参考文献(No. 41〜60)
No. 41
[PubMed]
Comparison of fluid infusion rates among peripheral intravenous and humerus,
femur, malleolus, and tibial intraosseous sites in normovolemic and hypovolemic
piglets.
Warren DW, Kissoon N, Sommerauer JF, Rieder MJ
Department of Pediatrics, University of Western Ontario, London, Canada.
DESIGN AND SETTING: A piglet model was used to assess rates of infusion under
varying conditions in a university hospital animal laboratory. Analysis of
variance was used to evaluate site differences.
PARTICIPANTS: Twenty-three
Yorkshire-Landrace mix pigs (weight, 12 to 23 kg) were studied.
INTERVENTIONS:
Animals were anesthetized and intubated before cannulation with 18-gauge bone
marrow needles at intraosseous sites and 22-gauge Teflon catheters in
peripheral
vessels. Infusion rates under gravity and 300 mm Hg pressure were determined.
Infusion rates under similar conditions were repeated in hypovolemic animals
with acute bleeding of 25 mL/kg.
MEASUREMENTS AND MAIN RESULTS: Mean infusion
rates (mL/min) for gravity versus 300 mm Hg pressure in normovolemic pigs were
13.1 versus 40.9 for peripheral IV, 11.1 versus 41.3 for humerus, 9.3 versus
29.5 for femur, 8.2 versus 24.1 for malleolus, and 4.3 versus 17.0 for tibia.
Hypovolemia resulted in average decreased rates of 32%. Infusion rates were
significantly different between sites and between normovolemia and hypovolemia
(P = .0001).
CONCLUSION: Intravenous access is the most efficacious method of
acute volume replacement. Intraosseous sites differ in the infusion rates
obtained--descending order is humerus, femur, malleolus, and tibia, but each is
a reasonable alternative for short-term vascular access.
PMID: 8427428, UI: 93151505
No. 42
[PubMed]
Plasma epinephrine concentrations after intraosseous and central venous
injection during cardiopulmonary resuscitation in the lamb.
Andropoulos DB, Soifer SJ, Schreiber MD
Cardiovascular Research Institute, University of California San Francisco
94143-0106.
PMID: 2299508, UI: 90133240
No. 43
[PubMed]
Effect of injection site on circulation times during cardiac arrest.
Emerman CL, Pinchak AC, Hancock D, Hagen JF
Department of Emergency Medicine, Cleveland Metropolitan General Hospital, OH
44109.
Cardiopulmonary resuscitation requires effective, prompt drug
administration. In
order to analyze Advanced Cardiac Life Support (ACLS) recommendations for site
of drug administration, we studied dye circulation times after central,
femoral,
and peripheral venous injection during both closed and open chest CPR using a
canine arrest model. Measurements of circulation times were made after
injection
of indocyanine green dye at femoral, central, and peripheral venous sites.
Circulation times during closed chest CPR were 62.7 +/- 19.6 sec after central
injection, 86.6 +/- 23.5 sec after femoral injection, and 93.6 +/- 17.9 sec
after peripheral injection (p less than .001). During closed chest CPR, peak
dye
concentration after central injection was significantly higher than that after
peripheral injection (4.0 +/- 1.3 vs. 3.1 +/- 0.8 mg/L, p less than .01).
Circulation times were significantly shorter during open chest CPR with times
again shortest after central injection. This animal model suggests that prompt
drug delivery during CPR is enhanced by central venous injection of medication.
There appears to be no advantage in femoral over peripheral injection.
Comments:
No. 44
[PubMed]
Epinephrine blood concentrations after peripheral bronchial versus endotracheal
administration of epinephrine in dogs.
Mazkereth R, Paret G, Ezra D, Aviner S, Peleg E, Rosenthal T, Barzilay Z
Pediatric Intensive Care Unit, Chaim Sheba Medical Center, Tel-Hashomer,
Israel.
