Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: KEGG:D01401 (CPR)
1,683 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Serum catecholamines were measured during continued prolonged cardiopulmonary resuscitation and after 10 mg increments of intravenous epinephrine. This was part of an ongoing trial of 10 mg epinephrine versus placebo. Eight patients were in the placebo arm and seven in the epinephrine arm and the rhythms were two ventricular fibrillation, nine asystole and four electromechanical dissociation. Data were analysed by time from onset of the cardiac arrest and samples were analysed for levels of DHPG (dihydroxyphenylglycol) nor-epinephrine, epinephrine, DOPA (dihydroxyphenylalanine) and DOPAC (dihydroxyphenyl acetic acid). There was a significant (P < 0.001) difference between arterial and venous samples of epinephrine but not the other catecholamines. High levels of catecholamines were maintained in all time phases except for nor-epinephrine where significant (P < 0.0003) reduction occurred progressively after 20 min. Non-steady state kinetics were suggested between epinephrine and nor-epinephrine and DHPG and nor-epinephrine for the first 20 min. Very large increases in epinephrine were achieved with administered 10 mg epinephrine and this resulted in high DHPG levels supporting the experimental belief that exogenously administered epinephrine induces myocardial release of nor-epinephrine. This data supports the known effects of CPR on catecholamine release. It provides data on the other neurotransmitter hormones and supports the relationships shown in other animal and human data. It is suggested that supplementation with epinephrine during CPR may be unnecessary and the levels reached may be deleterious. Nor-adrenaline supplementation may be necessary after prolonged CPR.
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PMID:Catecholamines during cardiopulmonary resuscitation for cardiac arrest. 133 86

We compared the haemodynamic effects of epinephrine 10 micrograms/kg iv (group A, n = 8) and 50 micrograms/kg iv (group B, n = 8) in a porcine CPR-model after 3 min of circulatory arrest induced by ventricular fibrillation. All animals of group A were successfully resuscitated after 4.9 +/- 2.8 min and 2.8 +/- 1.6 defibrillations, in group B only 6 of 8 animals were successfully resuscitated after 6.3 +/- 1.1 min and 4.0 +/- 2.7 defibrillations (Mean +/- SD). Cardiac output, left ventricular systolic pressure and mean arterial pressure during CPR were nearly identical in both groups. The first hour of restored spontaneous circulation in group B was characterised by a significantly increased heart rate combined with significantly lower values for cardiac inotropy, cardiac output, left ventricular systolic pressure and mean arterial pressure. It is concluded that in acute or short-term cardiac arrest the currently recommended epinephrine dosages are sufficient. Higher doses of epinephrine for CPR seem to be recommendable only after prolonged cardiac arrest and/or during prolonged resuscitation.
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PMID:[Potential risks of high-dose adrenaline for resuscitation following short-term heart arrest in animal experiments]. 139 64

A total of 6178 persons with out-of-hospital (70%) and in hospital (30%) cardiac arrests from the first of January 1982 until the end of 1989 were reviewed retrospectively with respect to 4 variables, contributing to a score for specific prediction of poor prognosis (cut-off point: greater than 3 points). These included age, initial ECG, type of respiratory arrest and bystander resuscitation. Presence of ventricular fibrillation, gasping and bystander resuscitation contributes nothing to the score, while presence of asystole or EMD (electromechanical dissociation), apnoea and absence of bystander resuscitation adds one point to it. Of patients scoring 4 or 5 points 44 were awake 14 days post CPR (Class 3). The positive predictive value of the score was 97% (95% CI 96-98%) for the out-of-hospital group and 92.2% (95% CI 88-95%) for the in-hospital group. The specificity was respectively 92.3% (95% CI 89-95%) and 94.2% (95% CI 91-96%). Although the score can weigh the likelihood of no success against that of success, we cannot recommend it for decision making as far as abandoning or continuing cardiopulmonary resuscitation efforts.
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PMID:Early prediction of non-survival for patients suffering cardiac arrest--a word of caution. The Belgian Cerebral Resuscitation Study Group. 157 40

