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Characteristics of in-hospital cardiac arrest and cardiopulmonary resuscitation  [PDF]
Tomislav Ru?man,Dubravka Ivi?,Vi?nja Iki?,Josip Ivi?
Medicinski Glasnik , 2009,
Abstract: Aim We have studied epidemiology of in-hospital cardiac arrest, characteristics of organizing a reanimationand its,procedures as well as its documenting.Methods We analyzed all resuscitation procedure data where anesthesiology reanimation teams (RT) providedcardiopulmonary resuscitation (CPR) during one-year period. We included resuscitation attemptsthat were initiated outside the Department of Anesthesiology, excluding incidents in operation rooms andIntensive Care Unit (ICU). Data on every cardiac arrest and CPR were entered in a special form.Results During one-year period 87 CPR were performed. Victims of cardiac arrest were principallyelderly patients (age 60 – 80), mostly male (60%). Most frequent victims were neurological patients(42%), surgical patients (21%) and neurosurgical patients (10%). The leading cause of cardiac arrestwas primary heart disease, following neurological diseases and respiration disorders of severe etiology.In over 90% cases CPR was initiated by medical personnel in their respective departments, RT arrivedwithin 5 minutes in 73,56% cases. Initially survival was 32%, but full recovery was accomplished in 4patients out of 87 (4,6%).Conclusion Victims of cardiac arrest are patients whose primary disease contributes to occurrence ofcardiorespiratory complications. High mortality and low percentage of full recovery can be explainedby characteristics of patients (old age, nature and seriousness of primary disease) which significantly affectthe outcome of CPR. In some cases a question is raised whether to initiate the CPR at all. We wouldlike to point out that continous monitoring of potentially critical patients may prevent cardiorespiratoryincidents whereas the quality and success of CPR may be improved by training of staff and better technicalequipment on the relevant locations in the in the hospital where such incidents usually occur.
Year in review 2010: Critical Care - cardiac arrest and cardiopulmonary resuscitation
Jeffery C Metzger, Alexander L Eastman, Paul E Pepe
Critical Care , 2011, DOI: 10.1186/cc10540
Abstract: In 2010, a number of papers were published in the field of cardiac arrest and cardiopulmonary resuscitation (CPR). Critical Care provided us with some innovative and important data within these fields of research. This review will summarize some of the notable data published in 2010 and focus on papers published in Critical Care. For example, we discuss the latest research in therapeutic hypothermia after cardiac arrest and also review the effects of bystander-initiated cardiopulmonary resuscitation (BCPR), the role of hypercapnea in near-death experiences (NDEs) during cardiac arrest, markers of endothelial injury after CPR, and the use of cell-free plasma DNA as a marker to predict outcome after CPR.While the idea of therapeutic hypothermia is not new by any means (dating back to its recommended use by Hippocrates for wounded patients [1]), therapeutic hypothermia has been shown for almost a decade to decrease mortality and improve outcomes after cardiac arrest [2,3]. In 2010, we continued to learn about this life-saving therapeutic modality.Several studies looked at the mechanisms of cooling patients. One study looked at the use of an external shower of water (2°C) which achieved a median rate of cooling of 3°C per hour [4]. Another study showed that the Arctic Sun device (Medivance, Inc., Louisville, CO, USA) cooled, on average, 54 minutes faster than other external measures such as ice packets and blankets [5], whereas yet another study [6] compared endovascular cooling with external cooling and showed that endovascular cooling led to more time in the target temperature range, less temperature fluctuation, and more control during rewarming. It is currently recommended that cooling be achieved as soon as possible [6]. In a study in Critical Care, ?kulec and colleagues [7] looked at the effectiveness of infusing 15 to 20 mL/kg of 4°C saline intravenously in the pre-hospital environment and found an average decrease in the tympanic temperature of 1.4°C over the co
Theoretical knowledge of nurses working in non-hospital urgent and emergency care units concerning cardiopulmonary arrest and resuscitation
Almeida, Angélica Olivetto de;Araújo, Izilda Esmenia Muglia;Dalri, Maria Célia Barcellos;Araujo, Sebasti?o;
Revista Latino-Americana de Enfermagem , 2011, DOI: 10.1590/S0104-11692011000200006
Abstract: 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.
