No. 21
[PubMed]
Tidal volumes which are perceived to be adequate for resuscitation.
Baskett P, Nolan J, Parr M
Department of Anaesthetics, Frenchay Hospital, Bristol BS16 UK.
Observers trained in basic life support assessed chest rise in 34 patients
who
were anaesthetised and paralysed and whose lungs were being mechanically
ventilated prior to routine surgery. Making 67 independent assessments, the
observers indicated the tidal volume that they considered produced adequate
chest rise for resuscitation. The mean tidal volume perceived to be adequate
was 384 ml with 95% confidence limits of 362-406 ml. The perceived volumes
correlated with the Body Mass Index. Guidelines by various authorities
recommend that tidal volumes sufficient to make the chest rise normally
should
be used during resuscitation. The volumes perceived as adequate by the
observers are much lower than the numerical values recommended by the
American
Heart Association (800-1200 ml). High tidal volumes are associated with an
increased risk of gastric regurgitation in patients with an unprotected
airway,
CO2 delivery to the lungs is likely to be low during cardiac arrest
obviating
the need for high tidal volumes. In the light of present knowledge and the
findings in this study, we would recommend that resuscitation training
manikins
are recalibrated to indicate satisfactory ventilation at tidal volumes of
400-600 ml. These volumes should reduce the risk of gastric inflation and
permit more chest compressions to be carried out in a minute because the
ventilation fraction of the CPR sequence is shorter. Adequate CO2
elimination
should still be assured.
Comments:
No. 22
[PubMed] No. 23
[PubMed] No. 24
[PubMed]
Treatment of out-of-hospital cardiac arrests with rapid defibrillation by
emergency medical technicians.
Eisenberg MS, Copass MK, Hallstrom AP, Blake B, Bergner L, Short FA, Cobb LA
The survival rate for patients with out-of-hospital cardiac arrest is low in
communities where emergency service is provided solely by emergency medical
technicians. We trained such technicians in a suburban community of 79,000
to
recognize and treat out-of-hospital ventricular fibrillation with up to
three
defibrillatory shocks without the use of medications or special airway
protection. Outcomes from cardiac arrest due to underlying heart disease
were
determined during two periods: two years with standard care by emergency
medical technicians and one year with defibrillator-trained technicians.
During
the period with standard care, four of 100 patients with cardiac arrest were
resuscitated and discharged alive from the hospital, as compared with 10 of
54
patients during the period with defibrillator-trained technicians (P less
than
0.01). In 12 of 38 patients with ventricular fibrillation, a stable
perfusing
cardiac rhythm followed defibrillatory shocks given by defibrillator
technicians. The enhanced survival after cardiac arrest is encouraging, and
further trials of defibrillation by emergency medical technicians are
warranted.
No. 25
[PubMed]
Citizen response to cardiopulmonary emergencies.
Montgomery WH, Brown DD, Hazinski MF, Clawsen J, Newell LD, Flint L
Straub Clinic and Hospital, Inc., Honolulu.
Since 1985, it has become apparent that the key to survival from adult
sudden
cardiac death is prompt defibrillation. Any delay from the time of collapse
to
the initial countershock will decrease the likelihood of survival. It also
has
been determined that CPR performed by lay rescuers is not begun promptly
and,
once started, often is performed for more than one minute before the
emergency
medical services (EMS) system is accessed, which significantly delays the
time
to defibrillation. In adults, therefore, the rescuer should phone first to
activate the EMS system before performing CPR. In the pediatric population,
respiratory arrests are far more common than cardiac arrests. Therefore, a
rescuer should perform one minute of rescue support before activating the
EMS
system (a concept termed phone fast). It is recognized that this change is
dependent upon a national EMS system that is still evolving. It is hoped
that
this change to phone first and phone fast will provide an impetus for rapid
development of the EMS infrastructure.
Publication Types:
No. 26
[PubMed]
Prehospital defibrillation performed by emergency medical technicians in
rural communities.
Stults KR, Brown DD, Schug VL, Bean JA
Survival after out-of-hospital cardiac arrest is poor in communities served
only by basic ambulance services, but conventional advanced prehospital care
is
not an option for most rural communities. Ambulance technicians in 18 small
communities (average population, 10,400) were trained to recognize and
defibrillate ventricular fibrillation. Neither endotracheal intubation nor
medication was used. Twelve additional communities of similar size where
such
early defibrillation was not attempted provided control data. In the
communities where early defibrillation was available, 12 of 64 patients (19
per
cent) who were found in ventricular fibrillation were resuscitated and
discharged alive from the hospital; this was true of only 1 of 31 such
patients
(3 per cent) in the control communities, where only basic life support was
available (P less than 0.05). Ten (83 per cent) of the long-term survivors
received electrical shocks administered solely by the technicians. Early
defibrillation by minimally trained ambulance technicians is an effective
approach to emergency cardiac care in rural communities.