RESULTS: Both routes of epinephrine administration
significantly increased plasma concentrations within 1 min of injection. Higher
plasma epinephrine concentrations were achieved after peripheral bronchial
epinephrine administration (maximal concentration 8.9 +/- 3.2 vs. 2.0 +/- 0.4
ng/mL), and the total dose absorbed was significantly (76.5 +/- 13.5 vs. 36.7
+/- 6.5 ng/min/mL, p < .05) higher. The time interval to reach maximal
concentration was significantly shorter with the peripheral bronchial dosing
than with the endotracheal route (1.3 +/- 0.2 vs. 2.7 +/- 0.5 min, p < .05).
Neither group demonstrated a significant change in heart rate, and both had
similar, minor decreases in BP for > 2 to 5 mins. There were no significant
differences between the arterial blood gases of the two groups at various
stages
of the experiment.
CONCLUSIONS: In dogs, epinephrine administered via the
peripheral bronchial route has a clear pharmacologic advantage over the
endotracheal route. This advantage may be more important during cardiopulmonary
resuscitation conditions and other low flow states, and may account for the
failure observed with the endotracheal route in recently published clinical
reports.
PMID: 1424703, UI: 93048042
No. 45
[PubMed]
Effects of different techniques of endotracheal epinephrine administration in
pediatric porcine hypoxic-hypercarbic cardiopulmonary arrest.
Jasani MS, Nadkarni VM, Finkelstein MS, Mandell GA, Salzman SK, Norman ME
Department of Anesthesia, A.I. duPont Institute, Wilmington, DE 19899.
SETTING: Large animal research facility at a children's hospital. SUBJECTS:
Thirty-six preadolescent anesthetized and paralyzed Yucatan swine (mean weight
10.0 +/- 1.9 kg) with apnea-induced hypoxic and hypercarbic cardiopulmonary
arrest. INTERVENTIONS: After 8 mins of cardiopulmonary arrest and 1 min of
cardiopulmonary resuscitation (CPR), 500 micrograms (51 +/- 9 micrograms/kg) of
radiolabeled endotracheal epinephrine was administered by direct injection (n =
17), injection via feeding catheter (n = 10), or via monitoring lumen built
into
the sidewall of the endotracheal tube (n = 9). CPR was resumed and continued
for
5 mins. If resuscitation occurred, monitoring was continued for 1 hr. Outcome
variables included successful resuscitation, pulmonary distribution, heart
rate,
mean arterial pressure, plasma radiolabeled epinephrine counts, and total
plasma
epinephrine concentrations. Analysis by Fisher's exact test, one-way
analysis of
variance and Pearson's phi coefficient was performed.
MEASUREMENTS AND MAIN
RESULTS: Successful resuscitation occurred in 31% of all pigs with no
difference
between groups (p = .69). Bilateral distribution occurred in 39% with no
difference between groups (p = .25). No correlation was noted between
successful
resuscitation and distribution (p = .65). HR, mean arterial pressure, plasma
radiolabeled epinephrine counts, and total plasma epinephrine concentrations
showed significant changes over time within groups, but no difference between
groups at any time point. Adherence of the epinephrine dose to the endotracheal
tube was < or = 1.5% in all cases.
CONCLUSIONS: Instillation of 50
micrograms/kg
of endotracheal epinephrine by three different techniques during pediatric
porcine asphyxial arrest does not affect resuscitation rate, pulmonary
distribution, hemodynamic response, or plasma exogenous and total epinephrine
concentrations. No correlation was found between successful resuscitation and
bilateral distribution. Therefore, currently recommended cumbersome
endotracheal
epinephrine instillation techniques may offer no resuscitation advantage over
commonly used direct injection in this setting.
Comments:
No. 46
[PubMed]
Comparison of endotracheal and peripheral intravenous adrenaline in cardiac
arrest. Is the endotracheal route reliable?