Effect of methylene blue on the genomic response to reperfusion injury induced by cardiac arrest and cardiopulmonary resuscitation in porcine brain
Cécile Martijn, Lars Wiklund
BMC Medical Genomics , 2010, DOI: 10.1186/1755-8794-3-27
Abstract: Pigs underwent either untreated cardiac arrest (CA) or CA with subsequent cardiopulmonary resuscitation (CPR) accompanied with an infusion of saline or an infusion of saline with MB. Genome-wide transcriptional profiling using the Affymetrix porcine microarray was performed to 1) gain understanding of delayed neuronal death initiation in porcine brain during ischemia and after 30, 60 and 180 min following reperfusion, and 2) identify the mechanisms behind the neuroprotective effect of MB after ischemic injury (at 30, 60 and 180 min).Our results show that restoration of spontaneous circulation (ROSC) induces major transcriptional changes related to stress response, inflammation, apoptosis and even cytoprotection. In contrast, the untreated ischemic and anoxic insult affected only few genes mainly involved in intra-/extracellular ionic balance. Furthermore, our data show that the neuroprotective role of MB is diverse and fulfilled by regulation of the expression of soluble guanylate cyclase and biological processes accountable for inhibition of apoptosis, modulation of stress response, neurogenesis and neuroprotection.Our results support that MB could be a valuable intervention and should be investigated as a therapeutic agent against neural damage associated with I/R injury induced by cardiac arrest.Despite recent advances in out-of-hospital cardiac arrest (CA) resuscitation, hypoxic-ischemic brain damage still causes considerable mortality and morbidity. Of the patients who survive to discharge, only 20% or fewer will have good neurologic function at the end of 1 year [1] After successful CPR and restoration of spontaneous circulation (ROSC) neuronal death initiated by ischemia during CA is increased also during reperfusion leading to secondary postischemic-anoxic encephalopathy [2], part of the so-called postresuscitation syndrome [3,4]. Cerebral recovery is dependent on duration of arrest and cardiopulmonary resuscitation (CPR), and numerous factors related to bas
Extensive colonic necrosis following cardiac arrest and successful cardiopulmonary resuscitation: report of a case and literature review  [cached]
Katsoulis Iraklis E,Balanika Alexia,Sakalidou Maria,Gogoulou Ioanna
World Journal of Emergency Surgery , 2012, DOI: 10.1186/1749-7922-7-35
Abstract: Non-occlusive colonic ischaemia is a recognized albeit rare entity related to low blood flow within the visceral circulation and in most reported cases the right colon was affected. This is the second case report in the literature of extensive colonic necrosis following cardiac arrest and cardiopulmonary resuscitation (CPR). A 83-year-old Caucasian woman was admitted to our hospital due to a low energy hip fracture. On her way to the radiology department she sustained a cardiac arrest. CPR started immediately and was successful. A few hours later, the patient developed increasing abdominal distension and severe metabolic acidocis. An abdominal multidetector computed tomography (MDCT) scan was suggestive of intestinal ischaemia. At laparotomy, the terminal ileum was ischaemic and extensive colonic necrosis was found, sparing only the proximal third of the transverse colon. The rectum was also spared. The terminal ileum and the entire colon were resected and an end ileostomy was fashioned. Although the patient exhibited a transient improvement during the immediate postoperative period, she eventually died 24h later from multiple organ failure. Histology showed transmural colonic necrosis with no evidence of a thromboembolic process or vasculitis. Therefore, this entity was attributed to a low flow state within the intestinal circulation secondary to the cardiac arrest.
