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Active compression-decompression cardiopulmonary resuscitation: a population-based, prospective randomised clinical trial in out-of-hospital cardiac arrest.

https://arctichealth.org/en/permalink/ahliterature54149
Source
Resuscitation. 1999 Nov;42(3):163-72
Publication Type
Article
Date
Nov-1999
Author
E. Skogvoll
L. Wik
Author Affiliation
Department of Anaesthesiology, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim. eirik.skogvoll@medisin.ntnu.no
Source
Resuscitation. 1999 Nov;42(3):163-72
Date
Nov-1999
Language
English
Publication Type
Article
Keywords
Aged
Cardiopulmonary Resuscitation - instrumentation - methods - mortality
Emergency medical services
Female
Heart Arrest - mortality - therapy
Humans
Male
Norway
Outcome and Process Assessment (Health Care)
Survival Rate
Abstract
Different mechanical devices have been developed to improve cardiopulmonary resuscitation (CPR). The aim of this study was to evaluate active compression-decompression (ACD) CPR applied by Emergency Medical Service (EMS) in a defined population. The Trondheim region EMS (population 154,000) employs simultaneous paramedic and physician response. Upon decision to treat, patients with cardiac arrest of presumed cardiac origin were allocated to ACD CPR (CardioPump) or standard CPR by drawing a random number tag. Outcome in each patient was determined on a 5 point ordinal scale (no clinical improvement = 1, survival to discharge = 5). In 4 years, CPR was attempted in a total of 431 cardiac arrests, 54 patients (13%) survived to discharge; 302 patients with similar baseline characteristics were randomised. The prevalence of bystander CPR was 57% and the median call-arrival interval 9 min. By intention to treat, the mean score in the standard CPR group was 2.51 and 17/145 patients (12%) survived. The mean score in the ACD CPR group was 2.53 (P = 0.9) and 20/157 patients (13%) survived. Cerebral outcome was similar in the two groups. Among the 145 ACD patients, the technique was successfully applied in 110, found inapplicable in 35 and in seven patients chest compressions were unnecessary. This is the largest, single-centre, randomised, population based study of ACD CPR in out-of-hospital cardiac arrest to date. Even when considering a wider outcome spectrum than crude survival, we found no evidence of clinical benefit. In a quarter of cases ACD CPR was inapplicable, further limiting its potential usefulness.
PubMed ID
10625156 View in PubMed
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[Acute medical coordination dispatch centres will be key partners, allowing more people to survive out-of-hospital cardiac arrests].

https://arctichealth.org/en/permalink/ahliterature118957
Source
Ugeskr Laeger. 2012 Nov 12;174(46):2848
Publication Type
Article
Date
Nov-12-2012

Acute physiology and chronic health evaluation (APACHE II) and Glasgow coma scores as predictors of outcome from intensive care after cardiac arrest.

https://arctichealth.org/en/permalink/ahliterature225250
Source
Crit Care Med. 1991 Dec;19(12):1465-73
Publication Type
Article
Date
Dec-1991
Author
M. Niskanen
A. Kari
P. Nikki
E. Iisalo
L. Kaukinen
V. Rauhala
E. Saarela
M. Halinen
Author Affiliation
Department of Anesthesiology, Kuopio University Hospital, Finland.
Source
Crit Care Med. 1991 Dec;19(12):1465-73
Date
Dec-1991
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Cardiopulmonary Resuscitation - standards
Critical Care - standards
Female
Finland - epidemiology
Glasgow Coma Scale
Heart Arrest - mortality - therapy
Humans
Length of Stay - statistics & numerical data
Logistic Models
Male
Middle Aged
Patient Admission
Predictive value of tests
Prognosis
Prospective Studies
Risk factors
Severity of Illness Index
Survival Analysis
Survival Rate
Treatment Outcome
Abstract
a) To examine the accuracy of the Acute Physiology and Chronic Health Evaluation (APACHE II) and the Glasgow Coma Scores as predictors of the outcome of patients following resuscitation from cardiac arrest; b) to study the impact of the components of APACHE II on the prediction.
A nationwide study in Finland with prospectively collected data on all patients admitted to intensive care after cardiac arrest during a 14-month period. Two thirds of the cardiac arrest patients included in the study were randomly selected to derive predictive models, and the remaining one third constituted the validation sample.
A total of 25 medical and surgical ICUs in Finland (13 in tertiary referral centers).
Six-hundred nineteen consecutive cardiac arrest patients. Fifteen patients less than 16 yrs were excluded.
Variables included in the APACHE II or Glasgow Coma Scores were collected at the time of ICU admission and then three times after admission, at 24-hr intervals. ICU- and hospital-mortality rates and a 6-month mortality rate after ICU admission were studied.
Of 604 study patients, 370 (61.3%) patients died in the hospital. The most accurate prediction of hospital outcome was based on data collected after the first day of ICU care, not on the admission values. Twenty-one (21.9%) of 96 patients with a low APACHE II score (less than or equal to 9) died compared with 66 (84.6%) of 78 patients with a high APACHE II score (greater than or equal to 25) (p less than .001). Of 160 patients with a normal Glasgow Coma Score (14 to 15), 45 (28.1%) died, whereas there were 114 (81.4%) nonsurvivors among 140 patients with a low Glasgow Coma Score of 3 (p less than .001). The performance of predictive models, including age, the Chronic Health Evaluation, and either the Acute Physiology Score (Acute Physiology Score model) or the Glasgow Coma Score (Glasgow Coma Score model) were compared with the prediction according to the APACHE II in the validation sample. When using 80% probability of death as a decision rule, the Acute Physiology Score model determined 35 of 153 patients to have high risk of death, 29 of whom died (the positive predictive value being 82.9%). The Glasgow Coma Score model predicted 34 patients to die, 26 of whom died (positive predictive value 76.5%), and the APACHE II score predicted seven deaths, five of whom actually died (positive predictive value 71.4%).
The APACHE II scoring system cannot be recommended as a prognostic tool to support clinical judgement in cardiac arrest patients, but by modifying it, a more accurate prediction of poor outcome could be achieved. The Glasgow Coma Score explained to a great extent the predictive power of the APACHE II.
Notes
Comment In: Crit Care Med. 1991 Dec;19(12):1460-11959362
Comment In: Crit Care Med. 1992 Dec;20(12):1736-81458955
PubMed ID
1959364 View in PubMed
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Adherence to guidelines when positioning the defibrillation electrodes.

