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)

The efficacy of bystander CPR in resuscitation from cardiac arrest when defibrillation is available within five to six minutes has been questioned. Epidemiologic studies from different cities have shown conflicting results. We conducted a study to determine the effect of early CPR versus no CPR on resuscitability, 24-hour survival, and neurologic deficit in an animal model of cardiac arrest. Twenty-two mongrel dogs were subjected to five minutes of electrically induced ventricular fibrillation. In 11 dogs, closed-chest massage and ventilation with room air was begun immediately and was continued for five minutes. The other 11 dogs received no CPR. At five minutes defibrillation was attempted and advanced cardiac life support (ACLS) protocols were followed until the animal was resuscitated or died. No statistical difference in resuscitability or 24-hour survival between the two groups was demonstrated. Eight of 11 "early CPR" animals were resuscitated and survived 24 hours; six of 11 "no CPR" dogs were resuscitated, and five lived for 24 hours. A significant difference was demonstrated by the Student t test in neurologic deficit and ease of resuscitation. "Early CPR" dogs had no neurologic deficit, while "no CPR" dogs had a 41% deficit (P less than .01). "Early CPR" dogs were resuscitated in significantly less time once ACLS was started (29 versus 317 seconds), and required less electrical energy (100 versus 560 J), fewer countershocks (1.3 versus 4.0), and less epinephrine (0.1 versus 1.7 mg) than did "no CPR" animals. In this animal model of cardiac arrest, early CPR was shown to be beneficial to neurologic function and ease of resuscitation, even when ACLS was provided within five minutes.
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PMID:Neurologic benefits from the use of early cardiopulmonary resuscitation. 380 85

A 23-year-old mentally retarded woman was brought to the emergency department 2-2.5 hr after ingesting an unknown quantity of mesoridazine. She was lethargic and somewhat uncooperative, but did answer questions. Her ECG was normal. She was treated with gastric lavage, 50 g activated charcoal, and 10 oz magnesium citrate solution. Her condition continued to decline until, at 2 hr after arrival, she was comatose and becoming increasingly hypotensive. Her ECG showed long runs of markedly widened QRS complexes. The patient was given an iv infusion of dobutamine to maintain blood pressure. She suffered a convulsion, loss of blood pressure, and developed ventricular tachycardia which progressed to ventricular fibrillation unresponsive to electrical cardioversion, pacing, and vigorous prolonged CPR. She was pronounced dead 6-6.5 hr after the ingestion. Antemortem blood level of mesoridazine was 16 micrograms/ml and no other drugs were detected. While sudden deaths have been reported with therapeutic doses of mesoridazine and its parent thioridazine, deaths are uncommon in overdose. Rapid death seen in this case emphasizes the importance of close monitoring and aggressive treatment of phenothiazine overdoses.
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PMID:Rapid death resulting from mesoridazine overdose. 382 77

The case of a 73-year-old man who developed acute thrombosis of the left subclavian artery during CPR is presented. The patient was known to have severe chronic obstructive lung disease, hypertension, coronary artery disease, and severe peripheral vascular disease. He was admitted with ventricular fibrillation. CPR was successful, and the ECG revealed acute extensive anterior and recurrent inferior wall myocardial infarctions. Soon after, acute occlusion of the left subclavian artery was diagnosed. Thrombectomy was performed and circulation was restored to the left upper limb. The patient died 12 hours later from severe bradycardia and asystole.
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PMID:Acute thrombosis of subclavian artery during CPR. 382 17