Quinton DN, O'Byrne G, Aitkenhead AR
Twelve patients presenting to an accident and emergency department in asystolic
cardiac arrest were randomly allocated to treatment with endotracheal
adrenaline
(five patients) or peripheral intravenous adrenaline (seven patients).
Femoral-artery blood samples were taken for assay of adrenaline and
noradrenaline. After intravenous adrenaline there was a good clinical and
biochemical response, but after endotracheal adrenaline there was no change in
serum adrenaline and no measurable clinical response. The endotracheal route of
adrenaline administration is not reliable in out-of-hospital cardiac arrest.
Publication Types: Clinical trial, Randomized controlled trial
PMID: 2882234, UI: 87171808
No. 47
[PubMed]
Comparison of the pharmacological effects of epinephrine administered by the
intravenous and endotracheal routes.
Roberts JR, Greenburg MI, Knaub M, Baskin SI
Epinephrine in various dosages was administered to anesthetized dogs by
intravenous and endotracheal routes. Both methods produced measurable
effects on
heart rate, blood pressure, and respiration. Tachycardia occurred more rapidly
after endotracheal administration than after intravenous administration.
Respiration appeared to be supported more advantageously with the larger
endotracheal dosages. The maximum blood pressure rise was delayed only 60
seconds by the endotracheal route. With an endotracheally administered dose of
ten times the intravenous dose, equal responses in blood pressure were
obtained.
However, when equal doses are compared, there is only a two to three fold
increase with the intravenous route. The endotracheal route may be less
toxic at
higher doses, affording greater safety when large amounts of epinephrine are
used. It is concluded that endotracheally administered epinephrine produces
significant pharmacologic effects in anesthetized dogs.
PMID: 671937, UI: 78221531
註.referenceのKnaub MAはKnaub Mの間違いのようです。
No. 48
[PubMed]
Intraosseous infusion.
Fiser DH
Department of Pediatrics, University of Arkansas for Medical Sciences, Little
Rock.
Publication Types: Review, Review literature
PMID: 2186277, UI: 90245061
No. 49
[PubMed]
Intraosseous infusion: an alternative route of pediatric intravascular access.
Rosetti VA, Thompson BM, Miller J, Mateer JR, Aprahamian C
Substantial difficulties can be encountered when establishing rapid
intravascular access in critically ill children. The historic technique of
tibial intraosseous infusion is presented as an alternate intravenous route in
children less than 3 years old. Review of the literature reveals this technique
to be a rapid, reliable method with an acceptably low complication rate.
Substances absorbed through the marrow, flow rates, technical difficulties, and
complications are discussed.
PMID: 4025988, UI: 85277492
No. 50
[PubMed]
Adrenergic agonists during cardiopulmonary resuscitation.
Brown CG, Werman HA
Division of Emergency Medicine, Ohio State University, Columbus 43210.
A number of studies have suggested that following a prolonged cardiopulmonary
arrest, large doses of alpha-adrenergic agonists that possess post-synaptic
alpha-2 agonist properties, i.e. epinephrine and norepinephrine, may be
required
to enhance myocardial and cerebral hemodynamics. While initial human studies
using large doses of epinephrine have shown improved hemodynamics over standard
therapy, hospital discharge rates and neurological outcome have been
discouraging. This probably reflects the fact that the administration of
epinephrine was employed late in the resuscitation effort. Future studies using
larger doses of epinephrine as the initial pharmacologic intervention during
cardiopulmonary resuscitation (CPR) will help to determine whether there is any
therapeutic benefit. In addition, a number of questions still remain unanswered
in delineating the specific alpha and beta adrenergic agonist components which
will maximally enhance hemodynamics and resuscitation rates during CPR. This
will help determine whether norepinephrine or a yet unsynthesized adrenergic
agonist may be more beneficial for use during cardiac arrest.