https://arctichealth.org/en/permalink/ahliterature180186
Source
Resuscitation. 2004 May;61(2):143-7
Publication Type
Article
Date
May-2004
Author
Jouni Nurmi
Per Rosenberg
Maaret Castrén
Author Affiliation
Uusimaa EMS, Helsinki University Hospital, Eteläinen Hesperiankatu, 22A 26, Helsinki 00100, Finland. jouni.nurmi@helsinki.fi
Source
Resuscitation. 2004 May;61(2):143-7
Date
May-2004
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Cardiopulmonary Resuscitation - instrumentation - standards
Clinical Competence
Confidence Intervals
Electric Countershock - instrumentation - standards
Electrodes
Emergency medical services
Female
Finland
Guideline Adherence
Health Care Surveys
Humans
Male
Practice Guidelines as Topic
Probability
Total Quality Management
Abstract
Placement of the defibrillation electrodes affects the transmyocardial current and thus the success of a defibrillation attempt. In the international guidelines 2000, the placement of the apical electrode was changed more laterally to the mid-axillary line. Finnish national guidelines, based on the international guidelines, were published in 2002.
The purpose of this study was to determine to what extent health care professionals adhere to the new guidelines when positioning the electrodes.
Professionals were recruited from emergency medical services, university hospitals and primary care. Not revealing the purpose of the test, participants were asked to place self-adhesive electrodes on a manikin as they would do in the resuscitation situation and to answer a questionnaire about resuscitation training and familiarity with the guidelines. The distance of electrodes from the recommended position was measured in horizontal and vertical planes.
One-hundred and thirty six professionals participated in the study, and only 25.4% (95% CI 18.5-32.9) of them placed both electrodes within 5 cm from the recommended position. The majority of the participants placed the apical electrode too anteriorly. Of the participants, 36.0% were not aware of the new guidelines. Awareness of the guidelines did not increase the accuracy in electrode placement.
The publication of the national evidence based resuscitation guidelines did not seem to have influenced the practice of placement of the defibrillation electrodes to any major extent. The correct placement of the electrodes needs be emphasized more in the resuscitation training.
PubMed ID
15135190 View in PubMed
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Admission interleukin-6 is associated with post resuscitation organ dysfunction and predicts long-term neurological outcome after out-of-hospital ventricular fibrillation.

