Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: 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)

An early prediction score (EPS) is constructed as the sum of five events: the type of cardiac arrest is ventricular fibrillation; the type of respiratory arrest is gasping; pupil reaction is unequal, slow or normal, but present; swallowing activity is present and the cardiac arrest has been witnessed. Presence of any of these events contributes one point to the score, while absence contributes nothing to it. EPS during resuscitation results in a comparable amount of information, whether used to predict success, alive and conscious 14 days post-CPR or no-success. EPS early (10 min) after initially successful resuscitation is more effective in predicting no-success than success. EPS during CPR does not allow decision making as far as stopping or continuing CPR efforts. EPS early after CPR does neither allow decision making as far as stopping or continuing critical care efforts after initially successful CPR. EPS does, however, weigh the likelihood of success against that of no-success, which can be used when discussing the chances of the patient with his relatives.
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PMID:Early prognostic indices after cardiopulmonary resuscitation (CPR). The Cerebral Resuscitation Study Group. 255 Oct 11

A review of the literature indicates that the intravenous bolus dose of lidocaine should be reduced in all conditions where cardiac output is diminished. During external cardiac compression the cardiac output is only approximately 20-40% of the normal resting value. Various routes of drug administration are currently used during CPR. The routine use of a central venous line is not recommended as a first-line procedure for resuscitation. This route of administration is favored by some authors, however, because it is presumed to result in a more rapid onset of drug action and higher peak concentrations of the drugs used. The aim of this study was to determine the aortic plasma concentration of lidocaine after central venous as compared to peripheral venous administration under the conditions of external cardiac compression. Twelve pigs were allocated to two groups of 6 animals each using random numbers. Ventricular fibrillation was induced by applying an alternating current via two needle electrodes placed subcutaneously. Cardiac arrest was allowed to continue for a period of 1 min before mechanical measures were applied. Cardiac massage was carried out using a pneumatic piston device set to a compression rate of 80/min. Sixty seconds after mechanical CPR had been initiated, a bolus of 1.5 mg/kg lidocaine was given to 6 animals via a central venous line. The remaining 6 animals were treated with the same dose given into a vein of the earlobe. The 2% lidocaine solution was diluted to 20 ml with physiological saline in all animals.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Lidocaine levels in the plasma following peripheral or central venous administration during cardiopulmonary resuscitation. Results of an experimental animal study]. 263 36

Many animal experiments have shown that alpha-receptor stimulation is a prerequisite for the improvement of myocardial perfusion during CPR. As there are no recent reports on the effectiveness of norepinephrine in the treatment of cardiac arrest, we investigated the effectiveness of epinephrine and norepinephrine after asphyxial or ventricular fibrillation cardiac arrest using a porcine model. After 3 min of asphyxial cardiac arrest, seven animals each received either 45 micrograms/kg epinephrine, 45 micrograms/kg norepinephrine, or placebo (controls). All drugs were given blind. All seven animals given epinephrine could be resuscitated after 174 +/- 53 sec, whereas six of seven given norepinephrine could be resuscitated after 473 +/- 116 sec. None of the seven given the placebo could be resuscitated. After 4 min of ventricular fibrillation cardiac arrest, none of the seven animals that received defibrillating countershocks at 4 min without either mechanical measures or drug therapy, and none of the seven that received CPR and countershocks but no drugs, could be resuscitated. In the group that received CPR plus 45 micrograms/kg epinephrine, defibrillation and restoration of spontaneous circulation were achieved in six of seven animals in 667 +/- 216 sec. In the group that received CPR plus 45 micrograms/kg norepinephrine, defibrillation and restoration of spontaneous circulation were achieved in all seven animals in the significantly shorter time of 86 +/- 18 sec. In this porcine model, norepinephrine appeared superior to the same dose of epinephrine in the treatment of ventricular fibrillation, with respect to resuscitation time.
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PMID:Comparison of epinephrine and norepinephrine in the treatment of asphyxial or fibrillatory cardiac arrest in a porcine model. 270 14

