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Sample records for cardiopulmonary resuscitation reduce

  1. 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.

  2. 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.

  3. 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...

  4. 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.

  5. 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

  6. 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

  7. 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.

  8. 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

  9. 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...

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. [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.

  17. 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.

  18. 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.

  19. 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

  20. 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...

  1. 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.

  2. 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

  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. [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.

  5. 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...

  6. [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.

  7. 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.

  8. 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

  9. 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

  10. [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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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...

  18. 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

  19. 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.

  20. 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.

  1. 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

  2. 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

  3. 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

  4. 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.

  5. 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

  6. 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.

  7. [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.

  8. 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.

  9. 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...

  10. 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.

  11. 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.

  12. [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.

  13. 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.

  14. 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.

  15. 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...

  16. 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...

  17. 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.

  18. 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

  19. 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.

  20. 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...

  1. 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.

  2. 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.

  3. 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.

  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. 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

  6. 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.

  7. 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.

  8. 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.

  9. 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

  10. 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.

  11. 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.

  12. 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.

  13. [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.

  14. 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...

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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

  20. 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

  1. 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

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

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    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.

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

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    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

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

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    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.

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

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    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.

  6. 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

  7. 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.

  8. 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.

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

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    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.

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

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    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.

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

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    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.

  12. [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

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

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    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.

  14. 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.

  15. 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.

  16. 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

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

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    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.

  18. 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…

  19. 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

  20. 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

  1. 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.

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    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.

  2. 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.

  3. 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

  4. 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....

  5. 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....

  6. 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。

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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

  13. 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.

  14. 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

  15. 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.

  16. 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.

  17. 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.

  18. 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...

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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

  4. 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.

  5. 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.

  6. 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.

  7. 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。

  8. 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

  9. 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....

  10. 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

  11. 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....

  12. 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)

  13. 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

  14. 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.

  15. 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.

  16. 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

  17. 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.

  18. 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

  19. 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

  20. 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

  1. (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.

  2. 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

  3. 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

  4. 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.

  5. 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

  6. 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。

  7. 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...

  8. 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

  9. 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.

  10. 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.

  11. 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

  12. Hypertonic/Hyperoncotic Resuscitation from Shock: Reduced Volume Requirement and Lower Intracranial Pressure

    Science.gov (United States)

    1989-10-01

    Volume 15, No. 4 ABSTRACTS OF PAPERS 433 INTRACRANIAL PRESSURE FOLLOWING RESUSCITATION FROM HEMORRHAGIC SHOCK John H. Whitley, Donald S. Prough, Michael ...SHOCK: COMPARISON OF FLUIDS John M. Whitley, PhD, Michael A. Olympio, MD, Donald S. Prough, MD Department of Anesthesia, Bowman Gray School of Medicine...fluid infused within the range of sodium and colloid concentrations examined in this study. In contrast, Gunnar et al.7’ 2 and Ducey et al.,8

  13. 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

    目的:研究分析专职化院前急救对心肺复苏成功率的影响。方法回顾分析本院2010年1月至2015年4月期间采取院前急救的184例患者临床资料,按照急救管理模式的不同分为两组,将2010年1月至2012年8月在实行专职化院前急救管理的91例患者作为对照组,将2012年9月至2015年4月期间开始实行专职化院前急救管理的93例患者作为观察组,对比研究分析两组医务人员状况、急救出车耗时、达到现场时效及院前应用高级生命支持技术(ACLS)技术情况,并对比两组抢救成功率。结果实行专职化院前急救的观察组CRI耗时显著短于对照组,差异显著有统计学意义(P<0.05);观察组患者通过及时有效的急救处理,其心肺复苏成功率达到17.2%(16例),而对照组患者心肺复苏成功率仅为3.3%(3例),两组对比差异性明显,有统计学意义(P<0.05)。结论院前急救实行专职化管理,可有效提升院前急救效率,增加了心肺复苏成功率。%Objective To study the effect of professional prehospital emergency treatment on the success rate of cardiopulmonary resuscitation. Methods During a retrospective analysis of our hospital in January 2010 2015 April take pre hospital emergency treatment of 184 cases of patients with clinical data, in accordance with the emergency management model is divided to two groups, will be 2010 January to August 2012 before implementing the professional hospital emergency management of 91 patients as the control group. During the period of April 2012 to September 2015 began practicing full-time Institude of emergency management of 93 patients as the observation group and comparison analysis of two group of medical personnel situation, emergency dispatch time, reached the scene of aging, and the hospital before the application of advanced life support technology (ACLS) technology, the success rate of rescue, and compared the difference between

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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...

  19. 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

  20. 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

  1. 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.

  2. 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.

  3. 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...

  4. 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....

  5. 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

  6. 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%;

  7. 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

  8. 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...

  9. 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....

  10. [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...

  11. 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

  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. 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

  14. Reduced fitness and abnormal cardiopulmonary responses to maximal exercise testing in children and young adults with sickle cell anemia.

    Science.gov (United States)

    Liem, Robert I; Reddy, Madhuri; Pelligra, Stephanie A; Savant, Adrienne P; Fernhall, Bo; Rodeghier, Mark; Thompson, Alexis A

    2015-04-01

    Physiologic contributors to reduced exercise capacity in individuals with sickle cell anemia (SCA) are not well understood. The objective of this study was to characterize the cardiopulmonary response to maximal cardiopulmonary exercise testing (CPET) and determine factors associated with reduced exercise capacity among children and young adults with SCA. A cross-sectional cohort of 60 children and young adults (mean 15.1 ± 3.4 years) with hemoglobin SS or S/β(0) thalassemia and 30 matched controls (mean 14.6 ± 3.5 years) without SCA or sickle cell trait underwent maximal CPET by a graded, symptom-limited cycle ergometry protocol with breath-by-breath, gas exchange analysis. Compared to controls without SCA, subjects with SCA demonstrated significantly lower peak VO2 (26.9 ± 6.9 vs. 37.0 ± 9.2 mL/kg/min, P < 0.001). Subjects demonstrated slower oxygen uptake (ΔVO2/ΔWR, 9 ± 2 vs. 12 ± 2 mL/min/watt, P < 0.001) and lower oxygen pulse (ΔVO2/ΔHR, 12 ± 4 vs. 20 ± 7 mL/beat, P < 0.001) as well as reduced oxygen uptake efficiency (ΔVE/ΔVO2, 42 ± 8 vs. 32 ± 5, P < 0.001) and ventilation efficiency (ΔVE/ΔVCO2, 30.3 ± 3.7 vs. 27.3 ± 2.5, P < 0.001) during CPET. Peak VO2 remained significantly lower in subjects with SCA after adjusting for age, sex, body mass index (BMI), and hemoglobin, which were independent predictors of peak VO2 for subjects with SCA. In the largest study to date using maximal CPET in SCA, we demonstrate that children and young adults with SCA have reduced exercise capacity attributable to factors independent of anemia. Complex derangements in gas exchange and oxygen uptake during maximal exercise are common in this population.

  15. 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.

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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

  1. 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...

  2. 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

  3. 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

  4. 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.

  5. 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.

  6. 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.

  7. Resuscitation with Pooled and Pathogen-Reduced Plasma Attenuates the Increase in Brain Water Content following Traumatic Brain Injury and Hemorrhagic Shock in Rats

    DEFF Research Database (Denmark)

    Genét, Gustav Folmer; Bentzer, Peter; Ostrowski, Sisse Rye;

    2017-01-01

    Traumatic brain injury and hemorrhagic shock is associated with blood-brain barrier (BBB) breakdown and edema formation. Recent animal studies have shown that fresh frozen plasma (FFP) resuscitation reduces brain swelling and improves endothelial function compared to isotonic NaCl (NS). The aim o......)-treated plasma attenuates the post-traumatic increase in brain water content, and that this effect may, in part, be explained by a high crystalloid and colloid osmotic pressure in SD-treated plasma.......Traumatic brain injury and hemorrhagic shock is associated with blood-brain barrier (BBB) breakdown and edema formation. Recent animal studies have shown that fresh frozen plasma (FFP) resuscitation reduces brain swelling and improves endothelial function compared to isotonic NaCl (NS). The aim...... of this study was to investigate whether pooled and pathogen-reduced plasma (OctaplasLG(®) [OCTA]; Octapharma, Stockholm, Sweden) was comparable to FFP with regard to effects on brain water content, BBB permeability, and plasma biomarkers of endothelial glycocalyx shedding and cell damage. After fluid...

  8. 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,

  9. 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

  10. 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.

  11. 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

  12. [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.

  13. 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 .

  14. 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

  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. Cardiopulmonary Benefits of Reducing Indoor Particles of Outdoor Origin: a Randomized Double-Blind Crossover Trial of Air Purifiers

    Science.gov (United States)

    Chen, Renjie; Zhao, Ang; Chen, Honglei; Zhao, Zhuohui; Cai, Jing; Wang, Cuicui; Yang, Changyuan; Li, Huichu; Xu, Xiaohui; Ha, Sandie; Li, Tiantian; Kan, Haidong

    2017-01-01

    Background Indoor exposure to fine particulate matter (PM2.5) from outdoor sources is a major health concern, especially in highly polluted developing countries, such as China. Few studies have evaluated the effectiveness of indoor air purification on the improvement of cardiopulmonary health in these areas. Objectives To evaluate whether a short-term indoor air purifier intervention improves cardiopulmonary health. Methods We conducted a randomized double-blind crossover trial among 35 healthy college students in Shanghai, China in 2014. These students lived in dormitories that were randomized into 2 groups and alternated the use of true or sham air purifiers for 48 h with a 2-week washout interval. We measured 14 circulating biomarkers of inflammation, coagulation and vasoconstriction, lung function, blood pressure (BP), and fractional exhaled nitric oxide (FeNO). We applied linear mixed-effect models to evaluate the effect of the intervention on health outcome variables. Results On average, air purification resulted in a 57% reduction in PM2.5 concentration from 96.2 to 41.3 μg/m3 within hours of operation. Air purification was significantly associated with decreases in geometric means of several circulating inflammatory and thrombogenic biomarkers, including 17.5% in monocyte chemoattractant protein-1, 68.1% in interleukin-1β, 32.8% in myeloperoxidase and 64.9% in soluble CD40 ligand. Further, systolic BP, diastolic BP, and FeNO were significantly decreased by 2.7%, 4.8%, and 17.0% in geometric mean, respectively. The impacts on lung function and vasoconstriction biomarkers were beneficial, but not statistically significant. Conclusion This intervention study demonstrated clear cardiopulmonary benefits of indoor air purification among young, healthy adults in a Chinese city with severe ambient particulate air pollution. (Intervention Study on the Health Impact of Air Filters in Chinese Adults; NCT02239744) PMID:26022815

  17. 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。

  18. 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

  19. 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

  20. Survival in a rat model of lethal hemorrhagic shock is prolonged following resuscitation with a small volume of a solution containing a drag-reducing polymer derived from aloe vera.

    Science.gov (United States)

    Macias, Carlos A; Kameneva, Marina V; Tenhunen, Jyrki J; Puyana, Juan-Carlos; Fink, Mitchell P

    2004-08-01

    Drag-reducing polymers (DRP) increase tissue perfusion at constant driving pressure. We sought to evaluate the effects of small-volume resuscitation with a solution containing a DRP in a rat model of hemorrhage. Anesthetized rats were hemorrhaged at a constant rate over 25 min. In protocol A, total blood loss was 2.45 mL/100 g, whereas in protocol B, total blood loss was 3.15 mL/100 g. Five minutes after hemorrhage, the animals were resuscitated with 7 mL/kg of either normal saline (NS) or NS containing 50 microg/mL of an aloe vera-derived DRP. In protocol B, a third group (CON) was not resuscitated. Whole-body O2 consumption (Vo2) and CO2 production (Vco2) were measured using indirect calorimetry. In protocol A, 5/10 rats in the NS group and 8/10 rats in the DRP group survived for 4 h (P = 0.14). Mean arterial pressure was higher in the DRP-treated group than in the NS-treated group 45 min after resuscitation (89 +/- 8 vs. 68 +/- 5 mmHg, respectively; P < 0.05). In protocol B, survival rates over 2 h in the DRP, NS, and CON groups were 5/15, 1/14, and 0/7, respectively (P < 0.05). Compared with NS-treated rats, those resuscitated with DRP achieved a higher peak Vo2 (9.0 +/- 1.0 vs. 6,3+/- 1.0 mL/kg/min) and Vco2 (9.0 +/- 1.1 vs. 6.0 +/- 1.0 mL/kg/min) after resuscitation. We conclude that resuscitation with a small volume of DRP prolongs survival in rats with lethal hemorrhagic shock.

  1. 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

  2. Analysis of Intensity-Modulated Radiation Therapy (IMRT), Proton and 3D Conformal Radiotherapy (3D-CRT) for Reducing Perioperative Cardiopulmonary Complications in Esophageal Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    Ling, Ted C.; Slater, Jerry M.; Nookala, Prashanth; Mifflin, Rachel; Grove, Roger; Ly, Anh M.; Patyal, Baldev; Slater, Jerry D.; Yang, Gary Y., E-mail: gyang@llu.edu [Department of Radiation Medicine, Loma Linda University Medical Center, 11234 Anderson Street, A875, Loma Linda, CA 92354 (United States)

    2014-12-05

    Background. While neoadjuvant concurrent chemoradiotherapy has improved outcomes for esophageal cancer patients, surgical complication rates remain high. The most frequent perioperative complications after trimodality therapy were cardiopulmonary in nature. The radiation modality utilized can be a strong mitigating factor of perioperative complications given the location of the esophagus and its proximity to the heart and lungs. The purpose of this study is to make a dosimetric comparison of Intensity-Modulated Radiation Therapy (IMRT), proton and 3D conformal radiotherapy (3D-CRT) with regard to reducing perioperative cardiopulmonary complications in esophageal cancer patients. Materials. Ten patients with esophageal cancer treated between 2010 and 2013 were evaluated in this study. All patients were simulated with contrast-enhanced CT imaging. Separate treatment plans using proton radiotherapy, IMRT, and 3D-CRT modalities were created for each patient. Dose-volume histograms were calculated and analyzed to compare plans between the three modalities. The organs at risk (OAR) being evaluated in this study are the heart, lungs, and spinal cord. To determine statistical significance, ANOVA and two-tailed paired t-tests were performed for all data parameters. Results. The proton plans showed decreased dose to various volumes of the heart and lungs in comparison to both the IMRT and 3D-CRT plans. There was no difference between the IMRT and 3D-CRT plans in dose delivered to the lung or heart. This finding was seen consistently across the parameters analyzed in this study. Conclusions. In patients receiving radiation therapy for esophageal cancer, proton plans are technically feasible while achieving adequate coverage with lower doses delivered to the lungs and cardiac structures. This may result in decreased cardiopulmonary toxicity and less morbidity to esophageal cancer patients.

  3. 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

  4. 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.

  5. 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

  6. 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

  7. 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

  8. [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.

  9. 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.

  10. 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

  11. 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).

  12. 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...

  13. 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

  14. 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.

  15. 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

  16. 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.

  17. 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...

  18. 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

  19. 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…

  20. 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.

  1. 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

  2. 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.

  3. 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.

  4. 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.

  5. 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...

  6. 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

  7. 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.

  8. Granulocyte colony stimulating factor reduces brain injury in a cardiopulmonary bypass-circulatory arrest model of ischemia in a newborn piglet

    Science.gov (United States)

    Pastuszko, Peter; Schears, Gregory J.; Greeley, William J.; Kubin, Joanna; Wilson, David F.; Pastuszko, Anna

    2014-01-01

    Background Ischemic brain injury continues to be of major concern in patients undergoing cardiopulmonary bypass (CPB) surgery for congenital heart disease. Striatum and hippocampus are particularly vulnerable to injury during these processes. Our hypothesis is that the neuronal injury resulting from CPB and the associated circulatory arrest can be at least partly ameliorated by pre-treatment with granulocyte colony stimulating factor (G-CSF). Material and Methods Fourteen male newborn piglets were assigned to three groups: deep hypothermic circulatory arrest (DHCA), DHCA with G-CSF, and sham-operated. The first two groups were placed on CPB, cooled to 18°C, subjected to 60 min of DHCA, re-warmed and recovered for 8-9 hrs. At the end of experiment, the brains were perfused, fixed and cut into 10 μm transverse sections. Apoptotic cells were visualized by in-situ DNA fragmentation assay (TUNEL), with the density of injured cells expressed as a mean number ± SD per mm2. Results The number of injured cells in the striatum and CA1 and CA3 regions of the hippocampus increased significantly following DHCA. In the striatum, the increase was from 0.46±0.37 to 3.67±1.57 (p=0.002); in the CA1, from 0.11±0.19 to 5.16±1.57 (p=0.001), and in the CA3, from 0.28±0.25 to 2.98±1.82 (p=0.040). Injection of G-CSF prior to bypass significantly reduced the number of injured cells in the striatum and CA1 region, by 51% and 37%, respectively. In the CA3 region, injured cell density did not differ between the G-CSF and control group. Conclusion In a model of hypoxic brain insult associated with CPB, G-CSF significantly reduces neuronal injury in brain regions important for cognitive functions, suggesting it can significantly improve neurological outcomes from procedures requiring DHCA. PMID:25082120

  9. 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

  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. 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

  12. 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.

  13. 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

  14. 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

  15. 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

  16. 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

  17. [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.

  18. 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.

  19. 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

  20. 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...

  1. Mild Hypothermia Combined with Hydrogen Sulfide Treatment During Resuscitation Reduces Hippocampal Neuron Apoptosis Via NR2A, NR2B, and PI3K-Akt Signaling in a Rat Model of Cerebral Ischemia-Reperfusion Injury.

    Science.gov (United States)

    Dai, Hai-Bin; Xu, Miao-Miao; Lv, Jia; Ji, Xiang-Jun; Zhu, Si-Hai; Ma, Ru-Meng; Miao, Xiao-Lei; Duan, Man-Lin

    2016-09-01

    We investigated whether mild hypothermia combined with sodium hydrosulfide treatment during resuscitation improves neuron survival following cerebral ischemia-reperfusion injury beyond that observed for the individual treatments. Male Sprague-Dawley rats were divided into seven groups (n = 20 for each group). All rats underwent Pulsinelli 4-vessel occlusion. Ischemia was induced for 15 min using ligatures around the common carotid arteries, except for the sham group. Immediately after initiating reperfusion, the mild hypothermia (MH), sodium hydrosulfide (NaHS), hydroxylamine (HA), MH + NaHS, MH + HA, and ischemia-reperfusion (I/R) control groups received an intraperitoneal injection of saline, sodium hydrosulfide, hydroxylamine, sodium hydrosulfide, hydroxylamine, and saline, respectively, and mild hypothermia (32 to 33 °C) was induced in the MH, MH + NaHS, and MH + HA groups for 6 h. The levels of NR2A, NR2B, p-Akt, and p-Gsk-3β in the hippocampus of the MH, NaHS, and MH + NaHS groups were higher than those in the I/R control group, with the highest levels observed in the MH + NaHS group (P sodium hydrosulfide treatment for resuscitation following ischemia-reperfusion injury was more beneficial for reducing hippocampal apoptosis and pathology than that of mild hypothermia or hydrogen sulfide treatment alone.

  2. 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.

  3. 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.

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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.

  9. 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.

  10. 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...

  11. 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...

  12. 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

  13. 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)

  14. 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

  15. 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

  16. 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.