https://arctichealth.org/en/permalink/ahliterature265459
Source
Resuscitation. 2014 Nov;85(11):1573-9
Publication Type
Article
Date
Nov-2014
Author
Jukka Vaahersalo
Markus B Skrifvars
Kari Pulkki
Mats Stridsberg
Helge Røsjø
Seppo Hovilehto
Marjaana Tiainen
Tero Varpula
Ville Pettilä
Esko Ruokonen
Source
Resuscitation. 2014 Nov;85(11):1573-9
Date
Nov-2014
Language
English
Publication Type
Article
Keywords
Aged
Biological Markers - blood
C-Reactive Protein - analysis
Cardiopulmonary Resuscitation - adverse effects - methods - mortality
Female
Finland
Hospital Mortality
Humans
Intensive Care Units
Interleukin-6 - blood
Logistic Models
Male
Middle Aged
Multiple Organ Failure - blood - mortality
Multivariate Analysis
Nervous System Diseases - epidemiology - etiology - physiopathology
Out-of-Hospital Cardiac Arrest - blood - mortality - therapy
Patient Admission
Predictive value of tests
Prognosis
Prospective Studies
Risk assessment
S100 Proteins - analysis
Survival Analysis
Time Factors
Treatment Outcome
Ventricular Fibrillation - blood - mortality - therapy
Abstract
To study plasma concentrations of interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP) and S-100B during intensive care after out-of-hospital cardiac arrest from ventricular fibrillation (OHCA-VF), and their associations with the duration of ischemia, organ dysfunction and long-term neurological outcome.
A 12-month prospective observational multicentre study was conducted in 21 Finnish intensive care units in 2011. IL-6, hs-CRP and S-100B were measured at 0-6 h, 24 h, 48 h and 96 h after ICU admission. Associations with the time to return of spontaneous circulation (ROSC), sequential organ failure assessment (SOFA) scores divided into tertiles and 12-month cerebral performance category (CPC) were tested.
Of 186 OHCA-VF patients included in the study, 110 (59.1%) patients survived with good neurological outcome (CPC 1-2) 12 months after cardiac arrest. Admission plasma concentrations of IL-6 but not hs-CRP were higher with prolonged time to ROSC (p
PubMed ID
25238742 View in PubMed
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Adrenaline in out-of-hospital ventricular fibrillation. Does it make any difference?

https://arctichealth.org/en/permalink/ahliterature11388
Source
Resuscitation. 1995 Jun;29(3):195-201
Publication Type
Article
Date
Jun-1995
Author
J. Herlitz
L. Ekström
B. Wennerblom
A. Axelsson
A. Bång
S. Holmberg
Author Affiliation
Division of Cardiology, Sahlgrenska Hospital, Göteborg, Sweden.
Source
Resuscitation. 1995 Jun;29(3):195-201
Date
Jun-1995
Language
English
Publication Type
Article
Keywords
Aged
Cardiopulmonary Resuscitation
Case-Control Studies
Comparative Study
Emergencies
Emergency medical services
Epinephrine - therapeutic use
Female
Heart Arrest - drug therapy - mortality - therapy
Humans
Male
Research Support, Non-U.S. Gov't
Survival Analysis
Sweden - epidemiology
Treatment Outcome
Ventricular Fibrillation - drug therapy - mortality - therapy
Abstract
BACKGROUND: A large proportion of cardiac arrests outside hospital are caused by ventricular fibrillation. Although it is frequently used, the exact role of treatment with adrenaline in these patients remains to be determined. AIM: To describe the proportion of patients with witnessed out-of-hospital cardiac arrest found in ventricular fibrillation who survived and were discharged from hospital in relation to whether they were treated with adrenaline prior to hospital admission. PATIENTS AND TREATMENT: All the patients with out-of-hospital cardiac arrest found in ventricular fibrillation in Göteborg between 1981 and 1992 in whom cardiopulmonary resuscitation (CPR) was initiated by our emergency medical service (EMS). During the observation period, some of the EMS staff were authorized to give medication and some were not. RESULTS: In all, 1360 patients were found in ventricular fibrillation and detailed information was available in 1203 cases (88%). Adrenaline was given in 417 cases (35%). Among patients with sustained ventricular fibrillation, those who received adrenaline experienced the return of spontaneous circulation more frequently (P
PubMed ID
7667549 View in PubMed
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[Advanced prehospital care in patients with life-threatening conditions--survival rate, health status and functional level]

