流场、温度场等的分布情况。计算结果表明:管束区最大干度为0.3;将典型传热管的动能数据提供给流致振动软件进行计算分析,结果显示在本工况下,传热管的流致振动在可接受范围内;对管板附近的流场及温度场进行分析,预测了此模型及工况下的泥渣沉积区域,为排污管的设计提供了输入数据。计算结果验证了CPR1000蒸汽发生器二次侧管束区设计的合理性。

  3. Surface Transportation: Watercraft

    Science.gov (United States)

    2007-11-02

    Cardiopulmonary resuscitation (CPR). (3) Ensuring the recommended surgical equipment, instruments , and supplies are maintained on board. (4) Remaining...diseases. (6) Remaining familiar with DH MEDICO (Medical advice by radio) procedures. Familiar with emergency station bill procedures. b. Must be...AR 215–1 Morale, Welfare, and Recreation Activities and Nonappropriated Fund Instrumentalities . AR 385–10 The Army Safety Program. AR 500–60 Disaster

  4. Postanoxic coma: prognosis after therapeutic hypothermia

    OpenAIRE

    2012-01-01

    Postanoxic coma, also known as anoxic-ischemic coma, is a state of unconsciousness caused by global anoxia of the brain. The most common cause is primary cardiac arrest followed by successful cardiopulmonary resuscitation (CPR). Other causes include primary respiratory arrest, near-drowning, strangulation, and prolonged severe hypotension. Patients may recover consciousness after variable periods of time, or remain unconscious indefinitely. The main focus of this thesis is on prediction of ou...

  5. 21 CFR 870.4410 - Cardiopulmonary bypass in-line blood gas sensor.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass in-line blood gas sensor... Cardiopulmonary bypass in-line blood gas sensor. (a) Identification. A cardiopulmonary bypass in-line blood gas sensor is a transducer that measures the level of gases in the blood. (b) Classification. Class...

  6. Activation of autophagy improves neuron injury after the restoration of spontaneous circulation from ventricular fibrillation in wistar rats

    Institute of Scientific and Technical Information of China (English)

    曾小云

    2014-01-01

    Objective To investigate the effects of activation of autophagy on cerebral injury after cardiopulmonary resuscitation(CPR)in Wistar rats.Methods At first 36healthy adult male Wistar rats were induced to suffer ventricular fibrillation(VF)by an external transthoracic alternating electricity current shock for 7 minutes and then received CPR.Before VF(0)and at 1 h,2 h,4 h,8 h and 12 hours after the restoration of spontaneous circulation(ROSC)from VF,cerebral cortex were harvested to

  7. Clinician performed resuscitative ultrasonography for the initial evaluation and resuscitation of trauma

    Directory of Open Access Journals (Sweden)

    Gillman Lawrence M

    2009-08-01

    Full Text Available Abstract Background Traumatic injury is a leading cause of morbidity and mortality in developed countries worldwide. Recent studies suggest that many deaths are preventable if injuries are recognized and treated in an expeditious manner – the so called 'golden hour' of trauma. Ultrasound revolutionized the care of the trauma patient with the introduction of the FAST (Focused Assessment with Sonography for Trauma examination; a rapid assessment of the hemodynamically unstable patient to identify the presence of peritoneal and/or pericardial fluid. Since that time the use of ultrasound has expanded to include a rapid assessment of almost every facet of the trauma patient. As a result, ultrasound is not only viewed as a diagnostic test, but actually as an extension of the physical exam. Methods A review of the medical literature was performed and articles pertaining to ultrasound-assisted assessment of the trauma patient were obtained. The literature selected was based on the preference and clinical expertise of authors. Discussion In this review we explore the benefits and pitfalls of applying resuscitative ultrasound to every aspect of the initial assessment of the critically injured trauma patient.