  17. The evidence for small-volume resuscitation with hyperoncotic albumin in critical illness

    OpenAIRE

    Myburgh, John A

    2008-01-01

    Small-volume resuscitation of critically ill patients with hyperoncotic albumin offers a number of theoretical advantages, such as increasing intravascular volume in excess of the volume of fluid administered and reducing interstitial edema. Whilst iso-oncotic albumin has been shown to be equi-effective to isotonic saline for the resuscitation of critically ill patients without associated traumatic brain injury, the efficacy of hyperoncotic albumin for resuscitation has not been evaluated in ...

  18. 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

  19. 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.

  20. 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....

  1. 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...

  2. 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.

  3. 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.

  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

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    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. 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

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    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.

  6. Cardiopulmonary bypass in pregnancy

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    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.

  7. 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.

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

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

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    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.

  10. [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.

  11. Early Management and Fluid Resuscitation

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    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

  12. Resuscitating the Baby after Shoulder Dystocia

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    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.

  13. [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.

  14. Hypothermia and room air resuscitation in NT2-N neurons, immature rats and newborn pigs

    OpenAIRE

    2011-01-01

    Perinatal asphyxia remains one of the major causes of perinatal mortality and morbidity worldwide. Mild therapeutic hypothermia reduces brain injury after perinatal asphyxia. There is an ongoing search for strategies to further improve outcome, including best practice resuscitation and interventions that can be used in combination with hypothermia. The use of supplemental oxygen during resuscitation causes a number of harmful effects including increased cerebral injury. It is not known whethe...

  15. Impact of hemoglobin nitrite to nitric oxide reductase on blood transfusion for resuscitation from hemorrhagic shock

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    Chad Brouse

    2015-01-01

    Full Text Available Background: Transfusion of blood remains the gold standard for fluid resuscitation from hemorrhagic shock. Hemoglobin (Hb within the red blood cell transports oxygen and modulates nitric oxide (NO through NO scavenging and nitrite reductase. Aims: This study was designed to examine the effects of incorporating a novel NO modulator, RRx-001, on systemic and microvascular hemodynamic response after blood transfusion for resuscitation from hemorrhagic shock in a hamster window chamber model. In addition, to RRx-001 the role of low dose of nitrite (1 × 10−9 moles per animal supplementation after resuscitation was studied. Materials and Methods: Severe hemorrhage was induced by arterial controlled bleeding of 50% of the blood volume (BV and the hypovolemic state was maintained for 1 h. The animals received volume resuscitation by an infusion of 25% of BV using fresh blood alone or with added nitrite, or fresh blood treated with RRx-001 (140 mg/kg or RRx-001 (140 mg/kg with added nitrite. Systemic and microvascular hemodynamics were followed at baseline and at different time points during the entire study. Tissue apoptosis and necrosis were measured 8 h after resuscitation to correlate hemodynamic changes with tissue viability. Results: Compared to resuscitation with blood alone, blood treated with RRx-001 decreased vascular resistance, increased blood flow and functional capillary density immediately after resuscitation and preserved tissue viability. Furthermore, in RRx-001 treated animals, both mean arterial pressure (MAP and met Hb were maintained within normal levels after resuscitation (MAP >90 mmHg and metHb <2%. The addition of nitrite to RRx-001 did not significantly improve the effects of RRx-001, as it increased methemoglobinemia and lower MAP. Conclusion: RRx-001 alone enhanced perfusion and reduced tissue damage as compared to blood; it may serve as an adjunct therapy to the current gold standard treatment for resuscitation from

  16. 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

  17. Oxygen resuscitation and oxidative-stress biomarkers in premature infants

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    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

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

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    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

  19. 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…

  20. Neonatal resuscitation technique to reduce neonatal asphyxia rate and mortality rate in China:a Meta-analysis%复苏技术降低我国新生儿窒息发生率和死亡率的 Meta分析

    Institute of Scientific and Technical Information of China (English)

    李鸿斌; 顾建明; 冯海娟; 沈莉

    2015-01-01

    目的:评价新生儿复苏技术对我国新生儿窒息发生率和死亡率下降的效果。方法检索万方数据库、知网数据库资料,收集有关新生儿复苏项目现状与效果的相关文献,并根据纳入标准及排除标准筛选文献,采用非随机前后对照试验的二分类数据Meta分析法判断复苏实施效果。结果最终纳入文献3篇。 Meta分析结果显示,项目地区推广应用新生儿复苏技术促进了新生儿窒息发生率和死亡率的下降,新生儿窒息发生率降低46%,RR=0.54,95%CI:0.33~0.91,P=0.02;新生儿窒息死亡率降低45%,RR=0.55,95%CI:0.35~0.86,P=0.009。结论新生儿复苏技术有助于降低新生儿窒息发生率和死亡率,建议向农村、基层医院普及推广。%Objective To evaluate the effect of neonatal resuscitation technique on reducing the neonatal asphyxia rate and mortality in China.Methods Wanfang data and CNKI-CAJD were retrieved to collect the literatures of neonatal resuscitation, and they were screened according to inclusion criteria and exclusion criteria.Meta-analysis of two-category data of non-randomized control study was conducted to evaluate the effect of neonatal resuscitation technique.Results Finally three articles were recruited.Meta-analysis showed that neonatal resuscitation technique applied in program areas reduced the neonatal asphyxia rate and mortality.The neonatal asphyxia rate decreased by 46%(RR=0.54,95%CI:0.33-0.91,P=0.02), and the mortality rate decreased by 45% (RR=0.55,95%CI:0.35-0.86, P=0.009) .Conclusion Neonatal resuscitation technique helps to reduce neonatal asphyxia rate and mortality, so it is suggested to be promoted in countryside and basic-level hospitals.

  1. Hypertonic saline resuscitation maintains a more balanced profile of T-lymphocyte subpopulations in a rat model of hemorrhagic shock

    Institute of Scientific and Technical Information of China (English)

    LU Yuan-qiang; CAI Xiu-jun; GU Lin-hui; MU Han-zhou; HUANG Wei-dong

    2007-01-01

    Objective: To investigate the potential and early effect of hypertonic saline resuscitation on T-lymphocyte subpopulations in rats with hemorrhagic shock. Methods: A model of rat with severe hemorrhagic shock was established in 18 Sprague-Dawley (SD) rats. The rats were randomly divided into Sham group, HTS group (hypertonic saline resuscitation group)and NS group (normal saline resuscitation group). Each group contained 6 rats. The CD4+ and CD8+ subpopulations of T-lymphocytes in peripheral blood were detected respectively before shock and after resuscitation by double antibody labelling and flow cytometry. Results: In the early stage after hemorrhagic shock, fluid resuscitation and emergency treatment, the CD4+ lymphocytes of peripheral blood in HTS and NS groups markedly increased. Small volume resuscitation with HTS also induced peripheral CD8+ lymphocytes to a certain extent, whereas NS resuscitation showed no effect in this respect. Consequently,compared with Sham and HTS groups, CD4+/CD8+ ratio of peripheral blood in NS group was obviously increased, and showed statistically differences. Conclusion: In this model of rat with severe hemorrhagic shock, small volume resuscitation with HTS is more effective than NS in reducing immunologic disorders and promoting a more balanced profile of T-lymphocyte subpopulations regulating network.

  2. SB203580 reduces proinflammatory cytokine production in rats after cardiopulmonary bypass%SB203580减轻体外循环肺组织炎症介质产生的实验研究

    Institute of Scientific and Technical Information of China (English)

    董啸; 徐建军; 何雄

    2009-01-01

    目的 研究体外循环肺组织中P38丝裂原活化蛋白激酶(P38 MAPK)的变化对肺组织炎症反应的作用及其机制.方法 54只SD大鼠随机分为3组:全麻开胸组(S组)、体外循环组(CPB组)、体外循环+SB203580组(SB组).不同时间段处死动物,留取标本,Western blotting检测肺组织中P38 MAPK、磷酸化P38 MAPK.EMSA检测核因子(NF)-κB的DNA结合活性变化,ELIASA分别检测TNF-α和IL-1β产量.结果 CPB组磷酸化P38MAPK较S组增加.NF-κB活性水平也较S组明显增加,肺组织中TNF-α和IL-1β产量增加.SB203580减轻了肺组织中磷酸化P38MAPK活性水平,减少了肺组织中炎症闪子的产生.结论 (1)P38MAPK通过影响NF-κB的激活而参与体外循环术后肺组织炎症因子的产生;(2)SB203580通过阻断P38MAPK的激活而减轻体外循环术后肺炎症因子的产生.%Objective To examine the changes in P38MAPK during and after cardiopulmonary bypass (CPB) and the effect of SB203580, a specific P38MAPK inhibitor, on CPB-induced pulmonary inflammatory response. Metholds Fifty-four SD rats were randomized into 3 groups (each=18), namely sham CPB group, CPB group, and SB203580 group in which rats underwent CPB with SB203580 pretreatment. The lungs were excised immediately after the rats were sacrificed at scheduled time points and p38, nuclear factor-κB (NF-ΚB), tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were detected. Results The activities of P38 MAPK and NF-ΚB were significantly increased in CPB group as compared with those in sham CPB group. CPB resulted in increased TNF-α and IL-1β production in the lung tissues. Administration of SB203580 prevented up-regulation of lung phosphorylated P38 MAPK, and decreased proinflammatory cytokine productions in the lung tissues. Conclusion P38 MAPK is activated in the lung tissue during and after CPB to affect the activation of NF-κB in the lung; SB203580 selectively inhibits P38 MAPK activation to reduce

  3. The evidence for small-volume resuscitation with hyperoncotic albumin in critical illness.

    Science.gov (United States)

    Myburgh, John A

    2008-01-01

    Small-volume resuscitation of critically ill patients with hyperoncotic albumin offers a number of theoretical advantages, such as increasing intravascular volume in excess of the volume of fluid administered and reducing interstitial edema. Whilst iso-oncotic albumin has been shown to be equi-effective to isotonic saline for the resuscitation of critically ill patients without associated traumatic brain injury, the efficacy of hyperoncotic albumin for resuscitation has not been evaluated in large-scale randomized-controlled trials. Overall, the evidence for resuscitation with hyper-oncotic albumin is limited by studies of poor methodological quality with heterogenous study populations and control regimens. There is marginal qualitative evidence of improvements in surrogate outcomes in disparate patient populations, but no evidence of any survival benefit associated with resuscitation with hyperoncotic albumin. Given the lack of evidence and clinical uncertainty about the efficacy of hyperoncotic albumin, a large-scale randomized-controlled trial is required to determine its role in the acute resuscitation of hypovolemic or hypoalbuminemic critically ill patients.

  4. Resuscitation with hydroxyethyl starch 130/0.4 attenuates intestinal injury in a rabbit model of sepsis

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    Wei-Hua Lu

    2015-01-01

    Conclusions: Fluid resuscitation with 6% HES 130/0.4 protects against intestinal mucosal barrier dysfunction in rabbits with sepsis, possibly via mechanisms associated with improving intestinal oxygen metabolism and reducing the release of inflammatory mediators.

  5. 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.

  6. 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.

  7. 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.

  8. [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.

  9. 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....

  10. 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.

  11. 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.

  12. 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...

  13. 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

  14. 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...

  15. 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

  16. 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 ...

  17. Impact of a nationwide training program for neonatal resuscitation in China

    Institute of Scientific and Technical Information of China (English)

    XU Tao; MA Yi; William Keenan; Susan Niermeyer; WANG Hui-shan; YE Hong-mao; YU Ren-jie; HUANG Xing-hua; WANG Dan-hua; Wang Li-xin; FENG Qi; GONG Li-min

    2012-01-01

    Background Seventeen million births occur in China each year.Neonatal mortality is the leading cause of under 5-year-old child deaths,and intrapartum-related injury accounts for much of mental retardation in young children.The Chinese Ministry of Health sought to improve infant and child survival through a nationwide initiative to have at least one person trained in neonatal resuscitation at every birth.The aim of the current study was to evaluate the impact of China Neonatal Resuscitation Program (NRP) on policy and infrastructure changes and its effectiveness in decreasing the incidence of mortality among newborn infants.Methods The Chinese NRP incorporated policy change,professional education,and creation of a sustainable health system infrastructure for resuscitation.Multidisciplinary teams from all 31 provinces and municipal states disseminated NRP in a train-the-trainer cascade.The intervention targeted 20 provinces with high neonatal mortality and programs to reduce maternal mortality.Program evaluation data came from 322 representative hospitals in those provinces.Results Changes in policy permitted midwives to initiate resuscitation and required resuscitation training for licensure.From 2004 through 2009 more than 110659 professionals received NRP training in the 20 target provinces,with 94% of delivery facilities and 99% of counties reached.Intrapartum-related deaths in the delivery room decreased from 7.5 to 3.4per 10000 from 2003 to 2008,and the incidence of Apgar ≤7 at 1 minute decreased from 6.3% to 2.9%.Conclusions The Chinese NRP achieved policy changes promoting resuscitation,trained large numbers of professionals,and contributed to reduction in delivery room mortality.Improved adherence to the resuscitation algorithm,extension of training to the township level,and coverage of births now occurring outside health facilities can further increase the number of lives saved.

  18. Filtration of activated granulocytes during cardiopulmonary bypass surgery : A morphologic and immunologic study to characterize the trapped leukocytes

    NARCIS (Netherlands)

    Smit, JJJ; de Vries, AJ; Gu, YJ; van Oeveren, W

    2000-01-01

    Cardiopulmonary bypass surgery induces an inflammatory reaction among others by activation of granulocytes. Leukocyte filtration has been shown to reduce the postoperative morbidity mediated by activated granulocytes. However, little is known about the mechanism of filter-leukocyte interaction, This

  19. 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.

  20. Cardiopulmonary Exercise Capacity and Preoperative Markers of Inflammation

    Directory of Open Access Journals (Sweden)

    Pervez Sultan

    2014-01-01

    Full Text Available Explanatory mechanisms for the association between poor exercise capacity and infections following surgery are underexplored. We hypothesized that aerobic fitness—assessed by cardiopulmonary exercise testing (CPET—would be associated with circulating inflammatory markers, as quantified by the neutrophil-lymphocyte ratio (NLR and monocyte subsets. The association between cardiopulmonary reserve and inflammation was tested by multivariable regression analysis with covariates including anaerobic threshold (AT and malignancy. In a first cohort of 240 colorectal patients, AT was identified as the sole factor associated with higher NLR (P=0.03 and absolute and relative lymphopenia (P=0.01. Preoperative leukocyte subsets and monocyte CD14+ expression (downregulated by endotoxin and indicative of chronic inflammation were also assessed in two further cohorts of age-matched elective gastrointestinal and orthopaedic surgical patients. Monocyte CD14+ expression was lower in gastrointestinal patients (n=43 compared to age-matched orthopaedic patients (n=31. The circulating CD14+CD16− monocyte subset was reduced in patients with low cardiopulmonary reserve. Poor exercise capacity in patients without a diagnosis of heart failure is independently associated with markers of inflammation. These observations suggest that preoperative inflammation associated with impaired cardiorespiratory performance may contribute to the pathophysiology of postoperative outcome.

  1. Dormant cells of Staphylococcus aureus are resuscitated by spent culture supernatant.

    Directory of Open Access Journals (Sweden)

    Ben Pascoe

    Full Text Available We describe the first in vitro model of dormancy in Staphylococcus aureus, showing that cells are generated which can be resuscitated by addition of spent medium supernatant taken from cultures of the same organism. Over 30 days, culturable counts in dormant cultures of S. aureus SH1000 fell from 10(6-10(7 cfu/ml to 600-fold increase in bacterial growth. Resuscitation was a specific effect, greatly reduced by boiling or addition of trypsin to the spent supernatant. Supernatant also effected a reduction in lag phase of dormant cultures. SEM demonstrated the presence of small coccoid cells in dormant cultures. The results are similar to those seen with resuscitation promoting factors (Rpfs in actinobacteria. This is the first time resuscitation has been demonstrated in Staphylococcus aureus, which is an important human pathogen. A better understanding of control and reactivation of dormant cells could lead to major improvements in managing staphylococcal infections; resuscitation could be an important step in restoring susceptibility to antibiotic treatment.

  2. 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

  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. 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.

  6. 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.

  7. 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

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. THE EFFECT OF ANISODAMINE ON CEREBRAL RESUSCITATION OF RATS IN ACUTE CEREBRAL ISCHEMIA FROM CARDIAC ARREST

    Institute of Scientific and Technical Information of China (English)

    彭新琦; 曹苏谊; 可君

    1995-01-01

    In order to investigate the mechanisms of acute cerebral ischemia,and to look for effective drugs on cerebral resuscitation,we made a model of acute complete global brain ischemia,reperfusion and resuscita-tion on rats according to Garavilla's method.Our results showed that the event of cerebral ischemia and reperfusion injury could result in the in-crease of total brain calcium content,and anisodamine has the same reducing brain calcium contents as dil-tiazem's,while improving neurological outcome and alleviating injury to neurons.

  13. 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.

  14. 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

  15. 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.

  16. 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

  17. Closed-Loop Resuscitation of Hemorrhagic Shock: Novel Solutions Infused to Hypotensive and Normotensive Endpoints

    Science.gov (United States)

    2007-06-29

    C infusion reduces fluid requirements in the resuscitation of bum-injured sheep. Shock 24(2):139-144, 2005. 8. Miller L, Kramer GC, Bolleter S...beta-agonists and beta-antagonists. Paper presented at: Society of Cardiovascular Anesthesiologists 26th Annual Meeting and Workshops; April 24-28

  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. "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.

  1. 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...

  2. [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...

  3. 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

  4. 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

  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. Efficiency and safety of leukocyte filtration during cardiopulmonary bypass for cardiac surgery

    NARCIS (Netherlands)

    Smit, JJJ; de Vries, AJ; Gu, YJ; van Oeveren, W

    1999-01-01

    Background. Leukocyte filtration of systemic blood during cardiopulmonary bypass surgery to reduce post-operative morbidity has not yet been established because of the enormous leukocyte release from the third space. This study was designed to examine the efficiency and safety of leukocyte filtratio

  7. The impact of heparin-coated circuits on hemodynamics during and after cardiopulmonary bypass

    NARCIS (Netherlands)

    de Vroege, R; Huybregts, R; van Oeveren, W; van Klarenbosch, J; Linley, G; Mutlu, J; Jansen, E; Hack, E; Eijsman, L; Wildevuur, C

    2005-01-01

    This study was performed to investigate if heparin-coated extracorporeal circuits can reduce the systemic inflammatory reaction with the subsequent release of vasoactive substances during and after cardiopulmonary bypass. Fifty-one patients scheduled for coronary artery bypass grafting were perfused

  8. 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...

  9. 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

  10. Acute Ethanol Gavage Attenuates Hemorrhage/Resuscitation-Induced Hepatic Oxidative Stress in Rats

    Directory of Open Access Journals (Sweden)

    B. Relja

    2012-01-01

    Full Text Available Acute ethanol intoxication increases the production of reactive oxygen species (ROS. Hemorrhagic shock with subsequent resuscitation (H/R also induces ROS resulting in cellular and hepatic damage in vivo. We examined the role of acute ethanol intoxication upon oxidative stress and subsequent hepatic cell death after H/R. 14 h before H/R, rats were gavaged with single dose of ethanol or saline (5 g/kg, EtOH and ctrl; H/R_EtOH or H/R_ctrl, resp.. Then, rats were hemorrhaged to a mean arterial blood pressure of 30±2 mmHg for 60 min and resuscitated. Two control groups underwent surgical procedures without H/R (sham_ctrl and sham_EtOH, resp.. Liver tissues were harvested at 2, 24, and 72 h after resuscitation. EtOH-gavage induced histological picture of acute fatty liver. Hepatic oxidative (4-hydroxynonenal, 4-HNE and nitrosative (3-nitrotyrosine, 3-NT stress were significantly reduced in EtOH-gavaged rats compared to controls after H/R. Proapoptotic caspase-8 and Bax expressions were markedly diminished in EtOH-gavaged animals compared with controls 2 h after resuscitation. EtOH-gavage increased antiapoptotic Bcl-2 gene expression compared with controls 2 h after resuscitation. iNOS protein expression increased following H/R but was attenuated in EtOH-gavaged animals after H/R. Taken together, the data suggest that acute EtOH-gavage may attenuate H/R-induced oxidative stress thereby reducing cellular injury in rat liver.

