Showing papers on "Resuscitation published in 1977"

Improved outcome for prehospital cardiopulmonary collapse with resuscitation by bystanders.

Abstract: Despite the development of trained mobile rescue squads, cardiopulmonary collapse outside the hospital continues to carry a poor prognosis. We examined retrospectively the clinical courses of 19 consecutive coronary unit patients who had experienced prehospital cardiopulmonary resuscitation. Seven patients received basic life support from bystanders within five minutes. Cardiopulmonary resuscitation in the other 12 patients was delayed beyond five minutes pending the arrival of rescue personnel. Six of seven early-resuscitated patients survived compared with six of 12 late-resuscitated patients (P less than 0.01). The early-resuscitated patients were more alert on admission and had lower pulmonary pressures and higher cardiac outputs compared to the late-resuscitated patients. The early-resuscitated patients also had less residual central nervous system and myocardial damage on discharge than the late-resuscitated patients. On follow-up, three early-resuscitated patients had returned to full-time work compared with none in the late group. Training laymen to initiate early basic life support can benefit the cardiopulmonary collapse victim.

Smoke, burns, and the natural history of inhalation injury in fire victims: a correlation of experimental and clinical data.

Abstract: Mortality and morbidity in fire victims is largely a function of injury due to heat and/or smoke. While degree and area of burn together constitute a reliable numerical measure of cutaneous injury due to heat, as yet no satisfactory measure of inhalation injury has been developed. In this study, with fluid resuscitation and pulmonary infection eliminated as variables, dose-response curves were constructed as a measure of inhalation injury by exposing burned and unburned animals to smoke of constant temperature and toxicity under conditions similar to the fire situation. In these animals, the natural history of inhalation injury: 1) proved to be a relatively simple function of smoke and burn dosage; 2) appeared to simulate and therefore aid interpretation of the inhalation injury syndromes seen in human fire victims; 3) indicated that within limits [COHgb] measured immediately after injury was directly proportional to, and might prove to be a clinically valuable measure of, absorbed dose of smoke. While fluid resuscitation and pulmonary contamination with bacterial pathogens may be eliminated experimentally, such is not the case with the vast majority of fire victims admitted to burn services with associated inhalation injury. Fluid resuscitation and inhalation of a Pseudomonas aeruginosa aerosol were therefore included serially in a study of animals with inhalation injury and burns large enough to require fluid resuscitation. In these animals it was demonstrated that: 1) pulmonary edema occurred in association with too little rather than too much fluid therapy; 2) after aerosol inoculation, fatal bacterial pneumonia was difficult to produce when inhalation injury was associated with no or only small burns, but common when associated with no or only small burns, but common when associated with a burn large enough to require fluid resuscitation.

Cardiac arrest in the emergency medical service system: Guidelines for resuscitation

Abstract: A two-year study of 198 consecutive patients treated for cardiac arrest in the emergency department at Stanford University Medical Center was undertaken. The relatively poor overall survival rate of 3% and the complexity of deciding how to treat cardiac arrest victims suggest the need for guidelines to assist the emergency physician when resuscitating cardiac arrest patients. From the above study and a survey of the literature, the authors formulated the following guidelines of when resuscitation should be discontinued or not attempted: Cases of apnea and pulselessness known to have exceeded 10 minutes, no response after more than 30 minutes of advanced cardiac life support (ACLS), no ventricular EKG activity after more than 10 minutes of ACLS, and preexisting terminal illness.

Cardiac output and pulmonary wedge pressure. Use for evaluation of fluid replacement in trauma patients.

Abstract: • Cardiac output and pulmonary wedge pressure (PWP) were used to evaluate the end point of fluid resuscitation in 20 patients suffering from multiple trauma and shock. Eleven patients received crystalloid resuscitation and nine patients received colloid resuscitation. Fifteen of 20 patients had an adequate cardiac output at the termination of resuscitation, but only six of these patients had a PWP above 10 mm Hg. There was no significant correlation between left ventricular stroke work index and PWP in these patients, either at the completion of resuscitation or during the following three days. Five patients did not achieve adequate cardiac output and four of these patients died, suggesting that cardiac output was the most important criterion for adequate resuscitation. If the goal of fluid resuscitation is to achieve an adequate cardiac output, then PWP was not a reliable guide. Furthermore, using both cardiac output and PWP as a guide to fluid resuscitation of our patients, we found that the type of fluid (crystalloid or colloid) for resuscitation did not influence the course of respiratory distress in these patients up to three days following resuscitation. ( Arch Surg 112:1161-1164, 1977)

Rupture of the papillary muscle of the tricuspid valve. A complication of cardiopulmonary resuscitation and a rare cause of tricuspid insufficiency.

