No abstract available.
Advanced Cardiac Life Support* ; Cardiopulmonary Resuscitation*

PURPOSE: Percutaneous cardiopulmonary support (PCPS) provides hemodynamic stability under various clinical settings, including cardiopulmonary arrest. We compared a single center's experience with performing PCPS during cardiopulmonary resuscitation (CPR) and post-resuscitation care to evaluate the prognostic factors for survival. METHODS: We retrospectively reviewed 83 patients with cardiopulmonary arrest who received PCPS during or within 6 hours of CPR from January, 2004, to December, 2007. Venoarterial bypass systems were used in all cases with femoral cannulation. RESULTS: The mean duration of CPR was 37.2+/-26.4 min and the mean time interval from CPR to PCPS insertion was 73.1+/-107.9 min. The mean duration of PCPS was 73.4+/-110.6 h. Of the 83 patients, 48 underwent PCPS during CPR before recovery of spontaneous circulation and 35 received PCPS during post-resuscitation care for hemodynamic support. Forty-eight patients (57.8%) were successfully weaned off of the PCPS and 34 patients (41.0%) were discharged from the hospital. Among the survivors, 29 patients (34.9%) had no neurological deficits. In multivariate regression analysis, the duration of CPR and defibrillation of pulseless ventricular tachycardia or fibrillation before PCPS were significant prognostic factors for survival (p=0.007 and p=0.015, respectively). In subgroup analysis of the 48 patients who received PCPS before resuscitation with conventional CPR, the duration of CPR that was equal to the time interval from CPR to PCPS insertion was also a significant factor for survival (p=0.011) with a survival rate of 27.1%. CONCLUSION: The duration of CPR is very important for survival. Application of PCPS in CPR can shorten the duration of CPR and maintain hemodynamic stability. Therefore, PCPS is a good resuscitative tool in CPR and post-resuscitation care with an acceptable survival rate and outcome when conventional measures fail.
Advanced Cardiac Life Support ; Cardiopulmonary Bypass ; Cardiopulmonary Resuscitation ; Heart Arrest ; Hemodynamics ; Humans ; Resuscitation ; Retrospective Studies ; Survival Rate ; Survivors ; Tachycardia, Ventricular

A primary cardiac arrest is rare in children. The usual course begins with respiratory arrest and culminates in profound bradycardia or asystole and cardiovascular collapse, so it is vitally important to quickly restore ventilation in pediatric patients(phone-fast). Children over 8 years of age follow the same sequence as adults; that is calling emergency medical services before providing rescue breathing(phone-first).
Adult ; Advanced Cardiac Life Support ; Bradycardia ; Cardiopulmonary Resuscitation* ; Child ; Emergency Medical Services ; Heart Arrest ; Humans ; Ventilation

PURPOSE: Hyperventilation during cardiopulmonary resuscitation (CPR) is common and can be detrimental to survival. We designed a method for delivery of an appropriate rate of ventilation during CPR by setting a compression numbers to ventilation ratio. METHODS: We conducted a virtual simulation trial using 12 randomly sorted actual CPR video files. Participants provided ventilation using a self-inflating bag while watching one minute of CPR video clips utilizing pre-set compression to ventilation ratios of 10:1, 12:1, and 15:1, respectively. Ventilation rates per minute were manually calculated and analyzed. RESULTS: Eight medical doctors and eight emergency medical technician students were included. Among the three groups, significant different mean (S.D) ventilation rate per min (compression to ventilation ratio were 10:1, 12:1, and 15:1) was (9.9 (1.3) vs. 8.8 (1.0) vs. 7.2 (0.8), respectively; p<0.0001). Proportion of the number of appropriately delivered ventilations was 62.5%, 89.6%, and 38.0% for compression to ventilation ratios of 10:1, 12:1, and 15:1, respectively (p<0.0001). CONCLUSION: Compression to ventilation ratio of 12:1 resulted in a significantly appropriate ventilation rate, compared with the ratio of 10:1 or 15:1. Pre-set compression to ventilation ratio of 12:1 seems to be a novel method for delivery of an appropriate number of ventilations during CPR after establishment of an advanced airway.
Advanced Cardiac Life Support ; Cardiopulmonary Resuscitation ; Emergency Medical Technicians ; Humans ; Hyperventilation ; Ventilation

PURPOSE: The purpose of this study was to provide direction to improvement of advanced cardiovascular life support (ACLS) training in Korea. METHODS: We conducted a retrospective analysis of the questionnaire written by 55 instructors of the 31 institutions registered in the Korean Association of Cardiopulmonary Resuscitation (KACPR) from 2009 and 2010. The contents of the questionnaire consisted of an evaluation of the ACLS curriculum, modification of the ACLS curriculum, problems of ACLS training, and other open-ended answers. RESULTS: In this questionnaire, the result for assessment of the lecture on acute coronary syndrome was intermediate, that answer was given by the majority, 40.0%. The result for assessment of the lecture on stroke was intermediate, that answer was given by the majority, 40.0%. In addition, the result for the necessity of the lecture on acute coronary syndrome was intermediate, 25.5%, which was the most common response. The result for the necessity of the lecture on stroke was intermediate, 27.3%, which was the most common response. In the ACLS curriculum, 14.5% of respondents responded that simulation curriculum should be strengthened; 20.0% of participants responded that training on equipment and medical technique should be enhanced. CONCLUSION: Lecture without practice should be avoided and simulation-oriented education should be strengthened in the ACLS course.
Acute Coronary Syndrome ; Advanced Cardiac Life Support ; Cardiopulmonary Resuscitation ; Curriculum ; Surveys and Questionnaires ; Korea ; Retrospective Studies ; Stroke