We investigated the influence of cardiac arrest upon the metabolic function of the lungs, especially on prostaglandins and angiotensin in pulmonary arterial and venous blood (PA, PV) in dogs resuscitated after cardiac arrest. Experiments were performed on 36 dogs. Cardiac arrest was produced with the electric ventricular fibrillation. The resuscitation was carried out with 100% oxygen using a ventilator. Open chest cardiac massage was performed and defibrillation was done with DC of 25-75 W.sec. Epinephrine and 7% sodium carbonate were administered. Experimental groups were as follow; Group 1 (G I): CPR 5 minutes after the cardiac arrest. Group 2 (G II): CPR 10 minutes after the cardiac arrest. There were no significant differences between G I and G II in hemodynamics and blood gas. AT I was higher in PA than in PV, and AT II showed no significant difference between PA and PV. PGE2 and PGF2 alpha showed no significant changes in G I. And in G II they reached the peak in PA after resuscitation, PGE2 increased in PV, and PGF2 alpha showed no significant changes in PV. TXB2 and 6-keto-PGF1 alpha showed no differences between PA and PV, and they reached a peak after resuscitation in G II.
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PMID:[An experimental study on CPR and lung metabolism]. 157 10

Cardiopulmonary resuscitation is one of the most important topics in modern emergency care medicine. Especially the management of the prehospital cardiac arrest is a region of interest. This article is an attempt to show the current situation of the out-of-hospital resuscitation in the german-speaking area. In an own analysis of 166 resuscitations by emergency physicians and by consideration of results from other groups we found an outcome between four and seventeen percent finally successful resuscitations. The main prognostically favourable factors seem to be the following: non-traumatic cause for the cardiac arrest, ventricular fibrillation as the primarily ECG-statement and begin with CPR within ten minutes.
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PMID:[Current status of preclinical resuscitation. An overview based on recent literature and personal results]. 158 1

A case of a patient with an acute anterior myocardial infarction (MI) and ventricular fibrillation is presented. The patient was resuscitated after cough-cardiopulmonary resuscitation (C-CPR) was administered in the emergency department. The patient received thrombolytic therapy without complication. Cough-CPR is a technique not in widespread use. With the advent of thrombolytic therapy for patients with acute myocardial infarctions, a relative contraindication to thrombolytic therapy is present in patients who receive "standard CPR." The use of cough-CPR in witnessed dysrhythmias can alleviate this problem. Cough-CPR can also reduce the morbidity of resuscitations.
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PMID:The use of cough-CPR in patients with acute myocardial infarction. 162 41

Using a standardized porcine CPR-model (3 min of cardiac arrest induced by ventricular fibrillation) the effects of epinephrine (10 micrograms/kg iv, 50 micrograms/kg iv, 100 micrograms/kg endobronchially, eb) and norepinephrine (10 micrograms/kg iv, 100 micrograms/kg eb) on resuscitability and early post-resuscitation haemodynamics were compared. Success rate was 100% after epinephrine 10 micrograms/kg iv and 100 micrograms/kg eb, 75% after epinephrine 50 micrograms/kg iv, 80% after norepinephrine iv and 60% after norepinephrine eb. In an unmedicated control group 50% of all animals were successfully resuscitated. Early post-resuscitation haemodynamics in the high dose epinephrine group were characterized by tachycardia and progredient myocardial failure, while in the norepinephrine groups a low cardiac output was accompanied by small cardiac stroke volumes and an increased vascular resistance. It is concluded that iv or eb epinephrine given in standard doses has still to be considered as the drug therapy of choice after short term cardiac arrest or in the presence of ventricular fibrillation. Before different drugs or dosing strategies can be recommended, further experimental and clinical validation is required.
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PMID:[New standards for catecholamine therapy in cardiopulmonary resuscitation? Results of a modified application in a resuscitation model]. 163 6

