No. 1
[PubMed]
International emergency cardiac care: support, science, and universal
guidelines.
Chamberlain D, Cummins RO
Royal Sussex Hospital, Brighton, England.
Mature resuscitation councils must continue to support educational and training
efforts of less-developed countries, but only when strong local interest
exists. The scientific basis for the interventions and organization of
emergency cardiac care is international in origin. Educational approaches are
varied and innovative and should be shared. The era of single national
guideline conferences on CPR and emergency cardiac care has ended. Future
guideline conferences must cast a broad net to be more international in both
participants and scientific knowledge. Existing organizations should support an
international infrastructure to help pool scientific and educational expertise.
No. 2
[PubMed]
No. 3
[PubMed] No. 4
[PubMed]
Racial differences in the incidence of cardiac arrest and subsequent survival.
The CPR Chicago Project.
Becker LB, Han BH, Meyer PM, Wright FA, Rhodes KV, Smith DW, Barrett J
Department of Medicine, University of Chicago, IL.
RESULTS. Our study population comprised 6451 patients: 3207
whites, 2910 blacks, and 334 persons of other races. The incidence of cardiac
arrest was significantly higher for blacks than for whites in every age group.
The survival rate after cardiac arrest was 2.6 percent in whites, as compared
with 0.8 percent in blacks (P < 0.001). Blacks were significantly less likely
to have a witnessed cardiac arrest, bystander-initiated cardiopulmonary
resuscitation, or a "favorable" initial rhythm or to be admitted to the
hospital. When they were admitted, blacks were half as likely to survive. The
association between race and survival persisted even when other recognized risk
factors were taken into account. We did not find important differences between
blacks and whites in the response times of the emergency medical services.
CONCLUSIONS. The black community in our study was at higher risk for cardiac
arrest and subsequent death than the white community, even after we controlled
for other variables.
Comments:
No. 5
[PubMed]
Cardiac arrest and resuscitation: a tale of 29 cities.
Eisenberg MS, Horwood BT, Cummins RO, Reynolds-Haertle R, Hearne TR
Center for Evaluation of Emergency Medical Services, King County Health
Department, Seattle, Washington.
Published reports of out-of-hospital cardiac arrest give widely varying
results. The variation in survival rates within each type of system is due, in
part, to variation in definitions. To determine other reasons for differences
in survival rates, we reviewed published studies conducted from 1967 to 1988 on
39 emergency medical services programs from 29 different locations. These
programs could be grouped into five types of prehospital systems based on the
personnel who deliver CPR, defibrillation, medications, and endotracheal
intubation; the five systems were three types of single-response systems (basic
emergency medical technician [EMT], EMT-defibrillation [EMT-D], and paramedic)
and two double-response systems (EMT/paramedic and EMT-D/paramedic). Reported
discharge rates ranged from 2% to 25% for all cardiac rhythms and from 3% to
33% for ventricular fibrillation. The lowest survival rates occurred in
single-response systems and the highest rates in double-response systems,
although there was considerable variation within each type of system.
Hypothetical survival curves suggest that the ability to resuscitate is a
function of time, type, and sequence of therapy. Survival appears to be highest
in double-response systems because CPR is started early. We speculate that
early CPR permits definitive procedures, including defibrillation, medications,
and intubation, to be more effective.
No. 6
[PubMed]
Resuscitation skills of trainee anaesthetists.
Bell JH, Harrison DA, Carr B
Department of Anaesthesia, Royal Hallamshire Hospital, Sheffield.
We assessed the basic and advanced cardiopulmonary resuscitation skills of 30
trainee anaesthetists in a simulated exercise. Only one person performed basic
cardiopulmonary resuscitation as outlined in the 1992 European Resuscitation
Council guidelines. The management of ventricular fibrillation and asystole
were correctly carried out by eight (27%) and nine (30%) anaesthetists,
respectively. Neither the seniority of the anaesthetists nor their postgraduate
qualifications correlated with their performance level. We conclude that all
trainee anaesthetists need to undergo regular training and assessment of their
resuscitation skills.
Comments:
No. 7
[PubMed]
A quasi-experimental research to investigate the retention of basic
cardiopulmonary resuscitation skills and knowledge by qualified nurses
following a course in professional development.
Broomfield R
University of Teesside College of Health, South Cleveland Hospital,
Middlesbrough, England.
The research was undertaken with the intention of testing six null hypotheses
regarding the retention of basic cardiopulmonary resuscitation (CPR) skills and
knowledge of registered nurses. The hypotheses were formulated from the broad
aims of the research, which were to investigate conclusions reached by other
researchers highlighting the speed with which retention of CPR skills and
knowledge deteriorates, and to investigate the need for regular updating in
CPR. The research was quasi-experimental in nature. The 19 nurses participating
in the research were qualified staff undertaking the English National Board
(ENB) 923 course in Professional Development, which included a refresher on
basic CPR skills and included some discussion regarding advanced techniques.