Publication Types: Review, Review-tutorial
PMID: 1967848, UI: 90139932
No. 51
[PubMed]
High-dose epinephrine improves outcome from pediatric cardiac arrest.
Goetting MG, Paradis NA
Department of Pediatrics, Henry Ford Hospital, Detroit, Michigan 48202.
DESIGN: Prospective intervention
versus
historic control groups.
TYPE OF PARTICIPANTS: Two similar groups of 20
consecutive patients each (median ages, 2.5 and 3 years) with witnessed cardiac
arrest who remained in arrest after at least two SDEs (0.01 mg/kg).
INTERVENTIONS: Treatment with an additional SDE versus HDE (0.2 mg/kg).
MEASUREMENTS AND MAIN RESULTS: The rates of return of spontaneous circulation
and long-term survival were compared. Fourteen of the HDE group (70%) had
return
of spontaneous circulation, whereas none of the SDE group did (P less than
.001). Eight children survived to discharge after HDE, and three were
neurologically intact at follow-up. No significant toxicity from HDE was
observed. CONCLUSION: HDE provided a higher return of spontaneous circulation
rate and a better long-term outcome than SDE in our series of pediatric cardiac
arrest. HDE may warrant incorporation into standard resuscitation protocols at
an early enough point to prevent irreversible brain injury.
Publication Types:Clinical trial
Comments: No. 52
[PubMed]
Epinephrine dosage effects on cerebral and myocardial blood flow in an infant
swine model of cardiopulmonary resuscitation.
Berkowitz ID, Gervais H, Schleien CL, Koehler RC, Dean JM, Traystman RJ
Department of Anesthesiology/Critical Care Medicine, Johns Hopkins Hospital,
Baltimore, Maryland 21205.
Although epinephrine increases cerebral blood flow (CBF) and left ventricular
blood flow (LVBF) during cardiopulmonary resuscitation (CPR), the effects of
high dosages on LVBF and CBF and cerebral O2 uptake have not been examined
during prolonged CPR. We determined whether log increment dosages of
epinephrine
would enhance LVBF and CBF and cerebral O2 uptake in an infant swine CPR model.
We compared these responses with epinephrine to those with the alpha-adrenergic
agonist, phenylephrine. CPR was performed in five groups (n = 6) of
pentobarbital-anesthetized piglets (3.5-5.6 kg) receiving a continuous
epinephrine infusion (0, 1, 10, and 100 micrograms.kg-1.min-1) or phenylephrine
infusion (40 micrograms.kg-1.min-1). Plasma epinephrine concentrations
increased
10-100-fold in the control group during CPR and in a stepwise manner such that
concentrations were increased by more than 10(4) in the 100
micrograms.kg-1.min-1 epinephrine group. In the control group with no
epinephrine infusion, LVBF decreased to less than 10 ml.min-1.100 g-1 by 5 min
of CPR. With epinephrine in dosages of 10 and 100 micrograms.kg-1.min-1,
LVBF at
5 min was 75 +/- 19 and 44 +/- 15 ml.min-1.100 g-1, respectively, which was
significantly greater than values in the control group. With more prolonged
CPR,
LVBF remained significantly greater than that in the control group but only at
10 micrograms.kg-1.min-1 of epinephrine. Phenylephrine also increased LVBF for
10 min of CPR when compared with the control group. All dosages of epinephrine
and phenylephrine maintained CBF close to prearrest values for 20 min of CPR.
With prolonged CPR, 10 and 100 micrograms.kg-1.min-1 epinephrine resulted in
significantly greater CBF than that in the control group. Incremental
dosages of
epinephrine did not statistically increase cerebral O2 uptake or lower the
cerebral fractional O2 extraction when compared with the control group, despite
the higher CBF that was generated. In this immature animal CPR model, 10
micrograms.kg-1.min-1 epinephrine is an optimal dosage for maximizing both CBF
and LVBF, a dosage that substantially exceeds the current recommended
epinephrine dosage for human infant CPR. In addition, for short periods of CPR,
40 micrograms.kg-1.min-1 phenylephrine increases CBF and LVBF to levels similar
to those generated by high dosages of epinephrine.