  11. TISSUE-TYPE PLASMINOGEN-ACTIVATOR AND FIBRIN MONOMERS SYNERGISTICALLY CAUSE PLATELET DYSFUNCTION DURING RETRANSFUSION OF SHED BLOOD AFTER CARDIOPULMONARY BYPASS

    NARCIS (Netherlands)

    DEHAAN, J; SCHONBERGER, J; HAAN, J; VANOEVEREN, W; EIJGELAAR, A

    1993-01-01

    Reduced hemostasis and bleeding tendency after cardiopulmonary bypass results from platelet dysfunction induced by the bypass procedure. The causes of this acquired platelet dysfunction are still subject to discussion, although, recently, greater emphasis has been placed on an overstimulated fibrino

  12. Effect of hypertonic saline resuscitation on heme oxygenase-1 mRNA expression and apoptosis of the intestinal mucosa in a rat model of hemorrhagic shock

    Institute of Scientific and Technical Information of China (English)

    LU Yuan-qiang; GU Lin-hui; HUANG Wei-dong; MOU Han-zhou

    2010-01-01

    Background Massive blood loss due to trauma is the leading cause of death in trauma patients and military combatants. The fluid category of resuscitation for hypotensive trauma patients is open to debate. This study was conducted to investigate the early effects of hypertonic and isotonic saline solutions on heme oxygenase-1 (HO-1) mRNA expression and apoptosis in the intestinal mucosa of rats with hemorrhagic shock.Methods A model of severe hemorrhagic shock was established in 21 Sprague-Dawley rats. The rats were randomly divided into sham, normal saline resuscitation (NS), and hypertonic saline resuscitation (HTS) groups, with 7 in each group. We assessed and compared the HO-1 mRNA expression and apoptosis in the small intestinal mucosa of rats after hemorrhagic shock and resuscitation using the SYBR Green I fluorescence quantitative reverse transcriptase polymerase chain reaction, fluorescein-iso-thiocyanate-annexin V/propidium iodide double staining, and flow cytometry.Results In the early stage of hemorrhagic shock and resuscitation, marked apoptosis occurred in the small intestinal mucosa from both the NS and HTS groups. The apoptotic rate in the NS group was higher than that in the HTS group (P <0.01). Among the three groups, HO-1 mRNA mucosa from the HTS group had the highest level of expression; however, the differences were not significant. There was a significant negative correlation between HO-1 mRNA expression and apoptosis in the small intestinal mucosa from the NS and HTS groups after hemorrhagic shock and resuscitation.Conclusions In this rat model of severe hemorrhagic shock, HTS resuscitation with a small volume is more effective than NS resuscitation in reducing apoptosis of the intestinal mucosa. Further, HO-1 mRNA over-expression in the intestinal mucosa may be one of the molecular mechanisms of HTS in the resuscitation of hemorrhagic shock.

  13. Hypothermia and normothermia effects on mortality rate of cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Ali Rahdari

    2015-12-01

    Full Text Available Introduction: Cardiopulmonary bypass is associated with higher risk of mortality and morbidity, thus it should be investigated regarding the major risk factors. Temperature management have a significant role in postoperative cerebral and neurological complications; however the optimum temperature during cardiopulmonary surgery is not certainly detected. This systematic review has investigated the differences between hypothermia and normothermia regarding postoperative mortality. Method: PubMed was searched for the relevant articles. Only English language articles were included with no time limitation. Data regarding in-hospital patient deaths provided in each article mostly within 30 days after the surgery, were extracted and compared based on relative risk reduction (RRR, absolute risk reduction (ARR, and number needed to treat (NNT.Result: Totally, 28 articles were retrieved and extracted. The mortality rate was zero in hypothermic and normotehrmic groups of 8/28 included studies, thus the RRR, ARR, and NNT could not be calculated. There were no significant differences between investigated groups of each included studies regarding the patients’ age, gender, and preoperative conditions.Conclusions: No significant difference was obtained between two studied groups. Similar prevalence of death observed between hypothermic and normothermic groups might be due to the sample size of studies, or the subsequent cares performed in intensive care units that assist to reduce the postoperative mortality rate. According to the obtained results, both of these procedures might be similarly safe regarding mortality rate.

  14. 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

  15. 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

  16. 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.

  17. 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.

  18. Carbachol promotes gastrointestinal function during oral resuscitation of burn shock

    Institute of Scientific and Technical Information of China (English)

    Sen Hu; Jin-Wei Che; Yi-Jun Tian; Zhi-Yong Sheng

    2011-01-01

    AIM: To investigate the effect of carbachol on gastrointestinal function in a dog model of oral resuscitation for burn shock.METHODS: Twenty Beagle dogs with intubation of the carotid artery, jugular vein and jejunum for 24 h were subjected to 35% total body surface area fullthicknessburns, and were divided into three groups:no fluid resuscitation (NR, n = 10), in which animals did not receive fluid by any means in the first 24 h postburn;oral fluid resuscitation (OR, n = 8), in which dogs were gavaged with glucose-electrolyte solution (GES)with volume and rate consistent with the Parkland formula; and oral fluid with carbachol group (OR/CAR,n = 8), in which dogs were gavaged with GES containing carbachol (20 μg/kg), with the same volume and rate as the OR group. Twenty-four hours after burns, all animals were given intravenous fluid replacement, and 72 h after injury, they received nutritional support. Hemodynamic and gastrointestinal parameters were measured serially with animals in conscious and cooperative state.RESULTS: The mean arterial pressure, cardiac output and plasma volume dropped markedly, and gastrointestinal tissue perfusion was reduced obviouslyafter the burn injury in all the three groups. Hemodynamic parameters and gastrointestinal tissue perfusion in the OR and OR/CAR groupswere promoted to pre-injury level at 48 and 72 h,respectively, while hemodynamic parameters in the NR group did not return to pre-injury level till 72 h,and gastrointestinal tissue perfusion remained lower than pre-injury level until 120 h post-burn. CO2 of the gastric mucosa and intestinal mucosa blood flow of OR/CAR groups were 56.4 ± 4.7 mmHg and 157.7 ± 17.7 blood perfusion units (BPU) at 24 h postburn,respectively, which were significantly superior to those in the OR group (65.8 ± 5.8 mmHg and 127.7 ± 11.9 BPU, respectively, all P < 0.05). Gastricemptying and intestinal absorption rates of GES were significantly reduced to the lowest level (52.8% and23.7% of pre

  19. [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.

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. 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...

  5. 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.

  6. Fresh-frozen plasma resuscitation after traumatic brain injury and shock attenuates extracellular nucleosome levels and deoxyribonuclease 1 depletion

    DEFF Research Database (Denmark)

    Sillesen, Martin; Jin, Guang; Oklu, Rahmi;

    2013-01-01

    Traumatic brain injury and shock are among the leading causes of trauma-related mortality. We have previously shown that fresh-frozen plasma (FFP) resuscitation reduces the size of brain lesion and associated swelling compared with crystalloids. We hypothesized that this effect would be associated...

  7. 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…

  8. 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.

  9. Conventional hemofiltration during cardiopulmonary bypass increases the serum lactate level in adult cardiac surgery

    Directory of Open Access Journals (Sweden)

    Rabie Soliman

    2016-01-01

    Full Text Available Objective: To evaluate the effect of hemofiltration during cardiopulmonary bypass on lactate level in adult patients who underwent cardiac surgery. Design: An observational study. Setting: Prince Sultan cardiac center, Riyadh, Saudi Arabia. Participants: The study included 283 patients classified into two groups: Hemofiltration group (n=138, hemofiltration was done during CPB. Control group (n = 145, patients without hemofiltration. Interventions: Hemofiltration during cardiopulmonary bypass. Measurements and Main Results: Monitors included hematocrit, lactate levels, mixed venous oxygen saturation, amount of fluid removal during hemofiltration and urine output. The lactate elevated in group H than group C (P < 0.05, and the PH showed metabolic acidosis in group H (P < 0.05. The mixed venous oxygen saturation decreased in group H than group C (P < 0.05. The number of transfused packed red blood cells was lower in group H than group C (P < 0.05. The hematocrit was higher in group H than group C (P < 0.05. The urine output was lower in group H than group C (P < 0.05. Conclusions: Hemofiltration during cardiopulmonary bypass leads to hemoconcentration, elevated lactate level and increased inotropic support. There are some recommendations for hemofiltration: First; Hemofiltration should be limited for patients with impaired renal function, positive fluid balance, reduced response to diuretics or prolonged bypass time more than 2 hours. Second; Minimal amount of fluids should be administered to maintain adequate cardiac output and reduction of priming volumes is preferable to maintain controlled hemodilution. Third; it should be done before weaning of or after cardiopulmonary bypass and not during the whole time of cardiopulmonary bypass.

  10. 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

  11. 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

  12. 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

  13. 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.

  14. 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.

  15. 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...

  16. Interleukin-27 as a Novel Biomarker for Early Cardiopulmonary Failure in Enterovirus 71-Infected Children with Central Nervous System Involvement

    Science.gov (United States)

    Huang, Mingyuan; Du, Wenjing; Liu, Jun; Zhang, Haiyang; Cao, Longbin; Yang, Weiqing; Zhang, Hui; Wang, Zhiyong; Wei, Pei; Wu, Weiquan; Huang, Zhulin; Fang, Ying; Lin, Qiling; Qin, Xingwen; Zhang, Zhizhong; Zhou, Keyuan

    2016-01-01

    Enterovirus 71 (EV71) is a major pathogen for severe hand, foot, and mouth disease (HFMD), which leads to severe neurological complications and has high morbidity and mortality. Reliable biomarker for the prediction of deterioration in EV71-infected children with central nervous system (CNS) involvement may reduce the cardiopulmonary failure and mortality. Here, we found that serum IL-27 levels were significantly higher in stage III EV71-infected HFMD patients with early cardiopulmonary failure and strong correlation with CRP levels. IL27p28 polymorphisms (rs153109, rs17855750, and rs181206) did not influence IL-27 production, and these three SNPs were not associated with EV71 infection risk and clinical stage. IL-27 can be used as an prediction indicator for early cardiopulmonary failure in EV71-infected children with CNS involvement. PMID:27403033

  17. Trauma hemostasis and oxygenation research position paper on remote damage control resuscitation: definitions, current practice, and knowledge gaps.

    Science.gov (United States)

    Jenkins, Donald H; Rappold, Joseph F; Badloe, John F; Berséus, Olle; Blackbourne, Lorne; Brohi, Karim H; Butler, Frank K; Cap, Andrew P; Cohen, Mitchell Jay; Davenport, Ross; DePasquale, Marc; Doughty, Heidi; Glassberg, Elon; Hervig, Tor; Hooper, Timothy J; Kozar, Rosemary; Maegele, Marc; Moore, Ernest E; Murdock, Alan; Ness, Paul M; Pati, Shibani; Rasmussen, Todd; Sailliol, Anne; Schreiber, Martin A; Sunde, Geir Arne; van de Watering, Leo M G; Ward, Kevin R; Weiskopf, Richard B; White, Nathan J; Strandenes, Geir; Spinella, Philip C

    2014-05-01

    The Trauma Hemostasis and Oxygenation Research Network held its third annual Remote Damage Control Resuscitation Symposium in June 2013 in Bergen, Norway. The Trauma Hemostasis and Oxygenation Research Network is a multidisciplinary group of investigators with a common interest in improving outcomes and safety in patients with severe traumatic injury. The network's mission is to reduce the risk of morbidity and mortality from traumatic hemorrhagic shock, in the prehospital phase of resuscitation through research, education, and training. The concept of remote damage control resuscitation is in its infancy, and there is a significant amount of work that needs to be done to improve outcomes for patients with life-threatening bleeding secondary to injury. The prehospital phase of resuscitation is critical in these patients. If shock and coagulopathy can be rapidly identified and minimized before hospital admission, this will very likely reduce morbidity and mortality. This position statement begins to standardize the terms used, provides an acceptable range of therapeutic options, and identifies the major knowledge gaps in the field.

  18. 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.

  19. 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...

  20. 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…

  1. Fast resuscitation and care of the burn patients by telemedicine: A review

    Directory of Open Access Journals (Sweden)

    Sima Ajami

    2014-01-01

    Full Text Available Background: In Iran, burns are the second most common cause of death, after traffic accidents in individuals under the age of 15 years. Many burned patients die or suffer injury due to lack of immediate care, so we need to use an alternative resuscitations to cure them immediately. Telemedicine describes the use of medical information exchanged from one site to another via electronic communications to improve patients′ health status and care. The aim of this study was to express the advantages of Telemedicine to resuscitate and care burn patients. Materials and Methods: This study was a narrative review. The literature was searched on fast resuscitation and care of the patients′ burn by telemedicine with the help of libraries, databases, and also searches engines available at Google, Google scholar, books and conference proceedings. In our searches, we employed the following keywords and their combinations: Telemedicine, Telecare, Burn, Burn patient, Air transport, Triage and Health Information Management in the searching areas of titles, keywords, abstracts and full texts. Results: In this study, more than 78 articles and reports were collected and 30 of them were selected based on their relevancy. Conclusion: Acute evaluation of burn patients can be performed by the telemedicine and it plays an important role in improving access to the required expertise, and raises physician confidence in treating burn patients. This can reduce under-triage or over-triage for air transport and finally lead to saving time and cost.

  2. 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.

  3. 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.

  4. Platelet Function in Stored Heparinised Autologous Blood Is Not Superior to in Patient Platelet Function during Routine Cardiopulmonary Bypass

    NARCIS (Netherlands)

    Huet, Rolf C. G. Gallandat; de Vries, Adrianus J.; Cernak, Vladimir; Lisman, Ton

    2012-01-01

    Background: In cardiac surgery, cardiopulmonary bypass (CPB) and unfractionated heparin have negative effects on blood platelet function. In acute normovolemic haemodilution autologous unfractionated heparinised blood is stored ex-vivo and retransfused at the end of the procedure to reduce (allogene

  5. 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,...

  6. 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.

  7. Nutrient resuscitation and growth of starved cells in sandstone cores: a novel approach to enhanced oil recovery.

    Science.gov (United States)

    Lappin-Scott, H M; Cusack, F; Costerton, J W

    1988-06-01

    Klebsiella pneumoniae, which was reduced in size (0.25 by 0.5 mum) by carbon deprivation, was injected into a series of sandstone cores and subjected to separate treatments. Scanning electron microscopy of 400-mD cores showed these small starved cells in nearly every core section. The cells were a mixture of small rods and cocci with little or no biofilm production. Continuous or dose stimulation with sodium citrate allowed the cells to grow throughout the sandstone and completely plug the length of the core. The resuscitated cells were larger than the starved cells (up to 1.7 mum) and were encased in glycocalyx. Scanning electron microscopic results of resuscitation in situ with half-strength brain heart infusion broth showed that a shallow "skin" plug of cells formed at the core inlet and that fewer cells were located in the lower sections. Starved cells also penetrated 200-mD cores and were successfully resuscitated in situ with sodium citrate, so that the entire core was plugged. Nutrient resuscitation of injected starved cells to produce full-size cells which grow and block the rock pores may be successfully applied to selective plugging and may effectively increase oil recovery.

  8. 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.

  9. 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

  10. Cerebral Tissue Oxygenation during Immediate Neonatal Transition and Resuscitation

    Science.gov (United States)

    Pichler, Gerhard; Schmölzer, Georg M.; Urlesberger, Berndt

    2017-01-01

    This article provides a review of cerebral tissue oxygenation during immediate transition after birth in human neonates. Recommended routine monitoring, especially if resuscitation is needed, during this period includes arterial oxygen saturation and heart rate measured by pulse oximetry and electrocardiogram. However, there is increasing interest to monitor in addition with near-infrared spectroscopy (NIRS) the oxygenation of the brain. There is a different pattern of increase between cerebral tissue oxygenation and arterial oxygen saturation during the immediate transition, with cerebral tissue oxygenation reaching a plateau faster than arterial oxygen saturation. Differences can be explained, since cerebral tissue oxygenation is not only affected by arterial oxygen saturation but also by cerebral blood flow, hemoglobin content, and cerebral oxygen consumption. Normal values have already been established for different devices, gestational ages, and modes of delivery in neonates without any medical support. Cerebral hypoxia during immediate transition might cause brain damage. In preterm neonates with cerebral hemorrhage evolving in the first week after birth, the cerebral tissue oxygenation is already lower in the first minutes after birth compared to preterm neonates without cerebral hemorrhage. Using cerebral NIRS in combination with intervention guidelines has been shown to reduce the burden of cerebral hypoxia in preterm neonates. Cerebral tissue oxygenation during immediate transition seems to have an impact on outcome, whereby NIRS monitoring is feasible and has the advantage of continuous, non-invasive recording. The impact of NIRS monitoring and interventions on short- and long-term outcomes still need to be evaluated. PMID:28280719

  11. 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.

  12. 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.

  13. 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.

  14. 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

  15. Design of a Functional Training Prototype for Neonatal Resuscitation

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    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.

  16. Current Neonatal Resuscitation Practices among Paediatricians in Gujarat, India

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    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.

  17. Resuscitation of traumatic hemorrhagic shock patients with hypertonic saline-without dextran-inhibits neutrophil and endothelial cell activation.

    Science.gov (United States)

    Junger, Wolfgang G; Rhind, Shawn G; Rizoli, Sandro B; Cuschieri, Joseph; Shiu, Maria Y; Baker, Andrew J; Li, Linglin; Shek, Pang N; Hoyt, David B; Bulger, Eileen M

    2012-10-01

    Posttraumatic inflammation and excessive neutrophil activation cause multiple organ dysfunction syndrome (MODS), a major cause of death among hemorrhagic shock patients. Traditional resuscitation strategies may exacerbate inflammation; thus, novel fluid treatments are needed to reduce such posttraumatic complications. Hypertonic resuscitation fluids inhibit inflammation and reduce MODS in animal models. Here we studied the anti-inflammatory efficacy of hypertonic fluids in a controlled clinical trial. Trauma patients in hypovolemic shock were resuscitated in a prehospital setting with 250 mL of either 7.5% hypertonic saline (HS; n = 9), 7.5% hypertonic saline + 6% dextran 70 (HSD; n = 8), or 0.9% normal saline (NS; n = 17). Blood samples were collected on hospital admission and 12 and 24 h after resuscitation. Multicolor flow cytometry was used to quantify neutrophil expression of cell-surface activation/adhesion (CD11b, CD62L, CD64) and degranulation (CD63, CD66b, CD35) markers as well as oxidative burst activity. Circulating concentrations of soluble intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVACM-1), P- and E-selectins, myeloperoxidase (MPO), and matrix metalloproteinase 9 (MMP-9) were assessed by immunoassay. Multiple organ dysfunction syndrome, leukocytosis, and mortality were lower in the HS and HSD groups than in the NS group. However, these differences were not statistically significant. Hypertonic saline prevented priming and activation and neutrophil oxidative burst and CD11b and CD66b expression. Hypertonic saline also reduced circulating markers of neutrophil degranulation (MPO and MMP-9) and endothelial cell activation (sICAM-1, sVCAM-1, soluble E-selectin, and soluble P-selectin). Hypertonic saline + 6% dextran 70 was less capable than HS of suppressing the upregulation of most of these activation markers. This study demonstrates that initial resuscitation with HS, but neither NS nor HSD, can attenuate

  18. Resuscitation of preterm infants: delivery room interventions and their effect on outcomes.

    LENUS (Irish Health Repository)

    O'Donnell, Colm P F

    2012-12-01

    Despite advances in neonatal care, the rate of oxygen dependence at 36 weeks\\' postmenstrual age or bronchopulmonary dysplasia has not fallen. Neonatologists are increasingly careful to apply ventilation strategies that are gentle to the lung in the neonatal intensive care unit. However, there has not been the same emphasis applying gentle ventilation strategies immediately after birth. A lung-protective strategy should start immediately after birth to establish a functional residual capacity, reduce volutrauma and atelectotrauma, facilitate gas exchange, and improve oxygenation during neonatal transition. This article discusses techniques and equipment recommended by international resuscitation guidelines during breathing assistance in the delivery room.