We examined the performance of a hospital-based mobile coronary care unit staffed by emergency physicians, coronary care nurses, and ambulance personnel in a metropolitan setting (Brisbane, Australia). Our unit attended 2,260 calls during 18 months of operation. Standard dispatched ambulances arrived first to 78% of the 2,260 calls. Ten percent of these calls were to patients who had died or had arrested; 45% of these patients were found in ventricular fibrillation and 10% were discharged alive from the hospital. Survival was related to the performance of CPR before the arrival of the unit and to the finding of ventricular fibrillation. As the success of our unit was clearly inferior to that reported from centers where the first-responders are licensed to defibrillate, its operations have ceased and regular ambulance crews are being taught to recognize and treat patients with ventricular fibrillation.
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PMID:Experience with a mobile coronary care unit in Brisbane. 276 30

Direct mechanical ventricular assistance (DMVA) is a method of biventricular circulatory support that employs a pneumatic device to apply both systolic and diastolic forces directly to the ventricular myocardium. This study investigated the effects of DMVA on myocardial hemodynamics when applied after a prolonged cardiopulmonary arrest. Seven swine weighting 28.3 +/- 2.5 kg were instrumented for regional myocardial blood flow (MBF) measurements using tracer microspheres. Ventricular fibrillation was then induced. After 10 min of ventricular fibrillation, CPR was initiated for 3 min. DMVA was then applied through median sternotomy. Defibrillation was attempted after 3.5 min of DMVA. If unsuccessful, DMVA was instituted for another 17.5 min and a subsequent defibrillation attempt was made. Arterial oxygen content (CaO2), coronary sinus oxygen content (CcSO2), myocardial oxygen delivery/consumption (mDO2/mVO2), extraction ratio (ER), and endocardial/epicardial blood flow ratio (EN/EP) were determined during CPR, during the initial application of DMVA (DMVA1), and after the subsequent 17.5 min of DMVA in those animals not initially defibrillated (DMVA2). Three of the seven animals were successfully defibrillated during DMVA1. After the additional 17.5 min of DMVA, only one other animal was defibrillated. There was a significant improvement in CaO2, CcSO2, MBF, mDO2, mVO2, ER, and EN/EP after DMVA1 compared to CPR. Only mVO2 and ER improved significantly after DMVA2. These findings support the concept that physical diastolic augmentation may improve myocardial hemodynamics when DMVA is applied during cardiac arrest.
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PMID:Effect of direct mechanical ventricular assistance on myocardial hemodynamics during ventricular fibrillation. 279 96

Hypokalemia frequently occurs after resuscitation from ventricular fibrillation (VF) in man. To test the casual roles of VF and resuscitation variables in this electrolyte change, we studied six groups of dogs: VF with CPR and electrical cardioversion (n = 9), control dogs with no intervention (n = 9), CPR without arrhythmia (n = 5), electrical cardioversion without arrhythmia (n = 5), CPR and cardioversion without arrhythmia (n = 5), and rapid right ventricular pacing (n = 5) (pacing rate 374 +/- 68 beat/min; BP 79/52 mm Hg during pacing). Blood for K, Ca, Mg, and glucose analysis was collected before each intervention (or at baseline in control animals) and sequentially for 3 hr. Mg had a maximum change of 0.3 mEq/L in the VF group 7 min after resuscitation, but did not change in the other groups (p less than .005). Glucose had a maximum change of 79 mg/dl in the VF group 7 min after resuscitation but did not change in the other groups (p less than .005). Ca had a maximum decrease of 0.4 mg/dl in the VF group 15 min after resuscitation but did not decrease in the other groups (p less than .005). K had a maximum decrease of 0.8 mEq/L in the VF group 60 min after resuscitation, whereas decreases were less in the other groups (p less than .005). Thus, VF caused a rapid rise in Mg and glucose followed by a fall in Ca and K. These changes were independent of resuscitation efforts as well as the moderate hypotension induced by rapid right ventricular pacing.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Postresuscitation electrolyte changes: role of arrhythmia and resuscitation efforts in their genesis. 279 97

Cardiopulmonary resuscitation is effective if established early and coupled with specific therapeutic interventions. Most cardiopulmonary arrest is due to ventricular fibrillation and early defibrillation offers the highest probability of success. External cardiac compression alone is inadequate to provide adequate perfusion to vital organs and, therefore, cannot sustain life unless coupled with advanced therapeutic interventions. Many new techniques for increasing flow have been developed, but have not been established clinically. The American Heart Association guidelines for CPR are still valid and are the basis for our current CPR. A practical perspective is presented whereby the therapeutic interventions are pursued systematically in an expeditious and coordinated fashion so that the key interventions are made within the first 10 to 15 minutes of the arrest.
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PMID:Cardiopulmonary resuscitation. A current perspective. 301 25

