Charles F. Babbs, William E. Schoenlein, Mark W. Lowe
DOI: http://dx.doi.org/10.1016/0735-6757(85)90029-4
Published in issue: March 1985
xThis study was undertaken to determine the effect of interposed abdominal compressions (IAC) during cardiopulmonary resuscitation (CPR) on gastric insufflation when the airway is not secured with an endotracheal tube. A canine model was used in which a common ventilation pressure was applied to separate cuffed esophageal and tracheal tubes. Gas entering the stomach was collected by a pre-placed gastrostomy tube leading to a bell spirometer. Gas entering the lungs was measured with a Wright Respirometer® in series with the endotracheal tube.
Carol L. Lake, T.Duncan Sellers, Stanton P. Nolan, Ivan K. Crosby, H.A. Wellons, Richard S. Crampton
DOI: http://dx.doi.org/10.1016/0735-6757(85)90030-0
Published in issue: March 1985
xDuring cardiopulmonary bypass, 150 cardiac surgical patients were prospectively evaluated for the number, energy, current, and success rates of direct current (DC) shocks required to terminate reperfusion ventricular fibrillation (1°) or ventricular fibrillation occurring subsequent to a nonfibrillatory reperfusion rhythm (2°). Thirty-one percent of 1-J shocks and 58% of 2.5-J shocks defibrillated. Above 2.5 J, the defibrillation success rate reached a plateau of 50–60%. Myocardial resistance decreased significantly after the first shock but remained stable during subsequent shocks.
Elizabeth J. Kicklighter, Scott A. Syverud, William C. Dalsey, Jerris R. Hedges, Johanna M. van der Bel-Kahn
DOI: http://dx.doi.org/10.1016/0735-6757(85)90031-2
Published in issue: March 1985
xAlthough electrical energy has the potential to produce myocardial injury, the risk of tissue damage from transcutaneous cardiac pacing is largely unknown. This study reports the anatomical findings of a canine transcutaneous stimulation study. Ten dogs had 100-mA, 20-msec (pulse duration), transcutaneous impulses delivered across the thorax for 30 minutes at a rate of 80 stimuli per minute. Seventy-two hours later the animals were sacrificed, and the heart, lungs, and tissues of the chest wall were examined for pathological changes.
Richard O. Cummins, Mickey S. Eisenberg, Alfred P. Hallstrom, Paul E. Litwin
DOI: http://dx.doi.org/10.1016/0735-6757(85)90032-4
Published in issue: March 1985
xRecords on 1,297 people with witnessed out-of-hospital cardiac arrest, caused by heart disease and treated by both emergency medical technicians (EMTs) and paramedics, were examined to determine whether or not early cardiopulmonary resuscitation (CPR) initiated by bystanders independently improved survival. Bystanders initiated CPR for 579 patients (bystander CPR); for the remaining 718 patients, CPR was delayed until the arrival of EMTs (delayed CPR). Survival was significantly better (P < 0.05) in the bystander-CPR group (32%) than in the delayed-CPR group (22%).
Donna L. Carden, Gerard B. Martin, Richard M. Nowak, Craig C. Foreback, Michael C. Tomlanovich
DOI: http://dx.doi.org/10.1016/0735-6757(85)90033-6
Published in issue: March 1985
xStudies have shown that over 50% of cardiovascular deaths occur before hospitalization. A major factor associated with survival in cases of out-of-hospital cardiac arrest is the time from cardiovascular collapse to the initiation of cardiopulmonary resuscitation (CPR) or “downtime.” The purpose of this study was to determine whether blood lactate levels could be used to predict downtime in the canine cardiac arrest model. Femoral arterial and Swan-Ganz catheters were placed in 22 mongrel dogs, and ventricular fibrillation was electrically induced.
J.Douglas White, Charles G. Brown
DOI: http://dx.doi.org/10.1016/0735-6757(85)90034-8
Published in issue: March 1985
xThis study was conducted to prospectively evaluate immediate transthoracic pacing in the emergency department for cardiac arrest patients presenting with asystole. All adult patients presenting over an 11-month period to a university teaching hospital with asystole following nontraumatic cardiopulmonary arrest received immediate transthoracic cardiac pacing. In these 48 patients, electrical capture was achieved in 23% and mechanical capture in 17%. With subsequent intraventricular administration of epinephrine and sodium bicarbonate, the percentage of responders increased to 48% and 33%, respectively.
Carin M. Olson, Michael S. Jastremski, Rodney W. Smith, Gary J. Tyndall, Gregory F. Montgomery, Mary C. Daye
DOI: http://dx.doi.org/10.1016/0735-6757(85)90035-X
Published in issue: March 1985
xCardiac pacing has been used successfully in patients with asystole or bradycardia compromising hemodynamics when it was applied soon after the onset of the event. An external cardiac pacemaker was used as part of initial resuscitative efforts for patients in primary, out-of-hospital, cardiac arrest who arrived in the emergency department in asystole, agonal rhythm, pulseless idioventricular rhythm, or bradycardia with hemodynamic compromise. A pulse was successfully generated in only one of twelve patients.
Sandra H. Ralston, William D. Voorhees, Lee Showen, Peter Schmitz, Constantina Kougias, Willis A. Tacker
DOI: http://dx.doi.org/10.1016/0735-6757(85)90036-1
Published in issue: March 1985
xThis study was undertaken to characterize blood gas, pH, and lactate changes during and after cardiopulmonary resuscitation (CPR) in arterial and venous samples. Blood samples were withdrawn from the brachial artery, aortic arch, pulmonary artery, coronary sinus, and either the right or left cardiac ventricle of 24 anesthetized dogs. Ventricular fibrillation (VF) was induced electrically, and mechanical CPR was begun. Blood samples were withdrawn before CPR, at 2, 5, 7, and 9 minutes during CPR, and at 1, 3, 10, 30, and 60 minutes after defibrillation.