  19. Acute and Subacute Effects of Urban Air Pollution on Cardiopulmonary Emergencies and Mortality: Time Series Studies in Austrian Cities

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    Daniel Rabczenko

    2013-10-01

    Full Text Available Daily pollution data (collected in Graz over 16 years and in the Linz over 18 years were used for time series studies (GAM and case-crossover on the relationship with daily mortality (overall and specific causes of death. Diagnoses of patients who had been transported to hospitals in Linz were also available on a daily basis from eight years for time series analyses of cardiopulmonary emergencies. Increases in air pollutant levels over several days were followed by increases in mortality and the observed effects increased with the length of the exposure window considered, up to a maximum of 15 days. These mortality changes in Graz and Linz showed similar patterns like the ones found before in Vienna. A significant association of mortality could be demonstrated with NO2, PM2.5 and PM10 even in summer, when concentrations are lower and mainly related to motor traffic. Cardiorespiratory ambulance transports increased with NO2/PM2.5/PM10 by 2.0/6.1/1.7% per 10 µg/m³ on the same day. Monitoring of NO2 (related to motor traffic and fine particulates at urban background stations predicts acute effects on cardiopulmonary emergencies and extended effects on cardiopulmonary mortality. Both components of urban air pollution are indicators of acute cardiopulmonary health risks, which need to be monitored and reduced, even below current standards.

  20. 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.

  1. 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.

  2. The amylase-creatinine clearance ratio following cardiopulmonary bypass.

    Science.gov (United States)

    Murray, W R; Mittra, S; Mittra, D; Roberts, L B; Taylor, K M

    1981-08-01

    The incidence of unexplained pancreatitis in patients dying after cardiac operations has been recorded as 16%, with evidence to implicate ischemia in the pathogenesis of the pancreatitis. Increased amylase--to--creatinine clearance ratios (ACCR), suggesting pancreatic dysfunction, have been reported in patients following nonpulsatile cardiopulmonary bypass (CPB). Pulsatile CPB is increasingly recognized to be a more physiological form of perfusion, particularly with respect to capillary blood flow. In this study the ACCR has been determined before, during, and after cardiac operations performed with both nonpulsatile and pulsatile CPB. Twenty patients undergoing elective cardiac operations were studied. Ten patients had nonpulsatile CPB (nonpulsatile group) and 10 had pulsatile CPB (pulsatile group). The two groups were comparable as regards perioperative variables and perfusion parameters. In both groups the ACCR was estimated preoperatively, on three occasions during the operation, and daily on the first 5 postoperative days. A significant elevation in ACCR was observed in nine of 10 patients in the nonpulsatile group but in only one of 10 patients in the pulsatile group (p less than 0.001). The significant improvement of ACCR stability following pulsatile CPB may indicate that this form of perfusion will reduce the risk of pancreatitis following cardiac operations performed with CPB.

  3. 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.

  4. 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

  5. Postoperative abdominal complications after cardiopulmonary bypass

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    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.

  6. 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.

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

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    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. The role of the vagus nerve in hypertonic resuscitation of hemorrhagic shocked dogs

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    Velasco I.T.

    2004-01-01

    Full Text Available Previous studies have suggested a critical role for the vagi during the hypertonic resuscitation of hemorrhagic shocked dogs. Vagal blockade prevented the full hemodynamic and metabolic recovery and increased mortality. This interpretation, however, was challenged on the grounds that the blockade also abolished critical compensatory mechanisms and therefore the animals would die regardless of treatment. To test this hypothesis, 29 dogs were bled (46.0 ± 6.2 ml/kg, enough to reduce the mean arterial pressure to 40 mmHg and held hypotensive for 45 min. After 40 min, vagal activity was blocked in a reversible manner (0ºC/15 min and animals were resuscitated with 7.5% NaCl (4 ml/kg, 0.9% NaCl (32 ml/kg, or the total volume of shed blood. In the vagal blocked isotonic saline group, 9 of 9 dogs, and in the vagal blocked replaced blood group, 11 of 11 dogs survived, with full hemodynamic and metabolic recovery. However, in the hypertonic vagal blocked group, 8 of 9 dogs died within 96 h. Survival of shocked dogs which received hypertonic saline solution was dependent on vagal integrity, while animals which received isotonic solution or blood did not need this neural component. Therefore, we conclude that hypertonic resuscitation is dependent on a neural component and not only on the transient plasma volume expansion or direct effects of hyperosmolarity on vascular reactivity or changes in myocardial contraction observed immediately after the beginning of infusion.

  9. 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

  10. 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

  11. Effects of resuscitation with three kinds of fluid on liver oxygen free radical in rats with severe hemorrhagic shock

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    Hua-mei LU

    2012-12-01

    group. Conclusions  HSH resuscitation produces loss liver injury after severe hemorrhagic shock by decreasing cytokine production and reducing oxygen free radical-mediated lipid peroxidation.

  12. 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.

  13. Strategies to prevent intraoperative lung injury during cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Siminelakis Stavros N

    2010-01-01

    Full Text Available Abstract During open heart surgery the influence of a series of factors such as cardiopulmonary bypass (CPB, hypothermia, operation and anaesthesia, as well as medication and transfusion can cause a diffuse trauma in the lungs. This injury leads mostly to a postoperative interstitial pulmonary oedema and abnormal gas exchange. Substantial improvements in all of the above mentioned factors may lead to a better lung function postoperatively. By avoiding CPB, reducing its time, or by minimizing the extracorporeal surface area with the use of miniaturized circuits of CPB, beneficial effects on lung function are reported. In addition, replacement of circuit surface with biocompatible surfaces like heparin-coated, and material-independent sources of blood activation, a better postoperative lung function is observed. Meticulous myocardial protection by using hypothermia and cardioplegia methods during ischemia and reperfusion remain one of the cornerstones of postoperative lung function. The partial restoration of pulmonary artery perfusion during CPB possibly contributes to prevent pulmonary ischemia and lung dysfunction. Using medication such as corticosteroids and aprotinin, which protect the lungs during CPB, and leukocyte depletion filters for operations expected to exceed 90 minutes in CPB-time appear to be protective against the toxic impact of CPB in the lungs. The newer methods of ultrafiltration used to scavenge pro-inflammatory factors seem to be protective for the lung function. In a similar way, reducing the use of cardiotomy suction device, as well as the contact-time between free blood and pericardium, it is expected that the postoperative lung function will be improved.

  14. 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

  15. 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...

  16. THE RESUSCITATION OF THE CENTRAL NERVOUS SYSTEM OF MAMMALS.

    Science.gov (United States)

    Stewart, G N; Guthrie, C C; Burns, R L; Pike, F H

    1906-03-26

    The cerebral circulation was interrupted for periods of three to eighty-one minutes by ligation of the innominate and left subclavian arteries proximal to the origin of the vertebral, in ninety-three cats. Eleven dogs were used in the earlier experiments. The eye reflexes disappear very quickly and a period of high blood pressure follows the occlusion immediately; vagus inhibition causes cardiac slowing and a fall in blood pressure, followed by a second rise after the vagus center succumbs to anaemia. Respiration stops temporarily (twenty to sixty seconds) after the beginning of occlusion, and then follows a series of strong gasps of the Cheyne-Stokes type, after which it stops until some time after the restoration of the cerebral circulation. The respiratory and vagus centers lose their power of functioning at approximately the same time. Asphyxial slowing of the heart may occur without the agency of the vagus center. The blood pressure slowly falls to a level which is maintained throughout the remainder of the period of occlusion. The anterior part of the cord and the encephalon lose all function; no reflexes are obtainable. The reflexes of the posterior part of the cord persist; the intravenous injection of strychnine does not affect the anterior part of the cord during the period of occlusion; but does affect the posterior portion of the cord. There is no secretion of tears or saliva, and the intra-ocular pressure is reduced. The blood pressure falls still more after release of the cerebra arteries, but soon begins to rise. The respiration returns suddenly, two to sixty minutes after restoration of the cerebral circulation, the first gasp being a strong one. The rate gradually increases until rapid enough for natural respiration. The eye reflexes and intra-ocular tension return more gradually, ten minutes to three hours after restoration of the cerebral circulation. The anterior part of the cord recovers its functions gradually. The first reflexes occur only on

  17. More confident trauma resuscitation team leaders: a novel simulation-based training curriculum utilizing video feedback

    Directory of Open Access Journals (Sweden)

    John L. Falcone

    2013-02-01

    Full Text Available There are deficiencies in trauma leader performance. Simulation training and video-based feedback can lead to durable changes in behavior. A trauma resuscitation team leader training curriculum was developed. The curriculum consisted of eight simulated trauma scenarios with a mix of acuities and injury patterns using patient simulators. Other team members included a surgeon, an anesthesiologist, a chief resident, a trauma nurse, a medical student, and presenting emergency medicine staff. Each scenario was followed by video-based feedback. Attitudes regarding this curriculum were evaluated before and after the intervention with Likert-based surveys. Eight residents completed the curriculum. On a seven-point Likert scale, the median overall curriculum rating, the video discussion quality, the plan to apply leadership skills, and the plan to apply learned knowledge and behaviors was 7/7. A Wilcoxon Sign-Rank test showed improved confidence for leading Level 1 trauma resuscitations, improved beliefs in adequate training, and improved attitudes regarding team leader training (P<0.05. There was reduced nervousness of being the team leader (P=0.048. Qualitative analyses showed that the learners valued the feedback process and scenario realism. This pilot curriculum was well-received by trauma residents and offers insight into meta-cognition of trauma team leaders.

  18. [Interdisciplinary treatment of severely injured patients in the trauma resuscitation room].

    Science.gov (United States)

    Wurmb, Thomas; Müller, Thorben; Jansen, Hendrik; Ruchholtz, Steffen; Roewer, Norbert; Kühne, Christian A

    2010-06-01

    The trauma resuscitation room in emergency departments is an important link between preclinical treatment and clinical management of patients with multiple trauma. For the trauma team (Trauma Surgery, Anaesthesiology, Radiology) to respond adequately, a high degree of training and standardisation is required. With arrival of the patient, the trauma team starts with priority orientated resuscitation. After life-threatening problems have been resolved, the diagnostic work is started with plain films of the chest and the pelvis and FAST. Additional plain films are made depending on further suspected injuries. Reassessment of the patient is done and necessary emergency interventions are performed before the patient is transferred to the radiology department for organ focused computed tomography. CT has gained importance in the early diagnostic phase of trauma care. The development of Multislice Helical Computed Tomography (MSCT) has led to substantial refinement in the diagnostic work-up. For many institutions it has become an essential part of the imaging of the traumatized patient. Delayed and insufficient medical interventions have a high impact on negative patient outcome. Anticipating and dealing with critical situations might reduce preventable errors in the treatment process and can be achieved by implementation of an algorithm-based structured workflow. In that context some elements of quality management are well established in clinical practice. In the presented paper we describe the effort that needs to be done to provide optimal care for multiple trauma patients after admission to a designed trauma centre.

  19. 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.

  20. 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.

  1. 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.

  2. A comparative analysis of nasogastric and intravenous fluid resuscitation in patients with malignant obstructive jaundice prior to endoscopic biliary drainage

    Directory of Open Access Journals (Sweden)

    Kavita Baghel

    2013-01-01

    Full Text Available Background: An alternative to intravenous is nasogastric fluid administration through normal functioning gut. Though not common, this practice has significance in mass causalities and elective situations. Aim: The study was designed to compare nasogastric and intravenous fluid resuscitation in malignant obstructive jaundice (OJ and their effect on endotoxemia. Materials and Methods: Sixty patients with malignant OJ undergoing endoscopic biliary drainage were randomized into two groups. A total of 4 l of fluid (Ringer′s lactate was administered to Group A through nasogastric tube and to Group B through intravenous route for 48 h. Vital parameters, serum bilirubin, serum creatinine, creatinine clearance rate, electrolytes, and endotoxemia were monitored. Results: Significant improvement in blood pressure (Group A, P = 0.014; Group B, P = 0.020 and significant decrease in serum bilirubin level (Group A, P = 0.001; Group B, P < 0.0001 was observed in both groups after resuscitation. Significantly decreased (P = 0.036 post hydration endotoxin level was observed in Group A as compared to Group B. Febrile events were significantly higher (P = 0.023 in Group B as compared to Group A (6 vs 0. Electrolyte abnormalities were found more in Group B, however statistically insignificant. Conclusion: In OJ patient undergoing biliary drainage, preoperative fluid resuscitation through nasogastric tube may be helpful in reducing postoperative septic complications and endotoxemia.

  3. Cardiopulmonary exercise testing early after stroke using feedback-controlled robotics-assisted treadmill exercise: test-retest reliability and repeatability

    NARCIS (Netherlands)

    Stoller, O.; de Bruin, E.D.; Schindelholz, M.; Schuster-Amft, C.; de Bie, R.A.; Hunt, K.J.

    2014-01-01

    Background: Exercise capacity is seriously reduced after stroke. While cardiopulmonary assessment and intervention strategies have been validated for the mildly and moderately impaired populations post-stroke, there is a lack of effective concepts for stroke survivors suffering from severe motor lim

  4. Protective Effect of Heparin-coated Circuits on the Platelets during Cardiopulmonary Bypass

    Institute of Scientific and Technical Information of China (English)

    张凯伦; 胡志伟; 杨运海; 黄如清; 范慧敏; 孙宗全

    2003-01-01

    To observe the protective effect of heparin-coated circuits (HCC) on the platelet function during cardiopulmonary bypass (CPB). 23 patients with heart valve replacement were studied. The system heparin dose was 3 mg/kg in the control group (n= 15) and heparin-coated circuits in the HCC group (n = 8). Platelet count, α-granule membrane protein-140 (GMP-140) concentrations were determined before CPB, at 60 min of CPB, 30 and 60 min after protamine administration, first 12 h after CPB, respectively. At end of CPB the arterial filters in the circuits were observed by electron microscopy. The amount of first 12-h postoperative blood loss was measured. There was significant reduction in platelet loss during and after CPB in the HCC group in contrast to the control group during CPB (P<0.05). During the first 12 h, postoperative blood loss was reduced in the HCC group as compared with that in the control group (218±61 ml, vs. 332±118 ml, P<0.05). Electron microscopy showed that in the HCC group the filter meshes and their fringes were clear and fragments of floccules were occasionally seen, without adherent cells or only few adherent cells on their surfaces, whereas several cellular and fibrous components were found to adhere to the surfaces of the filter meshes in the control group. This study indicates that heparin-coated circuits might reduce the platelet loss and activation during CPB and improve hemocompatibility of cardiopulmonary bypass equipment.

  5. Vitamin D Status After Cardiopulmonary Bypass in Children With Congenital Heart Disease.

    Science.gov (United States)

    Abou Zahr, Riad; Faustino, Edward Vincent S; Carpenter, Thomas; Kirshbom, Paul; Hall, E Kevin; Fahey, John T; Kandil, Sarah B

    2016-06-01

    Deficiency in 25-hydroxyvitamin D (25OHD) is associated with increased morbidity and mortality in the critically ill. Children who underwent surgery for congenital heart disease under cardiopulmonary bypass (CPB) are typically deficient in 25OHD. It is unclear whether this deficiency is due to CPB. We hypothesized that CPB reduces the levels of 25OHD in children with congenital heart disease. We conducted a prospective observational study on children aged 2 months to 17 years who underwent CPB. Serum was collected at 3 time points: immediately before, immediately after surgery, and 24 hours after surgery. 25-Hydroxyvitamin D, 1,25-dihydroxyvitamin D, 1,25(OH)2D, vitamin D binding protein, and albumin levels were measured. Levels were compared using repeated measures analysis of variance. We enrolled 20 patients, 40% were deficient in 25OHD with levels Vitamin D binding protein and albumin levels did not significantly change. Cardiopulmonary bypass decreases 25OHD by reducing the free fraction. Current investigations are geared to establish whether vitamin D deficiency is associated with outcomes and if treatment is appropriate.

  6. The ebb and flow of fluid (as in resuscitation).

    Science.gov (United States)

    Mattox, K L

    2015-04-01

    Since the early 1960's "resuscitation" following major trauma involved use of replacement crystalloid fluid/estimated blood loss in volumes of 3/1, in the ambulance, emergency room, operating room and surgical intensive care unit. During the past 20 years, MAJOR paradigm shifts have occurred in this concept. As a result hypotensive resuscitation with a view towards restriction of crystalloid, and prevention of complications has occurred. Improved results in both civilian and military environments have been reported. As a result there is new focus on trauma surgical involvement in all aspects of trauma patient management, focus on early aggressive surgical approaches (which may or may not involve an operation), and movement from crystalloid to blood, plasma, and platelet replacement therapy.

  7. Cardiorespiratory monitoring during neonatal resuscitation for direct feedback and audit

    Directory of Open Access Journals (Sweden)

    Jeroen Johannes van Vonderen

    2016-04-01

    Full Text Available Neonatal resuscitation is one of the most frequently performed procedures and it is often successful if the ventilation applied is adequate. Over the last decade, interest in seeking objectivity in evaluating the infant’s condition at birth or the adequacy and effect of the interventions applied has markedly increased. Clinical parameters such as heart rate, colour and chest excursions are difficult to interpret and can be very subjective and subtle. The use of ECG, pulse oximetry, capnography and respiratory function monitoring can add objectivity to the clinical assessment. These physiological parameters, with or without the combination of video recordings, can be used directly to guide care, but can also be used later for audit and teaching purposes. Further studies are needed to investigate whether this will improve the quality of delivery room management. In this review we will give an update of the current developments in monitoring neonatal resuscitation.

  8. Contingent leadership and effectiveness of trauma resuscitation teams.

    Science.gov (United States)

    Yun, Seokhwa; Faraj, Samer; Sims, Henry P

    2005-11-01

    This research investigated leadership and effectiveness of teams operating in a high-velocity environment, specifically trauma resuscitation teams. On the basis of the literature and their own ethnographic work, the authors proposed and tested a contingency model in which the influence of leadership on team effectiveness during trauma resuscitation differs according to the situation. Results indicated that empowering leadership was more effective when trauma severity was low and when team experience was high. Directive leadership was more effective when trauma severity was high or when the team was inexperienced. Findings also suggested that an empowering leader provided more learning opportunities than did a directive leader. The major contribution of this article is the linkage of leadership to team effectiveness, as moderated by relatively specific situational contingencies.