The use of bicarbonate during cardiopulmonary resuscitation remains controversial. The present standards, suggested in large part by the investigations of Bishop and Weisfeldt, and the acknowledged toxicity of treatment with bicarbonate led to aggressive use of hyperventilation, the frequent monitoring of pH, and a reduction in bicarbonate administration. However, to date no studies have indicated an improvement in outcome to support the importance of these changes. Instead, controversy continues concerning the most appropriate buffer and whether the pH gradient induced between venous and arterial beds during CPR is of importance. To date, a viable alternative regimen has not been proposed. Thus, at present there is little new data upon which to base a major change in strategy, although the logic of reducing further the use of bicarbonate seems compelling. The choice of antiarrhythmic therapy is equally difficult. Initially, experimental studies suggested a more potent antifibrillatory effect for bretylium than for lidocaine. Subsequent studies have challenged these initial experimental results and clinical data have failed to indicate the benefit of one drug over the other. There is little information to suggest that these agents are more effective than the aggressive use of defibrillation alone in patients with ventricular fibrillation. It therefore seems improbable that a definitive decision concerning the use of one or another of these agents can be made.
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PMID:Cardiovascular pharmacology. I. 302 64

The influence of fluid loading during CPR on oxygen uptake and blood flow was investigated in 18 dogs (12-26 kg). Blood flows were measured with radioactive microspheres at 5 (control CPR), 13 and 20 min after the initiation of ventricular fibrillation and CPR. After 10 min, 9 dogs received a rapid infusion of whole blood (11 ml/kg, i.v.) and 9 dogs received Ringer's solution (11 ml/kg, i.v.). Oxygen uptake was not significantly altered by fluid loading with either whole blood or Ringer's solution. Fluid loading increased cardiac output 34% over the 5 min control value. However, left ventricular perfusion decreased to 74% and brain flow decreased to 65% of control. At 20 min, cardiac output and brain flow returned to near control values, while left ventricular flow remained low. Changes in organ perfusion can be explained in part by the concurrent changes in blood pressures. Central venous diastolic pressure increased significantly (from 9 to 14 mmHg) after fluid load. However, central arterial diastolic pressure did not rise proportionately (from 32 to 34 mmHg). Hence, the central A-V diastolic pressure difference decreased. Although fluid loading during CPR improved cardiac output, flow to the heart and brain decreased. Further, there was no increase in oxygen consumption, indicating that fluid loading did not improve metabolic status.
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PMID:Fluid loading with whole blood or Ringer's lactate solution during CPR in dogs. 303 59

Previous CPR studies from our laboratory have shown that a standard iv dose of lidocaine (2 mg/kg) has a rapid antifibrillatory effect, while a standard dose of bretylium (5 mg/kg) produces a delayed but more pronounced effect. In order to determine the optimal doses, we investigated the antifibrillatory effects of a) high dose bretylium (10 mg/kg) and b) a combination of lidocaine (2 mg/kg) and bretylium (5 mg/kg) during CPR in two groups of anesthetized dogs. Ventricular fibrillation threshold (VFT) was determined using a train method and CPR was performed by a pneumatic device. During both a control and drug phase, the VFT was determined in each dog before CPR, and after each of three consecutive 3-min CPR periods. The combination of lidocaine and bretylium (11 dogs) caused a significant increase in VFT compared to the control phase after each of the 3-min CPR periods and maintained this effect for greater than 2 h. Bretylium 10 mg/kg (eight dogs) significantly elevated the VFT only after the third 3-min CPR period. We conclude that the combination of standard doses of lidocaine and bretylium produces a rapid and prolonged antifibrillatory effect and may be the optimal regimen in the CPR setting. High dose bretylium has a delayed onset of effect and appears to produce no greater effect than standard doses of the drug.
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PMID:Antifibrillatory effects of high dose bretylium and a lidocaine-bretylium combination during cardiopulmonary resuscitation. 313 Oct 67


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