Abstract: Rupture of a papillary muscle is a rare occurrence. Two patients are described in whom rupture of a papillary muscle of the tricuspid valve developed after external cardiac massage during cardiopulmonary resuscitation. One of these patients survived briefly with clinical evidence of triscupid regurgitation immediately after resuscitation. Although tricuspid valve papillary muscle rupture has been described as a complication of bacterial endocarditis, chest trauma and myocardial infarction, it is a generally unrecognized complication of external cardia massage. Findings in the two patients reported here suggest that patients with a dilated right ventricle may be more susceptible to this rare complication of cardiopulmonary resuscitation.

Resuscitation from cardiopulmonary arrest during accidental hypothermia due to exhaustion and exposure

Abstract: A 16-year-old boy with accidental hypothermia and cardiopulmonary arrest due to exhaustion and exposure was resuscitated after warming measures -- hot wet towels, hot water bottles, and hot water enemas and gastric lavage -- had increased his rectal temperature from 25.2 to 28.0 degrees C. Despite prolonged cardiopulmonary arrest, recovery was almost complete, with no evident cerebral damage. Cardiopulmonary resuscitation procedures should not be abandoned until the body temperature is more than 30 degrees C, because the prognosis in cases of accidental hypothermia without associated disease is excellent if cardiac function can be re-established.

Cerebral circulation after cardiac arrest. Microangiographic and protein tracer studies.

Abstract: The effects of ventricular fibrillation and subsequent resuscitation on the microcirculation of the verebral cortex were studied with microangiographic and fluorescent protein tracer techniques. Immediately after revival, a transient period of impaired cerebral perfusion occurred before complete recovery from circulatory arrest was obtained. A circulatory arrest of longer than ten minutes, followed by four to six hours of resuscitation, caused defects of cortical capillary filling in both microangiography and Trypan blue fluorescence. This was considered to represent impairment of cortical perfusion, most likely due to edema. Cardiac arrest up to 12 minutes and subsequent resuscitation per se caused no blood-brain barrier damage. Minimal blood-brain barrier damage occurred in one dog following uncomplicated revival from a 14-minute arrest and in animals with prolonged hypertension post-resuscitation. Up to three consecutive carotid angiographies did not cause blood-brain barrier damage in the postischemic brain.

Further studies of manually operated self-inflating resuscitation bags.

Abstract: Four resuscitators were tested, of which three had recently been improved by the manufacturers (Danish-made Ambu, Air Bird, Laerdal Resusci 2), and one was new (Hope 2). All functioned well at extremes of temperature and all would deliver 100 percent O2 to the patient. All are essentially vice-free

Sepsis in the baboon: factors affecting resuscitation and pulmonary edema in animals resuscitated with Ringer's lactate versus Plasmanate.

Abstract: Septic shock and the formation of pulmonary edema were studied in 19 baboons. Four animals served as controls. Four were subjected to deep septic shock by infusion of live E. coli and then deliberately killed while in deep shock. Four were subjected to septic shock, resuscitated with Ringer's lactate (RL), and then killed 11/2 hours after resuscitation was started. Seven were subjected to shock and resuscitation attempted with Plasmanate (PL). Resuscitation with RL was successful for 11/2 hours in all four RL-animals. Resuscitation with PL was successful for 11/2 hours in three of the 7 PL-animals. There was an increased tendency for albumin to extravasate into the interstitium of the lungs after resuscitation. The amount of pulmonary edema, measured by both the thermodye technique and by analysis of post-mortem lung composition, was the same in animals resuscitated with RL and PL. Administration of pure colloid offers no protection to the lungs in resuscitating patients from septic shock.

Accidental Intubation of the Pyriform Sinus: A Complication of Roadside Resuscitation

Abstract: PERFORATION of the hypopharynx during endotracheal intubation is most likely to occur in emergency settings such as cardiopulmonary resuscitation, but it may also occur in more controlled situations. The injury has been related to the urgency of the intubation and to the inexperience of the person performing the intubation. 1 The esophagus is the most commonly reported site of perforation, and barotrauma and abscess formation the most likely complications. While signs of barotrauma become evident soon after perforation, neck abscess does not become apparent for several days or weeks. Report of a Case A 58-year-old woman was brought to the emergency room by ambulance with apparent cardiorespiratory arrest. She was well 3 1/2 hours prior to admission. Shortly thereafter, she was found on the floor of a closed garage with a car engine running. Resuscitative measures were instituted by trained emergency medical technician personnel of a city ambulance crew. The

Massive upper gastrointestinal hemorrhage in the elderly

Abstract: Sixty-six elderly patients with massive upper gastrointestinal bleeding were retrospectively analyzed. This study supports the concept of vigorous resuscitation, early diagnosis with fiberoptic endoscopy, and prompt surgical intervention in patients with continued bleeding. When this approach was utilized in a community hospital, operative mortality was reduced to 5 per cent.