The latest guidelines issued by the Resuscitation Council (1993) were used,
which also aided in the design and use of the two research tools, namely an
eight-point skills-testing observation tool and a 26-point knowledge-testing
questionnaire. While a 3-hour update in CPR skills revealed an initial
improvement, the decrease in retention of skills 10 weeks later was significant
(P = 0.0000). The update in CPR knowledge also revealed an initial improvement
but the decrease in retention of knowledge 10 weeks later was significant (P =
0.0000). The findings of the research reflect similar results to previous
research undertaken and discussed in the literature review, suggesting that
retention of skills and knowledge quickly deteriorates if not used or updated
regularly. Therefore this research supports the importance of CPR refresher
courses on a regular basis.
No. 8
[PubMed]
Resuscitation skills amongst anaesthetists.
Quiney NF, Gardner J, Brampton W
Department of Anaesthesia, Gloucestershire Royal Hospital, UK.
Resuscitation skills were assessed in a group of 24 anaesthetists of varying
experience using 3 pre-determined scenarios. Seventy-nine percent of
participants were found to be competent at resuscitation following the
guidelines suggested by the Resuscitation Council (UK) in 1989. No one grade of
anaesthetist was found to be consistently poor at resuscitation. Anaesthetists
by the nature of their jobs may maintain the skills and knowledge of
cardiopulmonary resuscitation as well as other groups in the hospital.
No. 9
[PubMed]
Reluctance of internists and medical nurses to perform mouth-to-mouth
resuscitation.
Brenner BE, Kauffman J
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.
BACKGROUND: Physicians and nurses constitute a major part of citizen
cardiopulmonary resuscitation responders and serve as educators and resource
personnel concerning cardiopulmonary resuscitation. We decided to determine if
fear of infectious disease has dampened physician and nurse response to perform
mouth-to-mouth resuscitation (MMR).
METHODS: Four hundred thirty-three
internists and one hundred fifty-two medical nurses responded to presentations
of mock cardiac arrest scenarios. RESULTS: Forty-five percent of the physicians
and 80% of the nurses would refuse to do MMR on a stranger. Between 18% and 25%
of nurses and attending internists would not do MMR on a child. Being born in
the United States or white racial background decreased the reluctance of the
respondents to perform MMR. Only 15% of the respondents would do MMR on a
stranger in a gay neighborhood. All respondents that would not do MMR stated
that their reason involved fear of contracting communicable diseases,
especially acquired immunodeficiency syndrome.
CONCLUSIONS: Internists and
medical nurses are highly reluctant to perform MMR. We recommend that the
teaching of MMR should emphasize performance on children and family members
where willingness to perform MMR is high. We urge public education along with
widespread availability of effective barrier masks to resuscitate MMR itself.
No. 10
[PubMed]
Attitudes of BCLS instructors about mouth-to-mouth resuscitation during the
AIDS epidemic.
Ornato JP, Hallagan LF, McMahan SB, Peeples EH, Rostafinski AG
Department of Internal Medicine, Medical College of Virginia, Richmond 23298.
We surveyed 5,823 American Heart Association Virginia Affiliate basic cardiac
life support (BCLS) instructors to assess the impact that the acquired
immunodeficiency syndrome (AIDS) epidemic has had on their attitudes, beliefs,
and behaviors with respect to the training and performance of mouth-to-mouth
(MTM) ventilation. The response rate by those whose mail survey could be
delivered to a valid address was 41% (women, 63%; men, 37%; mean age, 38 +/- 1
years; health care providers, 87%; laypersons, 11%; and public safety workers,
2%). Of those surveyed, 49% had performed CPR within the past three years. Of
these, 40% reported having hesitated to provide MTM ventilation at least once.
Of those who had hesitated, more than one half identified fear of exposure to
disease as the reason for their hesitation. Forty percent of all respondents
had witnessed another provider hesitate to provide MTM ventilation. When
presented with mock rescue scenarios, the majority of respondents indicated
that they would not perform or would hesitate to perform MTM ventilation on
most adult strangers. More than half felt that there was some risk of
contracting AIDS from ventilating a manikin, and 71% said that their attitudes
about providing CPR to strangers had changed as a result of the AIDS epidemic.
We conclude that concern about AIDS appears to be adversely affecting the
attitudes, beliefs, and self-reported behaviors of BCLS instructors in Virginia
regarding the use of MTM ventilation on strangers.
No. 11
[PubMed]
Outcome of out-of-hospital cardiac arrest in New York City. The Pre-Hospital
Arrest Survival Evaluation (PHASE) Study.