Joseph P. Ornato, Timothy W. Ryschon, Edgar R. Gonzalez, Jan L. Bredthauer
DOI: http://dx.doi.org/10.1016/0735-6757(85)90037-3
Published in issue: March 1985
xPrevious studies have shown that pulmonary edema occurs in half of all pre-hospital cardiac arrest victims who cannot be successfully resuscitated and is a major cause of hypoxemia and poor lung compliance during resuscitation. Pulmonary vascular hypertension and elevation of pulmonary capillary wedge pressure have been observed during cardiac resuscitation in humans. To further define the time course of the pulmonary hemodynamic changes, pulmonary artery diastolic pressure (PAd) was measured on a computerized trend recorder prior to, during, and immediately after arrest in three adult patients.
James R. Mateer, Harlan A. Stueven, Bruce M. Thompson, Charles Aprahamian, Joseph C. Darin
DOI: http://dx.doi.org/10.1016/0735-6757(85)90038-5
Published in issue: March 1985
xRecent studies evaluating interposed abdominal compression cardiopulmonary resuscitation (IAC-CPR) have demonstrated a significant increase in cardiac output, mean arterial pressure, and cerebral perfusion, as compared with standard CPR. A clinical evaluation of IAC-CPR effectiveness on resuscitation out-come has not been reported. A prospective randomized study comparing IAC-CRP with standard CPR for resuscitation of pre-hospital cardiopulmonary arrest was undertaken using the Milwaukee County Paramedic System.
Arthur B. Sanders, Matthew Atlas, Gordon A. Ewy, Karl B. Kern, Steven Bragg
DOI: http://dx.doi.org/10.1016/0735-6757(85)90039-7
Published in issue: March 1985
xPresently, there is no reliable noninvasive method of assessing the adequacy of cardiopulmonary resuscitation (CPR). Studies of animals have shown that during prolonged arrest the coronary perfusion pressure (CPP) is correlated with successful resuscitation. During previous studies it appeared that expired PCO2 correlated with CPP. To investigate this relationship, eight mongrel dogs (mean weight, 22.7 ± 5.8 kg) were anesthetized with pentobarbitol. Catheters were placed in the thoracic aorta and right atrium of each dog.
H.L. Edmonds Jr., A. Wauquier, W. Melis, W.A.E. Van Den Broeck, J. Van Loon, P.A.J. Janssen
DOI: http://dx.doi.org/10.1016/0735-6757(85)90040-3
Published in issue: March 1985
xA 10-minute cardiac arrest was produced in dogs by electrical fibrillation of the heart. Recovery of cerebral function was monitored by estimating the cerebral metabolic rate of oxygen consumption (CMRO2), cerebral blood flow (CBF), electroencephalograph (EEG) and extent of neurological deficit. The study group received flunarizine (0.1 mg/kg intravenously) at the beginning of resuscitation, while control animals were given the drug vehicle. By four hours after resuscitation, CMRO2 in flunarizine-treated dogs was 121 ± 43% of pre-arrest baseline, as compared with 37 ± 9% in control animals (P < 0.02).
John L. McDonald
DOI: http://dx.doi.org/10.1016/0735-6757(85)90041-5
Published in issue: March 1985
xDespite the problems inherent in estimating blood flow from pressure, determination of systolic arterial pressure during cardiopulmonary resuscitation (CPR) is common and probably valuable as an indicator of potential systemic flow. The addition of interposed abdominal compression (IAC) to closed-chest CPR has been promoted because of its potential to increase systolic arterial pressure during CPR. Interposed abdominal compressions have also reportedly increased diastolic arterial-central venous pressure difference (DA-DCVP) and, thus, have the potential to increase coronary vascular flow.
Leo Rubin, P. Hudson
DOI: http://dx.doi.org/10.1016/0735-6757(85)90042-7
Published in issue: March 1985
xThis study evaluated the energy requirements for porous electrodes implanted on the parietal pericardium versus those for porous electrodes implanted on the epicardial surface of the heart. Defibrillation with a 2.5-cm porous electrode implanted on the parietal pericardium was successful in 42% of all episodes of ventricular fibrillation. The minimal energy requirement ranged from 30–68 J, with an average of 46 J. Epicardial defibrillation was successful in approximately 80% of all episodes. The average maximal energy was 21.3 J.
Charles F. Babbs
DOI: http://dx.doi.org/10.1016/0735-6757(85)90043-9
Published in issue: March 1985
xAbdominal counterpulsation improves blood flow during other-wise standard CPR in animal models and in electronic models of the circulation. The method generates both central aortic and central venous pressure pulses. Success depends upon maximizing the former and minimizing the latter. Solution of a simple, first-order, differential equation may provide insight into proper technique. The equation suggests that the central arteriovenous pressure difference is maximized when pressure is applied directly over the abdominal aorta and when fluid loading is avoided.
Richard O. Cummins
DOI: http://dx.doi.org/10.1016/0735-6757(85)90044-0
Published in issue: March 1985
W.A. Tacker Jr., Charles F. Babbs
DOI: http://dx.doi.org/10.1016/0735-6757(85)90045-2
Published in issue: March 1985
Thomas C. Majerus
DOI: http://dx.doi.org/10.1016/0735-6757(85)90046-4
Published in issue: March 1985
Rick A. Barbarash
DOI: http://dx.doi.org/10.1016/0735-6757(85)90047-6
Published in issue: March 1985