Publication Types:
No. 27
[PubMed]
Is pediatric resuscitation unique? Relative merits of early CPR and
ventilation versus early defibrillation for young victims of prehospital cardiac arrest.
Hazinski MF
Publication Types:
Comments:
Appleton GO, Cummins RO, Larson MP, Graves JR
Center for Evaluation of Emergency Medical Services, King County EMS
Division of
the Seattle-King County Department of Public Health.
STUDY OBJECTIVE: To determine whether the age-related frequency of ventricular
fibrillation (VF) in cardiac arrest supports the guideline that single rescuers
should "call first" for all victims of sudden collapse older than 8 years.
DESIGN: Analysis of data on all nontraumatic cardiac arrests treated by
emergency medical service (EMS) personnel in King County, Washington, between
1976 and 1992. MEASUREMENTS: Age, initial cardiac rhythm, witnessed versus
unwitnessed status, whether patient was discharged alive. RESULTS: We analyzed
10,992 cardiac arrests. Initial rhythm was VF in 4,252 (40%) and non-VF in
6,740
(60%). VF frequencies were 3% (0 to 8 years old), 17% (8 to 30 years), and 42%
(30 years or older). CONCLUSION: Most patients under age 30 were not in VF at
the time of EMS evaluation. Our data suggest that a "call fast" strategy may be
more effective when a single rescuer is present and the victim is between 8 and
30 years old.
Mogayzel C, Quan L, Graves JR, Tiedeman D, Fahrenbruch C, Herndon P
Department of Pediatrics, University of Washington School of Medicine, Seattle.
STUDY OBJECTIVE: To compare causes and outcomes of patients younger than 20
years with an initial rhythm of ventricular fibrillation versus asystole and
pulseless electrical activity. DESIGN: Retrospective cohort study. SETTING:
Urban/suburban prehospital system. PARTICIPANTS: Pulseless, nonbreathing
patients less than 20 years who underwent out-of-hospital resuscitation.
Patients with lividity or rigor mortis or who were less than 6 months old and
died of sudden infant death syndrome were excluded. RESULTS: Ventricular
fibrillation was the initial rhythm in 19% (29 of 157) of the cardiac arrests.
Rhythm assessment was performed by the first responder in only 44% (69 of 157)
of patients. All three rhythm groups were similar in age distribution,
frequency
of intubation (96%), and vascular access (92%); 93% of ventricular fibrillation
patients were defibrillated. The causes of ventricular fibrillation were
distributed evenly among medical illnesses, overdoses, drownings, and trauma,
only two patients had congenital heart defects. Seventeen percent were
discharged with no or mild disability, compared with 2% of asystole/pulseless
electrical activity patients (P = .003). CONCLUSION: Ventricular
fibrillation is
not rare in child and adolescent prehospital cardiac arrest, and these patients
have a better outcome than those with asystole or pulseless electrical
activity.
Earlier recognition and treatment of ventricular fibrillation might improve
pediatric cardiac arrest survival rates.
No. 28
[PubMed]
Outcome of out-of-hospital cardiac or respiratory arrest in children.
Schindler MB, Bohn D, Cox PN, McCrindle BW, Jarvis A, Edmonds J, Barker G
Department of Critical Care Medicine, Hospital for Sick Children, University
of
Toronto, Canada.
METHODS: We reviewed the records of
101
children (median age, two years) with apnea or no palpable pulse (or both)
who
presented to the emergency department at the Hospital for Sick Children in
Toronto. The characteristics of the patients and the outcomes of illness
were
analyzed. We assessed the functional outcome of the survivors using the
Pediatric Cerebral and Overall Performance Category scores.
RESULTS:
Overall,
there was a return of vital signs in 64 of the 101 patients; 15 survived to
discharge from the hospital, and 13 were alive 12 months after discharge.
Factors that predicted survival to hospital discharge included a short
interval
between the arrest and arrival at the hospital, a palpable pulse on
presentation, a short duration of resuscitation in the emergency department,
and the administration of fewer doses of epinephrine in the emergency
department. No patients who required more than two doses of epinephrine or
resuscitation for longer than 20 minutes in the emergency department
survived
to hospital discharge. The survivors who were neurologically normal after
arrest had had a respiratory arrest only and were resuscitated within five
minutes after arrival in the emergency department. Of the 80 patients who
had
had a cardiac arrest, only 6 survived to hospital discharge, and all had
neurologic sequelae.