Lombardi G, Gallagher J, Gennis P
Department of Medicine, Albert Einstein College of Medicine, Bronx, NY.
DESIGN--Observational cohort study.
SETTING--New York City.
PARTICIPANTS--Consecutive out-of-hospital cardiac arrests occurring between
October 1, 1990, and April 1, 1991.
INTERVENTION--Trained paramedics performed
immediate postarrest interviews with care providers, using a standardized
questionnaire.
MAIN OUTCOME MEASURES--Entry criteria, elapsed time intervals,
and nodal events conformed to Utstein recommendations. The single target end
point was death or discharge home.
RESULTS--Of 3243 consecutive cardiac arrests
on which resuscitation was attempted, 2329 (72%) met entry criteria as primary
cardiac events. Overall survival was 1.4% (99% confidence interval [CI], 0.9%
to 2.3%). No patients were lost to follow-up. Survival from witnessed
ventricular fibrillation was 5.3% (99% CI, 2.9% to 8.8%). Using survival from
witnessed ventricular fibrillation for intersystem comparison, our survival
rate was similar to that of Chicago, Ill (4.0%; 99% CI, 1.9% to 7.5%; P = .41),
the only other large city on which data were available. However, it was
significantly lower than that reported from midsized urban/suburban areas
(33.0%; 99% CI, 30.4% to 35.6%; P < .0001) and suburban/rural areas (12.6%; 99%
CI, 8.9% to 16.3%; P < .0001). Survival rate among arrests occurring after
arrival of emergency medical services personnel (8.5%; 99% CI, 4.7% to 14.0%)
was comparable with Chicago (6.6%; 99% CI, 3.3% to 11.5%; P = .41) but markedly
lower than King County, Washington (36%; 99% CI, 28.6% to 43.8%; P < .0001).
CONCLUSIONS--Survival from out-of-hospital cardiac arrest in New York City was
poor. This was partly attributable to lengthy elapsed time intervals at every
step in the chain of survival. However, examination of survival among arrests
occurring after emergency medical services arrival suggests that other features
may predispose residents of large cities to higher cardiac arrest mortality
than individuals living in more suburban or rural settings. Since half the US
population resides in large metropolitan areas, this represents a public health
problem of considerable magnitude.
Comments:
No. 12
[PubMed]
Bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac
arrest. The Cerebral Resuscitation Study Group.
Bossaert L, Van Hoeyweghen R
Department of Intensive Care and Emergency Medicine, University of Antwerp,
UIA, Belgium.
Prevalence of bystander CPR and effect on outcome has been evaluated on 3053
out-of-hospital cardiac arrest (CA) events. Bystander CPR was performed in 33%
of recorded cases (n = 998) by lay people in 406 cases (family members 178,
other lay people 228) and by bystanding health care workers in 592 cases
(nurses 86, doctors 506). Family members and lay people mainly applied CPR in
younger CA victims at public places, roadside or at the working place. Sudden
infant death syndrome (SIDS) and drowning are highly represented. Health care
workers performed CPR mainly in older patients, at public places or at the
roadside and especially in case of cardiac or respiratory origin. CA caused by
trauma/exsanguination and intoxication/metabolic origin received less bystander
CPR (23% resp. 22%). Cardiac arrests receiving bystander CPR are more
frequently witnessed and have a shorter access time to the emergency medical
service (EMS) system and shorter response time of basic life support (BLS).
Advanced life support (ALS) response time is significantly longer. In witnessed
arrests of cardiac origin receiving bystander CPR a significantly better late
survival was observed. In non-witnessed arrests of cardiac origin early and
late survival are significantly higher in patients receiving bystander CPR. In
CA events where response time of ALS exceeds 8 min, the beneficial effect of
bystander CPR is most significant. Furthermore no deleterious effect of bad
technique or inefficient bystander CPR can be demonstrated.
No. 13
[PubMed] No. 14
[PubMed] No. 15
[PubMed]
The palpation of pulses.
Mather C, O'Kelly S
Shackleton Department of Anaesthetics, Southampton General Hospital.
In 554 anaesthetised patients, the times taken to separately palpate and
identify each of the carotid, radial, brachial and femoral pulses were
recorded. The patients were divided into three groups based on the form of
airway management chosen (tracheal tube, facemask or laryngeal mask airway).
Our results demonstrate that in the operating theatre environment the
identification of the radial pulse is the most rapid and reliable; by 5 s, 98%
and by 10 s, more than 99% of radial pulses were identified. The carotid pulse
was not so easily identified, requiring 10 s to enable an identification rate
of greater than 95%. The presence of a laryngeal mask airway or a tracheal tube
did not hinder the identification of carotid pulse.
Publication Types:
No. 16
[PubMed] No. 17
[PubMed] No. 18
[PubMed]
Skills of lay people in checking the carotid pulse.