PMID: 1741496, UI: 92074602 No. 53
[PubMed]
A randomized clinical trial of high-dose epinephrine and norepinephrine vs
standard-dose epinephrine in prehospital cardiac arrest.
Callaham M, Madsen CD, Barton CW, Saunders CE, Pointer J
Division of Emergency Medicine, University of California, San Francisco.
DESIGN--Randomized, prospective, double-blind clinical trial.
SETTING--Prehospital emergency medical system of a major US city.
PATIENTS--All
adults in nontraumatic cardiac arrest, treated by paramedics, who would receive
epinephrine according to American Heart Association advanced cardiac life
support guidelines.
INTERVENTIONS--High-dose epinephrine (HDE, 15 mg),
high-dose
norepinephrine bitartrate (NE, 11 mg), or standard-dose epinephrine (SDE, 1 mg)
was blindly substituted for advanced cardiac life support doses of epinephrine.
MAIN OUTCOME MEASURES--Restoration of spontaneous circulation in the field,
admission to hospital, hospital discharge, and Cerebral Performance Category
score. RESULTS--Of 2694 patients with cardiac arrests during the study period,
resuscitation was attempted on 1062 patients. Of this total, 816 patients met
study criteria and were enrolled. In the entire cardiac arrest population, 63%
of the survivors were among the 11% of patients who were defibrillated by first
responders. The three drug treatment groups were similar for all independent
variables. Thirteen percent of patients receiving HDE regained a pulse in the
field vs 8% of those receiving SDE (P = .01), and 18% of HDE patients were
admitted to the hospital vs 10% of SDE patients who were admitted to the
hospital (P = .02). Similar trends for NE were not significant. There were 18
survivors; 1.7% of HDE patients and 2.6% of NE patients were discharged from
the
hospital compared with 1.2% of SDE patients, but this was not significant (P =
.37; beta = .38). There was a nonsignificant trend for Cerebral Performance
Category scores to be worse for HDE (3.2) and NE patients (3.7) than for SDE
patients (2.3) (P = .10; beta = .31). No significant complications were
identified. High-dose epinephrine did not produce longer hospital or critical
care unit stays. CONCLUSIONS--High-dose epinephrine significantly improves the
rate of return of spontaneous circulation and hospital admission in patients
who
are in prehospital cardiac arrest without increasing complications. However,
the
increase in hospital discharge rate is not statistically significant, and no
significant trend could be determined for neurological outcome. No benefit
of NE
compared with HDE was identified. Further study is needed to determine the
optimal role of epinephrine in prehospital cardiac arrest.
Publication Types: Clinical trial, Randomized controlled trial
Comments:
No. 54
[PubMed] No. 55
[PubMed]
High-dose epinephrine in adult cardiac arrest.
Stiell IG, Hebert PC, Weitzman BN, Wells GA, Raman S, Stark RM, Higginson LA,
Ahuja J, Dickinson GE
Division of Emergency Medicine, University of Ottawa, Ont., Canada.
METHODS. We randomly assigned 650 patients
who had had cardiac arrest either in or outside the hospital to receive up to
five doses of high-dose (7 mg) or standard-dose (1 mg) epinephrine at
five-minute intervals according to standard protocols for advanced cardiac life
support. Patients who collapsed outside the hospital received no
advanced-life-support measures other than defibrillation before reaching the
hospital.