  8. Critical care considerations in the management of the trauma patient following initial resuscitation

    Directory of Open Access Journals (Sweden)

    Shere-Wolfe Roger F

    2012-09-01

    Full Text Available Abstract Background Care of the polytrauma patient does not end in the operating room or resuscitation bay. The patient presenting to the intensive care unit following initial resuscitation and damage control surgery may be far from stable with ongoing hemorrhage, resuscitation needs, and injuries still requiring definitive repair. The intensive care physician must understand the respiratory, cardiovascular, metabolic, and immunologic consequences of trauma resuscitation and massive transfusion in order to evaluate and adjust the ongoing resuscitative needs of the patient and address potential complications. In this review, we address ongoing resuscitation in the intensive care unit along with potential complications in the trauma patient after initial resuscitation. Complications such as abdominal compartment syndrome, transfusion related patterns of acute lung injury and metabolic consequences subsequent to post-trauma resuscitation are presented. Methods A non-systematic literature search was conducted using PubMed and the Cochrane Database of Systematic Reviews up to May 2012. Results and conclusion Polytrauma patients with severe shock from hemorrhage and massive tissue injury present major challenges for management and resuscitation in the intensive care setting. Many of the current recommendations for “damage control resuscitation” including the use of fixed ratios in the treatment of trauma induced coagulopathy remain controversial. A lack of large, randomized, controlled trials leaves most recommendations at the level of consensus, expert opinion. Ongoing trials and improvements in monitoring and resuscitation technologies will further influence how we manage these complex and challenging patients.

  9. Transcatheter aortic valve implantation in a patient with circulatory collapse, using the lucas® chest compression system

    DEFF Research Database (Denmark)

    Jensen, Peter Blom; Andersen, Claus; Nissen, Henrik

    2013-01-01

    We describe a case of Transcatheter Aortic Valve Implantation (TAVI) using the LUCAS® Chest Compression System in an elderly high risk patient with severe aortic stenosis and heart failure. In this case, the patient developed severe aortic regurgitation following predilatation of the native aortic...... or cardiac damage. This case report shows, that it is possible to perform the TAVI procedure under ongoing A-CPR and that A-CPR, judged by invasive blood pressures, was capable of maintaining a satisfactory perfusion pressure even with a damaged aortic valve. © 2012 Wiley Periodicals, Inc....... valve and automated cardiopulmonary resuscitation (A-CPR) was initiated. The procedure was performed under ongoing A-CPR for a total of 28 min. The patient was transferred to the intensive care unit and to a step down unit the following day. At follow-up 30 days later, she showed no signs of neurologic...

  10. Structural and functional basis of transcriptional regulation by TetR family protein CprB from S. coelicolor A3(2).

    Science.gov (United States)

    Bhukya, Hussain; Bhujbalrao, Ruchika; Bitra, Aruna; Anand, Ruchi

    2014-09-01

    Antibiotic production and resistance pathways in Streptomyces are dictated by the interplay of transcriptional regulatory proteins that trigger downstream responses via binding to small diffusible molecules. To decipher the mode of DNA binding and the associated allosteric mechanism in the sub-class of transcription factors that are induced by γ-butyrolactones, we present the crystal structure of CprB in complex with the consensus DNA element to a resolution of 3.25 Å. Binding of the DNA results in the restructuring of the dimeric interface of CprB, inducing a pendulum-like motion of the helix-turn-helix motif that inserts into the major groove. The crystal structure revealed that, CprB is bound to DNA as a dimer of dimers with the mode of binding being analogous to the broad spectrum multidrug transporter protein QacR from the antibiotic resistant strain Staphylococcus aureus. It was demonstrated that the CprB displays a cooperative mode of DNA binding, following a clamp and click model. Experiments performed on a subset of DNA sequences from Streptomyces coelicolor A3(2) suggest that CprB is most likely a pleiotropic regulator. Apart from serving as an autoregulator, it is potentially a part of a network of proteins that modulates the γ-butyrolactone synthesis and antibiotic regulation pathways in S. coelicolor A3(2).

  11. The ebb and flow of fluid (as in resuscitati