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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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

A survey is given on the scientific background of cardiopulmonary-cerebral resuscitation, which supposedly will be the basis of all clinical practice in this field. Haemodynamic, respiratory, acid-base, and cerebral problems are discussed in detail. As for haemodynamics, the pathomechanisms of the conventional "heart pump" and the "thoracic pump" as background of the "New CPR" are compared, the flow being generated by a direct compression of the heart in the former and by a phasic increase of the intrathoracic pressure in the latter case. Combined effects of both modalities mainly depending on the geometry of the thoracic cage, are usually seen. Improvement of flow by modifying the criteria of thorax compression (duration, frequency, strength) is then discussed, and new methods or CPR as e.g. simultaneous/synchronous compression/respiration, Vest-CPR, MAST-CPR, abdominal compression and Cough-CPR are mentioned and their mechanisms explained. Finally, open cardiac massage is no doubt superior to all the other indirect and closed methods of cardiac resuscitation. Defibrillators and heart-lung "thumpers" are then described, mentioning the improvements in respect of automatic and semi-automatic defibrillation and the progress made by developing flexible and individually adaptable types of "thumpers". On assessing the sympathicomimetic drugs, it is evident that epinephrine is the method of choice in the acute phase of resuscitation; the pure beta-adrenergics isoprenaline and orciprenaline are not used any more, whereas the alpha-mimetics, although acutely effective similar to epinephrine, cannot produce positive long-term effects; the combination of dobutamine and dopamine seems to be ideal for establishing stable haemodynamic situations following a successful acute reanimation procedure.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The scientific basis of cardiopulmonary and cerebral resuscitation]. 163 3

Cough-CPR, a deep rhythmic forceful cough repeated 30-60 times per minute, can be an effective resuscitative technique during emergencies occurring in the cardiac catheterization laboratory. We provide documented evidence on the potential of cough-CPR to maintain adequate systemic arterial blood pressure and consciousness during malignant ventricular arrhythmias, including the longest cough-CPR episode (75-90 sec), with continuous hemodynamics recorded. Results in three patients disclose that 1) mean arterial pressure during cough-CPR was 47-66% of nonarrhythmic baseline at a cough rate of 38-46% of normal sinus rhythm heart rate; 2) mean arterial pressure during hypotensive ventricular tachycardia was 17-60 mm Hg higher with than without cough-CPR; 3) at comparable diastolic pressures (33 vs. 31 mm Hg), systolic arterial pressure during cough-CPR was 40 mm Hg higher than basic CPR; and 4) consciousness can be maintained with cough-CPR during prolonged malignant ventricular arrhythmias. Thus cough-CPR can be a valuable adjunct in maintaining patient stability while definitive therapy for the malignant ventricular arrhythmia is administered.
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PMID:Cough-cardiopulmonary resuscitation in the cardiac catheterization laboratory: hemodynamics during an episode of prolonged hypotensive ventricular tachycardia. 259 Sep 33

In summary, the cough CPR technique uses physiologic principles similar to those that maintain circulation during chest compression with a number of significant advantages over the latter. At the onset of lethal arrhythmias such as asystole, profound bradycardia, VT, and VF, coughing may assist in maintaining consciousness and an optimum systolic blood pressure. It may also generate the mechanism required to convert the arrhythmia. The simplicity and effectiveness of this technique warrants its consideration for greater clinical use by hospital staff in all monitored settings. It has been noted, however, that clinical research is indicated to more closely examine the proposed cause and effect relationship between cough and arrhythmia conversion and to compare the clinical efficacy between the cough CPR technique and chest blow or other clinical practice measures.
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PMID:The use of cough cardiopulmonary resuscitation in clinical practice. 351 34

The introduction of closed chest massage in 1960 initiated a widespread interest in cardiopulmonary resuscitation. Until that time, open chest cardiac massage was the standard for CPR. Initial explanations for blood flow during closed chest CPR were based upon direct compression of the heart. This explanation has given way to demonstrations that blood flows during CPR because of changes in intrathoracic pressure. Changes in intrathoracic pressure that create blood flow have been created by simple maneuvers such as coughing. More involved methods of affecting intrathoracic pressure, in an attempt to improve upon standard closed chest massage, have included applying positive pressure to the airway, binding of the abdomen, and the use of MAST. Cardiac output with closed chest massage is approximately one fourth of normal, and cerebral perfusion is approximately one tenth of normal. Cardiac output with open chest massage is approximately double that obtained by closed chest massage. Cerebral blood flow during open chest massage approaches physiologic values. The use of drugs possessing alpha adrenergic activity and maneuvers that augment intrathoracic pressure improve vital organ perfusion.
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PMID:Hemodynamics of cardiac massage. 639 69

To assess the potential of self administered, cough-induced cardiopulmonary resuscitation (CICPR) to sustain cerebral function during sudden onset ventricular fibrillation (VF), the authors studied four groups of six dogs each. Cough was simulated by: spontaneous gasping (group 1); cough elicited by bilateral electrical stimulation of the vagi (group 2); gasping with artificial glottic closure (group 3); and as a control, apnea under paralysis (group 4). Sudden onset of VF during apnea (group 4) resulted in cessation of arterial blood flow in 11 +/- 3 sec (mean +/- SD) and an isoelectric EEG in 26 +/- 5 sec. Spontaneous gasping (group 1) and cough resulting from vagal stimulation (group 2) resulted in minimal systemic and cerebral perfusion pressures and common carotid artery blood flows (CCABF). CCABF became 0 in group 1 at 31 +/- 12 sec, and in group 2 at 33 +/- 16 sec after the onset of VF. EEG silence occurred at 57 +/- 9 sec and 54 +/- 19 sec in groups 1 and 2, respectively. The decay of vital parameters was delayed further when spontaneous gasping via tracheal tube was against artificial glottic closure, which augments airway pressure fluctuations (group 3); pulselessness occurred at 52 +/- 28 sec and EEG silence at 66 +/- 27 sec. Self-induced fluctuations of intrathoracic pressure generated sufficient blood flow to briefly but statistically significantly (p less than 0.001) prolong EEG activity compared to apneic controls. In this dog preparation, gasping with artificial glottic closure sustained cerebral electrical activity for a maximum of 112 sec. CICPR may offer a means of briefly sustaining consciousness after the sudden onset of VF and, thus, constitutes self-administered CPR.
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PMID:Cerebral and hemodynamic variables during cough-induced CPR in dogs. 706 Mar 73