RESULTS. There was no significant difference between the high-dose
group (n = 317) and the standard-dose group (n = 333) in the proportions of
patients who survived for one hour (18 percent vs. 23 percent, respectively) or
who survived until hospital discharge (3 percent vs. 5 percent). Among the
survivors, there was no significant difference in the proportions who remained
in the best category of cerebral performance (90 percent vs. 94 percent) and no
significant difference in the median Mini-Mental State score (36 vs. 37). The
exploration of clinically important subgroups, including those with
out-of-hospital arrest (n = 335) and those with in-hospital arrest (n = 315),
failed to identify any patients who appeared to benefit from high-dose
epinephrine and suggested that some patients may have worse outcomes after
high-dose epinephrine.
CONCLUSION. High-dose epinephrine was not found to
improve survival or neurologic outcomes in adult victims of cardiac arrest.
Publication Types: Clinical trial, Randomized controlled trial
Comments:
No. 56
[PubMed]
A comparison of standard-dose and high-dose epinephrine in cardiac arrest
outside the hospital. The Multicenter High-Dose Epinephrine Study Group.
Brown CG, Martin DR, Pepe PE, Stueven H, Cummins RO, Gonzalez E, Jastremski M
Department of Emergency Medicine, Ohio State University, Columbus 43210.
METHODS. Adult patients were
enrolled in
the study if they remained in ventricular fibrillation, or if they had asystole
or electromechanical dissociation, at the time the first drug was to be
administered to treat the cardiac arrest. Patients were randomly assigned to
receive either 0.02 mg of epinephrine per kilogram of body weight
(standard-dose
group, 632 patients) or 0.2 mg per kilogram (high-dose group, 648 patients),
both given intravenously. RESULTS. In the standard-dose group 190 patients (30
percent) had a return of spontaneous circulation, as compared with 217 patients
(33 percent) in the high-dose group; 136 patients (22 percent) in the
standard-dose group and 145 patients (22 percent) in the high-dose group
survived to be admitted to the hospital. Twenty-six patients (4 percent) in the
standard-dose group and 31 (5 percent) in the high-dose group survived to
discharge from the hospital. Ninety-two percent of the patients discharged in
the standard-dose group and 94 percent in the high-dose group were conscious at
the time of hospital discharge. None of the differences in outcome between the
groups were statistically significant.
CONCLUSIONS. In this study, we were
unable to demonstrate any difference in the overall rate of return of
spontaneous circulation, survival to hospital admission, survival to hospital
discharge, or neurologic outcome between patients treated with a standard dose
of epinephrine and those treated with a high dose.
Publication Types: Clinical trial, Multicenter study, Randomized controlled trial
Comments:
No. 57
[PubMed]
A randomized, blinded trial of high-dose epinephrine versus standard-dose
epinephrine in a swine model of pediatric asphyxial cardiac arrest.
Berg RA, Otto CW, Kern KB, Hilwig RW, Sanders AB, Henry CP, Ewy GA
Department of Pediatrics, Steele Memorial Children's Research Center, Tucson,
AZ, USA.
DESIGN: A
randomized, blinded study.
SETTING: A large animal cardiovascular laboratory at
a university. SUBJECTS: Thirty domestic piglets (3 to 4 months of age) were
randomized to receive standard-dose epinephrine (0.02 mg/kg) or high-dose
epinephrine (0.2 mg/kg) during CPR after 10 mins of cardiac standstill with
loss
of aortic pulsation after endotracheal tube clamping.
INTERVENTIONS: Two
minutes
of CPR were provided, followed by advanced pediatric life support. Successfully
resuscitated animals were supported in an intensive care unit (ICU) setting for
2 hrs and then observed for 24 hrs.
MEASUREMENTS AND MAIN RESULTS:
Electrocardiogram, thoracic aortic blood pressure, and right atrial blood
pressure were monitored continuously until the intensive care period ended.
