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Ten of the 18 people who had a cardiac arrest at Chicago airports between June, 1999 and May, 2001 were alive one year later because the airports had automated external defibrillators available at many sites throughout the airport. All but two of the responders were Good Samaritans and many had no experience using an automated defibrillator.

Delaying the administration of fluids to patients with penetrating torso injuries and low blood pressure until the time of surgery may increase the chance of survival for these patients. Delaying fluid administration would represent a change in the current practice recommended by the American College of Surgeons to give intravenous fluids to hypotensive trauma patients before surgery to prevent bleeding to death. A prospective study of 598 adults with penetrating torso injuries and a pre-hospital systolic blood pressure less than 90 mm Hg suggests that aggressive administration of intravenous fluids to such patients before surgery may actually increase internal hemorrhaging. The study, conducted using the Houston, Texas Emergency Medical Services system, divided patients into two groups: those receiving immediate fluid resuscitation before reaching the hospital, and those who did not receive intravenous fluids until they went to surgery for their injuries.

Emergency medical technicians should stop resuscitating people in cardiac arrest if they cannot restore blood circulation within 25 minutes. However, they should continue resuscitating people in ventricular fibrillation. The records of 1,322 patients who went into cardiac arrest and received emergency care outside a hospital were reviewed. All survivors were successfully resuscitated within 25 minutes of the arrival of paramedics. The only surviving patients who were not resuscitated at the scene were those with persistent ventricular fibrillation. They accounted for 0.6% of the 952 patients who were not resuscitated. Because of the hazards involved in high-speed travel to a hospital, only those patients who are likely to benefit from hospital-based care should be transported., Objective. - To identify distinct criteria for appropriate on-scene termination of resuscitation efforts for out-of-hospital cardiac arrest when on-scene interventions fail to restore spontaneous circulation. Design. - For 18 months, all out-of-hospital cardiac arrests were evaluated prospectively for survival to hospital discharge and for all established survival predictors including age, gender, presenting cardiac rhythm, whether it was a witnessed event, performance of basic cardiopulmonary resuscitation by bystanders, and interval to paramedic arrival and return of spontaneous circulation (ROSC). Setting. - A large municipality with a single, centralized emergency medical services program. Patients. - All normothermic adults treated for out-of-hospital, unmonitored, primary cardiac arrest. Interventions. - Standard advanced cardiac life support provided at the scene by paramedics. Main Outcome Measures. - The number and circumstances of patients achieving survival to hospital discharge following failure to achieve on-scene ROSC. Results. - Of 1461 consecutive primary cardiac arrests, 139 were monitored (paramedic witnessed), including 59 that occurred en route to the hospital. Of the 1322 unmonitored patients, 370 achieved ROSC at the scene. Only six (0.6%) of the 952 who did not achieve ROSC at the scene survived, and all six were readily identifiable as having persistent ventricular fibrillation. Excluding those patients with persistent ventricular fibrillation, all survivors achieved ROSC within 25 minutes after paramedic arrival. Conclusions. - Excluding patients with persistent ventricular fibrillation, resuscitative efforts can be terminated at the scene when normothermic adults with unmonitored, out-of-hospital, primary cardiac arrest do not regain spontaneous circulation within 25 minutes following standard advanced cardiac life support. These criteria should now be validated in several large centers with high survival rates.

High-dose epinephrine may not be a more effective treatment than standard-dose epinephrine for treatment of patients who suffer cardiac arrest outside the hospital. Among 1,280 patients who suffered cardiac arrest outside the hospital, 648 were treated with 0.2 milligrams (mg) of intravenous (IV) epinephrine per kilogram of body weight and 632 were treated with 0.02 mg of IV epinephrine per kg of body weight. Thirty-three percent of the patients treated with high-dose epinephrine experienced a spontaneous return of circulation, compared to 30% of those treated with standard-dose epinephrine. Twenty-two percent of the patients in each of the treatment groups survived to be admitted to the hospital. Five percent of the patients in the high-dose treatment group survived to be discharged from the hospital, compared to four percent of those in the standard-treatment group. Treatment with high-dose epinephrine did not significantly improve neurological outcome.

A study of 1,019 patients who were brought to a hospital in cardiac arrest in one year found that when the number of arrests was plotted against the hour of the day, the number of arrests increased steadily from 6 a.m. until it peaked at noon. Circadian rhythms, which are biological rhythms that fluctuate around a 24-hour period, have been found to influence heart attacks, angina, blood pressure and strokes. Furthermore, heart rate, the aggregation of platelets, and blood levels of hormones that regulate the heart and blood vessels all peak in the early morning hours. Treatments for heart disease may be more effective if they are given at specific times of the day., Objectives.--Published studies have indicated a circadian rhythm in the occurrence of sudden cardiac death. However, these studies have involved either retrospective analyses of death certificates or analyses of data collected during studies of pharmacologic agents in selected populations. Purpose.--To determine whether a circadian pattern be clearly demonstrated in a prospective study of out-of-hospital sudden cardiac death in a large, unselected population. Design.--All adult cases of sudden death of presumed primary cardiac cause from a large urban population were prospectively evaluated over a 12-month period. The incidence of sudden cardiac death was analyzed using harmonic regression of the data tabulated by hour of the day. Results.--During the year of study, 1019 consecutive primary cardiac arrests were analyzed. A significant circadian pattern was found (P