Maintenance of arterial pressure and consciousness by vigorous coughing during ventricular fibrillation has been previously documented. Observations in 4 additional patients with unstable rhythms and in fibrillating dogs confirm that coughing: (1) produces an arterial pulse; (2) produces opening of the aortic valve; (3) generates forward blood flow; and (4) can maintain consciousness during circulatory arrest. The authors speculate that cough-induced systemic perfusion results from compression of the pulmonary vascular beds by a rise in intrathoracic pressure, the left heart acting only as a one-way conduit to the lower pressure extrathoracic vascular outlets. Recent data suggest that conventional CPR likewise produces blood flow by compression of the pulmonary vascular blood pool, and not by cardiac compression as previously thought.
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PMID:Cough-CPR: documentation of systemic perfusion in man and in an experimental model: a "window" to the mechanism of blood flow in external CPR. 736 29

A 43-year-old female with old myocardial infarction and stenosed bypass grafts developed sustained Torsades de Pointes/ventricular flutter (rate = 300-400 beats per minute) during coronary arteriography after contrast injection to the diagonal graft. Cough-CPR (rate = 37/min) was started within 5 s of dysrhythmia initiation and continued through two defibrillation attempts (200 and 360 joules), and IV lidocaine was administered until return of spontaneous circulation 62 s later. The patient never lost consciousness during this very rapid dysrhythmia. Certain cardiac arrest resuscitation measures (namely, initial defibrillation attemps, IV lidocaine administration) can thus be initiated in a patient while performing cough-CPR and maintaining adequate cerebral perfusion. During the dysrhythmia with Cough-CPR: (a) aortic systolic pressures averaged 100 mmHg--this has commonly been observed in other reports, and (b) aortic diastolic pressures were always > or = 50 mmHg and averaged 63 mmHg, which has seldom been this high during cough-CPR. Dysrhythmia reversion occurred 4 s after the second defibrillation attempt and 80 msec after the peak of the highest cough-generated aortic pressure pulse (128 mmHg). Cough-induced ventricular tachycardia reversion has previously been reported; this may have acted in concert with electrical defibrillation to facilitate dysrhythmia reversion. The patient recovered without incident.
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PMID:Hemodynamics of cough cardiopulmonary resuscitation in a patient with sustained torsades de pointes/ventricular flutter. 798 90

This report documents a case of hemodynamic collapse during primary angioplasty (PCI) for acute inferior ST-segment elevation myocardial infarction (STEMI). The patient had stable vital signs during the initial angiogram which had demonstrated an occluded mid right coronary artery (RCA). There was no evidence of right ventricular infarction or heart block. Reperfusion arrhythmia did not occur. The case illustrates triggering of the Bezold Jarisch Reflex (BJR) not by occlusion but reperfusion. In addition, this report illustrates the use of cough cardiopulmonary resuscitation (cough-CPR) to maintain consciousness during the BJR. Cough-CPR has previously been reported as a temporizing mechanism during ventricular arrhythmia prior to electrical cardioversion. This primary PCI case puts into clinical context the findings of historical animal studies and compares with clinical observations made during trials of intracoronary thrombolytic therapy.
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PMID:Triggering of the Bezold Jarisch Reflex by reperfusion during primary PCI with maintenance of consciousness by cough CPR: a case report and review of pathophysiology. 1868 71

The ring of the red notification phone breaks the relative calm of an otherwise typical Monday morning and heralds the arrival of a critically ill patient. The dispatcher announces that EMS is on the way with a 57-year-old man in cardiac arrest, with an ETA of 3 minutes. Shortly after preparations for their arrival are complete, EMS personnel enter with CPR in progress and the patient already intubated. As monitor/defibrillator attachment, ETT placement confirmation, additional IV access, and complete exposure of the patient occur, you hear more about the clinical scenario from EMS. Mr. I.C. is a 57-year-old male who was moving furniture when, as described by witnesses, he complained of difficulty catching his breath and a slight tightness in his chest. He began coughing violently, vomited once, gasped, and collapsed. Emergency medical services personnel state that they arrived approximately 20 minutes after the patient had collapsed, with CPR in progress. The patient was intubated in the field, and EMS reports that the initial rhythm was PEA. Upon the patient's arrival in the ED, the rhythm is noted to be ventricular fibrillation. Defibrillation is attempted twice over the next 4 minutes, with concomitant administration of medications. During the next rhythm check, QRS complexes are noted on the monitor and a pulse is palpated. The patient has had a return of spontaneous circulation, apparently 50 minutes from onset of the arrest. As you initiate postresuscitation care, you consider the patient's prognosis and wonder if he qualifies for therapeutic hypothermia; ie, will therapeutic hypothermia make a difference in his outcome?
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PMID:Current evidence in therapeutic hypothermia for postcardiac arrest care. 2216


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