Improving outcome in out-of-hospital cardiac arrest: impact of bystander cardiopulmonary resuscitation and prehospital physician care
Robert JH Jackson, Jerry P Nolan
Critical Care , 2011, DOI: 10.1186/cc9356
Abstract: Yasunaga and co-workers have used the nationwide registry of out-of-hospital cardiac arrest patients in Japan to evaluate prospectively two key components of the chain of survival: early cardiopulmonary resuscitation (CPR) and early advanced cardiac life support (ACLS) [1]. Following out-of-hospital cardiac arrest, it is generally acknowledged that bystander CPR increases long-term survival rates by two to three times [2] and that each minute of delay before defibrillation reduces the probability of survival to discharge by 10 to 12% [3]. Whether or not ACLS interventions (such as drugs and tracheal intubation) affect outcome is much more contentious [4].The study compares the combined impact of bystander-initiated cardiopulmonary resuscitation (BCPR) and physician-delivered ACLS a€“ with BCPR emergency life-saving technician (ELST)-delivered ACLS. The potential interventions provided by physicians, but not the ELSTs, included: tracheal intubation, central venous catheterisation, and injection of lidocaine, atropine and vasoactive, anaesthetic and fibrinolytic drugs. Yasunaga and co-workers have compared the outcomes from four groups of patients following witnessed cardiac arrest: those who received ELST-delivered ACLS without (Group A) and with (Group B) BCPR, and those who received physician-delivered ACLS without (Group C) and with (Group D) BCPR.Consistent with previous studies, bystander CPR improved survival rates at 1 month by approximately 50% in both those patients receiving ELST-delivered ACLS and those who received physician-delivered ACLS.Previous studies have failed to show a survival benefit following implementation of ACLS in the out-of-hospital setting [4]. This study has demonstrated an increase in survival in all patient groups associated with the addition of physician-delivered ACLS. Worryingly, however, in the patients who did not receive bystander CPR, this increase in survival was due largely to an increase in patients surviving with severe neu
Therapeutic Hypothermia Activates the Endothelin and Nitric Oxide Systems after Cardiac Arrest in a Pig Model of Cardiopulmonary Resuscitation  [PDF]
Frank Zoerner, Lars Wiklund, Adriana Miclescu, Cecile Martijn
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0064792
Abstract: Post-cardiac arrest myocardial dysfunction is a major cause of mortality in patients receiving successful cardiopulmonary resuscitation (CPR). Mild therapeutic hypothermia (MTH) is the recommended treatment after resuscitation from cardiac arrest (CA) and is known to exert neuroprotective effects and improve short-term survival. Yet its cytoprotective mechanisms are not fully understood. In this study, our aim was to determine the possible effect of MTH on vasoactive mediators belonging to the endothelin/nitric oxide axis in our porcine model of CA and CPR. Pigs underwent either untreated CA or CA with subsequent CPR. After state-of-the-art resuscitation, the animals were either left untreated, cooled between 32–34°C after ROSC or treated with a bolus injection of S-PBN (sodium 4-[(tert-butylimino) methyl]benzene-3-sulfonate N-oxide) until 180 min after ROSC, respectively. The expression of endothelin 1 (ET-1), endothelin converting enzyme 1 (ECE-1), and endothelin A and B receptors (ETAR and ETBR) transcripts were measured using quantitative real-time PCR while protein levels for the ETAR, ETBR and nitric oxide synthases (NOS) were assessed using immunohistochemistry and Western Blot. Our results indicated that the endothelin system was not upregulated at 30, 60 and 180 min after ROSC in untreated postcardiac arrest syndrome. Post-resuscitative 3 hour-long treatments either with MTH or S-PBN stimulated ET-1, ECE-1, ETAR and ETBR as well as neuronal NOS and endothelial NOS in left ventricular cardiomyocytes. Our data suggests that the endothelin and nitric oxide pathways are activated by MTH in the heart.