Lightning Injury: Management of a Case With Ten-Day Survival

Abstract: • A boy, injured by lightning, had cardiopulmonary arrest. Following resuscitation and during the course of hospitalization, he developed further cardiac arrhythmia, cerebral edema, generalized seizures, and upper gastrointestinal bleeding. Despite efforts to combat these complications, the patient's condition deteriorated, and he died on the tenth day of hospitalization. The pathologic findings are described and the treatment discussed. ( Am J Dis Child 131:413-415, 1977)

Bag-Valve-Mask O2 Ventilation

Abstract: The self-refilling bag-valve unit is a superior device for ventilation during cardiopulmonary resuscitation (CPR) as soon as the trachea is intubated and oxygen is available, particularly during transport of the cardiac arrest patient. As resuscitation technology has evolved, the role of the bag-valve assembly has changed from a mask unit utilizing air to a superb manual device for delivering ventilation with a high oxygen concentration via tracheal tube or equivalent airway (1–25). Bag-valve-mask resuscitation must be considered in terms of the requisite skill, experience, and judgment of the operator, and the limitations imposed by gastric complications. Prevention of regurgitation and pulmonary aspiration with the use of bag-valve-mask units is possible with the use of tracheal intubation and the esophageal obturator airway (EOA), or the esophageal pharyngeal airway (EPA) (26).

Traumatic hemipelvectomy: a case report.

Abstract: Traumatic hemipelvectomy is a devasting injury which few patients survive. A survivor of traumatic hemipelvectomy is described. Immediate and long-term management include prompt resuscitation, vascular control, urinary and fecal diversion, wound debridement, wound closure, and physical and psychologic rehabilitation.

Effects of sodium bicarbonate administration during cardiopulmonary resuscitation.

Abstract: To study whether sodium bicarbonate given in cardiopulmonary resuscitation may produce life-threatening hyperosmolality or hypernatremia, arterial blood was analysed for blood gas, alcohol, blood urea nitrogen, electrolyte and osmolality. The blood was drawn after resuscitation in successful cases, and while effective massage and ventilation were being applied in unsuccessful resuscitations. Seven of the 17 resuscitations were successful. Serum sodium concentrations ranged from 135 to 154 with one exception and did not correlate with the amount of sodium bicarbonate administered. Arterial pH ranged from 6.38 to 7.71; only one patient had metabolic alkalosis. Serum osmolality ranged from 301 to 407. The data suggests a net increase in osmolality of 6 mOsm/50 mEq of sodium bicarbonate.

Mechanisms of the "low-flow" state during resuscitation of the totally ischemic brain.

Abstract: Resuscitation of the brain following total circulatory arrest may be impeded by difficulty in establishing cerebral tissue perfusion, a postischemic "low-flow"state. We have confirmed this hypothesis in a rat model of total cerebral ischemia and have demonstrated marked imporvement in post-ischemic brain tissue perfusion following epinephrine injection. This is mainly due to the systemic vascular effects of epinephrine, resulting in improved central arotic pressure and cerebral perfusion pressure. Hyperkalemic induced vasoconstriction has also been postulated as a cause of the "low-flow/. We have, therefore, investigated the in vitro effects of increasing potassium ion concentration on cerebrovascular smooth muscle strips. Large arteries constrict, while small arteries dilate in response to hyperkalemia. The net effect on cerebral blood flow remains unsettled. Our research to date suggests that resuscitation of the totally ischemic brain, in animal models at least, is enhanced by epinephrine, mainly via its effects on central aortic pressure.

Cardiac arrests in children

Abstract: The management of cardiac arrests in infants and children is based upon principles common to management of arrests of all age groups. Specific pediatric disease states predispose the patient to arrest. Special adaptions and pharmacologic management are required for pediatric cardiopulmonary resuscitation.

The effect of hemorrhagic shock and resuscitation on regional blood flow in cynomulgus monkeys

Abstract: The effect of hemorrhagic hypotension and resuscitation on regional blood flow was studied in the Macaca fascicularis monkey. The majority of the splanchnic vasculature demonstrated a profound decrease in flow. Following fluid expansion and correction of acidosis, flow increased in these circulations but did not reach control values. Exceptions were the small bowel flow which fell only moderately and hepatic arterial flow which did not significantly change. Both coronary and adrenal circulations maintained flow during the shock and resuscitation periods, whereas brain and kidney blood flows fell significantly without recovery. There was a significant rise in serum glucose, lactate, and pyruvate during shock, with an increase in the lactate/pyruvate ratio. Following resuscitation, the ratio decreased, implying a return toward aerobic metabolism.