BACKGROUND AND OBJECTIVES: We previously reported that, compared with standard cardiopulmonary resuscitation(S-CPR), better hemodynamic effects could be achieved by simultaneous sterno-thoracic cardiopulamonary resuscitation(SST-CPR) in which we compressed the sternum and constricted the thorax circumferentially during the systolic period by using a device. This study was designed to assess whether SST-CPR, compared with S-CPR, improve the survival rate of dogs with cardiac arrest. SUBJECTS AND METHODS: Twenty-five mongrel dogs(19~31kg) were enrolled in this study. After four minutes of ventricular fibrillation induced by an AC current, animals were randomized to resuscitate with either S-CPR(n=13) or SST-CPR(n=12). Epinephrine(1mg) was injected into the right atrium every three minutes after the beginning of CPR. Defibrillation was attempted after 6 minutes of CPR. Standard advanced cardiac life support was started if defibrillation was not successful. RESULTS: SST-CPR resulted in significantly(p<0.001) higher systolic arterial pressure(91+/- 47 vs 47+/-24mmHg), diastolic pressure(43+/- 24 vs 17+/- 10mmHg), coronary perfusion pressure(35+/- 25 vs 13+/- 9mmHg), and end tidal CO2 tension(9+/- 4 vs 3+/- 2mmHg). Two of 13 animals(15%) resuscitated with S-CPR and six of 12 animals(50%) resuscitated with SST-CPR survived until 12 hours after cardiac arrest(p<0.05). CONCLUSION: SST-CPR, compared with S-CPR, improves the short-term survival rate in canine cardiac arrests.
Advanced Cardiac Life Support ; Animals ; Cardiopulmonary Resuscitation* ; Dogs ; Heart Arrest* ; Heart Atria ; Hemodynamics ; Perfusion ; Sternum ; Survival Rate* ; Thorax ; Ventricular Fibrillation

BACKGROUND: Provision of early adequate chest compression remains a standard of care for optimal outcome in cardiopulmonary arrest. Inadequate chest compression during CPR may result in the insufficient blood flow to preserve critical organ function. Therefore, authors performed this study to characterize fatigue-induced deterioration in the adequacy of closed-chest compression performed over period 5 minutes and to determine whether CPR providers recognize the effects of fatigue on compression adequacy. METHOD: Prospectively we carried out the study with an electronic CPR teaching mannequin(ResusciAnnie with Skillmeter; Laerdal) placed on a patient stretcher. The mannequin was equipped with a real-time remote display that records the numbers of total and correct compressions. Compression are judged as correct by the mannequin if both depth and placement are appropriate in keeping with standard advanced cardiac life support guidelines. Our study subjects were 27 nurses and doctors, each with certification of BLS and experience of CPR in ED. Each subject performed a 5 minute session of chest compressions. Also subjects were asked to verbally indicate the point during their 5 minute compression period at which they felt too fatigued to provide effective compressions. For statistical analysis, one-way repeated-measures ANOVA and regression test was used. RESULT: The number of total compressions attempted per minute did not decrease significantly(P=.565). But we found 81.0% of compressions performed during the first 1 minute to be correct. The percentages for minutes 2 through 5 were decreased significantly as follows: 73.0%, 68.0%, 65.0%, 57.0%(P=.0003). Regression analysis revealed a decrement in compression adequacy of 13.0% per minutes after the first 1 minute of compression. The time of indicated fatigue was 220+/-29 seconds(mean+/-SD) CONCLUSION: Although compression rate was maintained over time, chest compression quality declined significantly over the study period. Because CPR providers could not recognize their ability to provide proper compression, cardiac arrest team leaders should carefully monitor compression adequacy and change the CPR providers each 3 minutes during CPR to assure maximally effective care for patients receiving CPR.
Advanced Cardiac Life Support ; Cardiopulmonary Resuscitation* ; Certification ; Fatigue ; Heart Arrest ; Humans ; Manikins ; Prospective Studies ; Standard of Care ; Thorax

The acceptable total number of electrical shocks used in treating cardiac arrest is not exactly defined in any of the literature. It is generally expressed as "the more trials the less chance". Electrical therapy should be promptly performed in the presence of "shockable"rhythm. But for pulseless patients bystander cardiopulmonary resuscitation (CPR) should be done on instead. The most reasonable number of attempts of electrical therapy and the length of CPR or unresponsive ventricular fibrillation or pulseless ventricular tachycardia are not well defined. We report the case of 57-year-old woman presenting with mental change due to sustained pulseless ventricular tachycardia who survived to hospital discharge without neurological sequelae after 45 defibrillations and prolonged CPR for 86 minutes.
Advanced Cardiac Life Support ; Cardiopulmonary Resuscitation ; Female ; Heart Arrest ; Humans ; Middle Aged ; Shock ; Tachycardia, Ventricular ; Ventricular Fibrillation

No abstract available.
Cardiopulmonary Resuscitation*

No abstract available.
Cardiopulmonary Resuscitation*