Survival rate and neurologic outcome were determined. Return of spontaneous
circulation was obtained in 13 of 15 high-dose epinephrine piglets vs. ten
of 15
standard-dose epinephrine piglets (p < .20). Four of 13 high-dose piglets died
in the ICU period after initial resuscitation vs. 0 of ten standard-dose
piglets
(p < or = .05). Nine high-dose piglets survived 2 hrs vs. ten standard-dose
piglets. Three piglets in each group survived for 24 hrs, but all were severely
neurologically impaired. Two minutes after resuscitation, piglets treated with
high-dose epinephrine had higher heart rates (210 +/- 24 vs. 189 +/- 40
beats/min, p < .05) and higher aortic diastolic pressures (121 +/- 39 vs. 74
+/-
40 mm Hg, p < .01). Within 10 mins of return of spontaneous circulation, severe
tachycardia (> 240 beats/min) was more frequently noted in the high-dose group
than in the standard-dose group (p < .05). All four high-dose piglets that died
in the ICU period experienced ventricular fibrillation within 10 mins of return
of spontaneous circulation. CONCLUSIONS: High-dose epinephrine did not improve
2-hr survival rate, 24-hr survival rate, or neurologic outcome. High-dose
epinephrine resulted in severe tachycardia and hypertension immediately after
resuscitation and in a higher mortality rate immediately after resuscitation.
Publication Types: Clinical trial, Randomized controlled trial
PMID: 8874308, UI: 97028294
No. 58
[PubMed]
High-dose epinephrine in cardiac arrest.
Callaham M
PMID: 1949784, UI: 92056731
No. 59
[PubMed]
Pediatric injuries from cardiopulmonary resuscitation.
Bush CM, Jones JS, Cohle SD, Johnson H
Department of Emergency Medicine, Butterworth Hospital, Grand Rapids, MI, USA.
METHODS: A retrospective review was undertaken of the
records from all deceased children ( < 12 years old) who had been given CPR
during an 8-year period (1988 through 1995). Patients with historical or
physical evidence of preceding trauma were excluded. Clinical and autopsy
records were abstracted for patient demographics, clinical findings,
duration of
CPR, persons administering CPR, and medical examiner summaries. RESULTS: Two
hundred eleven children (mean age, 19.0 months) met the inclusion criteria and
were entered into the study. The most common cause of cardiac arrest was sudden
infant death syndrome (56%), followed by drowning (8%), congenital heart
disease
(7%), and pneumonia (4%). Mean duration of CPR was 45 minutes (range, 3 to 180
minutes). Fifteen children (7%) had at least one injury as a result of CPR; 7
(3%) had injuries that were considered medically significant. These included
retroperitoneal hemorrhage (n = 2), pneumothorax (n = 1), pulmonary hemorrhage
(n = 1), epicardial hematoma (n = 1), and gastric perforation (n = 1); in spite
of prolonged resuscitation performed with variable degrees of skill, only one
patient was noted to have rib fractures. CONCLUSION: Significant iatrogenic
injuries are rare in children who receive CPR; they occur in approximately
3% of
cases. Recognizing the possibility of a complication may help in the management
of children who survive cardiac arrest. Regardless of resuscitation history,
abuse should be considered whenever traumatic injuries are encountered.
PMID: 8669737, UI: 96266189
No. 60
[PubMed]
Cardiopulmonary resuscitation and rib fractures in infants. A postmortem
radiologic-pathologic study.
Spevak MR, Kleinman PK, Belanger PL, Primack C, Richmond JM
Department of Radiology, University of Massachusetts Medical Center, Worchester
01655.
DESIGN--Retrospective review. SETTING--Medical examiner's
office in a county consisting of a medium-sized city, towns, and rural areas.
PATIENTS--Ninety-one infants (56 males, 35 females; mean age, 2.4 months; age
range, 26 hours to 8.5 months) without evidence of child abuse who had
undergone CPR before death.
METHODS--Medical records, skeletal surveys, and autopsy
results were reviewed. RESULTS--No patient had rib fractures.
CONCLUSIONS--Cardiopulmonary resuscitation is unlikely to cause rib
fractures in
infants.
