Long-term results of electroimpulse treatment for cardiac fibrillation in 1292 patients performed in cardiological clinics of Moscow and Kaunas have been compared. It is shown that more strict selection, longer preparation for the impulse exposure may secure a significant decrease in the number of the fibrillation recurrences both 1 and 6 months after recovery of the normal rhythm.
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.
The Ontario Prehospital Advanced Life Support (OPALS) Study tested the incremental effect on the rate of survival after out-of-hospital cardiac arrest of adding a program of advanced life support to a program of rapid defibrillation.
This multicenter, controlled clinical trial was conducted in 17 cities before and after advanced-life-support programs were instituted and enrolled 5638 patients who had had cardiac arrest outside the hospital. Of those patients, 1391 were enrolled during the rapid-defibrillation phase and 4247 during the subsequent advanced-life-support phase. Paramedics were trained in standard advanced life support, which includes endotracheal intubation and the administration of intravenous drugs.
From the rapid-defibrillation phase to the advanced-life-support phase, the rate of admission to a hospital increased significantly (10.9 percent vs. 14.6 percent, P
Comment In: N Engl J Med. 2004 Dec 9;351(24):2553-4; author reply 2553-415590963
[Advanced prehospital treatment of heart arrest by the mobile emergency unit in Aarhus. 1-year survival after out-of-hospital heart arrest--with focus on response time, survival, the given treatment and admission]
INTRODUCTION: The Mobile Emergency Care Unit (MECU) in Arhus includes an experienced anaesthesiologist and a specially trained rescuer. It covers a radius of 25 km from the centre of Arhus with 330,000 inhabitants. Rescue workers in Denmark are permitted to give basic life support and defibrillation. The MECU carriers out advanced cardiac life support in accordance with "The 1998 Guidelines of the European Resuscitation Council". MATERIAL AND METHODS: Data collected by the MECU doctor on a standardised chart and survival data received from the Central Hospital Database were analysed retrospectively. RESULTS: In 1998, 4725 emergency calls were received. Twenty-five per cent of the calls were for trauma, 515 patients had cardiac disease, 158 of whom had cardiac arrest. In 86 patients, death was determined on the spot and no treatment was given. Seventy-two patients received advanced cardiac life support. Twenty-five patients were admitted to hospital. Thirteen patients were alive one year later, which gives a survival rate of 52% of the patients admitted to hospital. Of the 25 patients who were resuscitated and admitted to hospital, 21 received defibrillation, 16 were intubated, 19 had adrenaline, 11 lidocaine, and 9 amidarone. Other drugs used were atropine, NaHCO3, sotalol, and CaCl. DISCUSSION: These results illustrate that for patients with out-of-hospital cardiac arrest early treatment with advanced cardiac life support performed by experienced doctors probably had a positive impact on survival, as compared to basic cardiac life support.
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.
Aerobic interval training (AIT) has been shown to be superior to moderate continuous exercise training in improving exercise capacity and endothelial function in patients with both coronary artery disease and heart failure (HF). The objective of this study was to evaluate this training modality in patients with HF and an implantable cardioverter defibrillator (ICD) with regard to feasibility, safety, and effect.
We prospectively included 38 patients with an ICD: 26 patients participated in an AIT programme for 3 months, while 12 patients served as controls. At baseline and 12-week follow up, patients were assessed with a maximal ergospirometry stress test, echocardiography, endothelial function testing, and ICD interrogation.
No exercise-related adverse events occurred during or soon after the training sessions. ICD interrogation revealed no sustained arrhythmias, antitachycardia pacing, or ICD discharge related to exercise sessions. The AIT programme led to a significant increase in peak oxygen uptake, cycle ergometer workload, and endothelial function compared to the control group. The training programme was safe and not associated with any adverse events or ICD-related complications.
An AIT programme is feasible and seems safe in a well-treated, stable ICD population. Further, AIT for 3 months results in significantly increased aerobic capacity and endothelial function in this population.