The first link in the "chain of survival" concept is the activation of the emergency medical system (EMS) by a bystander after recognition of cardiac arrest (CA) or its immediate prodrome. Our ongoing study is aimed at evaluating the current effectiveness of bystander EMS activation for all cases of CA in the city and area of Mainz. Methods. Starting February 1991, we began to prospectively examine collapse-intervention intervals in all cases of CA treated by our physician-manned ambulance. Precision voice recorders carried by the ambulance crews are activated and linked to the EMS dispatcher to time the arrival of the ambulance vehicle. Time intervals starting from the time of collapse are then reconstructed from the dispatcher's time and the tapes. The emergency phone number dialled initially by the bystander and the time of collapse in witnessed cardiac arrests are identified. RESULTS. Sixty-six CAs were witnessed and included in this study. In 20% of those cases, the number dialled initially by the bystander was 19222 (EMS dispatcher), in 38% 110 (police), and in 42% other numbers (family practitioners or their on-call service, fire department). The time interval, as median (25th percentile; 75th percentile), between collapse and receipt call by the emergency dispatchers was 4 min (2; 8) for all patients (n = 66), and 6.5 min (3; 12) whenever numbers other than emergency phone numbers were dialled. All following time intervals (start of BLS or ACLS procedures) showed differences (P less than 0.05) between the 110 or 19222 group [BLS: 8.5 min (4.8; 13.1) or 10 min (7.35; 12.1); ACLS: 11.3 min (9.1; 13.45) or 12.9 min (10.6; 21.5)] vs the group, in which other phone numbers were initially dialled [BLS: 15.25 min (9.25; 19.4); ACLS: 20.11 min (12.6; 28.3)]. The first ECG rhythm showed VF in 56% and 54% in case 110 and 19222 were dialled, but only in 32% in the other group. CONCLUSION. Even one single weak link in the "chain of survival" can lower overall survival rates. An indispensable, but apparently underrated component of an effective EMS includes an informed citizenry able to call swiftly for help. Lack of an unequivocal emergency number, well known and accepted by the citizens, produces confusion and delays. In our systems, the correct medical emergency phone number (19222) was dialled in 20% of the cases only, thus demonstrating clearly the lack of public awareness of this 5-digit number. In a higher percentage, the three-digit police number (110) was dialled. In cases where numbers other than emergency numbers were dialled (42%), the longest time intervals between collapse and receipt of call by the dispatchers occurred, associated with the longest time intervals until initiation of CPR and the lowest percentage of patients found in ventricular fibrillation. We conclude that establishment of a simple three-digit EMS phone number, preferentially Europe-wide, in combination with an intensification of public awareness, could be a vital step not only to reduce time intervals between collapse and CPR in our EMS system but also to improve survival.
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PMID:[The emergency telephone number--the essential weak link in an emergency system. Prospective studies involving cardiac arrests observed by bystanders]. 163 20

Intraarterial (IA) volume infusion has been reported to be more effective than intravenous (IV) infusion in treating cardiac arrest due to exsanguination. A rapid IA infusion was felt to raise intraaortic pressure and improve coronary perfusion pressure (CPP). The purpose of this study was to determine if IA or IV volume infusion could augment the effect of epinephrine on CPP during CPR in the canine model. Nineteen mongrel dogs with a mean weight of 26.3 +/- 4.2 kg were anesthetized and mechanically ventilated. Thoracic aortic (Ao), right atrial (RA) and pulmonary artery catheters were placed for hemodynamic monitoring. Additional Ao and central venous catheters were placed for volume infusion. Ventricular fibrillation was induced and Thumper CPR was begun after 5 min (t = 5). At t = 10, all dogs received 45 micrograms/kg IV epinephrine. Six animals received epinephrine alone (EPI). Five dogs received EPI plus a 500 cc bolus of normal saline over 3 min intravenously (EPI/IV). Another group (n = 8) received EPI plus the same fluid bolus through the aortic catheter (EPI/IA). Resuscitation was attempted at t = 18 using a standard protocol. There was a significant increase in CPP over baseline in all groups. The changes in CPP from baseline induced by EPI, EPI/IV and EPI/IA were 20.6 +/- 3.7, 22.8 +/- 4.2 and 22.2 +/- 2.4 mmHg, respectively. Volume loading did not augment the effect of therapeutic EPI dosing. By increasing both preload and afterload, volume administration may in fact be detrimental during CPR.
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PMID:Effects of arterial and venous volume infusion on coronary perfusion pressures during canine CPR. 165 94

Data comparing the success of CPR in elderly hospitalized persons, those living in the community, and those in long-term care facilities show varying results. In general, elderly patients who receive CPR following arrest do not fare as well as younger patients, but there appears to be a subgroup of elderly in whom the success rate is relatively high. Specifically, patients who demonstrate ventricular fibrillation or ventricular tachycardia are more likely to survive than are those demonstrating asystole or electromechanical dissociation. Most studies have not shown a difference in mental or functional impairment between older and younger survivors of cardiac arrest.
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PMID:CPR in the elderly: when should it be performed? 174 30


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