Search

Purpose American Heart Association (AHA) 2010 cardiopulmonary resuscitation guidelines recommend high-quality chest compressions (minimum interruption, a pace [100 compressions/min, and a depth more than 5 cm). They propose minor changes for pregnant women: manual left deviation of the uterus or a left-lateral incline of 27°-30° to alleviate pressure on the inferior vena cava. We examined the performance of the Pentax-AWS Airwayscope (AWS) and Macintosh laryngoscope (McL) for airway management during chest compressions on a 27° left-lateral tilt (27 LLT) operating table. Methods The study included 18 novice doctors in our anesthesia department. They performed tracheal intubation on a manikin positioned on a 27 LLT operating table using the AWS or McL with or without chest compressions. We measured the intubation time and success rate for tracheal intubation. Results Intubation success rate with the McL decreased with chest compressions compared to without chest compressions (12/18 vs. 18/18, P < 0.05). Intubation time with the McL was lengthened with chest compressions compared to without chest compressions (18.9 ± 4.0 s vs. 11.1 ± 1.0 s, P < 0.05). Intubation success rate was the same for the AWS with and without chest compressions (18/18 in both cases), and intubation time did not increase significantly without compressions compared to with compressions (11.6 ± 1.4 s vs. 12.6 ± 1.2 s, NS). Conclusions The AWS is an effective tool for airway management during chest compressions in 27 LLT in a manikin, suggesting that the AWS may be a useful device for airway management during maternal resuscitation. Keywords Chest * Compression * Maternal cardiopulmonary resuscitation * 27° left-lateral tilt, Introduction Pregnancy-related mortality is rare in developed countries, estimated to occur in approximately 1:30,000 deliveries [1]. Although pregnant women are younger than most patients who experience cardiopulmonary arrest, their survival [...]

A study was conducted to evaluate and compare the survival rate in out-of-hospital cardiac arrest using compression-only (COCPR) by lay rescuers against conventional CPR. Results indicated that lay person COCPR resulted in higher survival rates in the case of such patients.

Author(s): Jerry P. Nolan [sup.1] [sup.2] , Alain Cariou [sup.3] Author Affiliations: (1) grid.5337.2, 0000000419367603, University of Bristol, , Bristol, UK (2) grid.416091.b, 0000000404170728, Royal United Hospital, , Bath, UK [...]

A study was conducted to evaluate whether intravenous drug administration in advanced cardiac life support (ACLS) would help improve the survival rate for out-of-hospital cardiac arrest. Results indicated that patients who received such intravenous administration had higher rates of short-term survival, but no significant differences in long-term survival and quality of CPR.

The study aims to investigate the survival rates among elderly patients after in-hospital cardiopulmonary resuscitation (CPR) as well as highlight those characteristics that increase the rate of survival. The results indicate that survival following CPR did not have very beneficial results, and also that in the case of African-American patients the rates of survival after CPR were lower.

OBJECTIVE. Cardiac arrest is uncommon among pediatric patients. Prehospital data demonstrate differences in care processes between children and adults receiving cardiopulmonary resuscitation and advanced life support. We sought to evaluate whether children receiving in-hospital cardiopulmonary resuscitation would attain superior 24-hour survival in hospitals with a higher level of pediatric physician staffing, greater intensity of pediatric care services, and higher pediatric patient volume. METHODS. A retrospective cohort of 778 hospital inpatients aged < 18 years receiving cardiopulmonary resuscitation was identified from the National Registry of Cardiopulmonary Resuscitation from January 2000 to December 2002. Data on hospital pediatric facilities were obtained via telephone survey. Univariate analyses comparing 24-hour survivors and nonsurvivors were conducted using Wilcoxon rank-sum testing for continuous variables and [chi square] analysis for dichotomous variables. Multivariate regression analysis was done to examine hospital characteristics as independent predictors of 24-hour survival. RESULTS. Complete data were available for 677 patients. Univariate analyses showed an association between several pediatric-specific facility characteristics and 24-hour survival. After accounting for indicators of pre-event clinical condition and monitoring, multivariate analysis showed improved 24-hour survival in hospitals staffed by pediatric residents and surgeons and pediatric residents, surgeons, and fellows than for hospitals with no pediatric physician staffing or pediatric surgeons alone. Measures of available facilities and patient volume were not associated with improved outcome. CONCLUSIONS. Improved 24-hour survival for children receiving in-hospital cardiopulmonary resuscitation is associated with the presence of pediatric residents and fellows. Key Words cardiopulmonary resuscitation, hospital performance, cardiac arrest Abbreviations CPR--cardiopulmonary resuscitation NRCPR--National Registry of Cardiopulmonary Resuscitation NoPeds--no pediatric housestaff or surgeons PedSurg--pediatric surgeons only PedRes--pediatric surgeons and residents PedFellow--pediatric surgeons--residents--and pediatric emergency medicine and/or pediatric critical care medicine fellows OR--odds ratio CI--confidence interval ED--emergency department, CARDIAC ARREST IS an uncommon phenomenon in children. Differences in physiology and etiology between adults and children have led to the creation of separate treatment algorithms for cardiac arrest in [...]