CONCLUSIONS: These results suggest that out-of-hospital
cardiac arrest among children has a very poor prognosis, especially when
efforts at resuscitation continue for longer than 20 minutes and require
more
than two doses of epinephrine.
Comments:
No. 29
[PubMed]
Appraisal of pediatric cardiopulmonary resuscitation.
Friesen RM, Duncan P, Tweed WA, Bristow G
Sixty-six patients more than 30 days and less thant 16 years of age
suffering
an unexpected cardiac arrest in an 18-month period were included in a study
of
resuscitative measures in children. Six children survived to be discharged
from
hospital. Respiratory disease accounted for most (29%) of the cardiac
arrests,
but it also had the most favourable prognosis, 21% of the 19 patients
surviving. None of the patients survived whose cardiac arrest was secondary
to
sepsis or trauma, even when the resuscitative efforts were initially
successful. Only 1 of the 41 patients who had a cardiac arrest outside of
hospital survived, and only 1 of the 34 patients who presented with asystole
survived, and then with considerable damage to the central nervous system.
The
interval between cardiac arrest and application of basic life support was
substantially shorter among the survivors. Also, most of the survivors did
not
present with asystole. The results of this study suggest that survival among
resuscitated children is no better than that among adults but can be
improved
with early recognition and monitoring of children at risk. earlier
application
of basic and advanced life support, improved education of medical and lay
personnel, and further research into pediatric resuscitative techniques.
No. 30
[PubMed]
CPR and the single rescuer: at what age should you "call first" rather than
"call fast"?
Appleton GO, Cummins RO, Larson MP, Graves JR
Center for Evaluation of Emergency Medical Services, King County EMS
Division
of the Seattle-King County Department of Public Health.
DESIGN: Analysis of data on all nontraumatic cardiac arrests treated by
emergency medical service (EMS) personnel in King County, Washington,
between
1976 and 1992. MEASUREMENTS: Age, initial cardiac rhythm, witnessed versus
unwitnessed status, whether patient was discharged alive.
RESULTS: We
analyzed
10,992 cardiac arrests. Initial rhythm was VF in 4,252 (40%) and non-VF in
6,740 (60%). VF frequencies were 3% (0 to 8 years old), 17% (8 to 30 years),
and 42% (30 years or older). CONCLUSION: Most patients under age 30 were not
in
VF at the time of EMS evaluation. Our data suggest that a "call fast"
strategy
may be more effective when a single rescuer is present and the victim is
between 8 and 30 years old.
Comments:
No. 31
[PubMed]
Out-of-hospital ventricular fibrillation in children and adolescents: causes
and outcomes.
Mogayzel C, Quan L, Graves JR, Tiedeman D, Fahrenbruch C, Herndon P
Department of Pediatrics, University of Washington School of Medicine,
Seattle.
DESIGN: Retrospective cohort study.
SETTING:
Urban/suburban prehospital system.
PARTICIPANTS: Pulseless, nonbreathing
patients less than 20 years who underwent out-of-hospital resuscitation.
Patients with lividity or rigor mortis or who were less than 6 months old
and
died of sudden infant death syndrome were excluded.
RESULTS: Ventricular
fibrillation was the initial rhythm in 19% (29 of 157) of the cardiac
arrests. Rhythm assessment was performed by the first responder in only 44% (69 of
157)
of patients. All three rhythm groups were similar in age distribution,
frequency of intubation (96%), and vascular access (92%); 93% of ventricular
fibrillation patients were defibrillated. The causes of ventricular
fibrillation were distributed evenly among medical illnesses, overdoses,
drownings, and trauma, only two patients had congenital heart defects.
Seventeen percent were discharged with no or mild disability, compared with
2%
of asystole/pulseless electrical activity patients (P = .003).
CONCLUSION:
Ventricular fibrillation is not rare in child and adolescent prehospital
cardiac arrest, and these patients have a better outcome than those with
asystole or pulseless electrical activity. Earlier recognition and treatment
of
ventricular fibrillation might improve pediatric cardiac arrest survival
rates.
Comments:
No. 32
[PubMed] No. 33
[PubMed] No. 34
[PubMed] No. 35
[PubMed] No. 36
[PubMed]
The new recovery position, a cautionary tale.
Fulstow R, Smith GB
Portsmouth Hospital NHS Trust, Hampshire, UK.