Bahr J, Klingler H, Panzer W, Rode H, Kettler D
Department of Anaesthesiology, Emergency- and Critical Care Medicine,
University of Gottingen, Germany.
American Heart Association as well as European Resuscitation Council require
the carotid pulse check to determine pulselessness in an unconscious victim and
to decide whether or not cardiopulmonary resuscitation (CPR) should be
initiated. Recent studies on the ability of health professionals to check the
carotid pulse have called this diagnostic tool in question and led to
discussions. To contribute to this discussion we performed a study to evaluate
skills of lay people in checking the carotid pulse. A group of 449 volunteers
(most had participated in a first aid course) were asked to check the carotid
pulse in a young healthy, non-obese person by counting aloud the detected pulse
rate. Time intervals until correct detection of the carotid pulse were
registered. Overall the volunteers needed an average of 9.46 s, ranging from 1
to 70 s. Only 47.4% of the volunteers were able to detect a pulse within 5 s,
and 73.7% within 10 s. A level of 95% volunteers detecting the pulse correctly
was reached only after 35 s. Based on these findings we conclude that the
intervals established for carotid pulse check may be too short and that perhaps
the value of pulse check within in the scope of CPR needs to be reconsidered.
No. 19
[PubMed]
Checking the carotid pulse check: diagnostic accuracy of first responders in
patients with and without a pulse.
Eberle B, Dick WF, Schneider T, Wisser G, Doetsch S, Tzanova I
Department of Anaesthesiology, Johannes Gutenberg University Medical School,
Mainz, Germany. moenk@goofy.zdv.uni-mainz.de
International guidelines for cardiopulmonary resuscitation (CPR) in adults
advocate that cardiac arrest be recognized within 5-10 s, by the absence of a
pulse in the carotid arteries. However, validation of first responders'
assessment of the carotid pulse has begun only recently. We aimed (1) to
develop a methodology to study diagnostic accuracy in detecting the presence or
absence of the carotid pulse in unresponsive patients, and (2) to evaluate
diagnostic accuracy and time required by first responders to assess the carotid
pulse. In 16 patients undergoing coronary artery bypass grafting, four groups
of first responders (EMT-1: 107 laypersons with basic life support (BLS)
training; EMT-2: 16 emergency medical technicians (EMTs) in training; PM-1: 74
paramedics in training; PM-2: 9 certified paramedics) performed, single-blinded
and randomly allocated, carotid pulse assessment either during spontaneous
circulation, or during non-pulsatile cardiopulmonary bypass. Time to diagnosis
of carotid pulse status, concurrent haemodynamics and diagnostic accuracy were
recorded. In 10% (6/59), an absent carotid pulse was not recognized as
pulselessness. In 45% (66/147), a pulse was not identified despite a carotid
pulse with a systolic pressure > or = 80 mmHg. Thus, although sensitivity of
all participants for central pulselessness approached 90%, specificity was only
55%. Both sensitivity and, to a lesser degree, specificity improved with
increasing training; blood pressure or heart rate had no significant effect.
The median diagnostic delay was 24 s (minimum 3 s). When no carotid pulse was
found, delays were significantly longer (30 s: minimum 13 s), than when a
carotid pulse was identified (15 s; minimum 3 s) (P < 0.0001). Of all
participants, only 15% (31/206) produced correct diagnoses within 10 s. Only
1/59 (2%) identified pulselessness correctly within 10 s. Our cardiopulmonary
bypass model of carotid pulse assessment proved to be feasible and realistic.
We conclude that recognition of pulselessness by rescuers with basic CPR
training is time-consuming and inaccurate. Both intensive retraining of
professional rescuers and reconsideration of guidelines about carotid pulse
assessment are warranted.
Publication Types:
No. 20
[PubMed]
BACKGROUND. Differences between blacks and whites have been reported in the
incidence of several forms of cardiovascular disease, including hypertension
and stroke. We examined racial differences in the incidence of cardiac arrest
in a large urban population and in subsequent survival. METHODS. We collected
data on all nontraumatic, out-of-hospital cardiac arrests in Chicago from
January 1, 1987, through December 31, 1988, and compared the incidence and
survival rates for blacks and whites. We examined the association between
survival and race and seven other known risk factors by logistic-regression
analysis. We computed incidence rates by coupling our data with U.S. Census
population data.
Ayanian JZ
Publication Types:Comment, Editorial
Harrod S
Publication Types:Letter
Cook B
Publication Types:Comment, Letter
OBJECTIVE--To determine survival from out-of-hospital cardiac arrest in New
York City and to compare this with other urban, suburban, and rural areas.
Bickell WH
Publication Types: Comment, Letter
Controlled clinical trial
Controlled clinical trial
（単独で行う成人の一次救命処置）