Byline: T. Horisberger (1), J. Fischer (1), S. Fanconi (2) Keywords: Cardiopulmonary resuscitation Children Infants Outcome Prediction Abstract: Objective: Reported survival after cardiopulmonary resuscitation (CPR) in children varies considerably. We aimed to identify predictors of 1-year survival and to assess long-term neurological status after in- or outpatient CPR. Design: Retrospective review of the medical records and prospective follow-up of CPR survivors. Setting: Tertiary care pediatric university hospital. Patients and m ethods: During a 30-month period, 89 in- and outpatients received advanced CPR. Survivors of CPR were prospectively followed-up for 1 year. Neurological outcome was assessed by the Pediatric Cerebral Performance Category scale (PCPC). Variables predicting 1-year survival were identified by multivariable logistic regression analysis. Interventions: None. Results: Seventy-one of the 89 patients were successfully resuscitated. During subsequent hospitalization do-not-resuscitate orders were issued in 25 patients. At 1 year, 48 (54%) were alive, including two of the 25 patients with out-of-hospital CPR. All patients died, who required CPR after trauma or near drowning, when CPR began >10 min after arrest or with CPR duration >60 min. Prolonged CPR (21--60 min) was compatible with survival (five of 19). At 1 year, 77% of the survivors had the same PCPC score as prior to CPR. Predictors of survival were location of resuscitation, CPR during peri- or postoperative care, and duration of resuscitation. A clinical score (0--15 points) based on these three items yielded an area under the ROC of 0.93. Conclusions: Independent determinants of long-term survival of pediatric resuscitation are location of arrest, underlying cause, and duration of CPR. Long-term survivors have little or no change in neurological status. Author Affiliation: (1) Department of Neonatology and Pediatric Intensive Care, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich, Switzerland (2) Department of Pediatrics, CHUV, Lausanne, Switzerland Article History: Received Date: 20/04/2001 Accepted Date: 05/11/2001 Article note: Electronic Publication

Byline: S. Gando (1), S. Nanzaki (1), Y. Morimoto (1), S. Kobayashi (1), O. Kemmotsu (1) Keywords: Key words Cardiac arrest; Cardiopulmonary resuscitation; Soluble adhesion molecules; Neutrophil; Endothelium Abstract: Objectives: To investigate the inflammatory responses in patients with out-of-hospital cardiac arrest, we examined the changes in markers of endothelial activation, neutrophil activation, and endothelial injury.APDesign: Prospective, cohort study.APSetting: General intensive care unit of a tertiary care center.APPatients and participants: Forty-four out-of-hospital cardiac arrest patients were classified into two groups, those who achieved return of spontaneous circulation (ROSC) (n = 23) and those without ROSC (n = 21). Eight normal healthy volunteers served as control subjects.APMeasurements and results: Serial levels of soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble E-selectin (sE-selectin) as markers of endothelial activation, neutrophil elastase as a marker of neutrophil activation, and soluble thrombomodulin as a marker of endothelial injury were measured during and after cardiopulmonary resuscitation (CPR). In patients with ROSC, cardiac arrest and CPR led to increases in the levels of three vascular endothelial adhesion molecules, neutrophil elastase, and soluble thrombomodulin that peaked 6 h or 24 h after arrival at the emergency department. In patients without ROSC, only neutrophil elastase showed moderate elevation during CPR. We could not find significant differences in all measured parameters between the two groups.APConclusions: As evidence of inflammatory responses in whole-body ischemia and reperfusion, our study demonstrates neutrophil-endothelium interaction with signs of endothelial injury in patients with out-of-hospital cardiac arrest. These inflammatory changes may have an important role in post-resuscitation syndrome after human cardiac arrest. Author Affiliation: (1) Department of Anesthesiology and Intensive Care, Hokkaido University School of Medicine, N15 W7, Kita-ku, Sapporo, 060 Japan e-mail: sgando@med.hokudai.ac.jp Tel.: + 81-11-7 06 73 77 Fax: + 81-11-7 06 73 78, JP Article note: Received: 19 May 1999 Final revision received: 9 November 1999 Accepted: 15 November 1999