  9. 21 CFR 870.4350 - Cardiopulmonary bypass oxygenator.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass oxygenator. 870.4350 Section 870.4350 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... gases between blood and a gaseous environment to satisfy the gas exchange needs of a patient during...

  10. Cardiopulmonary Fitness and Endurance in Children with Developmental Coordination Disorder

    Science.gov (United States)

    Wu, Sheng K.; Lin, Hsiao-Hui; Li, Yao-Chuen; Tsai, Chia-Liang; Cairney, John

    2010-01-01

    The purpose of this study was to compare cardiopulmonary fitness and endurance in 9-11-year-old children with DCD against a group of typically developing children in Taiwan. The Movement ABC test was used to evaluate the motor abilities of children. Forty-one participants (20 children with DCD and 21 children without DCD) were recruited for this…

  11. Cardiopulmonary interactions during mechanical ventilation in critically ill patients

    NARCIS (Netherlands)

    T.G.V. Cherpanath (Thomas); W.K. Lagrand (Wim); M.J. Schultz (Marcus); A.B.J. Groeneveld (Johan)

    2013-01-01

    textabstractCardiopulmonary interactions induced by mechan-ical ventilation are complex and only partly understood. Ap-plied tidal volumes and/or airway pressures largely mediate changes in right ventricular preload and afterload. Effects on left ventricular function are mostly secondary to changes

  12. The influence of biomaterials on inflammatory responses to cardiopulmonary bypass.

    Science.gov (United States)

    Courtney, J M; Matata, B M; Yin, H Q; Esposito, A; Mahiout, A; Taggart, D P; Lowe, G D

    1996-05-01

    The nature of cardiopulmonary bypass and the complexity of the inflammatory response make the detection and interpretation of a biomaterial influence difficult. However, if mediation of the inflammatory response is considered to be an appropriate clinical goal, alteration to the biomaterial influence merits further investigation.

  13. Gastrointestinal motility during cardiopulmonary bypass : A sonomicrometric study

    NARCIS (Netherlands)

    Gu, YJ; de Kroon, TL; Elstrodt, JM; Rakhorst, G

    2006-01-01

    Cardiopulmonary bypass (CPB) is known to impair the integrity of the gastrointestinal tract. However, little is known about the movement behavior of the gastrointestinal tract during CPB. This study was aimed to assess the gastrointestinal motility with sonomicrometry, a distance measurement using u

  14. Clinical benefit of steroid use in patients undergoing cardiopulmonary bypass

    DEFF Research Database (Denmark)

    Whitlock, Richard P; Chan, Simon; Devereaux, P J;

    2008-01-01

    We sought to establish the efficacy and safety of prophylactic steroids in adult patients undergoing cardiopulmonary bypass (CPB). We performed a meta-analysis of randomized trials reporting the effects of prophylactic steroids on clinical outcomes after CPB. Outcomes examined were mortality...

  15. Associations of Hospital and Patient Characteristics with Fluid Resuscitation Volumes in Patients with Severe Sepsis

    DEFF Research Database (Denmark)

    Hjortrup, Peter Buhl; Haase, Nicolai; Wetterslev, Jørn;

    2016-01-01

    PURPOSE: Fluid resuscitation is a key intervention in patients with sepsis and circulatory impairment. The recommendations for continued fluid therapy in sepsis are vague, which may result in differences in clinical practice. We aimed to evaluate associations between hospital and patient...... characteristics and fluid resuscitation volumes in ICU patients with severe sepsis. METHODS: We explored the 6S trial database of ICU patients with severe sepsis needing fluid resuscitation randomised to hydroxyethyl starch 130/0.42 vs. Ringer's acetate. Our primary outcome measure was fluid resuscitation volume......, lower respiratory SOFA subscore and surgery were all independently associated with increased fluid resuscitation volumes. CONCLUSIONS: Hospital characteristics adjusted for patient baseline values were associated with differences in fluid resuscitation volumes given in the first 3 days of severe sepsis...

  16. A Clinical Approach to Antioxidant Therapy: Hypertonic Fluid Resuscitation Trial

    Science.gov (United States)

    2003-06-01

    inflammatoires, qui contribuent collectivement au syndrome de réponse inflammatoire systémique (SRIS), aboutissant souvent au syndrome de détresse respiratoire ...unidentified bags. Subsequent resuscitation adhered to ATLS guidelines. Injury and disease severity were scored according to Severity of Injury Score (SIS...Bevilacqua, MP, Nelson, RM, Mannori, G, and Cecconi, O (1994) Endothelial-leukocyte adhesion molecules in human disease . Annu Rev Med 45:361-78

  17. 重度烧伤液体复苏的研究进展%Advances in the Research of Fluid Resuscitation Following Severe Burn

    Institute of Scientific and Technical Information of China (English)

    王碧莹(综述); 葛茂星(审校)

    2015-01-01

    Burn shock is the first hurdle in patients with severe burn injury.Fluid resuscitation is an important treatment of burn shock.Reasonable fluid resuscitation can not only avoid burn shock,but also reduce the death risk and complications incidence.Here is to make a review of the research of severe burn fluid infusion volume,infusion method,inhalation injury,wound depth,delayed resuscitation and etc.,for the sake of providing some thoughts for fluid resuscitation of severe burn patients .%烧伤休克是重度烧伤患者伤后面临的第一道难关。液体复苏是休克期救治的重要措施,合理的补液不仅能避免烧伤休克的发生,也将降低后续并发症的发生率及死亡的风险。该文就目前国内外对重度烧伤液体复苏的补液量、补液途径、吸入性损伤、创面深度及延迟复苏等方面的相关研究进行综述,以期为临床重度烧伤的液体复苏提供一个简要的总结和一些思考。

  18. Earlier application of percutaneous cardiopulmonary support rescues patients from severe cardiopulmonary failure using the APACHE III scoring system.

    Science.gov (United States)

    Song, Suk-Won; Yang, Hong-Suk; Lee, Sak; Youn, Young-Nam; Yoo, Kyung-Jong

    2009-12-01

    Percutaneous cardiopulmonary support (PCPS) is a widely accepted treatment for severe cardiopulmonary failure. This system, which uses a percutaneous approach and autopriming devices, can be rapidly applied in emergency situations. We sought to identify the risk factors that could help predict in-hospital mortality, and to assess its outcomes in survivors. During a 2-yr period, 50 patients underwent PCPS for the treatment of severe cardiopulmonary failure, and of those, 22 (44%) were classified as survivors and 28 (56%) as non-survivors. We compared the 2 groups for risk factors of in-hospital mortality and to establish proper PCPS timing. Twenty patients underwent PCPS for acute myocardial infarction, 20 for severe cardiopulmonary failure after cardiac surgery, 7 for acute respiratory distress syndrome, and 3 for acute myocarditis. Multivariate analysis showed that an acute physiology, age, and chronic health evaluation (APACHE) III score >or=50 prior to PCPS was the only significant predictor of in-hospital mortality (P=0.001). Overall 18-month survival was 42.2%. Cox analysis showed patients with APACHE III scores >or=50 had a poor prognosis (P=0.001). Earlier application of PCPS, and other preemptive strategies designed to optimize high-risk patients, may improve patient outcomes. Identifying patients with high APACHE scores at the beginning of PCPS may predict in-hospital mortality. Survivors, particularly those with higher APACHE scores, may require more frequent follow-up to improve overall survival.

  19. Resuscitation and post resuscitation care of the very old after out-of-hospital cardiac arrest is worthwhile

    DEFF Research Database (Denmark)

    Winther-Jensen, Matilde; Kjaergaard, Jesper; Hassager, Christian;

    2015-01-01

    BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis. As comorbidity and frailty increase with age; ethical dilemmas may arise when OHCA occur in the very old. OBJECTIVES: We aimed to investigate mortality, neurological outcome and post resuscitation care in octog......BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis. As comorbidity and frailty increase with age; ethical dilemmas may arise when OHCA occur in the very old. OBJECTIVES: We aimed to investigate mortality, neurological outcome and post resuscitation care...... to 86% (n=317, p=0.03) in the younger patients. CONCLUSION: OHCA in octogenarians was associated with a significantly higher mortality rate after adjustment for prognostic factors. However, the majority of octogenarian survivors were discharged with a favorable neurological outcome. Withholding...

  20. Impaired microcirculatory perfusion in a rat model of cardiopulmonary bypass: the role of hemodilution.

    Science.gov (United States)

    Koning, Nick J; de Lange, Fellery; Vonk, Alexander B A; Ahmed, Yunus; van den Brom, Charissa E; Bogaards, Sylvia; van Meurs, Matijs; Jongman, Rianne M; Schalkwijk, Casper G; Begieneman, Mark P V; Niessen, Hans W; Baufreton, Christophe; Boer, Christa

    2016-03-01

    Although hemodilution is attributed as the main cause of microcirculatory impairment during cardiopulmonary bypass (CPB), this relationship has never been investigated. We investigated the distinct effects of hemodilution with or without CPB on microvascular perfusion and subsequent renal tissue injury in a rat model. Male Wistar rats (375-425 g) were anesthetized, prepared for cremaster muscle intravital microscopy, and subjected to CPB (n = 9), hemodilution alone (n = 9), or a sham procedure (n = 6). Microcirculatory recordings were performed at multiple time points and analyzed for perfusion characteristics. Kidney and lung tissue were investigated for mRNA expression for genes regulating inflammation and endothelial adhesion molecule expression. Renal injury was assessed with immunohistochemistry. Hematocrit levels dropped to 0.24 ± 0.03 l/l and 0.22 ± 0.02 l/l after onset of hemodilution with or without CPB. Microcirculatory perfusion remained unaltered in sham rats. Hemodilution alone induced a 13% decrease in perfused capillaries, after which recovery was observed. Onset of CPB reduced the perfused capillaries by 40% (9.2 ± 0.9 to 5.5 ± 1.5 perfused capillaries per microscope field; P perfusion, which cannot fully explain impaired microcirculation following cardiopulmonary bypass. CPB led to increased renal injury and endothelial adhesion molecule expression in the kidney and lung compared with hemodilution. Our findings suggest that microcirculatory impairment during CPB may play a role in the development of kidney injury.

  1. Quantitative evaluation of cardiopulmonary functional reserve in treated patients with pulmonary embolism

    Institute of Scientific and Technical Information of China (English)

    YAN Wen-wen; WANG Le-min; CHE Lin; SONG Hao-ming; JIANG Jin-fa; XU Jia-hong; SHEN Yu-qin; ZHANG Qi-ping

    2012-01-01

    Background There is no research,either at home or abroad,focusing on assessing the cardiopulmonary functional reserve and exercise tolerance in patients with pulmonary embolism (PE),but the benefits of early exercise are well recognized.The goals of this study were to assess cardiopulmonary functional reserve in treated PE patients using the inert gas rebreathing method of the cardiopulmonary exercise test (CPET),and to compare it with traditional methods.Methods CPET on the bicycle ergometer were performed in 40 patients with age,gender,body mass index,systolic blood pressure,and pulmonary function matched.The first group was the PE group composed of 16 PE patients (5 male,11 female) who were given the standard antithrombotic therapy for two weeks.The second group was composed of 24 normal individuals (10 male,14 female).Both groups were evaluated by cardiac ultrasound examination,6-minute walking test (6MVVT),and CPET.Results (1) Right ventricular systolic pressure (RVSP) in the PE group increased significantly compared to the control group,(34.81±8.15) mmHg to (19.75±3.47) mmHg (P <0.01).But neither right atrial end-systolic diameter (RASD) nor right ventricular end-diastolic diameter (RVDD) in the PE patients had changed when compared with the controls.The 6-minute walk distance was significantly reduced in the PE patients compared with normal subjects,(447.81±79.20) m vs.(513.75±31.45) m (P <0.01).Both anaerobic threshold oxygen consumption (VO2AT) and peak oxygen consumption (VO2peak) were significantly lower in patients with PE,while CO2 equivalent ventilation (VE/VCO2 slope) was higher;VO2AT (9.44±3.82) ml·kg1.min-1 vs.(14.62±2.93) ml.kg-1.min-1 (P <0.01) and VO2peak (12.26±4.06) ml.kg-1.min-1 vs.(23.46±6.15) ml.kg-1.min-1 (P <0.01) and VE/VCO2 slope 35.47±6.66 vs.26.94±3.16 (P <0.01).There was no significant difference in resting cardiac output (CO) between the PE and normal groups,whereas peak cardiac output (peak CO)and the

  2. Effect of Haemostatic Control Resuscitation on mortality in massively bleeding patients: a before and after study

    DEFF Research Database (Denmark)

    Johansson, P I; Stensballe, J

    2009-01-01

    ) with preemptive use of platelets and plasma, administered in transfusion packages, comprising 5 units of RBCs, 5 units of fresh-frozen plasma and 2 units of platelet concentrates (PC), when massive bleeding occurred or upon arrival at the emergency room and thereafter directed by thrombelastography throughout......BACKGROUND AND OBJECTIVES: Evidence supporting the use of platelets and plasma in resuscitation of massive bleedings is questionable. Current consensus guidelines recommend restrictive use. Our aim was to determine the effect of changing the transfusion practice on 30-day survival in massively...... patients treated in 2002-2003. Thirty-day mortality was reduced in 2005-2006 (20.4% vs. 31.5%; P = 0.0002) and at 90-day (22.4% vs. 34.6%; P plasma, as guided by thrombelastography...

  3. Cardiopulmonary Exercise Test: Background, Applicability and Interpretation.

    Science.gov (United States)

    Herdy, Artur Haddad; Ritt, Luiz Eduardo Fonteles; Stein, Ricardo; Araújo, Claudio Gil Soares de; Milani, Mauricio; Meneghelo, Romeu Sérgio; Ferraz, Almir Sérgio; Hossri, Carlos; Almeida, Antonio Eduardo Monteiro de; Fernandes-Silva, Miguel Morita; Serra, Salvador Manoel

    2016-11-01

    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. Resumo O teste cardiopulmonar de exercício (TCPE) vem ganhando importância crescente como método de avaliação funcional tanto no Brasil quanto no Mundo. Nas suas aplicações mais frequentes, o teste consiste em submeter o indivíduo a um exercício de intensidade gradativamente crescente até a exaustão ou o

  4. Effects of biliverdin administration on acute lung injury induced by hemorrhagic shock and resuscitation in rats.

    Directory of Open Access Journals (Sweden)

    Junko Kosaka

    Full Text Available Hemorrhagic shock and resuscitation induces pulmonary inflammation that leads to acute lung injury. Biliverdin, a metabolite of heme catabolism, has been shown to have potent cytoprotective, anti-inflammatory, and anti-oxidant effects. This study aimed to examine the effects of intravenous biliverdin administration on lung injury induced by hemorrhagic shock and resuscitation in rats. Biliverdin or vehicle was administered to the rats 1 h before sham or hemorrhagic shock-inducing surgery. The sham-operated rats underwent all surgical procedures except bleeding. To induce hemorrhagic shock, rats were bled to achieve a mean arterial pressure of 30 mmHg that was maintained for 60 min, followed by resuscitation with shed blood. Histopathological changes in the lungs were evaluated by histopathological scoring analysis. Inflammatory gene expression was determined by Northern blot analysis, and oxidative DNA damage was assessed by measuring 8-hydroxy-2' deoxyguanosine levels in the lungs. Hemorrhagic shock and resuscitation resulted in prominent histopathological damage, including congestion, edema, cellular infiltration, and hemorrhage. Biliverdin administration prior to hemorrhagic shock and resuscitation significantly ameliorated these lung injuries as judged by histopathological improvement. After hemorrhagic shock and resuscitation, inflammatory gene expression of tumor necrosis factor-α and inducible nitric oxide synthase were increased by 18- and 8-fold, respectively. Inflammatory gene expression significantly decreased when biliverdin was administered prior to hemorrhagic shock and resuscitation. Moreover, after hemorrhagic shock and resuscitation, lung 8-hydroxy-2' deoxyguanosine levels in mitochondrial DNA expressed in the pulmonary interstitium increased by 1.5-fold. Biliverdin administration prior to hemorrhagic shock and resuscitation decreased mitochondrial 8-hydroxy-2' deoxyguanosine levels to almost the same level as that in the

  5. Nurses' Perceptions of Role, Team Performance, and Education Regarding Resuscitation in the Adult Medical-Surgical Patient.

    Science.gov (United States)

    O'Donoghue, Sharon C; DeSanto-Madeya, Susan; Fealy, Natalie; Saba, Christine R; Smith, Stacey; McHugh, Allison T

    2015-01-01

    The purpose of this study was to explore nurses' perception of their roles, team performance, and educational needs during resuscitation using an electronic survey. Findings provide direction for clinical practice, nursing education, and future research to improve resuscitation care.

  6. Neuroprotective Strategies during Cardiac Surgery with Cardiopulmonary Bypass

    Science.gov (United States)

    Salameh, Aida; Dhein, Stefan; Dähnert, Ingo; Klein, Norbert

    2016-01-01

    Aortocoronary bypass or valve surgery usually require cardiac arrest using cardioplegic solutions. Although, in principle, in a number of cases beating heart surgery (so-called off-pump technique) is possible, aortic or valve surgery or correction of congenital heart diseases mostly require cardiopulmonary arrest. During this condition, the heart-lung machine also named cardiopulmonary bypass (CPB) has to take over the circulation. It is noteworthy that the invention of a machine bypassing the heart and lungs enabled complex cardiac operations, but possible negative effects of the CPB on other organs, especially the brain, cannot be neglected. Thus, neuroprotection during CPB is still a matter of great interest. In this review, we will describe the impact of CPB on the brain and focus on pharmacological and non-pharmacological strategies to protect the brain. PMID:27879647

  7. Dobutamine for inotropic support during emergence from cardiopulmonary bypass.

    Science.gov (United States)

    Tinker, J H; Tarhan, S; White, R D; Pluth, J R; Barnhorst, D A

    1976-04-01

    Dobutamine, a recently introduced derivative of dopamine, is reported to retain inotropic properties with less pronounced chronotropic and arrhythmogenic effects than isoproterenol. The drug was evaluated in two doses, 5 mug/kg/min and 10 mug/kg/min, in two groups of ten patients each, during emergence from cardiopulmonary bypass. A third group of five patients was studied similarly with isoproterenol, 0.02 mug/kg/min. Cardiac index increased 16 and 28 per cent eith the two doses of dobutamine, respectively, and 9 per cent with isoproterenol. Heart rate, in contrast, increased 6 and 15 per cent with dobutamine (not significant) and 44 per cent with isoproterenol (significant). Dobutamine seemed to associated with fewer arrhythmias than isoproterenol. It is concluded that dobutamine, 5-10 mug/kg/min, is suitable for use during emergence from cardiopulmonary bypass and may possess advantages over isoproterenol.

  8. Role of cardiopulmonary mechanoreceptors in the postural regulation of renin

    Energy Technology Data Exchange (ETDEWEB)

    Sanchez, R.A.; Marco, E.J.; Oliveri, C.; Otero, F.J.; Degrossi, O.; Moledo, L.I.; Julius, S.