https://arctichealth.org/en/permalink/ahliterature70488
Source
Ugeskr Laeger. 2005 Nov 21;167(47):4465-8
Publication Type
Article
Date
Nov-21-2005
Author
Anette Marianne Fedder
Niels Kim Schønemann
Alf Jørgen Møl Christensen
Erika Frischknecht Christensen
Author Affiliation
Arhus Universitetshospital, Arhus Sygehus, Anaestesiologisk og Intensiv Afdeling. a.fedder@dadlnet.dk
Source
Ugeskr Laeger. 2005 Nov 21;167(47):4465-8
Date
Nov-21-2005
Language
Danish
Publication Type
Article
Keywords
Activities of Daily Living
Adult
Aged
Ambulances - manpower - organization & administration
Anesthesiology - manpower
Cardiopulmonary Resuscitation
Denmark
Emergency medical services
English Abstract
Family Practice - manpower - organization & administration
Female
Health status
Humans
Life Support Care - manpower - organization & administration
Male
Middle Aged
Questionnaires
Recovery of Function
Registries
Resuscitation
Survival Rate
Treatment Outcome
Abstract
INTRODUCTION: In Aarhus, Denmark, advanced prehospital care was carried out by anaesthetists working in a rendezvous model with ordinary ambulances. The effect on the patient was evaluated by the physician on scene. The purpose of the study was to evaluate survival rate, health status and functional level in patients after lifesaving prehospital care. MATERIALS AND METHODS: Consecutive data were reported to a prehospital database and the National Patient Registry. Data on survival from 1998 to 2000 were retrieved. Functional level was studied in lifesaving cases in the year 2000. We interviewed the general practitioners (GPs) involved according to EuroQol. The EuroQol interview concerned health status and function level. RESULTS: In 1998-2000, prehospital anaesthetists attended a total of 11,684 patients. Treatment was described as lifesaving in 238 (2%) of the cases, and 63% of the patients (151/238) were alive one year later. In the year 2000, 79 patients were identified as having had lifesaving treatment, and 48 were alive one year later; 67% (32/48) were without functional impairment according to EuroQol. The most frequent diagnoses were self-intoxication and cardiovascular and respiratory diseases. CONCLUSION: Lifesaving prehospital care, as evaluated by the prehospital physician on scene, was performed in 2 percent of all cases attended by a prehospital anaesthetist. Of these patients, the majority were alive after one year and without functional impairment, according to their GP. The diagnoses were varied.
Notes
Comment In: Ugeskr Laeger. 2006 Jan 16;168(3):297-8; author reply 29816430828
PubMed ID
16305767 View in PubMed
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Adverse events associated with lay emergency response programs: the public access defibrillation trial experience.

https://arctichealth.org/en/permalink/ahliterature168751
Source
Resuscitation. 2006 Jul;70(1):59-65
Publication Type
Article
Date
Jul-2006
Author
Mary Ann Peberdy
Lois Van Ottingham
William J Groh
Jerris Hedges
Thomas E Terndrup
Ronald G Pirrallo
N Clay Mann
Ruchir Sehra
Author Affiliation
Virginia Commonwealth University Health System, Box 908204, Richmond, VA 23298, USA. mpeberdy@aol.com
Source
Resuscitation. 2006 Jul;70(1):59-65
Date
Jul-2006
Language
English
Publication Type
Article
Keywords
Canada
Cardiopulmonary Resuscitation - adverse effects - education - psychology
Community Health Services - methods - statistics & numerical data
Defibrillators - adverse effects
Electric Countershock - adverse effects
Emergency Medical Services - methods - statistics & numerical data
Heart Arrest - therapy
Humans
Public Sector - statistics & numerical data
United States
Volunteers - education - psychology
Abstract
The adverse event (AE) profile of lay volunteer CPR and public access defibrillation (PAD) programs is unknown. We undertook to investigate the frequency, severity, and type of AE's occurring in widespread PAD implementation.
A randomized-controlled clinical trial.
One thousand two hundred and sixty public and residential facilities in the US and Canada.
On-site, volunteer, lay personnel trained in CPR only compared to CPR plus automated external defibrillators (AEDs).
Persons experiencing possible cardiac arrest receiving lay volunteer first response with CPR+AED compared with CPR alone.
An AE is defined as an event of significance that caused, or had the potential to cause, harm to a patient or volunteer, or a criminal act. AE data were collected prospectively.
Twenty thousand three hundred and ninety six lay volunteers were trained in either CPR or CPR+AED. One thousand seven hundred and sixteen AEDs were placed in units randomized to the AED arm. There were 26,389 exposure months. Only 36 AE's were reported. There were two patient-related AEs: both patients experienced rib fractures. There were seven volunteer-related AE's: one had a muscle pull, four experienced significant emotional distress and two reported pressure by their employee to participate. There were 27 AED-related AEs: 17 episodes of theft involving 20 devices, three involved AEDs that were placed in locations inaccessible to the volunteer, four AEDs had mechanical problems not affecting patient safety, and three devices were improperly maintained by the facility. There were no inappropriate shocks and no failures to shock when indicated (95% upper bound for probability of inappropriate shock or failure to shock = 0.0012).
AED use following widespread training of lay-persons in CPR and AED is generally safe for the volunteer and the patient. Lay volunteers may report significant, usually transient, emotional stress following response to a potential cardiac arrest. Within the context of this prospective, randomized multi-center study, AEDs have an exceptionally high safety profile when used by trained lay responders.
PubMed ID
16784998 View in PubMed
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524 records – page 1 of 53.