Contemporary cerebral-cardiopulmonary resuscitation investigations in the experimental laboratory have defined mechanisms for blood flow during closed-chest CPR and have demonstrated that the current CPR technique produces limited systemic perfusion. Modified closed-chest CPR techniques usually improve perfusion. Unfortunately few laboratory CPR studies have actually investigated resuscitation and survival. In addition, the animal model employed (prolonged ventricular fibrillation) may have limited clinical relevance, based on clinical experience and resuscitation practice, and data reporting techniques and their interpretation may be affected by control values that are not normal because of the effects of anesthetics. Closed-chest CPR was intended to buy time until a countershock could be delivered. Clinical and laboratory experience indicate that this goal can be met. Cerebral perfusion during closed-chest CPR is low, but adequacy from a functional perspective following restoration of circulation has not been carefully studied. Preservation of neuronal integrity after restoration of spontaneous circulation may be more important than cerebral perfusion during cardiac arrest and CPR. The role and benefit of open-chest CPR have yet to be determined, because this technique will most likely be used after conventional CPR failure. New and different experimental models are required to meet clinical needs and challenges. The alliance between practitioner and investigator should be strengthened if common goals are to be attained.
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PMID:Artificial perfusion techniques during cardiac arrest: questions of experimental focus versus clinical need. 389 59

Controlled clinically relevant animal models are essential in the ongoing search for increasingly cost-effective methods to reverse clinical death. Acute (up to 12 h) and short-term (up to 24 h) experiments are useful for the study of dying mechanisms and restoration of spontaneous circulation. Although long-term models are difficult and expensive, they are essential to permit lesions to mature, treatments to take effect, secondary deterioration to be recognized, and survival and brain damage to be quantified and compared between treatment groups. The insults studied include temporary complete global head ischemia in monkeys, ventricular fibrillation cardiac arrest in dogs, asphyxial cardiac arrest in rats and dogs, and exsanguination arrest in dogs. Standard external CPR combined with advanced life support is less successful than open-chest CPR or emergency cardiopulmonary bypass after prolonged ventricular fibrillation. Postinsult monitoring of multiple organ systems can be used to explore the postresuscitation syndrome and evaluate novel treatment potentials. Outcome measurements include brain enzyme leakage into the cerebrospinal fluid, neurologic deficit scoring, overall performance categorization, incidence of secondary deterioration, and histopathologic damage scoring of brain and viscera.
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PMID:Long-term animal outcome models for cardiopulmonary-cerebral resuscitation research. 393 81

Manual compression of the heart during open-chest cardiac massage (OCPR) has been shown to be superior to closed-chest compression. Our study sought to determine, in a canine model, the optimal hand position for manual compression of the heart. Twelve dogs were anesthetized with ketamine, an orotracheal tube was placed, and anesthesia was maintained with halothane and nitrous oxide. Cannulae were placed to monitor diastolic (DBP) and systolic (SBP) blood pressures, intracranial pressure (ICP), and common carotid blood flow (CCBF). Control values were obtained under light general anesthesia, and ventricular fibrillation was induced. External CPR (ECPR) was performed with a mechanical compressor before opening the chest and pericardium through the left fifth interspace. The following sequence of three hand positions was used for OCPR: technique A, one-handed technique with thumb on left ventricle, fingers over the right ventricle, and apex in palm; technique B, two-handed technique with right ventricle cupped in left hand and fingers of right hand over left ventricle; and technique C, one-handed technique with fingers of right hand over left ventricle and heart against sternum. Each was done at a rate of 60 compressions per minute with the operator blind to results during performance. All three techniques produced significantly (P less than .05) greater DBPs and CCBFs when compared with ECPR. All three also produced significantly lower (P less than .05) ICPs when compared with ECPR. DBPs, SBPs, CCBFs, and cerebral perfusion pressures were similar for techniques B and C, and all were significantly greater (P less than .05) than those achieved with technique A.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of open-chest cardiac massage techniques in dogs. 395 73

Thirty-two dogs subjected to 4 min of ventricular fibrillation were equally divided into four treatment groups: (a) immediate defibrillation (control); or 30 min of (b) standard CPR (SCPR), (c) simultaneous ventilation-compression CPR (SVC-CPR), or (d) open-chest CPR (OCCPR). After 30 min of CPR, restoration of spontaneous circulation was attempted using drug therapy and countershocks and the animals maintained for 24 h or until refractory hypotension occurred. During CPR, OCCPR yielded higher mean arterial and lower central venous pressures than either external method. Circulation was restored in all control dogs, and by 24 h they had nearly normal neurologic deficit scores. In the SCPR group, the heart was restarted in six dogs. Five of these dogs had severe neurologic damage and did not survive 24 h. The animal that survived 24 h, however, was nearly normal neurologically. Although circulation was restored in five SVC-CPR dogs, all were brain-dead and none survived 24 h. In the OCCPR group, seven animals survived 24 h and their neurologic deficit scores were not significantly different from control values. We conclude that OCCPR is greatly superior to SCPR and SVC-CPR with respect to preservation of the brain during resuscitation.
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PMID:Cerebral preservation during cardiopulmonary resuscitation. 397 29

