Mechanical CPR devices (Views : 6 times)
Abstract
It is recognized that the quality of cardiopulmonary resuscitation (CPR) is an important predictor of outcome from cardiac arrest. Mechanical chest-compression devices provide an alternative to manual CPR. Physiological and animal data suggest that mechanical chest-compression devices are more effective than manual CPR. Consequently, there has been much interest in the development of new techniques and devices to improve the efficacy of CPR. This review will consider the evidence and current indications for the use of some of the more common mechanical devices developed to increase the safety and efficacy of CPR administration.
Key words: cardiac arrest, chest compression, automatic mechanical devices, piston chest compression, LUCAS, vest CPR, Autpulse - load distributing band CPR, cost effectiveness, outcome, survival
Refractory ventricular fibrillation with prolonged resuscitation in dialysis-sensitive dysrhythmic patient (Views : 618 times)
Written by:
Paul Puchwein, Rainer Gumpert, Wilfried Hartwagner, Sylvia Archan, Gernot Wilder
Case reports
Abstract
Sudden cardiac death is a leading cause of death in chronic renal failure patients. We present a case of refractory ventricular fibrillation with successful prolonged resuscitation (> 1 hour) without neurological sequel in an outpatient dialysis centre. Implantation of a cardioverter-defibrillator is able to identify patients as dialysis-sensitive. Smoother potassium removal during hemodialysis could eliminate dysrhythmias. Prehospital (point-of-care) blood gas analysis can be helpful especially in prolonged resuscitation.
Keywords: successful resuscitation, ventricular fibrillation, point-of-care, blood gas analysis, potassium, hemodialysis, ICD
Acute mesenteric ischemia due to superior mesenteric artery embolism in a patient with permanent atrial fibrillation (Views : 726 times)
Written by:
Miroslav Šimunić, Nikola Perković, Zoran Bogdanović, Ante Tonkić, Damir Fabijanić, Marina Maras-Šimunić, Tonći Batinić
Case reports
Abstract
Acute mesenteric ischemia (AMI) is an uncommon disorder with a high mortality rate. Reduction in mortality requires a high index of suspicion and prompt diagnosis. We describe a case of AMI in a 59-year old man with a history of permanent atrial fibrillation. Pathogenesis of AMI, clinical implications, diagnostic and therapeutic options are discussed.
Key words: thromboembolism, superior mesenteric artery, diagnosis, mesenteric angiography
Rapid Sequence Intubation in the Pre-Hospital Setting – Difference Between Trauma and Nontrauma Patients (Views : 1487 times)
Abstract
Aim. To determine, in a prospective observational study, whether there are differences in the practice of rapid sequence intubation (RSI) and to ascertain the characteristics between trauma and non-trauma patients that were intubated in a pre-hospital setting.
Methods. Included were patients (18 years and over) who were not in cardiac arrest and who underwent RSI and were transported to hospital. From January 2000 to December 2006 we intubated 636 patients in cardiac arrest, 159 critically ill non-trauma patients and 142 trauma patients. Placement of an endotracheal tube was confirmed by capnography. We compared medical and trauma groups of intubated patients. We used the two-independent sample t-test, Chi-square test and Wilcoxon-Mann Whitney test for statistical analysis.
Results. Statistical differences between groups (medical vs. trauma): initial main arterial pressure (104.9 +/- 34.6 vs. 90.7 +/- 24.8; p=0.01), blood glucose levels (9.2 +/- 3.5 vs. 5.9 +/- 1.9; p=0.011), administration of colloids (13,1 % vs. 70,2; p=0.003) and Hyperhaes (2.5 % vs.17.6 %; p=0.001), male gender (62.3 vs 81.6; p=0.014), rate of RSI (71.1 % vs. 96.4 %; p<0.001), initial GCS distribution 3-4/5-8/9-15 (30.9 % /61.6 % /7.5 % vs 11.7 % /60,2 % /28,1 %; p<0.001), initial pet CO2 (49,5 +/- 8,4 mmHg vs. 32,8 +/- 5.4 mmHg; p=0.007), APACHE II first day of hospitalization (25,9 +/- 4.9 vs. 20,8 +/- 3.6; p=0.002) and hospital mortality (78/159 (49.1 %) vs. 44/142 (30.1 %); p=0.023). We also analyzed the number of intubation attempts, intubation success rate, perceived difficulty of intubation and side effects with complications. The hospital survival analysis showed that survivors are younger (54.2 +/- 19.9 vs. 62.3 +/-18.8; p=0.019), have a higher rate of RSI (175/179(97.7 %) vs. 75/122(61.6 %); p=0.002) and have a better (lower) APACHE II score (19.9 +/-3.6 vs.28.3 +/- 4.6; p=0.002). We found the highest mortality rate in the subgroup of patients with non-traumatic intracranial hemorrhage (58.8 %, 60/102).
Conclusion. In non-trauma, critically ill patients we found a lower rate of RSI, more patients with an initial GCS of 3-4, higher APACHE II first day, higher initial pet CO2 and higher hospital mortality than in trauma patients.
Keywords: rapid sequence intubation, pre-hospital setting, injured patients, critically ill patients, prognosis
Out-of-hospital cardiopulmonary resuscitation in four Serbian university cities: outcome follow-up according to the "Utstein style" (Views : 452 times)
Abstract
Aims. To investigate the return of spontaneous circulation (ROSC), survival to discharge, six-month and one-year survival of patients with out-of-hospital cardiac arrest in four university cities in Serbia.
Methods. A prospective, two-year, multicentre study was designed. Using the Utstein template, we recorded out-of-hospital cardiopulmonary (CPR) and its outcomes, and analyzed the immediate survival (ROSC>20 min.), short-term survival (to discharge), long-term survival (one year after discharge), or death following out-of-hospital CPR.
Results. During the study period, 591 patients met the inclusion criteria for enrollment and out-of-hospital CPR. The etiology of arrest was cardiac in 33.8% of patients. Cardiac arrest was witnessed by the advanced life support (ALS) team in 15.6% of cases. Asystole was the most frequent initial rhythm at time of arrest (46.4%). The highest survival rate (P<0,001) was observed in cases with initial VF and pulseless VT, while patients with asystole and pulseless electrical activity (PEA) had the least chance of survival. Within the whole group of patients, ROSC was detected with a frequency of 69.7%. The frequency of patients who died in the field or during admission to hospital was 58.9%, while 28.6% of admitted patients died before discharge. Thirteen percent of patients survived until discharge, and the overall six-month and one-year survival rates were 11.3% and 10%, respectively. No statistical difference in survival rates among the cities was found
Conclusion. The Utstein template should be implemented in the form of an official protocol for out-of-hospital CPR follow-up in all emergency medical services in Serbia.
Key words: out-of-hospital CPR, outcome, follow-up, Utstein style, Serbia
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