    1987-04-01

    To change the stretch on cardiopulmonary mechanoreceptors, large shifts of blood in the capacity space were elicited by tilting and by exerting positive lower body pressure in the tilted position. Twelve volunteers underwent invasive hemodynamic studies and in 10 other subjects cardiac size was determined by radionuclide cardiography. In all 22 subjects tilting caused the expected increase of renin, which was abolished by lower body compression. Decompression caused renin to increase again. Right atrial pressure in invasive studies and end-systolic and end-diastolic counts in noninvasive studies showed a significant and strong negative correlation with renin and norepinephrine levels. Thus, the degree of stretch of the cardiopulmonary mechanoreceptors is a major determinant of reflex regulation of renin release in humans.

  9. Ventilation during cardiopulmonary bypass for prevention of respiratory insufficiency

    Science.gov (United States)

    Chi, Dongmei; Chen, Chan; Shi, Yu; Wang, Wanyu; Ma, Ye; Zhou, Ronghua; Yu, Hai; Liu, Bin

    2017-01-01

    Abstract Background: Cardiopulmonary bypass (CPB) is necessary for most cardiac surgery, which may lead to postoperative lung injury. The objective of this paper is to systematically evaluate whether ventilation during CPB would benefit patients undergoing cardiac surgery. Methods: We searched randomized controlled trials (RCTs) through PubMed, Embase, and Cochrane Library from inception to October 2016. Eligible studies compared clinical outcomes of ventilation versus nonventilation during CPB in patients undergoing cardiac surgery. The primary outcome includes oxygenation index (PaO2/FiO2 ratio) or alveolar to arterial oxygen tension difference (AaDO2) immediately after weaning from bypass. The secondary outcomes include postoperative pulmonary complications (PPCs), shunt fraction (Qs/Qt), hospital stay, and AaDO2 4 hours after CPB. Results: Seventeen trials with 1162 patients were included in this meta-analysis. Ventilation during CPB significantly increased post-CPB PaO2/FiO2 ratio (mean difference [MD] = 21.84; 95% confidence interval [CI] = 1.30 to 42.37; P = 0.04; I2 = 75%) and reduced post-CPB AaDO2 (MD = –50.17; 95% CI = –71.36 to –28.99; P <0.00001; I2 = 74%). Qs/Qt immediately after weaning from CPB showed a significant difference between groups (MD = –3.24; 95% CI = –4.48 to –2.01; P <0.00001; I2 = 0%). Incidence of PPCs (odds ratio [OR] = 0.79; 95% CI = 0.42 to 1.48; P = 0.46; I2 = 37%) and hospital stay (MD = 0.09; 95% CI = –23 to 0.41; P = 0.58; I2 = 37%) did not differ significantly between groups. Conclusion: Ventilation during CPB might improve post-CPB oxygenation and gas exchange in patients who underwent cardiac surgery. However, there is no sufficient evidence to show that ventilation during CPB could influence long-term prognosis of these patients. The beneficial effects of ventilation during CPB are requisite to be evaluated in powerful and well

  10. Interspecific quorum sensing mediates the resuscitation of viable but nonculturable vibrios.

    Science.gov (United States)

    Ayrapetyan, Mesrop; Williams, Tiffany C; Oliver, James D

    2014-04-01

    Entry and exit from dormancy are essential survival mechanisms utilized by microorganisms to cope with harsh environments. Many bacteria, including the opportunistic human pathogen Vibrio vulnificus, enter a form of dormancy known as the viable but nonculturable (VBNC) state. VBNC cells can resuscitate when suitable conditions arise, yet the molecular mechanisms facilitating resuscitation in most bacteria are not well understood. We discovered that bacterial cell-free supernatants (CFS) can awaken preexisting dormant vibrio populations within oysters and seawater, while CFS from a quorum sensing mutant was unable to produce the same resuscitative effect. Furthermore, the quorum sensing autoinducer AI-2 could induce resuscitation of VBNC V. vulnificus in vitro, and VBNC cells of a mutant unable to produce AI-2 were unable to resuscitate unless the cultures were supplemented with exogenous AI-2. The quorum sensing inhibitor cinnamaldehyde delayed the resuscitation of wild-type VBNC cells, confirming the importance of quorum sensing in resuscitation. By monitoring AI-2 production by VBNC cultures over time, we found quorum sensing signaling to be critical for the natural resuscitation process. This study provides new insights into the molecular mechanisms stimulating VBNC cell exit from dormancy, which has significant implications for microbial ecology and public health.

  11. Systemic and Microvascular Effects of Resuscitation with Blood Products After Severe Hemorrhage in Rats

    Science.gov (United States)

    2014-01-01

    structural organization and stability of individual gly- cocalyx components, such as glycoproteins, proteoglycans with glycosaminoglycans, and adsorbed...adsorbed proteins and proteoglycans and therefore increase microvascular flow,32 which supports our findings that resuscitation with LR may cause...from cremaster preparations. B, Levels of plasma heparan sulfate proteoglycan relative to baseline after hemorrhage and resuscitation treatment. LR

  12. Pharmacist's impact on acute pain management during trauma resuscitation.

    Science.gov (United States)

    Montgomery, Kayla; Hall, A Brad; Keriazes, Georgia

    2015-01-01

    The timely administration of analgesics is crucial to the comprehensive management of trauma patients. When an emergency department (ED) pharmacist participates in trauma resuscitation, the pharmacist acts as a medication resource for trauma team members and facilitates the timely administration of analgesics. This study measured the impact of a pharmacist on time to first analgesic dose administered during trauma resuscitation. All adult (>18 years) patients who presented to this level II trauma center via activation of the trauma response system between January 1, 2009, and May 31, 2013, were screened for eligibility. For inclusion, patients must have received intravenous fentanyl, morphine, or hydromorphone in the trauma bay. The time to medication administration was defined as the elapsed time from ED arrival to administration of first analgesic. There were 1328 trauma response system activations during the study period; of which 340 patients were included. The most common analgesic administered was fentanyl (62% in both groups). When a pharmacist was participating, the mean time to first analgesic administered was decreased (17 vs 21 minutes; P = .03). Among the 78% of patients with documented pain scores, the overall mean reduction in pain scores from ED arrival to ED discharge was similar between the 2 groups. There was a 2.4 point reduction with a pharmacist versus 2.7 without a pharmacist, using a 0 to 10 numeric pain rating scale. The participation of a clinical pharmacist during trauma resuscitation significantly decreased the time to first analgesic administration in trauma patients. The results of this study supplement the literature supporting the integration of clinical ED pharmacists on trauma teams.

  13. Hormonal and metabolic responses of fetal lamb during cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    苏肇伉; 周成斌; 张海波; 祝忠群

    2003-01-01

    Objective To study the hormonal and metabolic responses of fetal lamb during cardiopulmonary bypass.Methods Six pregnant ewes underwent fetal cardiopulmonary bypasses with artificial oxygenators and roller pumps for 30 minutes, which maintained the blood gas value at the fetal physiological level. The fetal blood pressure, heart rate, pH value and blood lactate levels were monitored. The levels of catecholamine, cortisol and insulin were measured pre-bypass and then again 30 minutes later. The blood glucose and free fatty acid levels were monitored continuously during the bypass. Fetal hepatic PAS staining was also carried out.Results There were no changes before and during the bypass in fetal blood pressure, heart rate and blood gas. However, pH values decreased and blood lactate levels increased (P<0.05). The fetal catecholamine and cortisol levels increased significantly (P<0.01), while the levels of insulin did not change. The blood glucose and free fatty acid levels increased at the beginning of the bypass (P<0.01), and then gradually slowed down during the bypass. The fetal hepatic PAS staining showed that hepatic glycogen was consumed in large amounts. After 30 minutes of bypass, the fetal lamb would not survive more than 1 hour.Conclusion The fetal lamb has a strong negative reaction to cardiopulmonary bypass.

  14. Initial Assessment and Resuscitation in Nonvariceal Upper Gastrointestinal Bleeding.

    Science.gov (United States)

    Simon, Tracey G; Travis, Anne C; Saltzman, John R

    2015-07-01

    Acute nonvariceal upper gastrointestinal bleeding remains an important cause of hospital admission with an associated mortality of 2-14%. Initial patient evaluation includes rapid hemodynamic assessment, large-bore intravenous catheter insertion and volume resuscitation. A hemoglobin transfusion threshold of 7 g/dL is recommended, and packed red blood cell transfusion may be necessary to restore intravascular volume and improve tissue perfusion. Patients should be risk stratified into low- and high-risk categories, using validated prognostic scoring systems such as the Glasgow-Blatchford, AIMS65 or Rockall scores. Effective early management of acute, nonvariceal upper gastrointestinal hemorrhage is critical for improving patient outcomes.

  15. Dr. William Thornton's views on sleep, dreams, and resuscitation.

    Science.gov (United States)

    Paulson, George

    2009-01-01

    William Thornton, MD, was a polymath who designed the Capitol of the U.S. Capital and the Octagon House, present home of the American Institute of Architecture. He was the founding director of the U.S. Patent Office. His collected papers, which are now preserved at the U.S. Library of Congress, though pruned by the wife who lived almost 40 years after him, are extensive and include comments on science, education, slavery, and politics. His views on sleep and dreaming and his concepts of resuscitation are reviewed as the opinions of an educated man early in the nineteenth century.

  16. Influence of carbon sources on the viability and resuscitation of Acetobacter senegalensis during high-temperature gluconic acid fermentation.

    Science.gov (United States)

    Shafiei, Rasoul; Zarmehrkhorshid, Raziyeh; Mounir, Majid; Thonart, Philippe; Delvigne, Frank

    2017-02-15

    Much research has been conducted about different types of fermentation at high temperature, but only a few of them have studied cell viability changes during high-temperature fermentation. In this study, Acetobacter senegalensis, a thermo-tolerant strain, was used for gluconic acid production at 38 °C. The influences of different carbon sources and physicochemical conditions on cell viability and the resuscitation of viable but nonculturable (VBNC) cells formed during fermentation were studied. Based on the obtained results, A. senegalensis could oxidize 95 g l(- 1) glucose to gluconate at 38 °C (pH 5.5, yield 83%). However, despite the availability of carbon and nitrogen sources, the specific rates of glucose consumption (qs) and gluconate production (qp) reduced progressively. Interestingly, gradual qs and qp reduction coincided with gradual decrease in cellular dehydrogenase activity, cell envelope integrity, and cell culturability as well as with the formation of VBNC cells. Entry of cells into VBNC state during stationary phase partly stemmed from high fermentation temperature and long-term oxidation of glucose, because just about 48% of VBNC cells formed during stationary phase were resuscitated by supplementing the culture medium with an alternative favorite carbon source (low concentration of ethanol) and/or reducing incubation temperature to 30 °C. This indicates that ethanol, as a favorable carbon source, supports the repair of stressed cells. Since formation of VBNC cells is often inevitable during high-temperature fermentation, using an alternative carbon source together with changing physicochemical conditions may enable the resuscitation of VBNC cells and their use for several production cycles.

  17. Management of Anesthesia under Extracorporeal Cardiopulmonary Support in an Infant with Severe Subglottic Stenosis.

    Science.gov (United States)

    Soeda, Rie; Taniguchi, Fumika; Sawada, Maiko; Hamaoka, Saeko; Shibasaki, Masayuki; Nakajima, Yasufumi; Hashimoto, Satoru; Sawa, Teiji; Nakayama, Yoshinobu

    2016-01-01

    A 4-month-old female infant who weighed 3.57 kg with severe subglottic stenosis underwent tracheostomy under extracorporeal cardiopulmonary support. First, we set up extracorporeal cardiopulmonary support to the infant and then successfully intubated an endotracheal tube with a 2.5 mm inner diameter before tracheostomy by otolaryngologists. Extracorporeal cardiopulmonary support is an alternative for maintenance of oxygenation in difficult airway management in infants.

  18. Management of Anesthesia under Extracorporeal Cardiopulmonary Support in an Infant with Severe Subglottic Stenosis

    Directory of Open Access Journals (Sweden)

    Rie Soeda

    2016-01-01

    Full Text Available A 4-month-old female infant who weighed 3.57 kg with severe subglottic stenosis underwent tracheostomy under extracorporeal cardiopulmonary support. First, we set up extracorporeal cardiopulmonary support to the infant and then successfully intubated an endotracheal tube with a 2.5 mm inner diameter before tracheostomy by otolaryngologists. Extracorporeal cardiopulmonary support is an alternative for maintenance of oxygenation in difficult airway management in infants.

  19. Novel blood sampling method of an artificial endocrine pancreas via the cardiopulmonary bypass circuit.

    Science.gov (United States)

    Kawahito, Shinji; Higuchi, Seiichi; Mita, Naoji; Kitagawa, Tetsuya; Kitahata, Hiroshi

    2013-12-01

    We tried to perform continuous blood glucose monitoring during cardiovascular surgery involving cardiopulmonary bypass using an artificial endocrine pancreas (STG-22 or -55; Nikkiso, Tokyo, Japan); however, we often encountered problems during these procedures because insufficient blood was obtained for monitoring. Thus, we started performing the blood sampling via the venous side of the cardiopulmonary bypass circuit. As a result, continuous blood glucose monitoring using an artificial endocrine pancreas was proven to be stable and reliable during cardiovascular surgery involving cardiopulmonary bypass.

  20. Comparisons of Lactated Ringer’s and Hextend Resuscitation on Hemodynamics and Coagulation following Femur Injury and Severe Hemorrhage in Pigs

    Science.gov (United States)

    2013-01-01

    Wenjun Z. Martini, PhD, Michael A. Dubick, PhD, and Lorne H. Blackbourne, MD, Fort Sam Houston, Texas BACKGROUND: This study compared coagulation function ...after Hextend for the 6-hour experiment period. CONCLUSION: After traumatic hemorrhage, coagulation function was restored within 6 hours with LR...hour experimental period (Table 1). Blood amylase level did not change after hemorrhage but reduced after resuscitation with LR or Hextend, with a

  1. 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

  2. The brain metabolic activity after resuscitation with liposome-encapsulated hemoglobin in a rat model of hypovolemic shock.

    Science.gov (United States)

    Rao, Geeta; Hedrick, Andria F; Yadav, Vivek R; Xie, Jun; Hussain, Alamdar; Awasthi, Vibhudutta

    2015-09-01

    We examined the effect of resuscitation with liposome-encapsulated hemoglobin (LEH) on cerebral bioenergetics in a rat model of 45% hypovolemia. The rats were resuscitated with isovolemic LEH or saline after 15 minutes of shock and followed up to 6 hours. Untreated hypovolemic rats received no fluid. The cerebral uptake of F-18-fluorodeoxyglucose (FDG) was measured by PET, and at 6 hours, the brain was collected for various assays. Hypovolemia decreased cellular adenosine triphosphate (ATP), phosphocreatine, nicotinamide adenine dinucleotide (NAD)/NADH ratio, citrate synthase activity, glucose-6-phosphate, and nerve growth factor (NGF), even when FDG uptake remained unchanged. The FDG uptake was reduced by saline, but not by LEH infusion. The reduced FDG uptake in saline group was associated with a decrease in hexokinase I expression. The LEH infusion effectively restored ATP content, NAD/NADH ratio, and NGF expression, and reduced the hypovolemia-induced accumulation of pyruvate and ubiquitinated proteins; in comparison, saline was significantly less effective. The LEH infusion was associated with low pH and high anion gap, indicating anionic gap acidosis. The results suggest that hypovolemic shock perturbs glucose metabolism at the level of pyruvate utilization, resulting in deranged cerebral energy stores. The correction of volume and oxygen deficits by LEH recovers the cerebral metabolism and creates a prosurvival phenotype.

  3. An audit of resuscitation and anaesthesia during Operation 'Safe Haven'.

    Science.gov (United States)

    Rudland, S V; Tighe, S Q; Pethybridge, R J; Loxdale, P H

    1992-01-01

    The Royal Navy combined Surgical Support Team deployed for six weeks to Northern Iraq. Eighteen casualties of civilian and military trauma required active resuscitation, 10 of whom were under the age of 16. Three died. Triage of multiple casualties was necessary on three occasions. The principles of Advanced Trauma Life Support (ATLS) were adopted and the experience is described under the ABCDE headings of the primary survey. Deficiencies of training and equipment are identified. Seventy one anaesthetics, administered to 52 patients, were audited prospectively in detail. Systolic blood pressure was significantly higher with isoflurane and controlled ventilation (ICV), compared with halothane and trichloroethylene (HTCV) (P < 0.05). ICV patients recovered more quickly than with HTCV (P < 0.05), but were significantly older and heavier (P < 0.05). Isoflurane should replace the standard halothane/trichloroethylene combination. Controlled ventilation or ketamine anaesthesia allowed satisfactory SpO2 on air alone. With controlled ventilation, anaesthesia was entirely satisfactory for children down to 6.5 kg. Local anaesthetic procedures were useful. The entire anaesthetic drug cost was only 127 pounds. Three patients received a degree of intensive care. Recommendations are made to improve future outcome, but sophisticated resuscitation, anaesthesia and monitoring is now possible in the front line.

  4. Formation and resuscitation of viable but nonculturable Salmonella typhi.

    Science.gov (United States)

    Zeng, Bin; Zhao, Guozhong; Cao, Xiaohong; Yang, Zhen; Wang, Chunling; Hou, Lihua

    2013-01-01

    Salmonella typhi is a pathogen that causes the human disease of typhoid fever. The aim of this study was to investigate the viable but nonculturable (VBNC) state of S. typhi. Some samples were stimulated at 4°C or -20°C, while others were induced by different concentrations of CuSO4. Total cell counts remained constant throughout several days by acridine orange direct counting; however, plate counts declined to undetectable levels within 48 hours by plate counting at -20°C. The direct viable counts remained fairly constant at this level by direct viable counting. Carbon and nitrogen materials slowly decreased which indicated that a large population of cells existed in the VBNC state and entered the VBNC state in response to exposure to 0.01 or 0.015 mmol/L CuSO4 for more than 14 or 12 days, respectively. Adding 3% Tween 20 or 1% catalase enabled cells to become culturable again, with resuscitation times of 48 h and 24 h, respectively. The atomic force microscope results showed that cells gradually changed in shape from short rods to coccoids, and decreased in size when they entered the VBNC state. Further animal experiments suggested that resuscitated cells might regain pathogenicity.

  5. Do-not-resuscitate order: a view throughout the world.

    Science.gov (United States)

    Santonocito, Cristina; Ristagno, Giuseppe; Gullo, Antonino; Weil, Max Harry

    2013-02-01

    Resuscitation has the ability to reverse premature death. It can also prolong terminal illness, increase discomfort, and consume resources. The do-not-resuscitate (DNR) order and advance directives are still a debated issue in critical care. This review will focus on several aspects, regarding withholding and/or withdrawing therapies and advance directives in different continents. It is widely known that there is a great diversity of cultural and religious beliefs in society, and therefore, some critical ethical and legal issues have still to be solved. To achieve a consensus, we believe in the priority of continuing education and training programs for health care professionals. It is our opinion that a serious reflection on ethical values and principles would be useful to understand the definition of medical professionalism to make it possible to undertake the best way to avoid futile and aggressive care. There is evidence of the lack of DNR order policy worldwide. Therefore, it appears clear that there is a need for standardization. To improve the attitude about the DNR order, it is necessary to achieve several goals such as: increased communication, consensus on law, increased trust among patients and health care systems, and improved standards and quality of care to respect the patient's will and the family's role.