PMID: 8057518, UI: 94335164
STUDY OBJECTIVES: To compare infusion rates from various intraosseous sites
(tibial, medial malleolar, distal femoral, and humeral) and at a peripheral IV
site under gravity and pressure flow in normovolemic and hypovolemic states.
Effect of injection site on circulation times during cardiac arrest.
Martens P
Publication Types: Comment, Letter
BACKGROUND AND METHODS: Emergency endotracheal drug administration has
become an
acceptable route for drug delivery during cardiopulmonary resuscitation. The
purpose of the present study was to determine whether the site of endotracheal
epinephrine injection is an important factor in its absorption. Epinephrine
(1:1000), in a dose of 0.02 mg/kg diluted in 2 mL of saline, was given to ten
anesthetized mongrel dogs. Each dog was studied twice: once when the
epinephrine
was injected into the endotracheal tube, and on another day, through the
endotracheal tube via a flexible catheter wedged into a peripheral bronchus.
Arterial blood samples for plasma epinephrine concentration determinations were
collected, before and at 1, 2, 5, 10, 15, and 30 mins after each intratracheal
drug administration.
OBJECTIVE: To compare three endotracheal epinephrine instillation techniques in
a pediatric porcine hypoxic-hypercarbic cardiopulmonary arrest model. DESIGN:
Prospective, randomized, laboratory comparison of three instillation
techniques.
Endotracheal epinephrine in cardiac arrest.
Zaritsky A
Publication Types: Comment, Editorial, Review
STUDY OBJECTIVE: Animal studies suggest that the standard dose of epinephrine
(SDE) for treatment of cardiac arrest in human beings may be too low. We
compared the outcome after SDE with that after high-dose epinephrine (HDE) in
children with refractory cardiac arrest.
High-dose epinephrine in pediatric cardiac arrest.
Brown CG, Kelen GD
Publication Types: Clinical trial, Comment, Editorial
Postarrest hypertension in pediatric patients.
Wasserberger J, Ordog GJ
Publication Types: Comment, Letter
OBJECTIVE--To determine the relative efficacy of high- vs standard-dose
catecholamines in initial treatment of prehospital cardiac arrest.
High-dose epinephrine in cardiopulmonary resuscitation.
Polin K, Leikin JB
Publication Types: Comment, Letter
High-dose epinephrine in cardiopulmonary resuscitation.
Heiselman DE
Publication Types: Comment, Letter
BACKGROUND. Recent studies suggest that doses of epinephrine of 0.1 mg per
kilogram of body weight or higher may improve myocardial and cerebral blood
flow
as well as survival in cardiac arrest. Such studies have called into question
the traditional dose of epinephrine (0.007 to 0.014 mg per kilogram)
recommended
for advanced cardiac life support.
Mattana J, Singhal PC
Publication Types: Comment, Letter
(whole article)
BACKGROUND. Experimental and uncontrolled clinical evidence suggests that
intravenous epinephrine in doses higher than currently recommended may improve
outcome after cardiac arrest. We conducted a prospective, multicenter study
comparing standard-dose epinephrine with high-dose epinephrine in the
management
of cardiac arrest outside the hospital.
High-dose epinephrine in cardiopulmonary resuscitation.
Mattana J, Singhal PC
Publication Types: Comment, Letter
whole article
OBJECTIVE: To determine whether high-dose epinephrine administration during
cardiopulmonary resuscitation (CPR) in a swine pediatric asphyxial cardiac
arrest model improves outcome (i.e., resuscitation rate, survival rate, and
neurologic function) compared with standard-dose epinephrine.
STUDY OBJECTIVE: To assess the type, rate, and severity of unanticipated
complications of CPR (external cardiac compressions and ventilation) in a
pediatric population.
OBJECTIVE--To determine the incidence of rib fractures visible at autopsy or
with postmortem radiographs after cardiopulmonary resuscitation (CPR) in
infants
younger than 1 year.
(小児の心肺蘇生法)