Protective head-cooling during cardiac arrest and cardiopulmonary resuscitation: the original animal studies  [cached]
Eric W. Brader,Dietrich Jehle,Michael Mineo,Peter Safar
Neurology International , 2010, DOI: 10.4081/ni.2010.e3
Abstract: Prolonged standard cardiopulmonary resuscitation (CPR) does not reliably sustain brain viability during cardiac arrest. Pre-hospital adjuncts to standard CPR are needed in order to improve outcomes. A preliminary dog study demonstrated that surface cooling of the head during arrest and CPR can achieve protective levels of brain hypothermia (30°C) within 10 minutes. We hypothesized that protective head-cooling during cardiac arrest and CPR improves neurological outcomes. Twelve dogs under light ketamine-halothane-nitrous oxide anesthesia were arrested by transthoracic fibrillation. The treated group consisted of six dogs whose shaven heads were moistened with saline and packed in ice immediately after confirmation of ventricular fibrillation. Six control dogs remained at room temperature. All 12 dogs were subjected to four minutes of ventricular fibrillation and 20 minutes of standard CPR. Spontaneous circulation was restored with drugs and countershocks. Intensive care was provided for five hours post-arrest and the animals were observed for 24 hours. In both groups, five of the six dogs had spontaneous circulation restored. After three hours, mean neurological deficit was significantly lower in the treated group (P=0.016, with head-cooled dogs averaging 37% and the normothermic dogs 62%). Two of the six head-cooled dogs survived 24 hours with neurological deficits of 9% and 0%, respectively. None of the control group dogs survived 24 hours. We concluded that head-cooling attenuates brain injury during cardiac arrest with prolonged CPR. We review the literature related to the use of hypothermia following cardiac arrest and discuss some promising approaches for the pre-hospital setting.
Estrogen-Mediated Renoprotection following Cardiac Arrest and Cardiopulmonary Resuscitation Is Robust to GPR30 Gene Deletion  [PDF]
Michael P. Hutchens, Yasuharu Kosaka, Wenri Zhang, Tetsuhiro Fujiyoshi, Stephanie Murphy, Nabil Alkayed, Sharon Anderson
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0099910
Abstract: Introduction Acute kidney injury is a serious,sexually dimorphic perioperative complication, primarily attributed to hypoperfusion. We previously found that estradiol is renoprotective after cardiac arrest and cardiopulmonary resuscitation in ovariectomized female mice. Additionally, we found that neither estrogen receptor alpha nor beta mediated this effect. We hypothesized that the G protein estrogen receptor (GPR30) mediates the renoprotective effect of estrogen. Methods Ovariectomized female and gonadally intact male wild-type and GPR30 gene-deleted mice were treated with either vehicle or 17β-estradiol for 7 days, then subjected to cardiac arrest and cardiopulmonary resuscitation. Twenty four hours later, serum creatinine and urea nitrogen were measured, and histologic renal injury was evaluated by unbiased stereology. Results In both males and females, GPR30 gene deletion was associated with reduced serum creatinine regardless of treatment. Estrogen treatment of GPR30 gene-deleted males and females was associated with increased preprocedural weight. In ovariectomized female mice, estrogen treatment did not alter resuscitation, but was renoprotective regardless of GPR30 gene deletion. In males, estrogen reduced the time-to-resuscitate and epinephrine required. In wild-type male mice, serum creatinine was reduced, but neither serum urea nitrogen nor histologic outcomes were affected by estrogen treatment. In GPR30 gene-deleted males, estrogen did not alter renal outcomes. Similarly, renal injury was not affected by G1 therapy of ovariectomized female wild-type mice. Conclusion Treatment with 17β-estradiol is renoprotective after whole-body ischemia-reperfusion in ovariectomized female mice irrespective of GPR30 gene deletion. Treatment with the GPR30 agonist G1 did not alter renal outcome in females. We conclude GPR30 does not mediate the renoprotective effect of estrogen in ovariectomized female mice. In males, estrogen therapy was not renoprotective. Estrogen treatment of GPR30 gene-deleted mice was associated with increased preprocedural weight in both sexes. Of significance to further investigation, GPR30 gene deletion was associated with reduced serum creatinine, regardless of treatment.
New guidelines for cardiopulmonary resuscitation
Dalri, Maria Celia Barcellos;Araújo, Izilda Esmenia Muglia;Silveira, Renata Cristina de Campos Pereira;Canini, Silvia Rita Marin da Silva;Cyrillo, Regilene Molina Zacareli;
Revista Latino-Americana de Enfermagem , 2008, DOI: 10.1590/S0104-11692008000600020
Abstract: 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.
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