  6. Effects of Cardiopulmonary Bypass on Hemostasis

    Science.gov (United States)

    2007-11-02

    Berry BR, et al. Enoxaparin for unstable angina and ancrod for cardiac surgery following heparin allergy. Ann Pharmacother 1996;30(5):476-480. 229...first hour [37,38]. PG^ is extremely unstable in plasma, and after 1 hour the recirculated platelets regain their ability to aggregate in the presence...compared, must be established after the induction of anesthesia and the opening of the chest , since anesthesia and surgery have been shown to reduce the

  7. Resuscitation after severe burn injury using high-dose ascorbic acid: a retrospective review.

    Science.gov (United States)

    Kahn, Steven Alexander; Beers, Ryan J; Lentz, Christopher W

    2011-01-01

    Resuscitation of burn victims with high-dose ascorbic acid (vitamin C [VC]) was reported in Japan in the year 2000. Benefits of VC include reduction in fluid requirements, resulting in less tissue edema and body weight gain. In turn, these patients suffer less respiratory impairment and reduced requirement for mechanical ventilation. Despite these results, few burn centers resuscitate patients with VC in fear that it may increase the risk of renal failure. A retrospective review of 40 patients with greater than 20% TBSA between 2007 and 2009 was performed. Patients were divided into two groups: one received only lactated Ringer's (LR) solution and another received LR solution plus 66 mg/kg/hr VC. Both groups were resuscitated with the Parkland formula to maintain stable hemodynamics and adequate urine output (>0.5 ml/kg/hr). Patients with >10-hour delay in transfer to the burn center were excluded. Data collected included age, gender, weight, %TBSA, fluid administered in the first 24 hours, urine output in the first 24 hours, and Acute Physiology and Chronic Health Evaluation II score. PaO2 in millimeters mercury:%FIO2 ratio and positive end-expiratory pressure were measured at 12-hour intervals, and hematocrit was measured at 6-hour intervals. Comorbidities, mortality, pneumonia, fasciotomies, and renal failure were also noted. After 7 patients were excluded, 17 patients were included in the VC group and 16 in the LR group. VC and LR were matched for age (42 ± 16 years vs 50 ± 20 years, P = .2), burn size (45 ± 21%TBSA vs 39 ± 15%TBSA, P = .45), Acute Physiology and Chronic Health Evaluation II (17 ± 7 vs 18 ± 8, P = .8), and gender. Fluid requirements in the first 24 hours were 5.3 ± 1 ml/kg/%TBSA for VC and 7.1 ± 1 ml/kg/%TBSA for LR (P < .05). Urine output was 1.5 ± 0.4 ml/kg/hr for VC and 1 ± 0.5 ml/kg/hr for LR (P < .05). Vasopressors were needed in four VC patients and nine LR patients (P = .07). VC patients required vasopressors to maintain mean

  8. Differences in displayed pump flow compared to measured flow under varying conditions during simulated cardiopulmonary bypass.

    LENUS (Irish Health Repository)

    Hargrove, M

    2008-07-01

    Errors in blood flow delivery due to shunting have been reported to reduce flow by, potentially, up to 40-83% during cardiopulmonary bypass. The standard roller-pump measures revolutions per minute and a calibration factor for different tubing sizes calculates and displays flow accordingly. We compared displayed roller-pump flow with ultrasonically measured flow to ascertain if measured flow correlated with the heart-lung pump flow reading. Comparison of flows was measured under varying conditions of pump run duration, temperature, viscosity, varying arterial\\/venous loops, occlusiveness, outlet pressure, use of silicone or polyvinyl chloride (PVC) in the roller race, different tubing diameters, and use of a venous vacuum-drainage device.

  9. Pulmonary artery perfusion versus no pulmonary perfusion during cardiopulmonary bypass in patients with COPD

    DEFF Research Database (Denmark)

    Buggeskov, Katrine B; Sundskard, Martin M; Jonassen, Thomas;

    2016-01-01

    INTRODUCTION: Absence of pulmonary perfusion during cardiopulmonary bypass (CPB) may be associated with reduced postoperative oxygenation. Effects of active pulmonary artery perfusion were explored in patients with chronic obstructive pulmonary disease (COPD) undergoing cardiac surgery. METHODS: 90...... starting CPB and longitudinally in a mixed-effects model (MEM). Secondary outcomes were tracheal intubation time, serious adverse events, mortality, days alive outside the intensive care unit (ICU) and outside the hospital. RESULTS: 21 hours after starting CPB patients receiving pulmonary artery perfusion...... with normothermic oxygenated blood had a higher oxygenation index compared with no pulmonary perfusion (mean difference (MD) 0.94; 95% CI 0.05 to 1.83; p=0.04). The blood group had also a higher oxygenation index both longitudinally (MEM, p=0.009) and at 21 hours (MD 0.99; CI 0.29 to 1.69; p=0.007) compared...

  10. Impact of Intraoperative Events on Cerebral Tissue Oximetry in Patients Undergoing Cardiopulmonary Bypass.

    Science.gov (United States)

    Ševerdija, Ervin E; Vranken, Nousjka P A; Teerenstra, Steven; Ganushchak, Yuri M; Weerwind, Patrick W

    2015-03-01

    Previous studies showed that decreased cerebral saturation during cardiac surgery is related to adverse postoperative outcome. Therefore, we investigated the influence of intraoperative events on cerebral tissue saturation in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). A total of 52 adult patients who underwent cardiac surgery using pulsatile CPB were included in this prospective explorative study. Cerebral tissue oxygen saturation (SctO2) was measured in both the left and right cerebral hemisphere. Intraoperative events, involving interventions performed by anesthesiologist, surgeon, and clinical perfusionist, were documented. Simultaneously, in-line hemodynamic parameters (partial oxygen pressure, partial carbon dioxide pressure, hematocrit, arterial blood pressure, and CPB flow rates) were recorded. Cerebral tissue saturation was affected by anesthetic induction (p retractor (p cardiac surgery. Future studies are needed to identify methods of mitigating periods of reduced cerebral saturation.

  11. Resuscitation Prior to Emergency Endotracheal Intubation: Results of a National Survey

    Directory of Open Access Journals (Sweden)

    Robert S. Green

    2016-09-01

    Full Text Available Introduction: Respiratory failure is a common problem in emergency medicine (EM and critical care medicine (CCM. However, little is known about the resuscitation of critically ill patients prior to emergency endotracheal intubation (EETI. Our aim was to describe the resuscitation practices of EM and CCM physicians prior to EETI. Methods: A cross-sectional survey was developed and tested for content validity and retest reliability by members of the Canadian Critical Care Trials Group. The questionnaire was distributed to all EM and CCM physician members of three national organizations. Using three clinical scenarios (trauma, pneumonia, congestive heart failure, we assessed physician preferences for use and types of fluid and vasopressor medication in pre-EETI resuscitation of critically ill patients. Results: In total, 1,758 physicians were surveyed (response rate 50.2%, 882/1,758. Overall, physicians would perform pre-EETI resuscitation using either fluids or vasopressors in 54% (1,193/2,203 of cases. Most physicians would “always/often” administer intravenous fluid pre-EETI in the three clinical scenarios (81%, 1,484/1,830. Crystalloids were the most common fluid physicians would “always/often” administer in congestive heart failure (EM 43%; CCM 44%, pneumonia (EM 97%; CCM 95% and trauma (EM 96%; CCM 96%. Pre-EETI resuscitation using vasopressors was uncommon (4.9%. Training in CCM was associated with performing pre-EETI resuscitation (odds ratio, 2.20; 95% CI, [1.44-3.36], p<0.001. Conclusion: Pre-EETI resuscitation is common among Canadian EM and CCM physicians. Most physicians use crystalloids pre-EETI as a resuscitation fluid, while few would give vasopressors. Physicians with CCM training were more likely to perform pre-EETI resuscitation.

  12. [Serum immune complexes and cardiopulmonary bypass. A review of thirty-four cases (author's transl)].

    Science.gov (United States)

    Herreman, G; Poisson-Lespassailles, C; Puech, H; Vanetti, A; Delaunay, L; Yvart, J; Fermé, I

    1982-05-20

    The immunologic status of patients undergoing cardiopulmonary bypass as investigated. Rheumatoid factor, cryoglobulinemia and serum immune complexes were looked for. Studies were performed before the operation and eight or fifteen days later. From the results, it is concluded that the immunologic changes that occur in the immediate postoperative period cannot be interpreted because of the profound modifications resulting from cardiopulmonary bypass.

  13. Electronic documentation of trauma resuscitations at a level 1 pediatric trauma center.

    Science.gov (United States)

    Wurster, Lee Ann; Groner, Jonathan I; Hoffman, Jeffrey

    2012-01-01

    Although many hospitals across the country have implemented an electronic medical record (EMR) for inpatient care, very few have successfully implemented an EMR for trauma resuscitations. Although there is evidence that the EMR improves patient safety, increases access to all care providers, increases workflow efficiency, and minimizes time spent on documenting thereby improving nursing care, the fast paced, complex nature of trauma resuscitations makes it difficult to implement such a system for trauma documentation. With the support of multiple disciplines with a variety of clinical knowledge, this article describes the design process that has led us to successful development and implementation of an EMR for documentation of trauma resuscitations.

  14. Hemodynamic recovery after hypovolemic shock with lactated Ringer's and keratin resuscitation fluid (KRF), a novel colloid.

    Science.gov (United States)

    Nunez, Fiesky A; Callahan, Michael F; Trach, Simon; Burnett, Luke R; Kislukhin, Victor; Smith, Thomas L; Van Dyke, Mark

    2013-10-01

    Death after severe hemorrhage remains an important cause of mortality in people under 50 years of age. Keratin resuscitation fluid (KRF) is a novel resuscitation solution made from keratin protein that may restore cardiovascular stability. This postulate was tested in rats that were exsanguinated to 40% of their blood volume. Test groups received either low or high volume resuscitation with either KRF or lactated Ringer's solution. KRF low volume was more effective than LR in recovering cardiac function, blood pressure and blood chemistry. Furthermore, in contrast to LR-treated rats, KRF-treated rats exhibited vital signs that resembled normal controls at 1-week.

  15. Popular Hybrid Congenital Heart Procedures without Cardiopulmonary Bypass

    Science.gov (United States)

    Gupta, Aamisha; Amin, Zahid

    2017-01-01

    As surgical and catheter interventions advance, patients with congenital heart disease are now offered alternative treatment options that cater to their individual needs. Furthermore, collaboration between interventional cardiologists and cardiac surgeons have led to the development of hybrid procedures, using the best techniques of each respective field to treat these complex cardiac entities from initial treatment in the pediatric patient to repeat intervention in the adult. We present a review of the increased popularity and trend in hybrid procedures in congenital heart disease without the use of cardiopulmonary bypass.

  16. Cerebral autoregulation and flow/metabolism coupling during cardiopulmonary bypass: the influence of PaCO/sub 2/

    Energy Technology Data Exchange (ETDEWEB)

    Murkin, J.M.; Farrar, J.K.; Tweed, W.A.; McKenzie, F.N.; Guiraudon, G.

    1987-09-01

    Measurement of /sup 133/Xe clearance and effluent cerebral venous blood sampling were used in 38 patients to determine the effects of cardiopulmonary bypass, and of maintaining temperature corrected or noncorrected PaCO/sub 2/ at 40 mm Hg on regulation of cerebral blood flow (CBF) and flow/metabolism coupling. After induction of anesthesia with diazepam and fentanyl, mean CBF was 25 ml X 100 g-1 X min-1 and cerebral oxygen consumption, 1.67 ml X 100 g-1 X min-1. Cerebral oxygen consumption during nonpulsatile cardiopulmonary bypass at 26 degrees C was reduced to 0.42 ml X 100 g-1 X min-1 in both groups. CBF was reduced to 14-15 ml X 100 g-1 X min-1 in the non-temperature-corrected group (n = 21), was independent of cerebral perfusion pressure over the range of 20-100 mm Hg, but correlated with cerebral oxygen consumption. In the temperature-corrected group (n = 17), CBF varied from 22 to 32 ml X 100 g-1 X min-1, and flow/metabolism coupling was not maintained (i.e., CBF and cerebral oxygen consumption varied independently). However, variation in CBF correlated significantly with cerebral perfusion pressure over the pressure range of 15-95 mm Hg. This study demonstrates a profound reduction in cerebral oxygen consumption during hypothermic nonpulsatile cardiopulmonary bypass. When a non-temperature-corrected PaCO/sub 2/ of approximately 40 mm Hg was maintained, CBF was lower, and analysis of pooled data suggested that CBF regulation was better preserved, i.e., CBF was independent of pressure changes and dependent upon cerebral oxygen consumption.

  17. Pulmonary artery perfusion with HTK solution prevents lung injury in infants after cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    LI Jian-an; LIU Ying-long; LIU Jin-ping; LI Xiao-feng

    2010-01-01

    Background Pulmonary artery perfusion during cardiopulmonary bypass (CPB) is a novel adjunctive method, which can minimize the lung ischemic-reperfusion injury and inflammatory response. This study evaluated the protective effect of pulmonary perfusion with hypothermic HTK solution in corrections of congenital heart defects with pulmonary hypertension.Methods Between June 2009 and December 2009, 24 consecutive infants with congenital heart defects and pulmonary hypertension were randomly divided into perfused group (n=12) and control group (n=12). Oxygen index, alveolar-arterial O2gradient, serum levels of malondialchehyche (MDA), interleukin (IL)-6, -8, -10, soluble intercellular adhesion molecule-1(slCAM-1), and P-selectin were measured before commencement and serially for 48 hours after termination of bypass.Results Oxygenation values were better preserved in the perfused group than in the control group. The serum levels of IL-6 increased immediately after CPB in both groups and returned to baseline at 48 hours after CPB, but it was restored faster and earlier in the perfused group. The serum levels of IL-8, slCAM-1, and MDA remained at baseline at each point after CPB in the perfused group and elevated significantly immediately after CPB in the control group, except for sICAM-1.The serum level of IL-10 increased immediately after CPB and decreased to baseline at 48 hours after CPB in both groups, but the IL-10 level in the perfused group was significantly higher than in the control group at 12 hours after CPB.The serum P-selectin levels in the control group immediately after CPB were significantly higher than prebypass levels.Moreover, there were no significant differences in postoperative clinical characters, except for the intubated time.Conclusion In infants with congenital heart defects, pulmonary perfusion with hypothermic HTK solution during cardiopulmonary bypass could ameliorate lung function and reduce the inflammatory response.

  18. Subarachnoid clonidine and trauma response in cardiac surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Claudia Gissi da Rocha Ferreira

    2014-12-01

    Full Text Available Background and objectives: The intense trauma response triggered by cardiopulmonary bypass can lead to increased morbidity and mortality. The present study evaluated whether clonidine, a drug of the class of α-2 agonists, administered by spinal route, without association with local anesthetics or opioids, reduces this response in cardiac surgery with cardiopulmonary bypass. Method: A total of 27 patients between 18 and 75 years old, divided by non-blinded fashion into a control group (15 and a clonidine group (12, were studied. All patients underwent identical technique of general anesthesia. Then, only the clonidine group received 1 μg kg−1 clonidine by spinal route. Levels of blood glucose, lactate and cortisol were measured at three consecutive times: T1, at the time of installation of invasive arterial pressure; T2, 10 min after the first dose for cardioplegia; and T3, at the time of skin suture; and troponin I values at T1 and T3. The variation of results between T2-T1, T3-T2, and T3-T1 was also evaluated. Results: There was a statistically significant difference only with respect to the variation in blood glucose in the clonidine group: T3-T2, p = 0.027 and T3-T1, p = 0.047. Conclusions: Spinal clonidine at a dose of 1 μg kg−1 did not decrease blood measurements of troponin, cortisol, or lactate. Blood glucose suffered a more moderate variation during the procedure in the clonidine group. This fact, already reported in the literature, requires further investigation to be clarified.

  19. Resuscitation great. Willem Einthoven: the development of the human electrocardiogram.

    Science.gov (United States)

    Cajavilca, Christian; Varon, Joseph

    2008-03-01

    The electrocardiogram is one of the most commonly used diagnostic tools in healthcare. This ingenious device was developed and created in the early 1900s by Willem Einthoven, MD, PhD after studying the mechanisms of electromagnetism and Waller's capillary electrometer. Einthoven dedicated most of his research and clinical activities to improve the early versions of the electrical current recording medical devices. Einthoven's most notable invention was the string galvanometer which we now know as the electrocardiogram. Although the idea of using the string galvanometer as a diagnostic tool faced opposition by scientists and physicians of his time, he remained convinced of the potential of his machine to improve patient care. Einthoven's string galvanometer subsequently became the standard diagnostic tool for recognition and differentiation of heart conditions through the interpretation of cardiac waves, and has become standard practice in the field of resuscitation. In 1924, Einthoven received the Nobel Prize in Medicine for his development of the string galvanometer.

  20. Improving Drugs Administration Safety in Pediatric Resuscitation Using Mobile Technology.

    Science.gov (United States)

    Hagberg, Hamdi; Siebert, Johan; Gervaix, Alain; Daehne, Peter; Lovis, Christian; Manzano, Sergio; Ehrler, Frederic

    2016-01-01

    The fast preparation of drugs during pediatric resuscitation is of utmost importance. The influence of the patient's weight on the drug doses requires to perform complex calculations and is a source of errors. A technological solution could be a real help in avoiding these kinds of mistakes. Relying on a user centered approach we have developed an application supporting drug preparation. It has been tested in simulations with predefined scenario. The developed tool consists of a screen displaying a list of drug that can be administered. When the user select a drug, the instructions regarding its preparation are displayed with all dosage precisely calculated. The tool has demonstrated a significant reduction of errors associated to administration, a speeding up the overall process and has been well received by the nurses.

  1. Cardiopulmonary exercise testing in the evaluation of high risk patients with lung cancer

    Institute of Scientific and Technical Information of China (English)

    MAO You-sheng; WANG Yong-gang; HUANG Jin-feng; HE Jie; YAN Shao-ping; Dong Jing-si; CHENG Gui-yu; SUN Ke-lin; LIU Xiang-yang; FANG De-kang; LI Jian

    2010-01-01

    Background It is still unclear whether pulmonary function tests (PFTs) are sufficient for predicting perioperative risk,and whether all patients or only a subset of them need a cardiopulmonary exercise test (CPET) for further assessment.Thus, this study was designed to evaluate the CPET and compare the results of CPET and conventional PFTs to identify which parameters are more reliable and valuable in predicting perioperative risks for high risk patients with lung cancer.Methods From January 2005 to August 2008, 297 consecutive lung cancer patients underwent conventional PFTs (spirometry + single-breath carbon monoxide diffusing capacity of the lungs (DLCOsb) for diffusion capacity) and CPET preoperatively. The correlation of postoperative cardiopulmonary complications with the parameters of PFT and CPET was retrospectively analyzed using the chi-square test, independent sample t test and binary Logistic regression analysis.Results Of the 297 patients, 78 did not receive operation due to advanced disease stage or poor cardiopulmonary function. The remaining 219 underwent different modes of operations. Twenty-one cases were excluded from this study due to exploration alone (15 cases) and operation-related complications (6 cases). Thus, 198 cases were eligible for evaluation. Fifty of the 198 patients (25.2%) had postoperative cardiopulmonary complications. Three patients (1.5%)died of complications within 30 postoperative days. The patients were stratified into groups based on VO2max/pred respectively. The rate of postoperative cardiopulmonary complications was significantly higher in the group with cardiopulmonary complications were significantly correlated with age, comorbidities, and poor PFT and CPET results.used to stratify the patients' cardiopulmonary function status and to predict the risk of postoperative cardiopulmonary predicting perioperative risk. If available, cardiopulmonary exercise testing is strongly suggested for high-risk lung cancer patients in

  2. 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.