To determine if clinically accessible hemodynamic and blood gas measurements are of value in predicting outcome of countershock after prolonged ventricular fibrillation (VF) and artificial cardiopulmonary support, 14 dogs were studied during 30 minutes of VF using two randomly assigned closed-chest techniques. Seven dogs underwent conventional CPR; the other seven were supported with a pneumatic thoracic vest and abdominal binder, which were inflated synchronously with the airway. Ascending aortic (Ao), right atrial (RA), and instantaneous coronary perfusion pressures (Ao - RA) were measured at five-minute intervals. Ao and RA blood samples were analyzed at 10, 20, 25 and 30 minutes for PO2, PCO2, and pH. After 25 minutes, 1 mg epinephrine was given intravenously, and five minutes later defibrillation was attempted. If unsuccessful, repeated countershocks, conventional pharmacologic therapy, and artificial support were continued. If a perfusing spontaneous cardiac rhythm did not result within an additional 30 minutes, the experiment was terminated. Six animals developed a perfusing cardiac rhythm after one or more countershocks (Group 1); eight failed to develop a perfusing rhythm after repeated countershocks and an additional 30 minutes of resuscitative effort (Group 2). Five Group 1 dogs received vest/binder artificial support. When measured values were averaged over the study period, Group 1 was found to have a significantly greater Ao end-diastolic pressure (AoEDP) and peak diastolic coronary perfusion pressure (CPP) when compared to Group 2 (23 +/- 6 vs 14 +/- 8 mm Hg, P less than .05; and 22 +/- 6 vs 5 +/- 10 mm Hg, P less than .01, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Predictive indices of successful cardiac resuscitation after prolonged arrest and experimental cardiopulmonary resuscitation. 399 75

The dose-response curves of epinephrine given either IV or endotracheally (ET) were compared during resuscitation from electromechanical dissociation (EMD). Ten anesthetized dogs were subjected to a two-minute period of electrically induced ventricular fibrillation (VF) followed by defibrillation without CPR to produce EMD. Mechanical CPR was followed by injection of either ET or IV epinephrine. Successful response was defined as a return of pulsatile blood pressure within two minutes of drug administration. Using log-dose increments of epinephrine, experimental trials were repeated in each animal. The IV and ET median effective doses were 14 and 130 micrograms/kg, respectively. When the trials were successful, the time between drug administration and either arterial blood pressure increases or return of spontaneous circulation did not differ significantly for the ET and IV groups. These results show that the dosage for epinephrine delivered ET must be higher than the IV dosage to achieve the same response during CPR.
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PMID:Endotracheal versus intravenous epinephrine during electromechanical dissociation with CPR in dogs. 405 Dec 68

Manual and mechanical chest compressions during CPR were compared in the canine model. Endpoints were hemodynamics produced during CPR, resuscitation success at 30 min, 24-h survival, neurologic function of survivors, and CPR-produced trauma. Ten animals in each group underwent 20 min of ventricular fibrillation, during which CPR was performed for 17 min. Hemodynamics produced with manual and mechanical chest compressions were similar. Seven of ten animals in each group were resuscitated. Five animals from the manual group and four animals from the mechanical group survived for 24 h. Neurologic function of survivors was excellent and similar in each group. There was no significant difference in trauma between the two types of chest compression. The similar results for manual and mechanical chest compression in this canine model suggest that different experimental CPR studies can be compared regardless or whether manual or mechanical chest compressions were performed.
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PMID:Manual versus mechanical cardiopulmonary resuscitation in an experimental canine model. 405 36


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