In November 1992 the European Resuscitation Council issued new guidelines
which
included the description of a modified recovery position. Anecdotal reports
have suggested that this 'new' position may result in obstructed venous
return
in the dependent arm. The findings of a small study to evaluate the 'new'
recovery position are reported here. In a group of six healthy adult
volunteers
measurements of digital temperature, plethysmographic wave form and
transcutaneous oxygen saturation were made in the previously favoured
semi-prone recovery and repeated in the 'new' position. In the 'new'
position
67% of the study group developed signs of venous or venous and arterial
obstruction; no such complication was encountered when the same individuals
were placed in the semi-prone recovery position. The need to position
unconscious persons in some form of recovery position is emphasised,
however,
the suggestion that the semi-prone position be re-adopted is offered for
discussion. Alternatively, adequate monitoring of perfusion and venous
drainage
in the dependent limb must be undertaken if the 'new' recovery position is
chosen.
Comments:
No. 37
[PubMed]
Resuscitation. Resuscitation Council (UK) wants everyone who uses new
recovery
position to report experiences.
Handley AJ
Publication Types: Letter
Comments:
No. 38
[PubMed]
Public access to defibrillation. The Automatic Defibrillation Task Force.
Weisfeldt ML, Kerber RE, McGoldrick RP, Moss AJ, Nichol G, Ornato JP, Palmer
DG, Riegel B, Smith SC Jr
American Heart Association, Dallas, TX, USA.
No. 39
[PubMed]
Strengthening the in-hospital chain of survival with rapid
defibrillation by first responders using automated
external defibrillators: training and retention issues.
Kaye W, Mancini ME, Giuliano KK, Richards N, Nagid DM, Marler
CA, Sawyer-Silva S
Department of Surgery, Brown University, Miriam Hospital, Providence, RI.
INTERVENTIONS:
The nurses were taught how to use the Heartstart 1000s, a lightweight
portable shock-advisory AED, in a 2-hour class with an instructor and
manikin-to-student ratio of 1:5. The course emphasized hands-on practice of
the BLS-AED algorithm on a computerized manikin. RESULTS: Using a similar
scenario, each nurse was evaluated on the computerized manikin
immediately after training (posttest). At 1 to 3, 4 to 6, and 7 to 9 months
after
the initial training, convenience samples of the cohort in three different
groups were evaluated for retention. Satisfactory performance was defined
as delivery of the first AED shock within 2 minutes of recognition of the
arrest. At the posttest after training, 139 of 140 nurses (99%) demonstrated
satisfactory performance. Of 77 nurses evaluated, 31 of 32 at 1 to 3 months,
18 of 18 at 4 to 6 months, and 24 of 27 at 7 to 9 months after initial
training
(95% overall) performed satisfactorily.
CONCLUSION: As has been
demonstrated with prehospital emergency personnel, nurses outside critical
care areas who are proficient in BLS can easily learn and retain the
knowledge
and skills to use AEDs. Automated external defibrillation, a BLS skill,
should
be incorporated into BLS programs (BLS-AED) for all hospital personnel
expected to respond to a patient in cardiac arrest, with rapid
defibrillation
taking priority over CPR.
Bar-Joseph G, Bignall S
Publication Types: Comment, Letter
Review, tutorial
Editorial
BACKGROUND: Among adults who have a cardiac arrest outside the hospital, the
survival rate is known to be poor. However, less information is available on
out-of-hospital cardiac arrest among children. This study was performed to
determine the survival rate among children after out-of-hospital cardiac
arrest
and to identify predictors of survival.
Fruchter O
Publication Types: Comment, Letter
STUDY OBJECTIVE: To determine whether the age-related frequency of
ventricular
fibrillation (VF) in cardiac arrest supports the guideline that single
rescuers
should "call first" for all victims of sudden collapse older than 8 years.
Hazinski MF
Publication Types: Comment, Editorial
Quan L, Mogayzel C
Publication Types: Comment, Letter
STUDY OBJECTIVE: To compare causes and outcomes of patients younger than 20
years with an initial rhythm of ventricular fibrillation versus asystole and
pulseless electrical activity.
Hazinski MF
Publication Types: Comment, Editorial
Quan L, Mogayzel C
Publication Types: Comment, Letter
Handley AJ
Publication Types: Comment, Editorial
Leaves S, Donnelly P, Lester C, Assar D
Publication Types: Comment, Letter
STUDY OBJECTIVE: To determine whether staff outside critical care areas
who were proficient in basic life support (BLS) could be easily trained to
use
automated external defibrillators (AEDs) and whether they would retain
these skills. DESIGN: Prospective, longitudinal cohort series. SETTING: Two
university teaching hospitals. PARTICIPANTS: One hundred forty nurses
who had previously learned BLS and constituted the staff from three
medical/surgical nursing units from each study hospital.
（単独で行う成人の一次救命処置）