  3. 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 minutes, 29 cases were successfully rescued and the success rate was 34.1%; the other 140 cases begin to CPR after 10 minutes, 0 cases were successfully rescued, which indicates that the success rate within 5 minutes was significantly higher than after 5 minutes; 140 hospital treatment CPR cases, 80 cases were successfully rescued and the success rate was 57.1%, and 256 pre-hospital treatment CPR cases, 35 cases were successfully rescued and the success rate was 13.7%, which indicates the success rate of hospital treatment was significantly higher than that of the pre-hospital treatment; the success rate of CPR using electric defibrillation within 2 minutes was 54.2%, which was much higher than 34.0% success rate of CPR using electric defibrillation after 2 minutes ; the success rate of CPR with endolracheal intubation was 34.1%, much higher than a 13.0% success rate of CPR without endotracheal intubation; the success rate of CPR with both endotracheal intubation and breathing apparatus was 39.1%, much higher than a 10.7% success rate of CPR without breathing apparatus (including patients with and without endotracheal intubation), differences were statistically significant (all P < 0.01). Conclusion Early correct and effective CPR, electric defibrillation and endotracheal intubation are the keys to the success of CPR. To improve the success rate of CPR, professional first aid team construction was strenghened, emergency network was established and improved, and cooperate hospital treatment closely with pre-hospital treatment and the national first aid was popularized so as to further improve the success rate of CPR.

  4. Effect of β-sodium aescinate on hypoxia-inducible factor-1α expression in rat brain neurons after cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    康健

    2013-01-01

    Objective To investigate the expression of the hypoxia-inducible factor(HIF)-1α in rat brain neuronsand the intervention of β-sodium aescinate after restoration of spontaneous circulation(ROSC).Methods Sixty

  5. 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.

  6. 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 structuring of the own team is a prerequisite for timely and effective execution of CPR.

  7. Quality of Cardiopulmonary Resuscitation When Directing the Area of maximal Compression by Transesophageal Echocardiography During Cardiac Arrest in Swine (Sus scrofa)

    Science.gov (United States)

    2013-12-30

    at 20mins CPP was measured over the duration of the experiment ROSC was defined as a regular cardiac rhythm with SBP >60 for 1min...69.2) 0 (0.00) No ROSC 4 (30.8) 13 ( 100 ) * * * p=0.032 p=0.002 pɘ.001 Figure 1. CPP at baseline, during VF arrest, BLS, and ACLS

  8. Myocardial contractile function in survived neonatal piglets after cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Popov Aron-Frederik

    2010-11-01

    Full Text Available Abstract Background Hemodynamic function may be depressed in the early postoperative stages after cardiac surgery. The aim of this study was the analysis of the myocardial contractility in neonates after cardiopulmonary bypass (CPB and mild hypothermia. Methods Three indices of left ventricular myocardial contractile function (dP/dt, (dP/dt/P, and wall thickening were studied up to 6 hours after CPB in neonatal piglets (CPB group; n = 4. The contractility data were analysed and then compared to the data of newborn piglets who also underwent median thoracotomy and instrumentation for the same time intervals but without CPB (non-CPB group; n = 3. Results Left ventricular dP/dtmax and (dP/dtmax/P remained stable in CPB group, while dP/dtmax decreased in non-CPB group 5 hours postoperatively (1761 ± 205 mmHg/s at baseline vs. 1170 ± 205 mmHg/s after 5 h; p max and (dP/dtmax/P there were no statistically significant differences between the two groups. Comparably, although myocardial thickening decreased in the non-CPB group the differences between the two groups were not statistically significant. Conclusions The myocardial contractile function in survived neonatal piglets remained stable 6 hours after cardiopulmonary bypass and mild hypothermia probably due to regional hypercontractility.

  9. Gravity and the evolution of cardiopulmonary morphology in snakes.

    Science.gov (United States)

    Lillywhite, Harvey B; Albert, James S; Sheehy, Coleman M; Seymour, Roger S

    2012-02-01

    Physiological investigations of snakes have established the importance of heart position and pulmonary structure in contexts of gravity effects on blood circulation. Here we investigate morphological correlates of cardiopulmonary physiology in contexts related to ecology, behavior and evolution. We analyze data for heart position and length of vascular lung in 154 species of snakes that exhibit a broad range of characteristic behaviors and habitat associations. We construct a composite phylogeny for these species, and we codify gravitational stress according to species habitat and behavior. We use conventional regression and phylogenetically independent contrasts to evaluate whether trait diversity is correlated with gravitational habitat related to evolutionary transitions within the composite tree topology. We demonstrate that snake species living in arboreal habitats, or which express strongly climbing behaviors, possess relatively short blood columns between the heart and the head, as well as relatively short vascular lungs, compared to terrestrial species. Aquatic species, which experience little or no gravity stress in water, show the reverse - significantly longer heart-head distance and longer vascular lungs. These phylogenetic differences complement the results of physiological studies and are reflected in multiple habitat transitions during the evolutionary histories of these snake lineages, providing strong evidence that heart-to-head distance and length of vascular lung are co-adaptive cardiopulmonary features of snakes.

  10. Postgraduate Education for Physical Therapists at Cardiopulmonary Area in Colombia

    Directory of Open Access Journals (Sweden)

    Diana Durán Palomino

    2007-09-01

    Full Text Available This paper presents the supply of postdegreeprograms in the cardiopulmonary area in Colombiain orden to show its state and sufficiency.Plans of formation, objectives, curricular approach,methodology and profile of performanceare analyzed in terms of costs, duration,supply, location and research capabilities.Our results show problems in regard to supplyas well as unanimous criteria and strategic alliances.There are no Gremial associations thatfavor both discussion and analysis about epidemiologistaspects of respiratory and cardiovasculardiseases in Colombia there is necessityof professionals in this area with experience.Knowledge and appropiated skills in management,administration, laws, agreements andpublic policies that cover the affected population.Also, it is exposed that the Universities whitthis programs require support and pursuit forprofessionals positioning both in national andinternational context.MethodologyA descriptive study was carried out with a datacollection made in a period between April-Decemberof 2006. Cards were done and they allowedto review different aspects such as costs,occupational profile, duration, modality, methodology,practical component and evaluation inthe offering universities of programs of postdegreein the cardiopulmonary area for physiotherapists.Later an analysis was made oncurriculum, profiles, objectives, contents, professionalcompetitions the areas of research.

  11. Effects of resistance exercise on cardiopulmonary factors in sedentary individuals.

    Science.gov (United States)

    Janyacharoen, Taweesak; Thayon, Methiya; Bushong, Wanwisa; Jaikla, Nussamol; Sawanyawisuth, Kittisak

    2016-01-01

    [Purpose] This study investigated the effects of resistance exercise on cardiopulmonary functions in young sedentary subjects. [Subjects] Forty-two young and healthy subjects with a sedentary lifestyle were included in this study. [Methods] The subjects were randomly divided into 2 groups: control and experimental. The control group (n=21) received health education and continued with normal activities of daily living. The experimental group (n=21) underwent resistance training, health education, and continued with normal activities of daily living. The resistance exercise program consisted of 3 postural exercises: chest press, dumbbell pullover, and flat-bench dumbbell fly. The subjects received this intervention 3 times/week for 8 weeks. [Results] The baseline characteristics were comparable between the 2 groups. The 6-minute-walk test score, peak expiratory flow, forced vital capacity, forced expiratory volume in 1 second, maximal voluntary ventilation, and chest expansions were significantly improved post-intervention in the experimental group and between the 2 groups. [Conclusion] Cardiopulmonary functions in young sedentary subjects were significantly improved with the 8-week resistance exercise program.

  12. Nurses' responses to do-not-resuscitate orders in the neonatal intensive care unit.

    Science.gov (United States)

    Savage, T A; Cullen, D L; Kirchhoff, K T; Pugh, E J; Foreman, M D

    1987-01-01

    A statewide survey of nurses in perinatal centers was conducted to assess the prevalence of do-not-resuscitate (DNR) policies in neonatal intensive care units (NICUs) and to examine factors influencing nurses in those centers in their compliance with DNR orders. Three nurses in each of 10 perinatal centers were asked to complete a questionnaire on DNR policies and nurses' compliance and to respond to four hypothetical clinical situations. Eighteen of the 27 responding nurses reported the existence of a DNR policy. Factors affecting compliance with DNR orders were agreement that the infant should not be resuscitated (n = 24) or respect for the parents' wishes (n = 19). Nurses' intention to resuscitate despite a DNR order varied, depending on the description of the infant. Multiple regression analyses showed that subjective norms (beta = .41 to .82) rather than attitudes (beta = .17 to .39) exerted a more powerful influence on nurses' decisions not to resuscitate.

  13. "In the beginning...": tools for talking about resuscitation and goals of care early in the admission.

    Science.gov (United States)

    White, Jocelyn; Fromme, Erik K

    2013-11-01

    Quality standards no longer allow physicians to delay discussing goals of care and resuscitation. We propose 2 novel strategies for discussing goals and resuscitation on admission. The first, SPAM (determine Surrogate decision maker, determine resuscitation Preferences, Assume full care, and advise them to expect More discussion especially with clinical changes), helps clinicians discover patient preferences and decision maker during routine admissions. The second, UFO-UFO (Understand what they know, Fill in knowledge gaps, ask about desired Outcomes, Understand their reasoning, discuss the spectrum Feasible Outcomes), helps patients with poor or uncertain prognosis or family-team conflict. Using a challenging case example, this article illustrates how SPAM and UFO-UFO can help clinicians have patient-centered resuscitation and goals of care discussions at the beginning of care.

  14. Fresh frozen plasma resuscitation provides neuroprotection compared to normal saline in a large animal model of traumatic brain injury and polytrauma.

    Science.gov (United States)

    Imam, Ayesha; Jin, Guang; Sillesen, Martin; Dekker, Simone E; Bambakidis, Ted; Hwabejire, John O; Jepsen, Cecilie H; Halaweish, Ihab; Alam, Hasan B

    2015-03-01

    We have previously shown that early treatment with fresh frozen plasma (FFP) is neuroprotective in a swine model of hemorrhagic shock (HS) and traumatic brain injury (TBI). However, it remains unknown whether this strategy would be beneficial in a more clinical polytrauma model. Yorkshire swine (42-50 kg) were instrumented to measure hemodynamic parameters, brain oxygenation, and intracranial pressure (ICP) and subjected to computer-controlled TBI and multi-system trauma (rib fracture, soft-tissue damage, and liver injury) as well as combined free and controlled hemorrhage (40% blood volume). After 2 h of shock (mean arterial pressure, 30-35 mm Hg), animals were resuscitated with normal saline (NS; 3×volume) or FFP (1×volume; n=6/group). Six hours postresuscitation, brains were harvested and lesion size and swelling were evaluated. Levels of endothelial-derived vasodilator endothelial nitric oxide synthase (eNOS) and vasoconstrictor endothelin-1 (ET-1) were also measured. FFP resuscitation was associated with reduced brain lesion size (1005.8 vs. 2081.9 mm(3); p=0.01) as well as swelling (11.5% vs. 19.4%; p=0.02). Further, FFP-resuscitated animals had higher brain oxygenation as well as cerebral perfusion pressures. Levels of cerebral eNOS were higher in the FFP-treated group (852.9 vs. 816.4 ng/mL; p=0.03), but no differences in brain levels of ET-1 were observed. Early administration of FFP is neuroprotective in a complex, large animal model of polytrauma, hemorrhage, and TBI. This is associated with a favorable brain oxygenation and cerebral perfusion pressure profile as well as higher levels of endothelial-derived vasodilator eNOS, compared to normal saline resuscitation.

  15. Protective Effects of Estradiol on Myocardial Contractile Function Following Hemorrhagic Shock and Resuscitation in Rats

    Institute of Scientific and Technical Information of China (English)

    Mona Soliman

    2015-01-01

    Background:Hemorrhagic shock (HS) results in myocardial contractile dysfunction.Studies showed that 17β-estradiol protects the myocardium against contractile dysfunction.The study investigated the cardioprotective effects of treatment with 17β-estradiol before resuscitation following 1 h of HS and resuscitation.Methods:Male Sprague-Dawley rats were assigned to 2 sets of experimental protocols:Ex vivo and in vivo treatment and resuscitation.Each set had three experimental groups (n =6 per group):Normotensive (N),HS and resuscitation (HS-R) and HS rats treated with 17β-estradiol (E) and resuscitated (HS-E-R).Rats were hemorrhaged over 60-min to reach a mean arterial blood pressure of 40 mmHg.In the ex vivo group,hearts were resuscitated by perfusion in the Langendorff system.In the 17β-estradiol treated group,17β-estradiol 280 μg/kg was added for the first 5 min.Cardiac function was measured.Left ventricular generated pressure (LVGP) and +dP/dt were calculated.In the in vivo group,rats were treated with 17β-estradiol 280 μg/kg s.c.after 60-min HS.Resuscitation was performed in vivo by the reinfusion of the shed blood for 30-min to restore normotension.Results:Treatment with 17β-estradiol before resuscitation in ex vivo treated and resuscitated isolated hearts and in the in vivo treated and resuscitated rats following HS improved myocardial contractile function.In the in vivo treated group,LVGP and +dP/dt max were significantly higher in 17β-estradiol treated rats compared to the untreated group (LVGP 136.40 ± 6.61 compared to 47.58 ± 17.55,and +dP/dt 661.85 ± 49.88 compared to 88.18 ± 0.85).Treatment with 17β-estradiol improved LVGP following HS.Conclusions:The results indicate that treatment with 17β-estradiol before resuscitation following HS protects the myocardium against dysfunction.

  16. Closed-Loop and Decision-Assist Resuscitation of Burn Patients

    Science.gov (United States)

    2008-04-01

    contemporary methods of burn resuscitation, we performed a metaanalysis of the last 26 years of burn resuscitation. We searched Medline for all...Ringer solution to induce mean 24-hour UOs exceeding 1.0 mL/kg/hr. The primary conclu- sions from the metaanalysis are1 total volumes infused typi- cally... metaanalysis did not analyze whether burn centers are infusing more fluid than is optimal, or if the Brooke and Parkland burn formulas specify inadequate

  17. Resuscitation of Intraoperative Hypovolemia: Comparison of Normal Saline and Hyperosmotic/Hyperoncotic Solutions in Swine

    Science.gov (United States)

    1991-05-01

    hypocalcemia, hyperkalemia , metabolic acidosis , coagulation derangements, as well as viral infections (11. Isotonic crystalloid solutions are only...between groups over all time points (Table 4). During early resuscitation both groups were characterized by a metabolic acidosis (Table 4) which was...Pascual et al. -- 9 excess, while in the NS group the acidosis persisted (pH! 7.3 and negative values of base excess) throughout the resuscitation period

  18. The Effect of Repeat Cardiopulmonary bypass on Epicardial Microflow and Graft Flow during Intra-operative Heart Failure

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    Objective The relationship between graft blood flow, epicardial microflow,mean arterial pressure and hemorheologic changes was studied during intraoperative heart failure.Methods These parameters were done to evaluate the use of repeated cardiopulmonary bypass supportfor the intraoperative heart failure following aorto-coronary bypass surgery. Included in this study were10 patients with a mean age of 7 0 and unstable angina undergoing coronary bypass grafting and suffer-ing from intraoperative heart failure. The epicardiai microflow, graft flow, mean arterial pressureand blood cell filterability were measured. Resluts During heart failure, the mean arterial pressurefell by 41 % ( P < 0. 01 ), graft flow by 67 % ( P < 0. 01 ) and epicardialmicro flow by 64 % ( P <0. 01 ). After 1 5 to 56 min of assisted cardiopulmonary bypass support, the epicardial mioroflow andgraft flow were partially restored, while red cell and white cell filterability was reduced by 31% and644 % respectively ( P < 0. 01 ). There were significant correlations between graft flow, epicardial mi-croflow, blooxd cell filterability and cardiopulmonary bypass time. All patients recovered and were dis-charged from the hospital. Conclusion It is concluded that the use of temporary assisted CPB sup-port to treat intrapoperative heart failure allows the recovery of the myocardium and thereby restores themean arterial pressure. The recovery of graft flow and epicardial flow occurred to a lesser extent. TheCPB support seemed to be suitable for about 60 rain probably because of increasing disturbance to theblood cell filterability, graft flow and the epicardial microcirculation.

  19. Glibenclamide dose response in patients with septic shock: effects on norepinephrine requirements, cardiopulmonary performance, and global oxygen transport.

    Science.gov (United States)

    Morelli, Andrea; Lange, Matthias; Ertmer, Christian; Broeking, Katrin; Van Aken, Hugo; Orecchioni, Alessandra; Rocco, Monica; Bachetoni, Alessandra; Traber, Daniel L; Landoni, Giovanni; Pietropaoli, Paolo; Westphal, Martin

    2007-11-01

    Adenosine triphosphate-sensitive potassium channels are important regulators of arterial vascular smooth muscle tone and are implicated in the pathophysiology of catecholamine tachyphylaxis in septic shock. The present study was designed as a prospective, randomized, double-blinded, clinical pilot study to determine whether different doses of glibenclamide have any effects on norepinephrine requirements, cardiopulmonary hemodynamics, and global oxygen transport in patients with septic shock. We enrolled 30 patients with septic shock requiring invasive hemodynamic monitoring and norepinephrine infusion of 0.5 microg.kg-1.min-1 or greater to maintain MAP between 65 and 75 mmHg. In addition to standard therapy, patients were randomized to receive either 10, 20, or 30 mg of enteral glibenclamide. Systemic hemodynamics, global oxygen transport including arterial lactate concentrations, gas exchange, plasma glucose concentrations, and electrolytes were determined at baseline and after 3, 6, and 12 h after administration of the study drug. Glibenclamide decreased plasma glucose concentrations in a dose-dependent manner but failed to reduce norepinephrine requirements. None of the doses had any effects on cardiopulmonary hemodynamics, global oxygen transport, gas exchange, or electrolytes. These data suggest that oral glibenclamide in doses from 10 to 30 mg fails to counteract arterial hypotension and thus to reduce norepinephrine requirements in catecholamine-dependent human septic shock.

  20. Comparison of the T-piece resuscitator with other neonatal manual ventilation devices: A qualitative review.

    LENUS (Irish Health Repository)

    2012-01-31

    AIM: To review the literature surrounding various aspects of T-piece resuscitator use, with particular emphasis on the evidence comparing the device to other manual ventilation devices in neonatal resuscitation. DATA SOURCES: The Medline, EMBASE, Cochrane databases were searched in April 2011. Ongoing trials were identified using www.clinicaltrials.gov and www.controlled-trials.com. Additional studies from reference lists of eligible articles were considered. All studies including T-piece resuscitator use were eligible for inclusion. RESULTS: Thirty studies were included. There were two randomised controlled trials in newborn infants comparing the devices, one of which addressed short and intermediate term morbidity and mortality outcomes and found no difference between the T-piece resuscitator and self inflating bag. From manikin studies, advantages to the T-piece resuscitator include the delivery of inflating pressures closer to predetermined target pressures with least variation, the ability to provide prolonged inflation breaths and more consistent tidal volumes. Disadvantages include a technically more difficult setup, more time required to adjust pressures during resuscitation, a larger mask leak and less ability to detect changes in compliance. CONCLUSIONS: There is a need for appropriately designed randomised controlled trials in neonates to highlight the efficacy of one device over another. Until these are performed, healthcare providers should be appropriately trained in the use of the device available in their departments, and be aware of its own limitations.