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Latest & greatest articles for cardiac arrest
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Survival from in-hospital cardiacarrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation. --To determine whether interposed abdominal counterpulsation (IAC) during standard cardiopulmonary resuscitation (CPR) improves outcome in patients experiencing in-hospital cardiacarrest.--Randomized controlled trial in a university-affiliated hospital.--Patients experiencing in-hospital cardiacarrest during a 6-month period.--Patients were randomized to receive either IAC (...) during CPR or standard CPR in the event of cardiacarrest. Abdominal compressions were performed during the relaxation phase of chest compression, corresponding to CPR diastole, at a rate of 80/min to 100/min.--The three end points studied were (1) return of spontaneous circulation, (2) survival 24 hours after resuscitation, and (3) survival to hospital discharge. In addition, we examined neurological outcome in those patients surviving to hospital discharge.--During the study period there were 135
A randomized clinical trial of high-dose epinephrine and norepinephrine vs standard-dose epinephrine in prehospital cardiacarrest. To determine the relative efficacy of high- vs standard-dose catecholamines in initial treatment of prehospital cardiac arrest.Randomized, prospective, double-blind clinical trial.Prehospital emergency medical system of a major US city.All adults in nontraumatic cardiacarrest, treated by paramedics, who would receive epinephrine according to American Heart (...) Association advanced cardiac life support guidelines.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.Restoration of spontaneous circulation in the field, admission to hospital, hospital discharge, and Cerebral Performance Category score.Of 2694 patients with cardiacarrests during the study period, resuscitation was attempted on 1062 patients
A randomized clinical study of a calcium-entry blocker (lidoflazine) in the treatment of comatose survivors of cardiacarrest. Brain Resuscitation Clinical Trial II Study Group. Abnormalities of cellular calcium homeostasis have been implicated in the pathophysiology of postischemic encephalopathy. Calcium-entry-blocking drugs inhibit the influx of calcium into cells and have been shown to mitigate postischemic encephalopathy in animal models.Five hundred twenty patients with cardiacarrest who (...) and 23 percent of those given placebo recovered good cerebral function (normal or only moderately disabled cerebral performance) at some time.The administration of lidoflazine after cardiacarrest was not found to be beneficial. Our data do not support the routine use of this calcium-entry-blocking drug in comatose survivors of cardiacarrest.
Glucocorticoid treatment does not improve neurological recovery following cardiacarrest. Brain Resuscitation Clinical Trial I Study Group. Glucocorticoids are commonly given to patients with global brain ischemia, although their efficacy has not been proved. The database of the Brain Resuscitation Clinical Trial I, a multi-institutional study designed to evaluate the effect of thiopental sodium therapy on neurological outcome following brain ischemia, was used for a retrospective review (...) of the effects of glucocorticoid treatment on neurological outcome after global brain ischemia. This study included 262 initially comatose cardiacarrest survivors who made no purposeful response to pain after restoration of spontaneous circulation. The standard treatment protocol left glucocorticoid therapy to the discretion of the hospital investigators. This resulted in four patient groups that received either no, low, medium, or high doses of glucocorticoids in the first 8 hours after arrest
Comparison of endotracheal and peripheral intravenous adrenaline in cardiacarrest. Is the endotracheal route reliable? Twelve patients presenting to an accident and emergency department in asystolic cardiacarrest 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 cardiacarrest.
Randomized clinical study of thiopental loading in comatose survivors of cardiacarrest. Brain Resuscitation Clinical Trial I Study Group. After restoration of spontaneous circulation and adequate oxygenation, 262 comatose survivors of cardiacarrest were randomly assigned to receive standard brain-oriented intensive care or the same standard therapy plus a single intravenous loading dose of thiopental (30 mg per kilogram of body weight). The study was designed to have an 80 percent probability (...) ), or survived with permanent severe neurologic damage (2 percent of the thiopental vs. 5 percent of the standard-therapy group). The results of this study do not support the use of thiopental for brain resuscitation after cardiacarrest.